Chest Flashcards
Structures that form the Thoracic Cage:
•Sternum
•Ribs/Costal Cartilages
•Thoracic Vertebrae
Sternum
-Creates anterior boundary
-Components: Manubrium Body
-Xiphoid Process
-Jugular notch
Ribs
•Creates lateral boundary
•Articulates with the thoracic spine
Ribs names & numbers
True ribs: 1-7
attach directly to sternum
False ribs: 8-12
Don’t attach directly to sternum
Floating ribs: 11-12
Only articulate with vertebrae
Thoracic spine
-Vertebral bodies
-Intervertebral disks
-Pedicles
-Spinous Processes
Landmarks for chest x-rays
Jugular notch
T7 = Inferior angle of the scapula
Airway structures
•Trachea
•Bronchial Tree
•Right and Left Lungs
Trachea
-Trachea: C6-T4/T5
-Carina: T5
Right Main Bronchus
•Upper lobar
•Middle lobar
•Lower lobar
Left Main Bronchus
•Upper lobar
•Lower lobar
Bronchi’s and bronchioles
-Primary bronchi
-Secondary bronchi
-Tertiary bronchi
-Bronchioles
-Terminal bronchioles
Alveoli
Site of oxygen and carbon dioxide exchange by diffusion
Lungs
Organ of respiration
•Apex
•Base
•Hilum
Pleura
Double membrane that encloses each lung
•Visceral pleura: adheres to surface of the lung
•Parietal pleura: lines the thoracic cavity
-Pleural cavity: space between two layers
Right lung
3 lobes
-Oblique fissure: Separates inferior lobe from middle and superior
-Horizontal fissure: Separates middle lobe from superior lobe
Left lung
2 lobes
-Oblique fissure: Separates inferior lobe from superior
Cardiac notch: Large area on the medial surface
Diaphragm
Separates thoracic and abdominal cavities
During Inhalation the diaphragm __________ and moves to ________ position
-contracts, lower
During Exhalation the diaphragm _________ and moves _________ pushing air out of lungs
-relaxes, upwards
Mediastinum
•Heart
•Great Vessels
•Trachea
•Esophagus
•Thymus/Lymphatics
•Nerves
•Fibrous Tissue
•Fat
Position of the heart
-Lies obliquely in the mediastinum
-Apex toward the left side of the body
How should patient position usually be for chest x-rays and why?
Upright when possible
•Prevents engorgement of pulmonary vessels
•Gravity depresses diaphragm
•Demonstrates air fluid levels (with horizontal beam)
•Allows for full expansion of lungs
Inspiration/Expiration breathing are required for
•Pneumothorax
•Excursion (movement) of diaphragm
•Foreign body
•Atelectasis
Images obtained with high or low kVp?
High
If using ______ pay attention to cells/detectors
AEC
Why do we use 72 SID?
Decreases magnification of the heart and obtains greater spatial resolution of lung structures
Body habitus
-Asthenic (CR cassette is placed LW for PA/AP): very slender
-Sthenic: moderate heavy build
-Hyposthenic: intermediate between asthenic and sthenic
-Hypersthenic: large build
Patient preparation
-Patient changes into a gown and removes any metal objects (including bra and jewelry)
-Always ask “Do you have any metal on your chest?”
