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MIdterm2 Notes Flashcards

1
Q

PA chest specifics

A 
High kVp 100+
Full inspiration
72+ FFD
frontal view PA
Grid or non-grid (film or CR) - DR=grid
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2
Q

Thoracic spine specifics

A 
70-80 kVp
Suspend breathing
40inch FFD
Frontal view AP
Grid
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3
Q

Most common x-ray in humans

A

Chest x-ray

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4
Q

Most 911 emergencies in your office are on conditions involving

A

Chest anatomy

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5
Q

Controls density

A

KVp

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6
Q

15% increase in kVp

A

Doubles the density

Cut mAs by 1/2

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7
Q

Going from 80-90 kVp is about a

A

15% increase

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8
Q

Higher ___ = more grays = longer scale of contrast

A

KVp

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9
Q

C-spine kVp

A

70-80 kVp

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10
Q

T-spine kVp

A

70-80 kvp

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11
Q

L-spine kvp

A

80 kvp

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12
Q

Lat lumbar kvp

A

85/90 kvp

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13
Q

We determine if the patient is at full inspiration by

A

Rib count - right hemi-thorax usually can see 10 posterior ribs above the diaphragm

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14
Q

Heart size is always evaluated on

A

Full inspiration chest film

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15
Q

Expiration film is used for

A

Lung increases in density because less air volume

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16
Q

Radiolucency of lung is the ratio of

A

Air to soft tissue in the lung

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17
Q

Know if diaphragm is being pushed up or paralyzed

A

Inspiration expiration film

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18
Q

If pushed up from below, the diaphragm will

A

Still move with breathing

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19
Q

If phrenic nerve is damaged

A

Paradoxal motion of the diaphragm with paralysis

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20
Q 
Inhale = diaphragm goes
Exhale. = diaphragm goes
A

Up

Down

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21
Q

Pneumothorax is difficult to see because it is both air density. Easier to see on inspiration or expiration

A

Expiration since the lung increases in density on expiration film which provides more contrast to the air in the pleural space

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22
Q

Air-trapping is the opposite of ___ in mechanics

A

Atelectasis

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23
Q

When we inhale, bronchi

A

Dilate

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24
Q

When we exhale, bronchi

A

Passively return to neutral

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25
Q

If obstructed on both inspiration and expiration air is absorbed distal to the obstruction

A

Atelectasis

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26
Q

If obstructed on expiration

A

Air-trapping

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27
Q

Lung expands and becomes more radiolucent

Increase air volume compared to soft tissue

A

Air-trapping

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28
Q

FFD inverse square log

A

From 40 inches (80 kvp and 50 mAs) to 72 inches - need 200 mAs

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29
Q

The shorter the FFD, the more of the ___ is used

A

Cone of the beam

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30
Q

As we back up the FFD, we use more of the __ of the beam

A

Center

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31
Q

Gives us the shortest OFD to the heart

A

PA position

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32
Q

Greater than 10 cm and kVp greater than 60

A

Grid rule

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33
Q

Grid is used

A

To reduce scatter

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34
Q

If using a grid (12:1 is best for us - absorbs at least 70% of the beam) must increase mAs by

A

4x

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35
Q

If patient is less than ___ we don’t need a grid for chest x-ray

A

26cm

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36
Q

Lateral cervical air gap acts as a grid therefore

A

We don’t need it

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37
Q

72 inch lateral cervical is same technique as a

A

40 inch with grid

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38
Q

Film identification

A 
Facility name and address
Patient name and age (DOB)
Patient gneder
Film date
Film number is optional
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39
Q

Left lateral. Chest film time

A

The time you use on PA go up two time stations for the lateral

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40
Q

Chest obliques are done as

A

Anterior obliques

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41
Q

Gold standard for chest imaging is

A

CT

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42
Q

RAO observes

A

Left lung

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43
Q

Time station for oblique

A

1 time station up from PA

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44
Q

Patient postition

A

Visualize anatomy
Center anatomy on the cassette
Put CR to center of cassette

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45
Q

Way to clarify a lesion
Heels 18 inches out, lean back
Rotates bone aroudn apex of lung
Collimate

