Lecture 2: Chest Soft Tissue Neck Abdomen Flashcards
What preperation should be made to the patient prior to positioning for the chest?
- Everything off from the waist up (Hospital Gown)
- Remove long earrings, necklaces, body piercings, etc.
- Long hair (if thick, tie up)
- Move braids and pony tails off the chest
- Move oxygen tubing, IV lines, etc. off chest
Which projection of the chest should you clean the bucky?
PA chest
What vertebral level is the apecies located at?
C7
Reveiw merrils anatomy
DO IT JOSIE
Where is the top of the lung?
C7 prominence
Where is the bottom of the lung (posterior and anterior)
- Anterior portion just distal to xiphoid process
- Posterior portion 2.5-5cm (1-2”) distal to xiphoid process
Why is the patient imaged in the upright position for the chest?
- Gravity will help depress the diaphragm
- Assess air/fluid levels
- Prevent engorgement of pulmonary vessels
What is the most repeated proceedure?
Chest imaging
Where may we see a lot of tubing and wires?
The ICU
Should we remove nipple peircings?
Yes, when possible
Where does the patients chin go in a PA position?
Against the bucky tilted upwards, not in the chin holder
What side of the diaphram is higher?
The right is higher than the left due to the heart on the left side
True or false?
Portrait and landscape apply to cassettes.
True
What are some charecteristics of hypersthenic patients? What orientation should the IR be?
- Large patient (Usually male)
- Thorax broad, deep and short
-IR Landscape
What are some charecteristics of an asthenic patient? What orientation would the IR be?
- Tall, slender build
- Thorax is narrow & shallow
- Long lungs
-IR Portrait
Why is a chest done PA?
-Done PA to reduce the magnification of the heart
What is the respiration for all chest projections (unless otherwise indicated)
After the second full inspiration
Why do we image the chest after the second full inspiration?
Helps to relax the diaphragm and allow for a fuller inspiration
What should you see on a PA chest?
(7)
- No rotation
- Apices, costophrenic angles, lateral margins of the ribs in image
- Spine in middle of IR; centre @ T7
- Scapula is out of the lung field
- 10 posterior ribs visible on the patients** left side**
- Heart adequately penetrated (See shadow of spine through heart)
- Vascular markings seen at lateral margins of lungs
What tells us that our inspiration is adequate in a PA chest?
10 posterior ribs visible on the patients left side
How can we check that no rotation of a PA chest is present?
- Check SC joints are equidistant
- Equidistance from vertebrae to lateral border of ribs on each side
- Trachea visible in the midline (except with pathology)
What is one positioning error made in this image?
Shoulders are not rolled forward
Which way is the patient rotated in this image of the PA chest?
RAO
Where do mostly accidentally see the chin in PA images?
Mobile work
What are the positives and negatives of this image?
Positives:
-All 10 ribs imaged on L side
-Costophrenic angles imaged
Negatives:
-Scapula seen on the left and right side of the lung
-Clavicle on slight angle
-Very slight rotation LAO (not a repeat)
What is at the bottom left corner of the image?
Air in the fundus of the stomach-normal
What is the positioning for a PA expiration?
Same as PA insipration
What does PA expiration demonstrate?
- Free air that could be obscured on inspiration (small pneumothorax)
- Location of Foreign Body
- Movement of the diaphragm
- Should see a min of one less rib
How does an expiration view demonstrate the location of a foreign body?
Air in obstructed lung stays inflated during expiration
What type of respriation is occuring here?
Inspiration
What type of respiration is occuring here?
Expiration
What are the main differences between a PA chest inspiration vs. expiration?
-Difference of one rib on the expiration
-The heart shadow becomes wider (position of the cardiac silhouette) and pushed to the left on expiration due to the diaphragm
What is the pathology in this image?
Left lung has no markings due to pneumothorax
Why do we image as a left lateral?
- Reduces magnification of the heart
- Standard of practice
Which costophrenic angle is lower in a L lateral radiograph?
Right is lower than the left
How should the spine be oriented in relation to the IR on a left lateral chest?
Parellel to the IR
What should we see on a left lateral chest?
-Good Lateral Sternum
-Adequate penetration of lungs, heart
-Costophrenic angles-NEED TO SEE
-Lung markings
-Hilum in center of IR
-Posterior ribs and spine superimposed
What is one positioning error made in this image?
Rotated too much AND arms in the way
How do we ensure true superimposition of the ribs in a lateral chest?
