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Chapter 20 The Chest (Thorax) and Abdomen > Chest, Sternum, Ribs and Abdomen > Flashcards

Chest, Sternum, Ribs and Abdomen Flashcards

1
Q

Why are Upright done in a chest?

A
  1. Allows diaphragm to reach the lowest position
  2. Allows for demonstration of FREE air/fluid levels in pleural cavity
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2
Q

If Proper inspiration for chest what is visualize?

A

Demonstrate 10 posterior Ribs above diaphragm

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3
Q

S.I.D for chest? And why?

A

72”, minimizes magnification of the heart shadow/image

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4
Q

(Chest) High kVP 110-125, why?

A

Creates low radiographic contrast

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5
Q

(Chest) High mA, short time, why?

A

Minimizes heart motion and adequate density

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6
Q

Good penetration in a chest?

A

Faint visualization of thoracic spine through shadow of heart

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7
Q

Grid is used for?

A

Typically used to absorb scatter radiation

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8
Q

Proper IR placement and anatomical markers

A
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9
Q

Patient Prep for chest

A
  1. Everything off from waist up
  2. Gown open to the back
  3. Remove all artifacts
  4. Collimate the beam-reduce patient dose and improve quality of radiograph
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10
Q

Routine Chest Views

A
  1. Posteroanterior - Upright Anterior
  2. Left lateral projection- Upright left lateral
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11
Q

Landmarks for chest?

A
  1. T7- Inferior angle of scapula (PA)
  2. 7”-8” below C7 (Lateral)
  3. 4” inferior to the jugular notch (AP)
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12
Q

Size of Bucky, S.I.D for PA Chest

A

14x17- Vertical Bucky - 72” S.I.D

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13
Q

Position for PA chest?

A

Upright anterior position

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14
Q

Midpoint of IR centered to T7

A

Top cassette about 1.5-2” above shoulders if place lengthwise

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15
Q

Chest is

A

MSP centered to IR

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16
Q

Roll shoulders forward and depress

A

Draw scapula’s out laterally away from the lungs

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17
Q

Lift head slightly up why?

A

Move chin out of the way from chest

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18
Q

Central Ray for a PA chest?

A

Perpendicular to T7 at MSP

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19
Q

Respiration for PA chest?

A

Double inspiration, exposure at 2nd inspiration

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20
Q

Structures seen in a PA chest?

A

Heart, Lung, and mediastinum. No rotation of the sternoclavicular joints

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21
Q

Position of Lateral chest?

A

Upright left lateral position

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22
Q

Size of Bucky, S.I.D for lateral chest?

A

14x17- Vertical Bucky- 72” SID

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23
Q

Center thorax?

A

To middle of IR

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24
Q

Left lateral Chest

A

Is MSP parallel, MCP perpendicular

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25
Q

Extend chin up slightly

A

Move chin out of the way

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26
Q

Central Ray for left lateral chest?

A

Perpendicular to T7 at MCP

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27
Q

Respiration for left lateral chest

A

Double inspiration, exposure at 2nd inspiration

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28
Q

Structures seen in left lateral chest?

A

Superimposition of the posterior ribs, indicating no rotation

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29
Q

Hilum (Root)

A

Is a depressed surface at the center of the medial surface of the lung. It is the point at which various structures enter and exit the long

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30
Q

Size & S.I.D Lateral Decubitus Position

A

14x17 - Grid - 72” SID

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31
Q

Recumbent position, lying on side of interest

A

RLD or LLD position

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32
Q

(lateral decubitus position) no rotation raise patient approx. 2-3 inches with decub sponge

A

Patient on side, arms above head, flex knees and superimpose (help with rotation)

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33
Q

Lateral decubitus IR?

A

Approx. 2” beyond shoulders, cassette or IR lengthwise only

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34
Q

Central ray for Lateral decubitus?

A

horizontal and perpendicular to T7 at MSP

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35
Q

Lateral decubitus respiration

A

Exposure after 2nd inspiration, extend chin up slightly

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36
Q

What is visualized in a lateral decubitus?

A

Any FREE fluid present in the pleural space will be demonstrated on the dependent chest wall

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37
Q

Size & S.I.D Lordotic position?

A

14x17 - Grid- 72” SID

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38
Q

Lordotic standing position?

A

Upright posterior, approx. 8”-12” away from the vertical Bucky (lean back)

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39
Q

Positioning a lordotic

A

Center patient in middle of IR to midsternum

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40
Q

Central Ray for lordotic

A

Perpendicular to MSP at midsternum, or Tube angled 15-30 degrees cephalon with the patient upright

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41
Q

Respiration for lordotic

A

Exposure after 2nd inspiration

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42
Q

What is visualize in a lordotic X-ray?

A

Apices of both lungs, free of superimposition by the clavicles

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43
Q

Situs Inversus

A

All internal organs are on the opposite side, note heart and air in stomach on patient’s Right side

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44
Q

Size & SID AP RIB UPPER

A

14x17 - Bucky- 40” SID
Upright or Recumbent position

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45
Q

(AP Rib Upper) Coronal plane is parallel to IR

A

Upper margin of IR is 1.5-2” above level of spinous process of C-7

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46
Q

Central Ray for AP Rib Upper?

