Final Review part 1: Thoracic viscera and Bony Thorax Flashcards
Determines the shape, position, and movement of the internal organs
Body Habitus
sthenic
average
hypersthenic
larger build
asthenic
very slender
hyposthenic
slender
separates the thoracic cavity from abdominal cavity
diaphragm
separates pleural cavities
-contains all thoracic structures except lungs and pleurae
mediastinum
Contains the lungs and heart; the organs of the respiratory, cardiovascular, and lymphatic, systems; the inferior portion of the esophagus; and the thymus gland
Thoracic Cavity
Three separate chambers of thoracic cavity
-pericardial
-right and left pleural cavities
lies in midline, anterior to esophagus
Trachea
Respiratory system consists of:
-pharynx
-trachea
-bronchi
-two lungs
Fibrous, muscular tube with 16 to 20 C-shaped cartilaginous rings in its walls for strength
Trachea
hooklike process on the last cartilage
Carina
Trachea divides or bifurcates at carina
-Right primary bronchus
-Left Primary Bronchus
Which bronchi is shorter, wider, and more vertical than the other
The right primary bronchus
Position and size makes it easier for foreign bodies to enter which bronchus
right bronchus
What is at the end of the alveolar ducts
Alveolar sacs
where does oxygen and carbon dioxide exchange happen
alveolar sacs
difference in body habitus for chest xray
Hypersthenic (heavier) diaphragm becomes broader (flattens), heart shape broader
Trachea is more anterior or posterior to the esophagus
Anterior
what does the medistinum consist of
Trachea, esophagus, greater vessels, Heart, Thymus, Nerves, Lymphatics, Fat
What does the pleura cavity allow
Expansion of the lungs
what is each lung enclosed by
a double walled membrane sac called the pleura
inner layer - visceral pleura
outer layer- parietal pleura
How many lobes are on each side of the lungs
Two lobes on the left and three lobes on the right
medial border of the lungs
hilum
sides of the lungs
costophrenic angles
superior portion of the lungs and reaches about the clavicles
apex
organs of respiration
lungs
inferior of the lungs and rests obliquely on diaphragm and lower in back and sides than in front
base
why is the right lung shorter than the left
because of the presence of the liver
how do the lungs move during exhalation and inhalation
-move inferiorly during inspiration
-move superiorly during expiration
SID
source to image distance
OID
Object to image distance
why would we take one xray on inspiration and one on expiration
-demonstrates pneumothorax
-diaphragm movement
-presence of foreign body
-atelectasis
what is the distance for PA chest
72 inches
What is the central ray for PA chest
0 degrees/ perpendicular to IR
For a PA chest how many inches above should the top of the cassette be to the shoulders
1 1/2 to 2 inches
for PA chest what level do you need to be at ?
The level of T7
breathing technique for PA chest
two breaths in, exposure taken on second inspiration
Patient position for PA chest
shoulders rolled forward to get scapula out of the lung field, chin up
Why is a PA chest projection done?
Because the heart is closer to the IR (sits more anterior than posterior) to decrease magnification
What should be included in a chest xray to make it a good xray?
10 posterior ribs
Apices (top of lungs)
Costophrenic angles (bottom of ribs)
Heart shadow
Trachea
Carina
Right Bronchioles (shorter, wider, more vertical, easier for foreign body objects to get stuck)
Left Bronchioles
No rotation (SC joints equal, Ribs look equal)
What is the distance for supine chest
72 inches
why do we do PA chest upright
To demonstrate air or fluid levels and allow diaphragm to move to its lowest position
Where are we centering for PA and AP chest
T7 or 1 1/2 inches above the shoulder
What is the CR for supine chest
0 degrees/perpendicular to IR
distance for lateral chest
72 inches
CR for lateral chest
0 degrees/ perpendicular
If a lateral chest is being done what side do we do
left lateral
what are we centering at for lateral chest
T7, 1 1/2 inches above the shoulders
breathing technique for lateral chest
2 breaths, exposure taken on second deep inspiration
breathing technique for supine chest
2 breaths, exposure taken on second deep inspiration
arm position for lateral chest
arms should be more than 90 degrees above
What should we be able to see on the lateral chest
Apices, costophrenic angles, posterior ribs superimposed, hilum
which body structure forms the anterior border of the medistinum
sternum
what is the area of primary interest in a lordadic position
To see the apices without the clavicles obscuring them
why should chest images be performed after the pt has suspended respiration after the second inspiration
to expand the lungs better
what does decubitus demonstrate
air or fluid levels
another name for Limbolm method
lordotic or AP axial
How to position patient for lordotic
One step forward, and lean back
