MIdterm2 Notes Flashcards
(207 cards)
1
Q
PA chest specifics
A
High kVp 100+ Full inspiration 72+ FFD frontal view PA Grid or non-grid (film or CR) - DR=grid
2
Q
Thoracic spine specifics
A
70-80 kVp Suspend breathing 40inch FFD Frontal view AP Grid
3
Q
Most common x-ray in humans
A
Chest x-ray
4
Q
Most 911 emergencies in your office are on conditions involving
A
Chest anatomy
5
Q
Controls density
A
KVp
6
Q
15% increase in kVp
A
Doubles the density
Cut mAs by 1/2
7
Q
Going from 80-90 kVp is about a
A
15% increase
8
Q
Higher ___ = more grays = longer scale of contrast
A
KVp
9
Q
C-spine kVp
A
70-80 kVp
10
Q
T-spine kVp
A
70-80 kvp
11
Q
L-spine kvp
A
80 kvp
12
Q
Lat lumbar kvp
A
85/90 kvp
13
Q
We determine if the patient is at full inspiration by
A
Rib count - right hemi-thorax usually can see 10 posterior ribs above the diaphragm
14
Q
Heart size is always evaluated on
A
Full inspiration chest film
15
Q
Expiration film is used for
A
Lung increases in density because less air volume
16
Q
Radiolucency of lung is the ratio of
A
Air to soft tissue in the lung
17
Q
Know if diaphragm is being pushed up or paralyzed
A
Inspiration expiration film
18
Q
If pushed up from below, the diaphragm will
A
Still move with breathing
19
Q
If phrenic nerve is damaged
A
Paradoxal motion of the diaphragm with paralysis
20
Q
Inhale = diaphragm goes Exhale. = diaphragm goes
A
Up
Down
21
Q
Pneumothorax is difficult to see because it is both air density. Easier to see on inspiration or expiration
A
Expiration since the lung increases in density on expiration film which provides more contrast to the air in the pleural space
22
Q
Air-trapping is the opposite of ___ in mechanics
A
Atelectasis
23
Q
When we inhale, bronchi
A
Dilate
24
Q
When we exhale, bronchi
A
Passively return to neutral
25
If obstructed on both inspiration and expiration air is absorbed distal to the obstruction
Atelectasis
26
If obstructed on expiration
Air-trapping
27
Lung expands and becomes more radiolucent
| Increase air volume compared to soft tissue
Air-trapping
28
FFD inverse square log
From 40 inches (80 kvp and 50 mAs) to 72 inches - need 200 mAs
29
The shorter the FFD, the more of the ___ is used
Cone of the beam
30
As we back up the FFD, we use more of the __ of the beam
Center
31
Gives us the shortest OFD to the heart
PA position
32
Greater than 10 cm and kVp greater than 60
Grid rule
33
Grid is used
To reduce scatter
34
If using a grid (12:1 is best for us - absorbs at least 70% of the beam) must increase mAs by
4x
35
If patient is less than ___ we don’t need a grid for chest x-ray
26cm
36
Lateral cervical air gap acts as a grid therefore
We don’t need it
37
72 inch lateral cervical is same technique as a
40 inch with grid
38
Film identification
```
Facility name and address
Patient name and age (DOB)
Patient gneder
Film date
Film number is optional
```
39
Left lateral. Chest film time
The time you use on PA go up two time stations for the lateral
40
Chest obliques are done as
Anterior obliques
41
Gold standard for chest imaging is
CT
42
RAO observes
Left lung
43
Time station for oblique
1 time station up from PA
44
Patient postition
Visualize anatomy
Center anatomy on the cassette
Put CR to center of cassette
45
Way to clarify a lesion
Heels 18 inches out, lean back
Rotates bone aroudn apex of lung
Collimate
Apical lordotic
46
Recumbant AP view for non-ambulatory patients
40 inch
47
Frontal view with patient in a lateral decubitus
Beam parallel to floor
Cassette perpendicular to the floor and beam
Done to observe pleural fluid or pleural air (pneumothorax)
48
Done to observe pleural fluid or pleural air
Decubitus series
49
If suspect left pleural effusion
Do left decubitis view
50
The lung on the side down is
Dpeendent in a decubitus view
51
Fluroscopy is useless for
Chest
52
Vascular contrast evaluation of pulmonary vessels
Pulmonary angiography
53
Gold standard for heart imaging
US
54
Ventilation and perfusion scans - tells you where air is going and where blood is going
Nuclear medicine
55
Good for mediastinum and chest walls, not best for lungs
MRI
56
Advanced chest imaging
```
Decubitus series
PA full inspiration
Fluoroscopy
Bronchography
Pulmonary angiography
Tomography
US
Nuclear medicine
MRI
```
57
Contains anterior, middle, and porition of superior anatomical divisions
Anterior mediastinum
58
Posterior to the line to 1cm behind vertebral body
Middle mediastinum
59
Spine