A

Apical lordotic

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46
Q

Recumbant AP view for non-ambulatory patients

A

40 inch

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47
Q

Frontal view with patient in a lateral decubitus

A

Beam parallel to floor
Cassette perpendicular to the floor and beam
Done to observe pleural fluid or pleural air (pneumothorax)

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48
Q

Done to observe pleural fluid or pleural air

A

Decubitus series

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49
Q

If suspect left pleural effusion

A

Do left decubitis view

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50
Q

The lung on the side down is

A

Dpeendent in a decubitus view

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51
Q

Fluroscopy is useless for

A

Chest

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52
Q

Vascular contrast evaluation of pulmonary vessels

A

Pulmonary angiography

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53
Q

Gold standard for heart imaging

A

US

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54
Q

Ventilation and perfusion scans - tells you where air is going and where blood is going

A

Nuclear medicine

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55
Q

Good for mediastinum and chest walls, not best for lungs

A

MRI

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56
Q

Advanced chest imaging

A 
Decubitus series
PA full inspiration
Fluoroscopy
Bronchography
Pulmonary angiography
Tomography
US
Nuclear medicine
MRI
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57
Q

Contains anterior, middle, and porition of superior anatomical divisions

A

Anterior mediastinum

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58
Q

Posterior to the line to 1cm behind vertebral body

A

Middle mediastinum

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59
Q

Spine

A

Posterior mediastinum

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60
Q

Midline structure
As passes the transverse arch of aorta (aortic knkob) deviates tot he right slightly
Divides at the carina into left and right mainstem bronchi

A

Trachea

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61
Q

Carina
Infants
Teens
Adults

A

T4
T5
T6

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62
Q

Origination of the hilus (unilateral structures)

A 
1 mainstem bronchi
1 pulmonary artery
2 pulmonary veins
Vagus nerve
(Recurrent laryngeal nerve)
Phrenic nerve
Lymph nodes
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63
Q

Mainstem bronchi

A

Left = longer and more horizontally oriented, less obtuse

Right = shorter and more vertically oriented

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64
Q

Pulmonary artery L vs R

A 
L = arches up over the top of L mainstem bronchus
R = passes in front of R mainstem bronchus

Contributes to majority of hilar denisty

L is higher than R

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65
Q

Pulmonary veins

A

Add density to the area but not visible as individual structures

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66
Q

Vagus nerve runs directly____ to the hilus

A

Posterior

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67
Q

Vaguse nerve on left

A

Gives recurrent laryngeal nerve that curves under arch of aorta at the hilus

Can be compressed by hilar tumors

Peter jennings - unexplained hoarseness

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68
Q

Vagus nerve on right

A

Recurrent laryngeal branches earlier on the R

hilar tumor does NOT compress recurrent laryngeal nerve but DOES compress the superior vena cava = SVC syndrome

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69
Q

Phrenic nerve runs ___ to the hilus

A

Anterior

Hilar tumors can compress the phrenic nerves

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70
Q

Extensive lymphatic system in the chest

Lymph nodes

A

Rt peritracheal nodes very common in sarcoidosis

Not normally visible as individual structures - can be seen individually with a distinct shape with pathology

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71
Q

Lymphadenopathy

A

LAN

Enlarged due to inflammatory, neoplastic, benign lymphoid hyperplasia

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72
Q

Infectious inflammatory LAN

A

TB, fungal (histo, coccidio)

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73
Q

Non-infectious inflammatory LAN

A

Sarcoidosis

Silicosis

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74
Q

Neoplastic LAN primary

A

Lymphoma - HL, NHL

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75
Q

Neoplastic LAN secondary

A

Metastasis

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76
Q

Benign lymphoid hyperplasia

A

Castleman’s

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77
Q

Calcification lymph nodes

A

End-stage granulomatous disease

Fibrotic, scarred, calcified
TB, fungal, pneumoconiosis

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78
Q

Medullary lymphatic drainage (big orange)

