Chest and Soft Tissue Flashcards
Chest AP Axial Lordotic SID, IR, Position, CR, Collimation, Respiration
SID: 72”
IR: 14x17 LW, upper border 3” above top of shoulders
Position: Upright if possible
•MSP centered to midline of IR
•Patient upright facing CR, standing 1 foot away from IR then leans back
•Mid coronal plane forms 15-20º angle to WB
CR: Perpendicular to mid-sternum
Collimation: 14”x17”
Respiration: Suspend after second inspiration
If patient can’t be placed in lordotic position…
angle the CR 15-20 degrees cephalic
Chest AP Axial Lordotic Evaluation Criteria
-Entire apices and portion of lungs
-Clavicles are located superior to the apices
-Sternal ends of the clavicles equidistant from vertebral column
-Clavicles are horizontal with the sternal ends overlapping only the first or second ribs
-Ribs are distorted
When would we use the Chest AP Axial Lordotic view?
Interlobar effusions or lesions of the lung apices
Pneumothorax
A collection of free air in the pleural space that compresses lung tissue
Pleural Effusion
A collection of fluid in the pleural cavity, blunting of costrophrenic angle
Imaging Air-Fluid Levels in the Chest: Pneumothorax
•Pneumothorax:
•Air rises
•Best seen when affected side is elevated
Imaging Air-Fluid Levels in the Chest: Hemothorax or Pleural Effusion
•Fluid will settle to the bottom
•Best seen when affected side is down
How can we best detect small fluid levels on Chest X-rays?
-The LATERAL DECUBITUS position is most sensitive, able to identify even a small amount of fluid
-It is also used for detecting air in the pleural cavity
What does decubitus mean?
-Patient is lying down and that the central ray is horizontal and parallel with the floor.
-Decubitus positions include:
•Left lateral (patient lying on left side)
•Right lateral (patient lying on right side)
•Dorsal
•Ventral
Fluid: affected side _________
Air: affected side_________
Down, Up
Chest Lateral Decubitus positioning, SID, IR, CR, Collimation, Respiration
-SID: 72”
-Shielding: Yes
-IR: 14x17 LW with body, upper border 1.5”-2” above shoulders
-Position: Lateral decubitus x 5 minutes
•Fluid: affected side down
•Air: unaffected side down
•Elevate patient, Arms raised
•No rotation or bending
-CR: Perpendicular to center of IR 3” below jugular notch (AP) or at T7 (PA)
-Collimation: 14”x17”
-Marker and annotation on “up” side
-Respiration: Suspend after second inspiration
Chest Lateral Decubitus Evaluation Criteria
-Affected side in entirety (apex to costophrenic angle)
-No rotation: sternal ends equidistant from spine
-Patient arms not visible
-Proper identification
What view would you use for a 18 month old: Foreign body
Chest Lateral decubitus
Pharynx
•Passage for air and food
•Common to Respiratory and Digestive Systems
Adenoids
a patch of lymphoid tissue that sits at the very back of the nasal passage
Nasopharynx
Above the soft and hard palates
Oropharynx
•Soft Palate -> Hyoid Bone
Laryngeal pharynx
Posterior to Larynx
Larynx
•Organ of voice
•C4->C6
•Protected by Epiglottis during deglutition(swallowing)
Thyroid Cartilage
•Laryngeal prominence
-T1
Thyroid Gland
•2 Lobes connected at the Isthmus
Epiglottis
•Cartilaginous structure that is depressed during swallowing to cover the opening of the trachea
Imaging Considerations
•Presence of Foreign bodies, swelling, masses, fractures of the Larynx and Hyoid bone
•Order should indicate upper or lower airway
•Patient may be recumbent or Upright
•Upright is preferred
•10 X 12 IR LW
•Collimation should include nasal cavity to thoracic inlet
Where should we center the CR for the Soft Tissue Neck?
Upper airway or Lower airway
Soft tissue neck AP SID, IR, Position, CR, Collimation, Respiration
-SID: 40”
-IR: 10”x12” LW
-Position: Upright
•MSP is perpendicular and centered
•Shoulders in the same plane
•Extend chin
-CR: Perpendicular entering the laryngeal prominence (adam’s apple)
-Collimation: 12” LW, 1” beyond skin shadow
-Respiration: Exposure as patient inhales slowly (Breath in slowly through your nose)
AP Soft Tissue Neck (Lower Airway)
-Position: Center MSP, Extend neck slightly
-Respiration: slow inspiration
-CR: Perpendicular to MSP at Manubrium
Soft tissue neck AP Evaluation Criteria
-Soft tissue neck with air-filled trachea
-No rotation with spinous processes equidistant to the pedicles and aligned with the midline of the cervical bodies
-Collimation should include from the soft palate to thoracic inlet (first rib)
Soft tissue neck Lateral SID, IR, Position, CR, Collimation, Respiration
-SID: 72”
-IR: 10”x12” LW
-Position: Upright
•Shoulder against grid
•MSP is parallel to IR
•Elevate chin slightly
•Rotate shoulders back, arms behind back
-CR: Horizontal through the midcoronal plane at the level of the laryngeal prominence
-Collimation: 12” LW, 1” beyond skin line of anterior and posterior surfaces
-Respiration: Exposure as patient inhales slowly (Slow deep breath through your nose)
Why 72” for our SID for Lateral Neck soft tissue
Because of OID
Soft tissue neck Lateral Evaluation Criteria
-Soft tissue neck with air-filled trachea
-No rotation
-Superimposed or nearly superimposed mandibular rami
Which position checks for epiglottitis?
Lateral soft tissue neck
Pediatric considerations for soft tissue neck x-rays
Indications:
•Foreign body
•Stridor (high-pitched sound heard on inspiration caused by an obstruction)
•Croup (barking cough from infection)
•Adenoid Hypertrophy (increased size of the adenoids)
•Epiglottitis (tissue protecting the windpipe becomes inflamed)
Perform upright (especially in cases of epiglottitis)
Younger patients not old enough to sit up may be done supine but neck roll or towels must be placed underneath shoulders to extend head
Make exposure after scream to catch inspiration
AP:
•Place occlusal plane perpendicular to the IR to prevent the occipital bone from superimposing the airway
•Slight cephalic angle may be used
Lateral:
•Collimation should include from the nasion (bridge of the nose) to thoracic inlet
Protocols may vary depending on indication (AP & Lat versus Lat only)
AP Chest Lordotic view is also known as
Lindblom projection