Posterior mediastinum
60
Midline structure
As passes the transverse arch of aorta (aortic knkob) deviates tot he right slightly
Divides at the carina into left and right mainstem bronchi
Trachea
61
Carina
Infants
Teens
Adults
T4
T5
T6
62
Origination of the hilus (unilateral structures)
```
1 mainstem bronchi
1 pulmonary artery
2 pulmonary veins
Vagus nerve
(Recurrent laryngeal nerve)
Phrenic nerve
Lymph nodes
```
63
Mainstem bronchi
Left = longer and more horizontally oriented, less obtuse
Right = shorter and more vertically oriented
64
Pulmonary artery L vs R
```
L = arches up over the top of L mainstem bronchus
R = passes in front of R mainstem bronchus
```
Contributes to majority of hilar denisty
L is higher than R
65
Pulmonary veins
Add density to the area but not visible as individual structures
66
Vagus nerve runs directly____ to the hilus
Posterior
67
Vaguse nerve on left
Gives recurrent laryngeal nerve that curves under arch of aorta at the hilus
Can be compressed by hilar tumors
Peter jennings - unexplained hoarseness
68
Vagus nerve on right
Recurrent laryngeal branches earlier on the R
hilar tumor does NOT compress recurrent laryngeal nerve but DOES compress the superior vena cava = SVC syndrome
69
Phrenic nerve runs ___ to the hilus
Anterior
Hilar tumors can compress the phrenic nerves
70
Extensive lymphatic system in the chest
Lymph nodes
Rt peritracheal nodes very common in sarcoidosis
Not normally visible as individual structures - can be seen individually with a distinct shape with pathology
71
Lymphadenopathy
LAN
Enlarged due to inflammatory, neoplastic, benign lymphoid hyperplasia
72
Infectious inflammatory LAN
TB, fungal (histo, coccidio)
73
Non-infectious inflammatory LAN
Sarcoidosis
| Silicosis
74
Neoplastic LAN primary
Lymphoma - HL, NHL
75
Neoplastic LAN secondary
Metastasis
76
Benign lymphoid hyperplasia
Castleman’s
77
Calcification lymph nodes
End-stage granulomatous disease
Fibrotic, scarred, calcified
TB, fungal, pneumoconiosis
78
Medullary lymphatic drainage (big orange)
Lymph re-absorbed into hilar, subcarinal, peratracheal
79
Cortical lymphatic drainage big orange
Lymph travels in pleura - subpleural lymphatics - over surface of lung
80
When a hilus is abnormal =
Enlargement
81
Unilateral hilar enlargement
Bronchus or lymph nodes
82
Bilateral hilar enlargement
Blood vessels (arteries/veins) with pulmonary hypertension OR lymph nodes
83
Imbalance between pulmonary leakage and absorption
Largely a MEDULLARY lung problem
Pulmonary edema
84
Right mainstem bronchus
Shorter and more obtuse angle to trachea
85
First mainstem branch
Right upper lobe bronchus
86
First mainstem branch branches
First =
Second =
Third =
```
Apical segmental (RUL #1)
Anterior segmental (RUL #2)
Goes to upper posterior chest wall - posterior segmental (RUL #3)
```
87
Intermediate branch splits into the 2nd and 3rd mainstem branches
Anterior
| Posterior
88
Anterior branch - right middle lobe bronchus
Lateral running branch = lateral segmental (RML #4)
Medial running branch = medial segmental (RML #5)
89
Posterior branch =
Right lower lobe bronchus
90
Posterior branches
One non-basal - superior segemnet right lower lobe (RLL #6) - aka apical segemnet RLL - directly below RUL #3 - goes to mid-lower scapulae
Four basal (sit on diaphragm) - medial basal (RLL#7) directly behind 4,5; anterior basal RLL #8 directly behind 4,5; lateral basal (RLL #9); posterior basal (RLL #10)
91
3-D orientation right
5,7,10 medial A-P at level just below hilum
4,8,9 lateral AP at level just below hilum
2, lower 3, 6 at level just above hiluym
92
Left mainstem bronchus
Longer and less obtuse
93
First mainstem branch left
Left upper lobe bronchus
94
Left upper lobe bronchus branches
```
First = apical/posterior segmental (LUL #1-3)
Second = anterior segmenetal (LUL #2)
```
95
Lingular bronchus is a branch off
The upper lobe bronchus
96
Superior segemental lobe
Lingula #4
97
Inferior segmental
Lingula #5
98
Second mainstem branch left
Left lower lobe bronchus
99
Left lower lobe bronchus branches
One non-basal
Superior segment left lower lobe (LLL#6) aka apical segement LLL - directly below LUL #3 goes to mid-lower scapula
Four basal
Medial basal (LLL#7) directely behind 4,5
Anterior basal (LLL#8) directly behind 4,5
(Anteromedial 7,8)
Lateral basal (LLL#9)
Posterior basal (LLL#10)
100
Lateral x-ray view
Retro-sternal clear space =
Retro-cardiac clear space =
2
| 7, 8
101