A

Lymph re-absorbed into hilar, subcarinal, peratracheal

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79
Q

Cortical lymphatic drainage big orange

A

Lymph travels in pleura - subpleural lymphatics - over surface of lung

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80
Q

When a hilus is abnormal =

A

Enlargement

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81
Q

Unilateral hilar enlargement

A

Bronchus or lymph nodes

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82
Q

Bilateral hilar enlargement

A

Blood vessels (arteries/veins) with pulmonary hypertension OR lymph nodes

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83
Q

Imbalance between pulmonary leakage and absorption

Largely a MEDULLARY lung problem

A

Pulmonary edema

84
Q

Right mainstem bronchus

A

Shorter and more obtuse angle to trachea

85
Q

First mainstem branch

A

Right upper lobe bronchus

86
Q

First mainstem branch branches
First =
Second =
Third =

A 
Apical segmental (RUL #1)
Anterior segmental (RUL #2)
Goes to upper posterior chest wall - posterior segmental (RUL #3)
87
Q

Intermediate branch splits into the 2nd and 3rd mainstem branches

A

Anterior

Posterior

88
Q

Anterior branch - right middle lobe bronchus

A

Lateral running branch = lateral segmental (RML #4)

Medial running branch = medial segmental (RML #5)

89
Q

Posterior branch =

A

Right lower lobe bronchus

90
Q

Posterior branches

A

One non-basal - superior segemnet right lower lobe (RLL #6) - aka apical segemnet RLL - directly below RUL #3 - goes to mid-lower scapulae

Four basal (sit on diaphragm) - medial basal (RLL#7) directly behind 4,5; anterior basal RLL #8 directly behind 4,5; lateral basal (RLL #9); posterior basal (RLL #10)

91
Q

3-D orientation right

A

5,7,10 medial A-P at level just below hilum
4,8,9 lateral AP at level just below hilum

2, lower 3, 6 at level just above hiluym

92
Q

Left mainstem bronchus

A

Longer and less obtuse

93
Q

First mainstem branch left

A

Left upper lobe bronchus

94
Q

Left upper lobe bronchus branches

A 
First = apical/posterior segmental (LUL #1-3)
Second = anterior segmenetal (LUL #2)
95
Q

Lingular bronchus is a branch off

A

The upper lobe bronchus

96
Q

Superior segemental lobe

A

Lingula #4

97
Q

Inferior segmental

A

Lingula #5

98
Q

Second mainstem branch left

A

Left lower lobe bronchus

99
Q

Left lower lobe bronchus branches

A

One non-basal
Superior segment left lower lobe (LLL#6) aka apical segement LLL - directly below LUL #3 goes to mid-lower scapula

Four basal
Medial basal (LLL#7) directely behind 4,5
Anterior basal (LLL#8) directly behind 4,5
(Anteromedial 7,8)
Lateral basal (LLL#9)
Posterior basal (LLL#10)

100
Q

Lateral x-ray view
Retro-sternal clear space =
Retro-cardiac clear space =

101
Q

Fissures are ___ to the beam and visible about ___ of the time

A

Parallel

50%

102
Q

Each lobe is completely covered by

A

Visceral pleura

103
Q

Where two layers of visceral pleura touch

104
Q

Isolation barriers between lobes

105
Q

Right lung fissures

A

Minor fissure - separates RUL from RML (2 from 4, 5)

Major fissure - separates RLL from RUL/RML
Upper half - 6 from 3
Lower half - 7, 8 from 4, 5

106
Q

Azygous fissure

A

4 layers of pleura - 2 parietal + 2 visceral

Right side only to contain parietal pleura

Only to split a segment (RUL #1)

5% of the time the azygous vein descends too early

Seen on AP view (runs front to back)

107
Q

Inferior accessory fissure

A

Most commonly on the right

Separates 7 from rest of basals

Seen on AP view

Creates an inferior accessory lobe

108
Q

Separates 7 from other basals

A

Inferior accessory fissure

109
Q

Superior accessory fissure

A

Right or left

Separates 6 from basals

Seen on AP view

Creates posterior accessory lobe

Where minor fissure runs but posterior

110
Q

Accessory minor fissure

A

Only on the L

Separates 2 and 4 - creates a L minor fissure

Creates middle lobe of left lung

111
Q

Primary lobule

A

Too small - about 23 million on average

112
Q

Acinus

A

Just right, radiographic functional unit

5-8 mm in size
Has many primary lobules in it

113
Q

Secondary lobule

A

Too big

Made of several acini (3-5)

Separated by subpleural interstitium lung tissure

114
Q

Radiographic functional unit

115
Q

Anatomical functional unites

A

Primary lobule
Acinus
Secondary lobule

116
Q

Ends the conducting portion (just moving air)