-Beware of shirts with pockets (gum, coins, glasses, cough drops, credit cards)
-Long hair should be moved
-Inpatients/ED patients: Look/Ask about monitoring devices, safety pins
Chest PA SID, IR,Position, CR, Collimation, Respiration
SID: 72”
IR: 14x17 LW or CW, upper border 1.5”-2” above relaxed shoulders
Position: Upright
•MSP centered to IR
•Weight equally distributed
•Chin extended upward
•Elbows flexed with hands on lower hips
•Shoulders depressed and in same plane
•Shoulders rotated forward
CR: Perpendicular to center of IR at T7 (inferior angle of scapula)
Collimation: 14”x17”
Respiration: Suspend after second inspiration
Viewing chest radiographs
PA or AP views
•Patient’s right is always on viewers left
•Left marker will be on viewer’s right side
Chest PA Evaluation Criteria
-Entire lung fields from apices to the costophrenic angles
-No rotation:
•Sternal ends of clavicles equidistant to spine
•Trachea in the midline
•Equal distance from the vertebral column to lateral border of the ribs
-Proper shoulder rotation demonstrated by scapulae projected outside the lung fields
-Proper inspiration demonstrated by ten posterior ribs visible above the diaphragm
-Sharp outlines of heart and diaphragm
-Ribs and superior thoracic vertebrae visible through the heart shadow
-Lung markings visible from the hilum to the periphery of the lung
Chest Lateral SID, IR,Position, CR, Collimation, Respiration
SID: 72”
IR: 14x17 LW, upper border 1.5”-2” above shoulders Position: Left Lateral, Upright
•MSP is parallel with IR, shoulder is touching grid
•Mid coronal plane perpendicular to midline of IR
•Arms extended upwards, forearms resting on head
•Avoid leaning or forward bending
CR: Perpendicular to IR
•entering midcoronal plane at the level of T7 (inferior aspect of scapula)
Collimation: 14”x17”
Respiration: Suspend after second inspiration
Chest lateral evaluation criteria
-Arms not overlapping superior lung field
-Costophrenic angles and the apices of the lungs not obscured by arms and shoulders
-No rotation:
•Hila in the center of the radiograph
•Superimposition of ribs posterior to the vertebral column
•Sternum in profile
•Trachea visible in the midline
-Long axis of the lung fields in vertical position, without forward or backward leaning
-Open thoracic intervertebral spaces and intervertebral foramina (except in patients with scoliosis)
What if my patient can’t stand?
Use wheelchair or stretcher
Chest AP SID, IR,Position, CR, Collimation, Respiration
SID: 72”
IR: 14x17 LW or CW, upper border 1.5”-2” above relaxed shoulders
Position: Supine or Upright
•MSP centered to IR
•Flex elbows, place hands on hips
•Shoulders in same plane
CR: Perpendicular to long axis of sternum, entering 3” inferior to jugular notch
Collimation: 14”x17”
Respiration: Suspend after second inspiration Watch patient’s chest if unable to follow commands
Chest AP Evaluation Criteria
-Entire lungs (apices to angles)
-No rotation:
•Sternal ends of clavicles equidistant from spine
•Trachea in midline
•Equal distance from spine to lateral border of ribs
-Clavicles appear more horizontal than PA projection
-1 inch of pulmonary apices should be seen superior to clavicles
Chest AP Portable SID, IR,Position, CR, Collimation, Respiration
SID: 72”
IR: 14x17 LW or CW, upper border 1.5”-2” above relaxed shoulders
Position: Upright if possible
•MSP centered to IR
•Chin extended upward
•Shoulders depressed/relaxed
•Torso not rotated or leaning
CR: Perpendicular to long axis of sternum, entering 3” inferior to jugular notch
Collimation: 14”x17”
Respiration: Suspend after second inspiration Watch patient’s chest if unable to follow commands
Annotate image: Portable, Supine or Upright
T or F: for Chest AP portable incorrect angulation of the CR causes an apical (lordotic) appearance
True
Chest AP Portable Evaluation Criteria
-No motion; well-defined (not blurred) diaphragmatic domes
-Lung fields in their entirety Pleural markings
-Ribs and thoracic intervertebral disk spaces visible through the heart shadow
-No rotation, medial portion of clavicles and lateral border of ribs equidistant from vertebral column
What is Atelectasis?
Partial or complete collapse of the lung
What is Pneumothorax?
Accumulation of air in the pleural resulting in collapse of the lung
What is pneumonia?
Acute infection of the lung parenchyma
