Ch. 3 Thorax And Chest Positioning Flashcards
What organs are in the respiratory system?
Pharynx, trachea, bronchi, and two lungs
Trachea
Fibrous, muscular tube with 16-20 C shaped rings in its walls for strength, anterior to the esophagus lines in the midline (midsagittal plane)
Carnia
A hooklike process in the trachea this is where it splits into two, splits into the right and left primary bronchus
Bifurcates
Another word for divide in terms of the trachea
Right primary bronchus
Shorter, wider, more vertical than left, position and size make it easier for foreign bodies to enter
Subdivision of the bronchial tree in order
Primary brunchi, secondary bronchi, tertiary bronchi, bronchioles, terminal bronchioles
What do the terminal bronchioles do?
They communicate with the alveolar ducts
Alveolar ducts end in what?
Alveolar sacs
Walls of the alveolar sacs are lined with __________.
Alveoli
What occurs in the alveoli?
Gas exchange by diffusion,nth is is the functional unit of the lunch
Anatomy of the lungs
Organs for respiration, apex, base, costophrenic angles, hilum
Location of the Apex of the lung
It reaches above the clavicles
Base of the lungs
Rests on the diaphragm, lower in the back and sides than in the front
What lies on the end and lateral sides of the lungs?
Costophrenic angles
What is the medial border of the lungs?
The hilum
How many lobes does the right lung have?
3
How many lobes does the left lung have?
2
Horizontal fissure
Only on right lung, separates the middle and superior lobes
Oblique fissure
Separates the inferior and middle lobes at an angle on the right side and separates the inferior and superior lobes at an angle on the left side
Right Lung
Shorter than the left due to the presence of the liver, broader than the left as well
Inspiration
Lungs move inferiorly, full of air
Expiration
Lungs move superiorly, empty air
Pleura
Each lung is enclosed in this double walled serous membrane sac, 2 layers
2 layers of pleura
Visceral pleura, parietal pleura
Visceral pleura
Inner layer, on the surface of the organ
Parietal pleura
Outer layer, on the outer surface, closer to skin
Mediastinum
separates pleural cavities
Area/ location of the thorax
Bounded by the sternum anteriorly, the spine posteriorly, and the lungs laterally
Body habits and lungs
Asthenic - rly long and narrow (old men)
Hyposthenic - longer lungs
Sthenic - normal
Hypersthenic - shorter longs, apices of the lungs do no show above clavicles
How many chambers does the thoracic cavity have and what are they?
3: Pericardial cavity, and right and left pleural cavities
Patient preparation before procedure
Look for any special needs for patient, know where to retrieve patient, check two forms of ID, Make sure having right thing done, remove artifacts, ask if pregnant (11-55)
Ambulatory
Patient can walk or sit on there own
Non-ambulatory
Patient in wheelchair or stretcher
How do you position an non-ambulatory patient?
Supine if air fluid levels are not essential
Decubitus if air fluid levels are essential (if they can’t sit upright)
Upright in stretcher if possible
What is SID?
Source to image distance
The SID for a chest X-ray
72 inches
Where should markers be placed on a chest X-ray and which one?
The Left is the most commonly used so you do not have to change between PA and Lateral, it needs to be placed in the upper left hand corner
Shielding
Every patient every time, reproductive age and pediatric patients
3 things you can do to protect from radiation?
Shield, collimate, and technique
What size cassette is used for a chest X-ray?
14 x 17
Patient instruction for chest X-ray:
Give clear instructions, one step at a time, try to demonstrate when possible, deep and double inspiration - vital for lung expansion
When would 2 X-rays be taken on purpose in the PA position for a chest X-ray?
When a X-ray is needed for both inspiration and expiration, examples of illness: pneumothorax, diaphragm movement, presence of foreign body, and atelectasis
Emphysema (COPD) on an X-ray
Looks like a barrel chest
Metastases on an X-ray
Cancerous lesion, looks like cotton balls in lungs
Pleural effusion
Liquid in the lungs
Pnemothorax on and X-ray
On an X-ray there will be NO lung markings
Chest Projections
PA, lateral, AP, AP Axial
Posterioranterior chest projection
PA - CR enters the posterior and exits the anterior then hits the IR
Lateral position on a chest
Left lateral, left side closest to the IR to decrease magnification of the heart
Anteriorposterior chest projection
AP - CR enters the anterior and exits the posterior then hits the IR
AP Axial chest projection
Angulated/ angled
What projections are used for a decubitus position?
(Laying down, horizontal CR)
Use AP or PA laying down on left AND right sides, use lateral laying down ventral and dorsal
What is the normal projection used for a chest X-ray and why?
PA and Left Lateral , it decreases magnification
How to preform a PA chest in order of patient positioning.
Upright if possible to demonstrate air fluid levels, patient facing IR (PA), MSP centered, relax shoulders, chin slightly tilted up, Light on IR should be 1 - 1 1/2 inches above shoulders, dorsal surface of hands on hips, roll shoulders forward, shield, and deep inspiration hold on the second
For a chest X-ray the CR should be _________ to the IR.
Perpendicular
For a chest X-ray the CR should enter at the level of….
T7 ( inferior angle of the scapula)
How many inches of light should be showing above the shoulders for a chest X-ray?
1- 1 1/2 inches
What to look for on a chest X-ray to see if it is acceptable?
Apices should be above clavicles, costophrenic notches should be completely visible, ribs should be superior to check for full inspiration, check rotation either by symmetry of clavicles or ribs or by the spinous processes being centered (will look like circles).
How to position a patient for a L Lateral chest X-rays?
Upright, MCP perpendicular to IR and parallel to CR, left side against IR (always left lateral unless other wise stated by physician), arms raised elbows flexed and resting on head, light should be 1- 1 1/2 inches above shoulders, shield, 2 deep inspirations while holding in the second, expose
For a lateral chest X-ray how is the CR positioned?
The CR is perpendicular to the IR, and enters at the level of T7
What should be in a L lateral chest X-ray to make it acceptable?
Costophrenic angle, vertebral bodies, spinous processes should be circles, sternum should be lateral, apices
AP chest positioning a patient
Patient is supine or erect and the rest is exactly the same as positioning a patient in PA
CR positioning for a AP chest projection
The CR should be perpendicular to IR, the CR should be 3 inches below jugular notch
How to position patient for an AP Axial (Lordotic) projection
Position the patient 1 foot away from IR, assist the patient in leaning back towards the IR, light should be 3 inches above shoulders, MSP centered, MCP should form 15-20 degree angle with IR, shield, 2 inspirations holding the second, expose
For an AP Axial (Lordotic) X-ray the CR should be….
Perpendicular to IR and entering at the level of midsternum
AP or PA Decubitus positioning of the patient
Patient is lying down on the left side (and on the right side for the second exposure), arms are stretched out above the head, MCP perpendicular to table, anterior or posterior side against IR, allow patient to sit for 5 minutes in this position before exposure, light above shoulders should be 1 1/2 - 2 inches
How the CR should be positioned for a decubitus patient position?
Horizontal beam, perpendicular to IR, 3 inches below jugular notch, CR at the level of T7
Ventral/ dorsal decubitus positioning of a patient
Position patient supine or prone, elevate patient, arms extended over head, lateral side against IR, allow patient to lie for 5 minutes, top of IR should be at the level of thyroid, two deep inspirations hold on second, shield, expose
How should the CR be positioned for a ventral/ dorsal decubitus position?
The CR should be horizontal, perpendicular to IR, for dorsal - 3 to 4 inches below jugular notch, for ventral - level of T7