Fissures are ___ to the beam and visible about ___ of the time
Parallel
| 50%
102
Each lobe is completely covered by
Visceral pleura
103
Where two layers of visceral pleura touch
Fissure
104
Isolation barriers between lobes
Fissures
105
Right lung fissures
Minor fissure - separates RUL from RML (2 from 4, 5)
Major fissure - separates RLL from RUL/RML
Upper half - 6 from 3
Lower half - 7, 8 from 4, 5
106
Azygous fissure
4 layers of pleura - 2 parietal + 2 visceral
Right side only to contain parietal pleura
Only to split a segment (RUL #1)
5% of the time the azygous vein descends too early
Seen on AP view (runs front to back)
107
Inferior accessory fissure
Most commonly on the right
Separates 7 from rest of basals
Seen on AP view
Creates an inferior accessory lobe
108
Separates 7 from other basals
Inferior accessory fissure
109
Superior accessory fissure
Right or left
Separates 6 from basals
Seen on AP view
Creates posterior accessory lobe
Where minor fissure runs but posterior
110
Accessory minor fissure
Only on the L
Separates 2 and 4 - creates a L minor fissure
Creates middle lobe of left lung
111
Primary lobule
Too small - about 23 million on average
112
Acinus
Just right, radiographic functional unit
5-8 mm in size
Has many primary lobules in it
113
Secondary lobule
Too big
Made of several acini (3-5)
Separated by subpleural interstitium lung tissure
114
Radiographic functional unit
Acinus
115
Anatomical functional unites
Primary lobule
Acinus
Secondary lobule
116
Ends the conducting portion (just moving air)
Has hyaline cartilage
Terminal bronchiole
117
Starts the respiratory zone (parenchymal zone) - mucous production starts here
Respiratory bronchiole
118
Start in trachea
```
L or R mainstem bronchus
Pick a lobe
Segmental bronchus
Subsegmental bronchus
Terminal bronchiole
Respiratory bronchiole
Alveolar duct
Alveolar sac
Alveoli
```
119
Acinus =
Everything distal to one terminal bronchiole
Respiratory bronchiole, alveolar duct, alveolar sacs, alveoli
Contains a bunch of priamry lobes
120
Respiratory bronchioles
Either 2 or 3
| First branch is RB1, RB2, RB3, ducts, sacs, alveoli
121
Filling up the acinus with fluid -
Consolidation
122
Primary lobule is everything distal to the respiratory bronchiold
Ducts - sacs - alveoli
123
Two secondary lobules are separated by
Subpleural interstitial membrane - honeycombed
Lymphatic channels reside here
124
Subpleural interstitial membrane thickened =
Kerley lines
125
Channels of peripheral (intralobar) airway communication aka
Collateral air drift
126
Collateral air drift facilitates
Air perfusion in the periphery of the lung
127
Pores of kohn
Interalveolar communications - 3-13 microns
Allows air to flow easily between alveoli
Exudate can also traverse these opres
128
Canals of lambert
Subsegmental bronchi (larger than terminal bronchi) directly to alveoli - up to 30 microns
Helps keep alveoli perfused/inflated
Exudate can fill up the bronchi
129
Direct airway anastomosis - channels of martin
Airway communication between bronchi - up to 64 microns
May be visible with naked eye
130
No channels of peripheral airway communication happen across
Fissures
131
Bronchial wall is so thin that it is not visible. We see
Blood vessles
132
Carry de-saturated blood
Follows the bronchi - parallel course
Pulmonary arteries
133
Carry saturated blood
Runs independent of the bronchi
Pulmonary veins
134
Dot + hyperlucent structure =
Pulmonary artery
135
Dot without hyperlucent structure =
Pulmonary vein
136
Bronchial artery supplies
Oxygenated blood
137
Carries de-oxygenated blood away from lungs
Pulmonary artery
138
2/3 of heart is on _____ of midline
Left
139
Apex of heart is ____ in both directions and sits _____
Oblique
Anteriorly
140
Heart borders are made up of
Chambers
141
Right ventricle is directly behind
Sternum
142
middle 1/3 mediastinum
```
Vessels
SVC
IVC
Ascending aorta
Pulmonary artery
```
143
Arises from left ventricle, to the right of the midline
Ascending aorta, transverse arch of aorta, aortic knob
144
Arises from right ventricle, to left of midline
Pulmonary artery - slight convex border directly below aortic knob, above left heart border
145
2 convex borders to the R of midline
R heart border and ascending aorta (just medial to R hilus
146
3 convex borders to the L of midline
Knob
Pulmonary artery (medial to left hilus)
Left heart border
147
If left atrium is enlarged
4 convex structures
