Exam 2 (part 4)

Question 1

PA chest

Answer 1

SID - 72
KVP range - 100-125
CR at MCP parallel, MSP perpendicular, at T7
2 full inspirations

Question 2

Lateral chest

Answer 2

only difference is center at MSP parallel, MCP perpendicular

Question 3

Describe the positioning for an AP chest x-ray in detail. Give central ray location, SID and average kVP range with a grid.

Answer 3

SID: 72
Center at MSP perpendicular
IR 1.5 to 2" above relaxed shoulders
Adjust shoulders to lie in same transverse plane
Flex patients elbows and pronate hands
Place hands on hip to draw the scapulae laterally
2 full inspirations
CR 3" below jugular notch
KVP: 100-125 with grid

Question 4

Describe the positioning for a decubitus chest x-ray in detail. Give central ray location, SID and average kVP range with a grid.

Answer 4

Air: lay on unaffected side
Fluid: lay on affected side
SID: 72"
KVP: 100-125
Elevate body
True lateral
Arms above head 
IR 1.5 - 2" inches above shoulders
2 full inspirations

Question 5

Describe how you would evaluate your final images for quality and accurate positioning. How would you identify rotation? Tilt? Adequate inspiration?

Answer 5

AP+PA Chest: Equal SC Joints, equidistance spine to lateral border of ribs, marker
Lateral chest: Posterior ribs superimposed, no arms in lung field
Decubitus: equal SC joints, arms out of lung field

Question 6

Why is it always best to take a chest radiograph after the 2nd full inspiration?

Answer 6

Ensures maximum expansion of lungs

Question 7

Why is it best to use a 72” SID for a routine chest x-ray?

Answer 7

Decreases magnification of the heart

Question 8

Why is a PA projection preferred over an AP projection of the chest?

Answer 8

Places heart closer to IR to reduce magnification

Question 9

Why is it best to always take a chest x-ray with the patient fully upright?

Answer 9

Prevent engorgement of pulmonary vessels, gravity helps keep diaphragm at lowest point, air/fluid levels

Question 10

If the patient cannot be fully upright for a chest x-ray what adjustment should be made to the x-ray tube?

Answer 10

Angle the tube caudad 5 degrees

Question 11

How can you identify the level of T7 when centering for a PA chest x-ray? (What anatomical landmark would you use?)

Answer 11

Inferior portion of scapulae

Question 12

How can you identify the level of T7 when centering for an AP chest x-ray? (What anatomical landmark would you use?)

Answer 12

3” below jugular notch, at nipple line

Question 13

When taking a chest x-ray on a young child what technical factor should be adjusted to lessen the chance of motion?

Answer 13

Short exposure time, 80-90 kvp, time it for full inspiration

Question 14

What kVp would be used for a routine abdomen, per Merrill’s? (No contrast media used)

Answer 14

80-85 kvp

Question 15

If the proper kVp range was used which abdominal structures should be well visualized?

Answer 15

Psoas muscle
Lower border of the liver
Kidneys
Ribs and transverse processes

Question 16

How would you determine rotation on a supine abdomen image?

Answer 16

Spinous processes – middle of vertebral column
Iliac wings - symmetrical
Obturator foramen - symmetrical

Question 17

What breathing instructions should be given for a routine abdomen?

Answer 17

2 inspirations, hold out on second

Question 18

Which projection of the abdomen would give the least gonadal radiation dose to the patient?

Answer 18

PA

Question 19

Describe positioning for a routine supine abdomen x-ray. What is the position, projection, CR location, SID, kVp, breathing instructions.

Answer 19

SID: 40”
Center at MSP perpendicular to midline of IR
Arms/hands out of area of interest
IR centered at level of illiac crest
ASIS & shoulders equidistance to the table
2 breaths, hold out on last

Question 20

How would you evaluate a supine abdomen radiograph for quality? What are you looking for? What anatomy must be included?

Answer 20

Kidneys
Psoas muscle
Lower border of the liver
Transverse process
No rotation:
Spinous processes – middle of vertebral column
Iliac wings - symmetrical
Obturator foramen - symmetrical
Marker

Question 21

Describe positioning for an upright abdomen x-ray, AP projection. What is the CR location, SID, kVp, breathing instructions. What anatomy must be included on an upright abdomen?

Answer 21

SID: 40"
center at MSP perpendicular, 2" above illiac crest to midline of IR
Weight equally distributed
Arms/hands out of area of interest
IR centered at 2” above level of Iliac Crest
ASIS & shoulders equidistant to the IR
Anatomy:
Kidneys
Psoas muscle
Lower border of the liver
Transverse process

KVP: 80-85

Question 22

Describe positioning for a lateral decubitus abdomen x-ray. What is the CR location, , projection , position, SID, kVp, breathing instructions.

Answer 22

KVP: 90-95 
SID: 40"
Center MCP to midline of IR
Arms/hands out of area of interest
IR centered at 2” above level of Iliac crest
Shoulders & ASIS equidistant to table
Flex knees for comfort
Wait 5 minutes for air/fluid to settle