Chapter 3: Chest and Abdomen Flashcards
What are the criteria for a PA chest?
- clavicles are in the same plane
- SC joints equal from manubrium
- one inch of apical lung field
- No foreshortening
Where do we center for PA chest?
Center to T7 (inferior angle of scapula)
What level is the manubrium in a good PA chest or good image?
The manubrium is at the level of the 4th vertebra or T4
How does the lung expand?
The lung expand in 3 dimensions: transversely, anteroposterteriorly, vertically or superior/ inferiorly
How many inches can the lung expand to?
could be as much as 4 inches
In a good breath how many ribs do you see in a PA chest?
10 posterior ribs or 11
How do you know is a PA chest
the markers are reverse
What should be seen through the T-spine in a PA chest?
T-spine through the heart shadow
Done on inspiration and expiration
Pneumothorax
lack of lung markings
pneumothorax
Where does pneumothorax happen?
up in the apices
What breathing technique shows heart shadow broader and shorter
expiration
Expiration will show how many ribs?
will only show 8th to 9th posterior ribs diaphragm
What breathing technique is used for foreign body location?
expiration
What bronchi is more vertical and larger in diameter?
- easier for foreign body to get stuck
Right bronchi
Which bronchi is more horizontal and narrower?
Left bronchi
Collapse of the lung
atelectasis
How is free air found?
Free air is found by using upright or decubitus chest images
lungs and heart foreshorten, which will lower the manubrium at the level of the 5th vertebra or lower, more than one inch of apices show
- clavicles long + angled
- manubrium below T4
Anterior tilt of PA chest
lung and heart foreshorten manubrium will move up at the level of 1st or 3rd vertebrae, clavicles will move superiorly, less than one inch of apices show
- clavicles move superior than apices
- manubrium above T4
- Apices + ribs horizontal
- heart is broader and larger
- lordotic view
Posterior tilt of PA chest
When pt’s shoulders are elevated
clavicles will be angled but the manubrium stays at T4
Why do we do a left lateral chest?
We do the left side because the heart is closer to the IR and reduces magnification
The trachea is more
anterior
The esophagus is more
posterior
What’s in profile for the lateral chest
sternum is in profile
How should the posterior and anterior ribs be for a lateral chest
posterior and anterior ribs superimposed no more than 1/2 inch
What should be open for the lateral chest
Invertebral foramina of T-spine should be open
In a good inspiration of the lateral chest what shows
It shows right and left hemidiaphragms at the level of T11
The heart continues beyond the sternum and into anterior lung
what rotation is this?
( away from IR)
left lung anteriorly
( away from IR)
When you do a left lung anteriorly ( away from IR)
what happens to the shoulder
left shoulder anteriorly
right shoulder posterior
Sternum is not in profile for a what
rotation
the heart shadow does not extend into the anterior lung but ends at the sternum
- not passing sternum
- heart moves posteriorly moving off sternum
What rotation is this?
( towards IR)
right lung anterior
when you do a right lung anteriorly ( towards IR)
What happens to the shoulder?
Right shoulder anteriorly
Left shoulder posteriorly
When you should repeat for rotation of lateral chest with right lung or left lung anteriorly?
If more than 2cm or 2 finger breaths shift in posterior ribs
What are the common mistakes for lateral chest?
tilt the hips and shoulder too much
- Poor midsagittal plane positioning
Why does the right diaphragm sits higher than the left?
because of the liver
When you turn the hips tilt (towards Ir) what happens
the right hemidiaphragms sits inferiorly than the left
What lung sits further away when doing a lateral chest
the right lung is further away which is magnified
In a good lateral at what levels are the diaphragm?
diaphragm is at the same level in a good lateral
What should you make sure regarding the spine in the lateral chest?
that the spine is straight and horizontal
On which side is the fundus of the stomach
on the left side
Sternum is not in profile
- diaphragms are at the same level but not superimposed
rotation
when gastric bubble is posteriorly this is vertifying what
right lung is situated anterior to the sternum ( right thorax rotated anteriorly)
When the right diaphragm is more anterior and the left diaphragm more posteriorly
what happens to the shoulder
right shoulder anteriorly and left shoulder posteriolry
When sternum is in profile is it a rotation or tilt?