A

C.R. Perpendicular IR. Center of midclavicular line at approx. level of axillary fold

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47
Q

What is visualizable in a AP upper rib?

A

Ribs 1-10 visualized. Posterior ribs best visualized

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48
Q

Size & SID AP Oblique Upper Rib

A

14x17 - Bucky - 40”SID
RPO or LPO Position

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49
Q

(AP Oblique Upper Rib) Conronal plane is 45 degrees to IR

A

Upper margin of IR is 1.5-2” above level of spinous process of C7

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50
Q

Central ray AP oblique upper rib?

A

C.R. Perpendicular IR. Center of midline of anterior surface at approx. Level of axillary fold

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51
Q

AP oblique upper rib respiration?

A

Exposure after inspiration- no motion (upper)

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52
Q

What is visualized in the AP oblique upper rib?

A

Ribs 1-10 visualized. Axillary portions are best seen.
RPO- Right axillary ribs
LPO- Left axillary ribs

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53
Q

Size & SID PA upper Rib

A

14x17 - Bucky - 40”SID
Prone or Upright Anterior Position

54
Q

(PA upper Rib) Coronal plane is parallel to IR

A

Upper margin of IR is 1.5-2” above level of spinous process of C7

55
Q

Central ray for PA upper Rib?

A

C.R perpendicular IR. Center of midclavicular line at approx. level of axillary fold

56
Q

Respiration for PA upper Ribs?

A

Exposure after inspiration- no motion (upper)

57
Q

What is visualized in PA upper Rib?

A

Ribs 1-10 visualized. Anterior ribs best visualized

58
Q

Size & SID PA Oblique upper Rib

A

14x17 - Bucky - 40” SID
RAO or LAO position

59
Q

(PA oblique upper rib) Coronal plane is 45 degrees to IR

A

Upper margin of IR is 1.5-2” above level of spinous process of C7

60
Q

Central Ray for PA oblique upper Rib?

A

C.R. Perpendicular IR. Center of midline of posterior surface midway between spine and midaxillary line of affected side of approx. level of axillary fold

61
Q

Respiration of PA oblique upper rib?

A

Exposure after inspiration- no motion (upper)

62
Q

What is visualized in PA oblique upper rib?

A

Ribs 1-10 visualized. Axillary portions are best seen.
LAO- Right axillary rib
RAO-Left axillary rib

63
Q

Size & SID AP Lower Posterior Ribs

A

14x17- Bucky - 40”SID

64
Q

(AP lower ribs) coronal plane is parallel to IR

A

Lower margin of IR is at level of iliac crest

65
Q

Central Ray AP lower ribs?

A

C.R. Perpendicular IR. Center of midclavicular line at approx. level of tip of xiphoid process

66
Q

Respiration for AP lower Ribs?

A

Expiration-no motion

67
Q

AP lower ribs best visualized?

A

Ribs 8-12, posterior ribs are best visualized

68
Q

Size & SID AP Oblique lower ribs?

A

14x17 - Bucky - 40” SID
RPO or LPO

69
Q

(AP Oblique lower ribs) Coronal plane is 45 degrees to IR

A

Lower margin ofIR is at level of iliac crest

70
Q

Central ray AP Oblique lower ribs

A

C.R. Perpendicular IR. Center of midline of anterior surface at approx. level of xiphoid process

71
Q

Respiration AP Oblique lower ribs

A

Expiration- no motion

72
Q

What is best visualized in AP Oblique lower ribs?

A

Ribs 8-12 visualized. Axillary portions are best been
RPO- right axillary Ribs
LPO- left axillary Ribs

73
Q

AP abdomen a.k.a

A

KUB (kidney, Ureters, Bladder)

74
Q

what do ways can a KUB be performed?

A

Upright and Supine

75
Q

Upright/decubitus abdomen

A

Demonstrate air-fluid levels in intestines and to visualize free intraperitoneal air, if present.

76
Q

Why do we have to wait several minutes to perform an upright KUB

A

Demonstrate true results

76
Q

Why do we have to wait several minutes to perform an upright KUB

A

Demonstrate true results

77
Q

Why do we have to wait several minutes to perform an lateral abdomen?

A

Demonstrate abdominal aorta and foreign bodies in GI tract

78
Q

KUB shield

A

May shield male patient with gonad shield if requested
Shield both genders with upright exam of abdomen if requested

79
Q

Prep for Abdomen

A

Remove everything except underpants, shoes and socks
Gown open to the back, you may need two if Hypersthenic body habitus

80
Q

Technical prep for Abdomen

A
  1. KVP- Sthenic 70-80kVp, long scale of contrast
  2. mAs- short enough exposure time to decrease motion(s)
  3. Sufficient density (mA) or brightness
81
Q

Involuntary motion (peristalasis) (abd)

A

Patient can not control, Appear as a localized haze in bowels

82
Q

Voluntary motion (Abd)

A

Patient CAN control
PREVENT BY:
1. Prep of breathing instructions
2. Patient comfort
3. Pause after expiration before exposure

83
Q

Quietly of x-ray, or what we need to see an a x-ray abdomen

A
  1. Psoas muscle
  2. Lower border of liver
  3. Kidney shadows Right and left
  4. Transverse process of lumbar spine
84
Q

Abdomen x-ray ways?

