Chest, Soft Tissue Neck and Abdomen Flashcards
Chest imaging repeats
chest X-ray are the most frequently ordered diagnostic imaging procedure, yet most repeated due to technologist errors
patient preparation - chest
everything off from the waist up - hospital gown
remove long earrings, necklaces, body piercings, etc.
long hair (tie up if you can)
move oxygen tubing, iv lines, etc. off chest
CLEAN bucky for PA chest
topographical landmarks
C7 - Level of apices - vertebra prominens
T7 - inferior angle of the scapula - mid thorax - center
T10 - xiphoid tip
top/bottom landmark
Top of lung - include C7 prominence in light field
Bottom of lung - anterior portion just distal xiphoid, posterior 2” distal to xiphoid
PA Chest
patient images erect
- gravity help depress diaphragm
- assess air/fluid levels
- prevent engorgement of pulmonary vessels
Chest collimation guidelines
Light must not exceed the size of IR
top of light to C7
CP at T7 at MSP
Marker face down
Hands out of the light field
hypersthenic chest
large patient - usually male
thorax broad, deep and short
landscape orientation
Asthenic chest
tall slender build
thorax is narrow and shallow
portrait orientation
PA Chest position relative to bucky
erect preferred
- sitting or standing
- elevate chin
- roll shoulders forward - relax
- include costophrenic angles
light field is 1-2” above RELAXED shoulders
CP - MSP at T7
SID - 180cm
Respiration for all chest projections
unless otherwise requested suspend respiration after the second full inspiration - helps to relax the diaphragm and allow for a fuller inspiration
straining of deep inspiration can cause elongation of the heart
PA Chest Criteria
No rotation
apices, costophrenic angles, lateral margins of the ribs within collimated area
spine in middle of IR
scapula out of lung field
10 posterior ribs on the patients left side
heart adequately penetrated - see shadow of spine through heart
vascular markings seen at lateral margins of lungs
How do we evaluate rotation of a PA Chest?
check that SC joints are equidistant
equidistance from vertebrae to lateral border of ribs on each side
trachea visible in the midline (except pathology)
PA chest expiration
no change in positioning
demonstrates:
free air that could be obscured on inspiration
- small pneumothorax
location of foreign body
- air in obstructed lung stays inflated during expiration
movement of the diaphragm
should see a minimum of one less rib
lateral chest
left lateral unless otherwise indicated to reduce magnification of heart - position slightly LAO
SID - 180cm
Erect with no leaning or rotation - weight equally distributed
Arms raised above head to avoid superimposition
CP - MSP 1” below T7
divergence of the CR will project the right costophrenic angle slightly lower than the left, hence why you center 1” lower than PA
lateral chest evaluation criteria
motion free
arms out of the way
lateral sternum
adequate penetration of lungs and heart
costophrenic angles
lung markings
hilum in center of IR
posterior ribs and spine superimposed
AP Supine Chest
supine - internally rotate arms - moves scapula off chest
MAX SID 100-152cm
CR 5 caudad to IR - perpendicular to sternum
CP - 3-4” inferior to jugular notch (C7 down)
Markers face up and arrow down
AP Semi-erect chest
internally rotate arms
IR - portrait/landscape
Maximize SID 150-180cm
CR 5 caudad to IR - perpendicular to sternum
CP - 3-4” inferior to jugular notch (C7 down)
Markers: face up - arrow sideways or semi erect marker
Lateral decubitus chest
AP or PA - patient on side
Rt side down - Rt. lateral decubitus - marker for left side
Lt side down - LT. lateral decubitus - marker for right side
leave patient in position 5 mins before exposure
AIR UP - FLUID DOWN
to demostrate left side pneumothorax what position
right lateral decubitus
to demonstrate fluid in left lower lobe (pleural effusion) what position would you use
left lateral decubitus
lateral decubitus positioning
patient lying on rt or lt side with arms above head
Posterior or anterior chest against IR or veritcal bucky
place the IR so it is 2” above shoulders (C7)
CR - horizontal
SID 180
CP - AP 3-4” below jugular notch, PA level of T7
expose on second full inspiration
lateral decubitus evaluation criteria
no rotation
visualize affected side in its entirety
patients arms not visible in the field of interest
