Lecture 4-Chest

Question 1

What indicates a full inspiration on a PA chest?

Answer 1

10 posterior ribs on left side above diaphragm

Question 2

What should the collimation of a PA chest inlude?

Answer 2

Costophrenic angles to above the 1st rib

Question 3

What vertebral level should the sternum be located at in a PA chest? How can we check radiographically for this?

Answer 3

-Manubrium is superimposed on T4
-We can check this by counting the number of ribs, below T1 since the bottom of the clavicles line up with the manubrium

In practice, it should be at T2/T3

Question 4

How can you decrease time for an exposure?

Answer 4

Use large mA, and large focal spot

Question 5

What is the one slight error made in this PA chest? Would this be a repeat?

Answer 5

-Slightly lordotic looking patient
-Not a repeat

(good image)

Question 6

What errors have been made in this image of the PA chest?

Answer 6

-Kyphotic looking
-Scapula is not off ribs
-Clipping superior portion of ribs

Question 7

What error(s) have been made in this image of the PA chest?

Answer 7

-Trachea to the left of the spinous process-RAO
-Lordotic looking image
-Scapula is over ribs

Question 8

What error(s) have been made in this image of the PA chest?

Answer 8

-Not a full inspiration-only seeing 8 ribs
-LAO
-Scapula on ribs

Question 9

What errors have been made in this image of the PA chest?

Answer 9

-First rib clipped
-Slightly lordotic

Question 10

What error(s) have been made in this image of the PA chest?

Answer 10

-Lordotic looking
-LAO rotation
Did not get the scapula off ribs
Not a full inspiration

Question 11

What error(s) have been made in this image of the PA chest?

Answer 11

-Not a full inspiration (could mimic cariomegaly)
-RAO looking

Question 12

What error(s) have been made in this image? What projection is this?

Answer 12

-LPO looking
-Scapula not off ribs
-This is an AP supine chest image

Question 13

How does an ET tube appear if the patient is in a more kyphotic position? A more lordotic position?

Answer 13

Kyphotic image: ET tube appears too low
Lordotic image: ET tube too high in image

Question 14

What error(s) have been made in this image of the PA chest?

Answer 14

Shoulders not depressed

Question 15

What error(s) have been made in this image of the PA chest?

Answer 15

-RAO looking
-Slightly kyphotic

Question 16

What errors have been made in this image of the PA chest?

Answer 16

-Shoulders too high
-RAO looking

Question 17

What chambers are the pacemakers located in?

Answer 17

Pacemaker in R ventricle and R atrium

Question 18

What projection is this? What errors have been made in this image?

Answer 18

-Lordotic projection
-Clipping the top of the rib

Question 19

T/F

We cannot acess the CT ratio when the chest is AP

Answer 19

True

Question 20

What error is made in this image of the PA chest?

Answer 20

-Lordotic looking image
-Scapula on
-Not a full inspiration

Question 21

What error(s) have been made in this image of the PA chest?

Answer 21

None

Question 22

What error(s) have been made in this image of the PA chest?

Answer 22

-Slightly clipped first ribs
-Slightly lordotic looking

ET tube in the right mainstem bronchus

Question 23

What errors have been made in this image of the PA chest?

Answer 23

-Not full inspiration
-Lordotic looking

Question 24

What error(s) have been made in this image of the PA chest? Would this be a repeat?

Answer 24

-Scapula over ribs
-Clipped the first rib and the base of the lung

-Would we repeat for scapula on image; wouldn’t repeat for this image because they would probably have more x rays after surgery

-PTX; hard to see with the scapula over top

Question 25

What error(s) have been made in this image of the PA chest?

Answer 25

-Scapula is on the ribs -Shoulders elevated | (hiding a PTX)

Question 26

What errors have been made in this image of the PA chest?

Answer 26

-Slight RAO -Shoulders are shrugged up -Scapula on

Question 27

# T/F Right hemi-diaphragm is often higher on PA

Answer 27

True

Question 28

If right hemidiaphragm is lower than left in a left lateral, what does that mean?

Answer 28

Hips have been pushed against wall detector

Question 29

Where does the Left hemi-diaphragm appear to stop anteriorly?

Answer 29

Left hemi-diaphragm appears to stop at the posterior margin of the heart

Question 30

What one landmark we can use to tell where the left hemidiaphragm is?

Answer 30

Gas bubble is under left hemi-diaphragm

Question 31

What error(s) have been made in this image of the lateral chest?

Answer 31

None; minus the face down marker ## Footnote (radiologist flips the image, so marker was put on incorrectly to begin with)

Question 32

What error(s) have been made in this image of the lateral chest?

Answer 32

Arms out rather than up | (necklace is fine)

Question 33

What error(s) have been made in this image of the lateral chest?

Answer 33

-Arms not straight up

Question 34

What error(s) have been made in this image of the lateral chest?

Answer 34

-Arms not straight up -Patient in an LAO position

Question 35

What error(s) have been made in this image of the lateral chest?

Answer 35

-LPO position looking -Arms straight out

Question 36

What error has been made in this image of the lateral chest?

Answer 36

Not a full inspiration ## Footnote ensure that the breath is completely held before pressing on the roter

Question 37

What error has been made in this image of the lateral chest?

Answer 37

Patient rotated LAO and arms are straight out ## Footnote (you can look at the humeri)

Question 38

What error has been made in this image of the lateral chest?

Answer 38

-Arms are in the image -LPO (identify by the gas bubble) ## Footnote -Disc space is perfect, so for some reason the hemidiaphragms are not at the same level

Question 39

What error has been made in this image of the lateral chest?

Answer 39

Patient rotated LAO

Question 40

What error has been made in this image of the lateral chest?

Answer 40

Right hip rotated posterior ## Footnote Not LPO because the upper ribs are fine

Question 41

What error has been made in this image of the lateral chest?

Answer 41

Right hip too anterior ## Footnote Shoulders are in a lateral (but humeri are off) Don’t care as much about the top

Question 42

What error has been made in this image of the lateral chest?

Answer 42

Hips are tilted towards the bucky (lost the disc spaces)

Question 43

How do you position a patient with a recently placed pacemaker for a lateral chest?

Answer 43

Raise elbow 90 degrees and hold the biceps with the other hand ## Footnote CANNOT RAISE THE ELBOW ABOVE THE SHOULDER AFTER PACEMAKER PLACEMENT (pacemaker hasn’t been anchored to the body yet)