Has hyaline cartilage

A

Terminal bronchiole

117
Q

Starts the respiratory zone (parenchymal zone) - mucous production starts here

A

Respiratory bronchiole

118
Q

Start in trachea

A 
L or R mainstem bronchus
Pick a lobe
Segmental bronchus
Subsegmental bronchus
Terminal bronchiole
Respiratory bronchiole
Alveolar duct
Alveolar sac
Alveoli
119
Q

Acinus =

A

Everything distal to one terminal bronchiole

Respiratory bronchiole, alveolar duct, alveolar sacs, alveoli

Contains a bunch of priamry lobes

120
Q

Respiratory bronchioles

A

Either 2 or 3

First branch is RB1, RB2, RB3, ducts, sacs, alveoli

121
Q

Filling up the acinus with fluid -

A

Consolidation

122
Q

Primary lobule is everything distal to the respiratory bronchiold

A

Ducts - sacs - alveoli

123
Q

Two secondary lobules are separated by

A

Subpleural interstitial membrane - honeycombed

Lymphatic channels reside here

124
Q

Subpleural interstitial membrane thickened =

A

Kerley lines

125
Q

Channels of peripheral (intralobar) airway communication aka

A

Collateral air drift

126
Q

Collateral air drift facilitates

A

Air perfusion in the periphery of the lung

127
Q

Pores of kohn

A

Interalveolar communications - 3-13 microns

Allows air to flow easily between alveoli

Exudate can also traverse these opres

128
Q

Canals of lambert

A

Subsegmental bronchi (larger than terminal bronchi) directly to alveoli - up to 30 microns

Helps keep alveoli perfused/inflated

Exudate can fill up the bronchi

129
Q

Direct airway anastomosis - channels of martin

A

Airway communication between bronchi - up to 64 microns

May be visible with naked eye

130
Q

No channels of peripheral airway communication happen across

131
Q

Bronchial wall is so thin that it is not visible. We see

A

Blood vessles

132
Q

Carry de-saturated blood

Follows the bronchi - parallel course

A

Pulmonary arteries

133
Q

Carry saturated blood

Runs independent of the bronchi

A

Pulmonary veins

134
Q

Dot + hyperlucent structure =

A

Pulmonary artery

135
Q

Dot without hyperlucent structure =

A

Pulmonary vein

136
Q

Bronchial artery supplies

A

Oxygenated blood

137
Q

Carries de-oxygenated blood away from lungs

A

Pulmonary artery

138
Q

2/3 of heart is on _____ of midline

139
Q

Apex of heart is ____ in both directions and sits _____

A

Oblique

Anteriorly

140
Q

Heart borders are made up of

141
Q

Right ventricle is directly behind

142
Q

middle 1/3 mediastinum

A 
Vessels
SVC
IVC
Ascending aorta
Pulmonary artery
143
Q

Arises from left ventricle, to the right of the midline

A

Ascending aorta, transverse arch of aorta, aortic knob

144
Q

Arises from right ventricle, to left of midline

A

Pulmonary artery - slight convex border directly below aortic knob, above left heart border

145
Q

2 convex borders to the R of midline

A

R heart border and ascending aorta (just medial to R hilus

146
Q

3 convex borders to the L of midline

A

Knob
Pulmonary artery (medial to left hilus)
Left heart border

147
Q

If left atrium is enlarged

A

4 convex structures

148
Q

Upper 1/3 mediastinum

A

Trachea and other vascular structures aren’t normally visible

149
Q

On lateral x-ray

A

Anterior border - R ventricle

Posterior border - L atrium, L ventricle

150
Q

Right is right, front is right

A

Left is left
Back is left
Rights are singles
Lefts are both

151
Q

Esophagus is

A

Right behind the trachea

152
Q

Trachea stops at ____ but esophagus continues down in front of vertebral bodies

___ contacts the esophagus

A

Carina

Left atrium

153
Q 
Are
There
Many
Lung
Lesions
A 
Abdomen
Thorax
Mediastinum
One lung
Both lungs
154
Q

More weight is in the lower lung

A

More blood in lower lung

155
Q

Vessel diameter ratio above hilus to lower
In vertical position

Supine/prone position

156
Q

Split lungs into vertical thirds the vessels are larger closer to

A

The midline

Decrease in size and increase in number moving toward the periphery

157
Q

Cortical lung is not avascular but is devoid of visible vessels

A

Any densities visible in cortical lung are ABNORMAL

158
Q

Soft tissues visible

A 
Breast
Areola and nipple
Axillary fold
SCM
Supraclavicular soft tissue silhouette
159
Q

