Chest and Abdomen Flashcards
Special Considerations for Chest and Abdomen
1) Much overlapping anatomy in chest and abdomen on the radiographic image
2) Both cavities contain air and fluid
3) Minimum of one view upright
4) Air goes up until it meets a barrier; fluids fall to seek their own level
5) Using a horizontal x-ray beam and a vertical IR demonstrates air-fluid levels
What is chest radiography performed?
to visualize the visceral anatomy of the chest (heart and lungs)
chest radiography requires (high/low) (kvp/mAs) to adequately demonstrate subtle lung markings
high kVp
Chest radiography is performed at 72” why?
To reduce magnification of the heart
Set-Up Flow
1) Measure for all set-ups in the series
2) Set control panel
3) Set SID
4) Set collimation and apply side marker
5) Apply lead shielding to patient
6) position patient at bucky
7) Align cassette to the patient
8) Align CR to center of cassette
9) No filtration
Routine Chest Series (view)
PA Chest
Left Lateral Chest
PA Chest: SID?
72”
PA Chest: Film Size?
14 x 17
PA Chest: Film Placement?
Vertical / 1 1/2 above VP
If you have a wide chest you can turn it transverse with the top at the shoulders
PA Chest: ID Blocker?
Up
PA Chest: CR
CR to spine and mid film
PA Chest: Collimate
to film size
PA Chest: Patient Positioning
Roll shoulders forward, deep inspiration and hold
PA Chest: Filter?
No
Optimal PA Chest Criteria
1) All heart and lung anatomy is included
2) Unwanted anatomy out of lungs
3) No rotation / SC joints symmetrical
4) Adequate penetration of structures
5) Upper 4 thoracic vertebrae identified well
6) Adequate inspiration of lungs
7) Count 10 posterior ot 7 anterior ribs
8) Lung markings are “crisp” / not “fuzzy”
PA Chest Image Criteria
1) Upper 4 Thoracic Identified Well
2) 10 Posterior or 7 Anterior Ribs Visible
3) Tracheal Air Shadow Midline to Spine
4) Include Top of Apices to Bottom of Costophrenic Angles
5) Unwanted anatomy out of lungs
6) SC joints symmetrical
7) Lung markings “crisp”
Left Lateral Chest: SID
72”
Left Lateral Chest: Film Size
14 x 17
Left Lateral Chest: Placement
Vertical / 1 1/2 above VP
Left Lateral Chest: ID Blocker
Up
Left Lateral Chest: Patient Placement
patient true lateral with left side against bucky and arms extended over head, Left perked on bucky upper left, deep inspiration and hold, no filter
Left Lateral Chest: CR
CR to center of film and mid-axillary line
Left Lateral Chest: Filter
No
Left Lateral Chest Image Criteria
1) Apices through costophrenic angles visualized and clear
2) Posterior ribs superimposed
3) IVFs open
4) Sternum in profile
The most common radiographic exams performed on pediatric patients and toddlers include
1) Chest
2) Abdomen
3) Bone Survey
4) Extremities
Correct Immobilization Procedures
1) Place blanket covered film on table
2) Lay child on film
3) Have one person (preferably a parent or caretaker) hold the arms over the baby head
4) Have another person (preferably a parent or caretaker) hold baby waist and leg
For Infants - Swaddling
The wrapping of the arms and legs is comforting to most babies making it much easier to keep them still. You may still need assistance to anchor the babys legs - Mom or Dad should be your helper
Infant Inspiration
With some infants and small children, the best way to get a good inspiration might be to ‘flick’ the soles of their feet to induce crying. Although this may seem cruel, it assists the radiographer in catching the child taking in a deep breath between wails
Accessory Views
1) Apical Lordotic Chest
2) Left Lateral Decubitus Chest
Apical Lordotic Chest
**this removes clavicles from the lung fields for evaluation of the lung apices
1) Chest is tipped and CR is directed parallel to film
OR
2) Chest is parallel to film and CR is tilted 15 degrees cephalic
72” SID
Projects Clavicles
Left Lateral Decubitus Chest
** either right or left put side with suspected fluid down / this view is done to evaluate air fluid levels in the chest and must have a beam that is parallel to the floor otherwise the image will be distorted
CR parallel to floor
A-P Projection
Chest (does/does not) equal bony thorax
does not
Deep inspiration is absolutely necessary to demonstrate lung’s ability to aerate
no more to add
Should be done upright to demonstrate fluid levels or a decubitus can be done
no more to add
May be done with AP projection if necessary
no more to add
Shield the front of the pelvis; most scatter ricochets back from the bucky (because of high kVp and easily penetrated lung tissue)
no more to add
Abdominal Series
Recumbent AP Abdomen
Upright AP Abdomen
**Done to evaluate the air fluid levels in the abdomen as well as the organs inside. Also referred to as a KUB (kidney, ureter, bladder) a Scout Film
Recumbent AP Abdomen
• "Flat Plate", "KUB" • Used to rule out: masses, aneurysm, calcifications, foreign bodies, fetal shadows, bowel gas pattern • If aneurysm is suspected, do lateral abdomen (soft-tissue lateral lumbar) • Patient Supine (table bucky) • 14 x 17 film, vertical • 40" SID • Bottom of Film at greater trochanters • Must see bottom of bladder • Exhale and Hold ***Must include Bladder
Upright AP Abdomen
Used to identify:
Free air in abdominal cavity
Air-fluid levels
• 14x17, vertical • 40" SID • Top of cassette at axilla level • CR approx 2" above crest • center mid-film • must include top of diaphragm • expose on expiration ***Must include diaphragm
Megan Blas
It’s usually normal to see air under the left hemi-diaphragm
A left lateral decubitus abdomen view may be taken in place of the upright
no other info
Exposing on expiration raises the diaphragm and makes the abdomen thinner requiring less exposure
no other info
Gonadal shield may be used on males if it doesn’t interfere with abdominal anatomy
no other info
To make sure you used enough kVp you should only be able to count the first 4 thoracic vertebrae
no other info