If a patient cant lean back for the lordotic what will you do
angle 15-20 degrees
What is the CR for lordotic
0 degrees/ perpendicular as long as patient can lean back
Breathing technique for lordotic
2 breaths in
when doing lordotic, is it better do do inspiration or expiration if their is a possible pneumo
expiration
what should you be able to see on the later chest
Apices, costophrenic angles, posterior ribs superimposed, hilum, manubrium
What is the distance for oblique chest
72
what are we entering at for oblique chest
T7
CR for PA oblique chest
-perpendicular to IR
-enters at level of T7
breathing technique for PA oblique chest
two breaths in
exposure made after second full inspiration
How many degrees for an PA oblique chest
45 degrees LAO or RAO
which side is being demonstrated in a LAO or RAO on chest
side up (elongated)
which lung does RAO demonstrate
left lung
which lung does LAO demonstrate
Right Lung
what is the degree of obliquity for barium cardiac series
55 to 60 degrees oblique
How long should the patient wait in a decub position
5 minutes
Breathing technique for AP oblique chest
two breaths. exposure made on second full inspiration
degree for ap oblique chest
45 degrees LPO or RPO
CR for AP oblique chest
-perp to ir
-enters 3 inches below jugular notch
for Ap oblique chest, what side id being best demonstrated
side of interest is closer to IR
Distance for decub chest
72 inches
if laying down where does the air and fluid go
fluid goes down
air goes up
where are we centering for decub chest
AP:3 inches below jugular notch
PA:T7
RAO =
LPO
LAO=
RPO
decubitus is mainly to see:
pleurasie (fluid that goes around the pleura)
How is the sternum in a lateral chest
in profile
CR for lordotic
-perp to IR
-enters MSP at midsternum
how is the ir placed for the lordotic position
3 inches above the shoulders
CR for AP/PA lateral decubitus position
-horizontal and perp to center of IR
-enters MSP at 3 inches below jugular notch for AP, T7 for PA
3 parts of the sternum
manubrium
body
xiphoid
Bony Thorax is formed by
sternum
12 pairs of ribs
12 thoracid vertebrae
functions of bony thorax
protects heart and lungs
position for upper ribs
standing
position for lower ribs
laying down
breathing technique for upper ribs
inspiration, to lower diaphragm
distance for rib
4o inches
CR for ribs
0 degrees/ perpendicular
true ribs
1-7 attach directly to sternum
false ribs
8-12, attach indirectly to the sternum via costal cartilage
floating ribs
11-12, attach only to vertebra
anterior portions of the ribs compared to the posterior
anterior portion compared to posterior lies 3 to 5 inferior to posterior
head of the ribs articulate with vertebral bodies
costovetebral joints
Tubericles articulate with Tspine transverse processes
costotransverse
-centered on midline of anterior thorax
-narrow, flat bone
-approx. six inches long
sternum
space inbetween ribs
intercostal space
typical rib conists of
head, neck, tubercle, body
distance for sternum PA oblique RAO
30-40 inches
essential for sternum
PA oblique RAO
rotation for sternum PA oblique RAO
15-20 degree to take sternum off of ribs
breathing technique for PA oblique sternum
shallow, blur the ribs and lung markings
what are we centering for sternum
mid sternum
the thicker the person the less we rotate, the thinner the (blank) we rotate
more
centeral ray for PA. oblique rao
0 degrees/ perpendicular
top of the manubrium is the most (blank) portion of the sternum
superior
why do we do an rao of sternum
To put sternum over the heart
distance for lateral sternum
72
How do i visualize axillary portion of the ribs
oblique 45 degrees
breathing technique for lateral sternum
inspiration
what do we do with the arms in lateral sternum
roll shoulders back, hands back locked in together, chin up , chest out , head up, inspiration
where should the top border of the IR be positioned for the lateral projection of the sternum
1 1/2 inches above the jugular notch
with which part of the sternum does the first pair of ribs articulate
lateral border of manubrium
which of the following articulates with the articular facets located just lateral to the jugular notch
clavicle
how should the central ray be directed for the oblique position to best demonstrate the sternum
perpendicularly
with reference to the patient where should the top border of the IR be positioned for the lateral projection of the sternum
1 1/2 inches above jugular notch
how should the central ray be directed and centered for the pa prjection for bilateral SC joints
perp to T3
breathing technique for SC joints
expiration (taking air out of the lungs for denser background)
how much do ou oblique for bilateral SC joints
10 degrees
-distal; smallest portion
- lies over T10
-often deviates from midline
xiphoid process
Breathing technique for lateral sternum
inspiration
Central ray for lateral sternum
-perpendicular
- enters lateral border of sternum at mid sternum