SCM and supraclavicular tissue silhouette cover the

A

Apex of the lung

160
Q

1 and 8 sit

A

On the high point of the diaphragm - if they contain air, we see the diaphragm border

161
Q

9 and 10

162
Q

5 touches

A

Right heart

163
Q

Lower lung vessels are ___ the size of upper vessels

164
Q

PA chest is a____ view of aorta
LAO
RAO

A

Oblique
Lateral
PA

165
Q

Lack of detail

A

Underpenetrated

166
Q

Faint bone spine through mediastinum no bone detail

A

Over-penetrated

167
Q

Chest obliques

A

Swim position to get arms out fo the way

RAO
LAO

168
Q

Heart sits ____ in chest

When you rotate the heart is at 45 degree angle

A

Anteriorly

169
Q

Straight frontal aorta

170
Q

The right ventricle is ALWAYS

A

The front of the heart

171
Q

The left atrium is the most

A

Posterior chamber of the heart

172
Q

RAO assesses the

173
Q

LAO assesses

A

Right lung

174
Q

The heart is viewed straight up and down - tear drop

175
Q

See right atrium and right ventricle on the right heart border

See left atrium and left ventricle on left heart border

176
Q

Only view where all four chambers border from

177
Q

Diaphragm scalloping

A

Normal variant

178
Q

Diaphragm eventration

A

Localized area of muscle thinning most common at medial-anterior R hemi-diaphragm

179
Q

Bochdelek hernia

A

Posterior eventration of the diaphragm

180
Q

Missing breast causes

A

Unilateral localized hyperlucency

181
Q

Rhomboid fossa is aattachment for

A

Costoclavicular ligament

182
Q

When like densities are in anatomical contact, any border that existed, disappears. In chest this concept can be used to localize lesions densities

A

Silhouette sign

183
Q

If the same denistis are touching the beam cannot tell a difference and photon absorption will be the same

Used to localize where something is

A

Silhouette sign

184
Q

Only segment to touch right atria

185
Q

Tocuhes ascending aorta

186
Q

Touches aortic knob

187
Q

Touches pulmonary artery - anterior structure

188
Q

Upper left heart border

A

Superior lingual 4

189
Q

Lower left heart border

A

Inferior lingual 5

190
Q

Silhouette the diaphragm on PA view

191
Q

Descending thoracic aorta can be silhouetted

A

Upper is 6

Lower is 10

192
Q

Directly above minor fissure

193
Q

Basal segments are below

A

Superior accessory fissure

194
Q

Blood, pus, water, cells, protein

A

Consolidation

195
Q

Fissure boundaries are ___ with consolidation

196
Q

Pleural effusion has the chance to touch

A

Everything

197
Q

Increase radiographic density

A

Move lung to water density

198
Q

Decrease radiograhpic density

A

Move lung to greater air density

199
Q

Conduction tissue

A

Trachea down to terminal bronchi, blood vessels and lymphatics

200
Q

Gaseous exchange tissue

A

Acini or lung parenchyma, consisting of peripheral air spaces, extravascular interstitial tissue and capillaries

201
Q

Air may be replaced either by tissue or fluid (consolidation) or absorbed/removed and not replaced (atelectasis)

A

Air space disease

202
Q

Thickening of the tissue surrounding the air space

A

Interstitial disease

203
Q

Interstitial disease

A

Widespread, bilateral, non-homogenous increase in density

204
Q

Total acinus

A

Combined air space and interstitial disease

Consolidation + interstitial disease

205
Q

All pulmonary disease must change the ratio of

A

Air vs soft tissue so denisty must change

206
Q

Parenchymal interstitial

A

Capillaries, interstitial walls - gaseous exchange

207
Q

Sub-pleural interstitium

A

Framework, structure space

Soft A (6 decks)

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