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Radiographic Procedures 2 > Chest, Soft Tissue Neck and Abdomen > Flashcards

Chest, Soft Tissue Neck and Abdomen Flashcards

1
Q

Chest imaging repeats

A

chest X-ray are the most frequently ordered diagnostic imaging procedure, yet most repeated due to technologist errors

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2
Q

patient preparation - chest

A

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

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3
Q

topographical landmarks

A

C7 - Level of apices - vertebra prominens
T7 - inferior angle of the scapula - mid thorax - center
T10 - xiphoid tip

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4
Q

top/bottom landmark

A

Top of lung - include C7 prominence in light field
Bottom of lung - anterior portion just distal xiphoid, posterior 2” distal to xiphoid

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5
Q

PA Chest

A

patient images erect
- gravity help depress diaphragm
- assess air/fluid levels
- prevent engorgement of pulmonary vessels

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6
Q

Chest collimation guidelines

A

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

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7
Q

hypersthenic chest

A

large patient - usually male
thorax broad, deep and short
landscape orientation

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8
Q

Asthenic chest

A

tall slender build
thorax is narrow and shallow
portrait orientation

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9
Q

PA Chest position relative to bucky

A

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

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10
Q

Respiration for all chest projections

A

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

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11
Q

PA Chest Criteria

A

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

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12
Q

How do we evaluate rotation of a PA Chest?

A

check that SC joints are equidistant
equidistance from vertebrae to lateral border of ribs on each side
trachea visible in the midline (except pathology)

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13
Q

PA chest expiration

A

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

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14
Q

lateral chest

A

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

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15
Q

lateral chest evaluation criteria

A

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

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16
Q

AP Supine Chest

A

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

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17
Q

AP Semi-erect chest

A

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

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18
Q

Lateral decubitus chest

A

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

19
Q

to demostrate left side pneumothorax what position

A

right lateral decubitus

20
Q

to demonstrate fluid in left lower lobe (pleural effusion) what position would you use

A

left lateral decubitus

21
Q

lateral decubitus positioning

A

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

22
Q

lateral decubitus evaluation criteria

A

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

23
Q

AP Lordotic Chest

A

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

24
Q

structures shown in AP Lordotic Chest

A

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

25
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
26
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
27
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
28
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
29
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
30
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
31
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
32
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
33
PA Abdomen
Prone CP midline at iliac crests Collimate to include entire abdomen or KUB if indicated
34
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
35
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
36
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
37
Erect abdomen purpose
shows air/fluid levels Diaphragm must be present Pt. May require support Exposure technique - 80 kVp
38
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
39
AP Upper Diaphragm
CP - MSO at level of xiphoid
40
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
41
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
42
LLD abdomen evaluation criteria
Diaphragm without motion Bothe lateral margins of the abdomen No rotation RT. marker and decubitus marker or row up
43
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

Radiographic Procedures 2 (15 decks)

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