apices to costophrenic angles
marker on raised side with up arrow
AP Lordotic Chest
sit or stand the patient 1 foot from upright bucky
lean backwards and rest shoulders against bucky
Top of IR - 3” above shoulders (include C7)
CR - perpendicular to center of IR midsternum
SID - 180
expose on second full inspiration
structures shown in AP Lordotic Chest
clavicles projected superior to apices
clavicles and ribs lying more horizontally
lungs are seen in their entirety
assess presence of interlobar effusions or apical lung lesions
AP Axial Chest
if patient cannot assume the upright lordotic position use CR angle to move clavicles of the apical portion
roll shoulders forward
CP - mid sternum
CR - 15-20 cephalad - ensure CR is centered to the IR
Expose on the second full inspiration
Lateral Soft Tissue Neck
SID 180
CR perpendicular
CP at level of C5 - light to the naison
Raise chin - look ahead - acanthiomeatal line AML is parallel to the floor
Include the nose and nasopharynx (entire nasal cavity)
Expose on slow deep inspiration
AP Soft Tissue Neck
SID min 100cm
CP 1” above jugular notch
AML perpendicular to Ir
Top of light field at level of symphysis menti
Expose on slow deep inspiration
KVP 75 to 80
So Soft Tissue Neck Evaluation Criteria
Larynx and trachea from C3-4 will be filled with air
Proximal area of larynx is not seen - superimposed by mandible
Soft tissue window technique
Abdomen imaging indications
Trauma - organ rupture
Severe pain of unknown
etiology
Bowel obstruction, perforation, ischemia and ileus
Intussusceotion
Infection - abscess - pancreatitis
Ectopic pregnancy
Malignancy
Renal colic
Foreign body localization
Patient preparation for abdomen imaging
All clothing an opaque objects removed from chest to pelvis
Hospital gown
Pillow for head, clean linen on table
Cover patient for warmth and modesty
Routine Views of the abdomen
AP/PA supine, AP/PA Erect, Decubitus Lateral
- left lateral decubitus
Acute abdomen series 3 views or 2 views if you
omit chest
-AP supine abdomen
- AP erect abdomen or lld
- PA erect chest
AP Supine/Flat Plate KUB abdomen
Supine, legs extended
Support under knees
CR - perpendicular
CP - midline at level of iliac crests
Include superior symphysis pubis
Suspended in expiration - let the visceral rest
AP for digestive system
KUB - collinate side to side to ASIS - urinary system
PA Abdomen
Prone
CP midline at iliac crests
Collimate to include entire abdomen or KUB if indicated
What is KUB?
AP - include lateral margins of abdomen for non urinary indications
KUB - Kidneys-Ureters-Bladder
Kidney and papas shadow evident
Upper poles of the kidneys must be shown
Include symphysis pubis
Evaluation criteria for Supine Abdomen
Proper alignment
- centred vertebral column
- ribs pelvis and hips equidistant to edge of IR
No rotation
- Spinous processes in the center of the vertebral column
- ischial spines symmetrical
- ala of ilia symmetric
Exposure technique 80 kvp
Erect abdomen imaging
PA or AP
- PA when kidneys are not primary interest
Pt. Standing or sitting - erect 5 mins before
SID 100, CR perpendicular
CP 2” Superior iliac crests to include diaphragm for series, or at crests if bladder to be included
Expose on suspended expiration
Erect abdomen purpose
shows air/fluid levels
Diaphragm must be present
Pt. May require support
Exposure technique - 80 kVp
Erect abdomen evaluation Criteria
Lateral abdominal wall margins
Psoas Muscles
Kidney shadow
Inferior ribs
Transverse processes if lumbar vertebrae
Diaphragm without motion
Rt. Or Lt. Marker visible near edge of image
Upright abdomen identified with marker
AP Upper Diaphragm
CP - MSO at level of xiphoid
AP Bladder
Supine or erect
CP - 2” superior to symphysis pubis - greater trochanter
CP - MSP
CR - Perpendicular
May use 10-15 degree caudad angle for urinary studies to project pubis symphysis below bladder
LLD Abdominal AP or PA
On side for 5 mins prior to exposure
Flex knees for stability
CR perpendicular to midline
CP 2” superior to the iliac crests
Suspend on expiration
LLD abdomen evaluation criteria
Diaphragm without motion
Bothe lateral margins of the abdomen
No rotation
RT. marker and decubitus marker or row up
When do we do an acute abdomen series
Patient in acute distress
Presents with severe abdominal pain of known or suspected cause or unknown etiology
Usually quite unwell and potentially unstable