148
Upper 1/3 mediastinum
Trachea and other vascular structures aren’t normally visible
149
On lateral x-ray
Anterior border - R ventricle
| Posterior border - L atrium, L ventricle
150
Right is right, front is right
Left is left
Back is left
Rights are singles
Lefts are both
151
Esophagus is
Right behind the trachea
152
Trachea stops at ____ but esophagus continues down in front of vertebral bodies
___ contacts the esophagus
Carina
| Left atrium
153
```
Are
There
Many
Lung
Lesions
```
```
Abdomen
Thorax
Mediastinum
One lung
Both lungs
```
154
More weight is in the lower lung
More blood in lower lung
155
Vessel diameter ratio above hilus to lower
In vertical position
Supine/prone position
1: 2
1: 1
156
Split lungs into vertical thirds the vessels are larger closer to
The midline
Decrease in size and increase in number moving toward the periphery
157
Cortical lung is not avascular but is devoid of visible vessels
Any densities visible in cortical lung are ABNORMAL
158
Soft tissues visible
```
Breast
Areola and nipple
Axillary fold
SCM
Supraclavicular soft tissue silhouette
```
159
SCM and supraclavicular tissue silhouette cover the
Apex of the lung
160
1 and 8 sit
On the high point of the diaphragm - if they contain air, we see the diaphragm border
161
9 and 10
Posterior
162
5 touches
Right heart
163
Lower lung vessels are ___ the size of upper vessels
2x
164
PA chest is a____ view of aorta
LAO
RAO
Oblique
Lateral
PA
165
Lack of detail
Underpenetrated
166
Faint bone spine through mediastinum no bone detail
Over-penetrated
167
Chest obliques
Swim position to get arms out fo the way
RAO
LAO
168
Heart sits ____ in chest
| When you rotate the heart is at 45 degree angle
Anteriorly
169
Straight frontal aorta
RAO
170
The right ventricle is ALWAYS
The front of the heart
171
The left atrium is the most
Posterior chamber of the heart
172
RAO assesses the
Lfet lung
173
LAO assesses
Right lung
174
The heart is viewed straight up and down - tear drop
LAO
175
See right atrium and right ventricle on the right heart border
See left atrium and left ventricle on left heart border
LAO
176
Only view where all four chambers border from
LAO
177
Diaphragm scalloping
Normal variant
178
Diaphragm eventration
Localized area of muscle thinning most common at medial-anterior R hemi-diaphragm
179
Bochdelek hernia
Posterior eventration of the diaphragm
180
Missing breast causes
Unilateral localized hyperlucency
181
Rhomboid fossa is aattachment for
Costoclavicular ligament
182
When like densities are in anatomical contact, any border that existed, disappears. In chest this concept can be used to localize lesions densities
Silhouette sign
183
If the same denistis are touching the beam cannot tell a difference and photon absorption will be the same
Used to localize where something is
Silhouette sign
184
Only segment to touch right atria
RML 5
185
Tocuhes ascending aorta
2
186
Touches aortic knob
1-3
187
Touches pulmonary artery - anterior structure
2
188
Upper left heart border
Superior lingual 4
189
Lower left heart border
Inferior lingual 5
190
Silhouette the diaphragm on PA view
7 and 9
191
Descending thoracic aorta can be silhouetted
Upper is 6
| Lower is 10
192
Directly above minor fissure
2
193
Basal segments are below
Superior accessory fissure
194
Blood, pus, water, cells, protein
Consolidation
195
Fissure boundaries are ___ with consolidation
Sharp
196
Pleural effusion has the chance to touch
Everything
197
Increase radiographic density
Move lung to water density
198
Decrease radiograhpic density
Move lung to greater air density
199
Conduction tissue
Trachea down to terminal bronchi, blood vessels and lymphatics
200
Gaseous exchange tissue
Acini or lung parenchyma, consisting of peripheral air spaces, extravascular interstitial tissue and capillaries
201
Air may be replaced either by tissue or fluid (consolidation) or absorbed/removed and not replaced (atelectasis)
Air space disease
202
Thickening of the tissue surrounding the air space
Interstitial disease
203
Interstitial disease
Widespread, bilateral, non-homogenous increase in density
204
Total acinus
Combined air space and interstitial disease
Consolidation + interstitial disease
205
All pulmonary disease must change the ratio of
Air vs soft tissue so denisty must change
206
Parenchymal interstitial
Capillaries, interstitial walls - gaseous exchange
207
Sub-pleural interstitium
Framework, structure space