A
  1. Three way- abdomen acute series KUB(supine), upright abdomen, and PA CXR
  2. Two way- Abdomen 2 view KUB (supine) and upright
85
Q

Size & SID for AP abdomen

A

14x17, LW 40” SID
Position: Supine

86
Q

(AP abd) MSP perpendicular to table and centered to IR

A

IR centered at height of iliac crest

87
Q

Central Ray AP ABD

A

C.R: iliac crest down MSP

88
Q

Respiration for AP ABD

A

Expiration

89
Q

Pubic Symphysis

A

Must be at the bottom of the IR.

90
Q

If pubic symphysis missing?

A

Perform “bladder shot” collimate 10x12 CW.
CR: perpendicular 2” above symphysis, down MSP

Rotation determined by spinous process are center equally

91
Q

Size & SID AP Upright ABD

A

14x17, LW 40” SID
Position Upright posterior

92
Q

IR for upright abd

A

MSP perpendicular to wall Bucky

93
Q

Central ray upright abd?

A

C.R. Perpendicular 2” above iliac crest, down MSP

94
Q

Respiration for upright abd

A

Expiration

95
Q

Image: distention of bowel, free air on right side and air fluid line

A

remember to perform first. This allows a true reflection of air-fluids levels if any present

96
Q

Diaphragm must be present?

A

On top of image for a upright

97
Q

Left lateral decubitus abd

A

Performed when patient cannot stand for upright

98
Q

Left later decubitus abd

A

Always perform left side down= LLD

99
Q

Why it needs to be left lateral decubitus abd, and not right

A

Any amount of free air could be better seen outlined against the lower margin of the liver than it could against any organ on the left side (stomach)

100
Q

Size & SID left lateral decubitus abd

A

14x17, 40” SID, Grid or VB

101
Q

IR LW to patient (LLD abd)

A

CW in IR

102
Q

Position: LLD

A

Patient elevated on sponge

103
Q

Central Ray left lateral decubitus abd

A

C.R perpendicular and horizontal 2” above iliac crest, down MSP

104
Q

LLD abd IR

A

MSP perpendicular to IR and horizontal

105
Q

Respiration for LLD abd

A

Expiration

106
Q

Decubitus and/ or Upright abd

A

*horizontal x-ray beam is necessary to demonstrate air fluid levels

107
Q

Sternum
Size & SID position

A

10x12, LW 40” SID for RAO
10x12, LW 72” SID for Lateral

108
Q

Typical position for sternum

A

Upright RAO and Lateral

109
Q

What kind of kVp for sternum?

A

Low kVp

110
Q

Respiration for Sternum

A

Inspiration

111
Q

Oblique for sternum, degree?

A

15-20 degrees

112
Q

Bony thorax most common reason for x-ray?

A

Trauma

113
Q

Nontraumatic (bony thorax)

A

Usually malignant bone disease
Multiple myeloma/ metastatic bone lesions

114
Q

Atelectasis

A

Lung collapse

115
Q

Pneumothorax

A

Air in pleural cavity
Always shows atelectasis

116
Q

Pneumonia

A

Inflammation of the lungs by bacteria or viral infection

117
Q

Emphysema

A

Chronic lung condition (COPD-Barrel-chested)..obstruction and destruction of the small airways and alveoli of the lungs (causes over inflation)

118
Q

Tuberculosis (TB)

A

Infections lungs disease. Primary screening test for TB done with skin test.

119
Q

Pneumoconiosis

A

Group of chronic occupational lung disease caused by inhalation of irritating dust (asbestos)

120
Q

Congestive heart failure

A

Advanced cardiac insufficiency with pulmonary edema

121
Q

Pleural effusion

A

Collection of fluid in the pleural space

122
Q

Returned hollow viscus

A

Opening between the gastrointestinal tract and the peritoneal cavity

123
Q

Peritonitis

A

Inflammation in the peritoneal cavity

124
Q

Ascites

A

Accumulation of fluid in the peritoneal cavity

125
Q

Other chest images

A
  1. Decubitus position
  2. Oblique position
  3. Lordotic position
  4. Right lateral
  5. Supine position
  6. Images with nipple markers
126
Q

(Ribs) best visualized

A

Ribs closest to the IR

127
Q

Respiration Upper ribs

A

Inspiration (diaphragm low)

128
Q

Respiration lower ribs

A

Expiration (diaphragm high)

129
Q

Oblique posterior positions

A

Same side oblique…clinical side of interest closest to the IR
RPO-right
LPO-Left

130
Q

Oblique anterior positions (ribs)

A

Clinical side of interest FARTHER away from IR
RAO-Left
LAO-right

Chapter 20 The Chest (Thorax) and Abdomen (1 decks)

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