tilt
Hips tilted to IR causes what to the diaphragms
left hemidiaphragms superior than right
One diaphragm is more superior than the other
tilt
forward or posterior diaphragm
rotation
superior or inferior left or right
tilt
Fundus sits on what diaphragm
left side of diaphragm
used to inflate lungs
ETT tube
What does ETT tube stand for
Endotracheal tube
Where should the ETT tube be centered
should be centered 1 to 2 inches above carina
What is the most common misplaced when inserting ETT tube
most commonly misplaced into right main bronchus
used for infusion
CV line
How should the CV line be placed
Should be 2 to 3cm above the right atrial junction
Done when pt can’t stand
decubitus
Pleural effusion (fluid in lungs) is best seen on
decub
In decub if the manubrium is superimposed over the fifth T- vertebra what does this indicate
the superior MCP was tilted anteriorly
In decub if the manubrium is superimposed over 3rd T-vertebra what does this indicate
the superior MCP plane was tilted posteriorly
What side do you mark up in a decub
you mark side up
How do you know what kind of decub it is
you put the affected side in contact with the table
air goes
up
fluid goes
down
In AP RPO when the ribs are rotated the side down is ( central ray angle)
elongated
In AP RPO when the ribs are rotated the side up is ( at a angle)
foreshorten
How to tell if is a AP chest
able to see bodies and disk space with no distortion
- disk space are open
How to tell if is a PA chest
the bodies are distorted
- disk space are closed
- spinous processes and laminae are well demonstrated
What are other names for AP axial chest
Limbolm method
- Lordotic view
Why do we do the limbolm method
we do it for the apices
Where does TB typically start
starts in the apices
How is the patient position for a lordotic chest
patient is positioned one foot from IR and tilted backwards
Why do we do the lordotic view
for the clavicles to be above the apices
How should the clavicles look in a limbolm method
the clavicles should look horizontal
If patient can’t tilt back for the limbolm method what do we do
we angle the tube 15 to 20 degrees cephalic
If superimposed posterior ribs look obscure what does this mean for a limbolm method
back was arched too much or central ray was angled too much
If you over tilt for limbolm what happens
can take clavicles right back into the apices
For obliques what side do we mark
we mark side down
RAO=
LPO
LAO=
RPO
When not given a degree for oblique what degrees do we do
we do a 45 degrees
What degree will help get heart off the spine
LAO 60 degrees
Done for cardiac series
LAO 60 degrees
twice as much lung field as you do on the other side
45 degrees rotation oblique
heart shadow will be slightly superimposed over t spine
45 degrees oblique
For mobile positioning what should you make sure that must be accurately aligned
- pt
- IR
- central ray
RAO shows what lung field
shows left lung field
side further away
LAO shows what lung field
shows right lung field
side further away
trachea will be demonstrated on which side for oblique
demonstrated in lung field farther away from IR
in how many directions should you evaluate the tube for mobile positioning
evaluate in two directions
When pt is centered to the bed for mobile positioning how should the tube be center
tube should be centered with the foot of the bed to avoid off centering
Whe doing a AP chest mobile positioning and you have 72 inches how should you be centered
CR should be perpendicular to the sternum
What breathing technique is decreased in a mobile positioning
inspiration
When doing a AP chest mobile positioning at 40 inches where should you centered
downward angle of 3 degrees to the sternum should be used ( slightly caudal apperance)
In a mobile positioning the heart shadow is further away from the IR what can we conclude from this
the heart will appear larger broader
in mobile positioning what happens to the diaphragm
the diaphragm flattens out
For upright abdomen what should you get on
need diaphragm
for supine abdomen what should you get on
need pubic symphysis
Good technique for abdomen will show
you should see psoas muscles
When doing decub abdomen which side should be up
the right side up
what should be equal in a good abdomen x-ray
pedicle, ribs, transverse process
why should the right side be up for a decub abdomen
because the liver is on the right side
what kind of study is a decub
a time study
what decub do we do for abdomen
left lateral decub
how much is a time study for decub
5 minutes
what must you get on for decub
needs crests and diaphragm
laying on stomach
ventral
laying on back
dorsal
What should be mindful of when doing AP peds chest
be mindful of collimation
For infants what should we infer about the distance for AP chest
don’t need to do 72 in the nursery
Where should you center for AP peds chest
4th vertebra in center of collimated field
In AP peds chest how are the anterior ribs
the anterior ribs are projected downwards
In AP peds chest how are the posterior ribs
posterior ribs are gentle cephalic bow ( look horizontal)
What are not developed as newborns
alveolar sacs
At what age do alveolar sacs develop
8 years old
How many ribs are shown for a AP peds chest
8th posterior ribs demonstrated above diaphragm
What must you do with the head for peds
keep the head straight since it keeps the body straight
How do the lungs appear for peds
the lungs appear smaller, denser, fluffy, and white because they don’t have sacs
Why do neonate tend to have a lordotic apperance
because of the lack of a kyphotic thoracic curvature seen in an adult
How can we fix the lordotic appearance in neonate and infants
this can be offset by a 5 or 3 degrees caudal angle
What is the tendency to do with neonate
there is a tendency to center to inferior when we should center high at T4
When we angled too low or center too low what happens in neonate
foreshortens lungs and mediastinal structures, causing the cardiac Apex to appear uptilted
Rotation of the chest commonly happens when an infants
rotation of the chest commonly happens due to head rotation
Chest will rotate towards what in neonate
chest will rotate towards the side the head moves
How many ribs should neonate demonstrate
should demonstrate 8 posterior ribs
how many days are they considered neonate
28 days
how many days are they considered infant
1 month
how many ribs should be demonstrated for infants
9 posterior ribs
Where should we center for neonate and infants for lateral chest
center mid-coronal plane at the 5th T vertebra
why should neonate be done as a cross table
because overhead lateral tends to collapse the lung adjacent to the IR squish lung that they are laying on
to prevent superimposition in neonate and infants lateral chest what should we do
raise chin
if a child is being held what should we do
the holder hands should remain out of the radiation field
how will the posterior ribs look for neonate and infants lateral chest
posterior ribs will be directly superimposed due to the close OID of the right and left lung
