Chapter 3: Starred slides for Chest Flashcards
What IR should be used for chest images?
14 x 17
What should the collimation be like for chest images?
17 inches lengthwise
1 inch beyond the lateral shadows but no more than 14 inches
What collimation and radiation field size should be used for hypersthenic patients
Opposite of normal patient
17 height x 14 length
Patient instructions for chest x-ray
explain and demonstrate positions when possible
respiration instructions are critical
exposures are usually made after the second inspiration
What are the essential projections for a chest x-ray?
Posteroanterior (PA)
Lateral
PA oblique
Anteroposterior oblique ( AP)
AP
AP axial
What should the patient position be for a PA chest?
Upright either standing or seated
demonstrates air or fluid levels
allows diaphragm to move to its lowest position
Where should the top of the IR be for a PA chest?
1 1/2 to 2 inches above shoulders
What should the part position be like for a PA chest?
patient faces vertical grid device (buckey)
MSP centered perpendicular to IR
weight equally distributed on both feet
Flex elbows and rest back of hands low on hips
depress shoulders into same transverse plane
roll shoulders forward to touch vertical grid
Where should the CR be for a PA chest?
perpendicular to center of IR
enters MSP and level of T7 (inferior angle of the scapula)
What should the patients position be like for a lateral chest?
upright either standing or seated
demonstrates air or fluid levels and allows diaphragm to move to its lowest position
top of the IR should be 1 1/2 to 2 inches above shoulders
What side is demonstrated in the image for a lateral chest?
the side placed closest to the IR
Why is the left lateral positioned used?
to minimize the magnification of the heart
What should the part position be like for a lateral chest?
true lateral position
MSP parallel with IR
MCP perpendicular to IR
shoulder in contact with grid
extend arms over head, flex elbows and rest forearms on head
(if needed place IV stand in front of an unsteady patient)
ensure patient is not leaning sideways or bending forward
Where should the the CR be for a lateral chest?
directed perpendicular to IR
enters patient on MCP at level of T7
exposure made at the end of second deep inspiration
What should the patient position be like for a PA oblique chest?
upright standing or seated
top of IR 1 1/2 inches to 2 inches above vertebra prominens
What should the general part position be like for a PA oblique chest?
45 degree for a left anterior oblique (LAO or right anterior oblique (RAO)
side of interest is farther from IR (elevated side)
shoulders in same transverse plane
arms positioned out of radiation field
What should the part position be for a PA oblique Left anterior oblique chest x-ray be?
rotate 45 degrees
left shoulder in contact with grid
left hand on hip
raise right arm
shoulders in same horizontal plane
If the LAO position is being used for a cardiac series, how rotated should the patient be?
55-60 degrees
What should the part position be for a RAO oblique (right anterior oblique) chest x ray be?
rotate 45 degrees
right shoulder in contact with grid
right hand on hip
raise left arm
shoulders in same horizontal plane
Where should the CR be for a PA oblique chest?
perpendicular to IR
enters at level of T7
What should the patient position be like for an AP oblique chest?
upright or recumbent
used when patient is too ill to be turned prone
top of IR 1 1/2 to 2 inches above vertebral prominens
What should the part position be for a AP oblique chest?
45 degree left posterior oblique (LPO) or right posterior oblique (RPO)
side of interest is closer to IR
arms positioned out of field
shoulders in same transverse plane
Where should the central ray be for an AP oblique chest?
perpendicular to IR center
Enters 3 inches below jugular notch
exits T7
What should the patient position be for an AP chest?
supine or seated upright in wheelchair or stretcher
used when patient is too ill to sit or stand
top of IR 1 1/2 to 2 inches above relaxed shoulders
What should the part position be for an AP chest?
center MSP to IR
if patient condition permits, flex elbows, pronate hands, and place hands on hips to draw scapula laterally
adjust shoulders into same transverse plane
Where should the CR be for an AP chest?
perpendicular to long axis of sternum and center of IR
enters 3 inches below jugular notch
exposure made after second full inspiration
What should the patient position be like for an AP axial chest? (lordotic position/lindblom)
upright, facing tube
approximately 1 foot in front of grid
top of IR placed 3 inches above shoulders
What should the part position be like for an AP axial chest?
MSP centered to midline of grid
assist patient to lean backward until shoulders rest on grid
coronal plane of thorax 15 to 20 degrees from vertical
Where should the CR be for an Ap axial chest?
perpendicular to IR
enters MSP at midsternum 3 to 4 inches below jugular notch
What should the patient position be like for an AP/PA lateral decubitus chest x-ray?
Lateral decubitus on right or left side
top of IR 1 1/2 to 2 inches beyond shoulders
If you’d like to demonstrate fluid in a lateral decubitus position, what side should the patient lie on?
on the affected side
To demonstrate free air in a lateral decubitus position, what side should the patient lie on?
on the unaffected side
Why should the patient remain in position for 5 minutes before exposure for a lateral decubitus position?
in order to allow fluid to settle or air to rise
What should the part position be like for an AP/PA lateral decubitus position
elevate body 2 to 3 inches if lying on affected side
true lateral without rotation
extend arms over head
anterior or posterior surface of chest against vertical grid device
Where should the CR be for an PA lateral decubitus x ray
horizontal and perpendicular to center of IR
It should enter at T7
Where should the CR be for an AP lateral decubitus x ray
horizontal and perpendicular to center of IR
enters MSP at 3 inches below jugular notch
What should the patient position be for a ventral or dorsal decubitus x ray
Prone or supine
body elevated 2 to 3 inches
top of IR at level of thyroid cartilage
remains in position for 5 minutes to allow fluid to settle air to rise
What should the part position be for a lateral ventral or dorsal decubitus position?
True prone or supine position without rotation
affected side against vertical grid
arms above head
What structures are show in a ventral or dorsal decubitus position?
changes in fluid position
What is the evaluation criteria for a ventral or dorsal decubitus position?
entire lung fields, including the anterior and posterior surfaces
upper lung field not obscured by the arms
no rotation of the thorax
T7 in the center of the IR
pulmonary vascular markings from the hilar regions to the periphery of the lungs