Slight RAO
Which way do we need to rotate the patient?
Forward
What positioning errors are made in this image? Is this a reapeat?
- Shoulders not rolled forward – scapula on lung
- Shoulders are not relaxed, so clavicles are angled
- Clipped the bottom of Rt costophrenic angle
Yes, this is a repeat?
Name the position and the projection. What marker would we use?
Position: Right lateral decubitus
Projection: AP
Mark the left side
What happens to fluid in the erect position in the chest?
It falls due to gravity to the lowest position
What happens to fluid in the decubitus position of the chest?
Drops to the lowest point
If there is a pleural diffusion in the right lung, what position would we put the patient in for a lateral decub.
Left lateral decub.
REMEMBER: AIR UP, FLUID DOWN
What collimation error did the technologist make in this image? What pathology is present?
-Want to the costophrenic angles (we are clipping)
-Free air under the diaphragm (emerg.)
What position do we put a patient in with a left sided pneumothorax?
Right lateral decub. (AP or PA)
How would you demonstrate fluid in left lower lobe (pleural effusion)?
Left lateral decub. (AP or PA)
What should you see on a lateral chest decubitus?
- No rotation
- Visualize affected side in its entirety
- Patient’s arms not visible in the field of interest
- Apices to costophrenic angles
- Markers – usually on the raised side
Why do we do the AP lordotic position?
Trying to see apical regions better
What structures are shown in an AP lordotic position?
- Clavicles projected superior to apices
- Clavicles and ribs lying more horizontally
- Lungs are seen in their entirety
- Assess presence of inter-lobar effusions or apical lung lesions
How do you image an AP axial chest?
-Lying down
-Roll shoulders forward
-(2nd) full Inspiration
-CP mid sternum
-CR 15-20º cephalad to move clavicles off the apical portion
-Ensure the CR is centered to the IR
When would we do an AP axial chest?
If patient could not do AP lordotic position
What dose AML stand for?
Acanthomeatal line
Why do we image the upper airway?
To look at the trachea
What position is this?
Lateral lower airway
What kVp do you use for an AP upper airway?
kVp- 75-80
What should you see on an AP upper airway?
- Larynx and trachea from C3-4 will be filled with air
- Proximal area of larynx is not seen – superimposed by mandible
What collimation error is made in this image? What pathology is present?
-Should see tip of nose
-Small piece of wire in trachea
Give three examples of why we would image the abdomen:
- Ectopic Pregnancy
- Malignancy
- Renal Colic
What patient preperation should be made prior to positioning the patient?
- All clothing and opaque objects removed- from chest to pelvis (Hospital gown)
- Pillow for head, clean linen on table
- Cover patient for warmth and modesty
True or false?
For the lateral decubitus in the abdomen, we only image right lateral.
False- only Left Lateral decubitus
What 3 views are imaged in an Acute abdomen series?
- AP supine abdomen
- AP erect abdomen or Left lateral decubitus
- PA erect chest
What is KUB?
Kidneys, ureter, bladder (colliamated view of supine abdomen)
Why do we image the KUB PA?
-Helps with compression
-Decreased dose
What abdomen view is best to start with? Why?
The erect abdomen because patient has already been uprigh for 5 minutes
What kVp do you use for the abdomen?
80 kVp
What should you see on an erect abdomen?
- Lateral abdominal wall margins
- Psoas muscles
- Kidney shadow
- Inferior ribs
- Transverse processes of lumbar vertebrae
- Diaphragm without motion
What piece of anatomy did this tech miss in this image of the erect abdomen?
Diaphram
Is this image taken supine or erect? How do we know?
Upright; can see air fluid levels
Is this image take erect or supine? How do you know?
Supine; we do not see the air fluid levels
Why do we do the AP Upper Diaphragm projection?
If we clip the diaphram in the erect abdomen
What should we see in a Left Lateral Decubitus abdomen?
- Diaphragm without motion
- Both lateral margins of the abdomen
- No rotation
- RT marker indicating the side that is up and decubitus marker or arrow (up)
What is pneumoperitoneum?
Free air or gas in the peritoneal cavity– medical emergency
If only 2 images are to be done in an acute abdomen series, what two positions should you do?
- AP erect or left lateral decubitus (must include diaphragm)
- AP supine
What projection is this?
Erect abdomen
What projection is this? What antomy is missing?
Supine abdomen
-Missing symph
