Quiz #1 Flashcards
What are the 5 steps of Evaluation?
1) Identify the study (anatomy, number of films etc)
2) Information (patients age, gender, position)
3) Collimation (sheilding/artifacts)
4) Film Quality (contrast, density of film and positioning)
5) Use search pattern (ABCS)
What are the 5 steps of Evaluation?
1) Identify the study (anatomy, number of films etc)
2) Information (patients age, gender, position)
3) Collimation (sheilding/artifacts)
4) Film Quality (contrast, density of film and positioning)
5) Use search pattern (ABCS)
What are the 5 cervical lines?
Prevertebral Soft Tissue, Anterior Body line, Posterior body line, Spinolaminar junction line, spinous process interspacing
What are the 3 parts of the prevertebral soft tissue line?
1) Retropharyngeal: down to C2
2) Retrolaryngeal C3-5
3) Retrotracheal C6- and below
What is the rule of 2’s and 6’s
at C2< 6mm
C6<22mm
What is the anterior vertebral body line?
it is a smooth line with no interruptions and it is not as sensitive for vertebral displacement as the posterior body line
What is the posterior vertebral body line?
AKA george’s line. It is also smooth and uninterrupted. It evaluates the vertebral body displacement. Key landmarks: superior and inferior body corners
What is the spinolaminar junction line?
AKA posterior cervical line, extrapolate line through anterior aspect of each spinolaminar junction. Evaluates for displacement. 1-2mm offset is accepted at C1
What are the SP interspaces?
it is used to check for equal spacing between adjacent SP’s and evaluates relative segmental positioning.
When evaluating bone what are you looking for?
Shape, size, cortical integrity, internal matrix, radiographic density and specific structures
When evaluating cartilage what are you looking for?
joint shape, size and density
When evaluating soft tissue what are you looking for?
shape, size, position and density
When evaluating soft tissue what are you looking for?
shape, size, position and density
What are the 5 cervical lines?
Prevertebral Soft Tissue, Anterior Body line, Posterior body line, Spinolaminar junction line, spinous process interspacing
What are the 3 parts of the prevertebral soft tissue line?
1) Retropharyngeal: down to C2
2) Retrolaryngeal C3-5
3) Retrotracheal C6- and below
What is the rule of 2’s and 6’s
at C2< 22mm
What is the anterior vertebral body line?
it is a smooth line with no interruptions and it is not as sensitive for vertebral displacement as the posterior body line
What is the posterior vertebral body line?
AKA george’s line. It is also smooth and uninterrupted. It evaluates the vertebral body displacement. Key landmarks: superior and inferior body corners
What are Paranasal Sinuses
pneumatic extensions of the respiratory system, should not contain water densities.
- Frontal: superior to anterior portion of orbit
- Maxilary: inferior to orbit, large
- Ethmoid: medial to orbit, multiple, small
- Sphenoid; inf. to sella turcia on lateral view and midline on AP/PA
What are the SP interspaces?
it is used to check for equal spacing between adjacent SP’s and evaluates relative segmental positioning.
When evaluating bone what are you looking for?
Shape, size, cortical integrity, internal matrix, radiographic density and specific structures
When evaluating cartilage what are you looking for?
joint shape, size and density
Will NORMAL cartilage be seen on plain film?
no, only see the space it occupies
When evaluating soft tissue what are you looking for?
shape, size, position and density
What is the minimum diagnositc series of the cervical spine?
AP, APOM, Lateral
What are supplemental view for cervical spine?
Flexion, Extension laterals and Right and Left Obliques
What can you use as contrast agents on Xrays
air (natural) or barium/iodine
What is fluoroscopy?
real time motion images observed, hard images taken at specific times for permanent record
What is phonation study
the cavities or potential spaces of the pharynx and larynx can be filled with air or contrast material. the prevertebral tissues form the posterior wall of the pharynx
What can you see in the nasal cavity
concha/turbinate (osseous portion not seen on plain films but can be “seen” as soft tissue surrounded by air), meatus (3)–>linear collections of air on lateral views, tonsils–> if enlarged: adenoids
What are Paranasal Sinuses
pneumatic extensions of the respiratory system, should not contain water densities.
- Frontal: superior to anterior portion of orbit
- Maxilary: inferior to orbit, large
- Ethmoid: medial to orbit, multiple, small
- Sphenoid; inf. to sella turcia on lateral view and midline on AP/PA
What tonsils can you see?
Pharyngeal (upper most aspect of the prevertebral soft tissue line), Lingual (base of tongue), Palatine (at level of the soft palate in the PL pharyngeal wall)
Why is looking at tonsils important?
if enlarged can be a site of abnormal calcification
Where is the pharynx located?
inferior to nasal and oral cavities, esophagus lies inferior and posterior to it and trachea lies inferior and anterior to it.
What does the epiglottis do?
prevents swallowed food from entering lower respiratory passages
where should the tracheal air shadow be
should be midline, look for deviations, normal small right deviations at the level of the aortic arch
Where is the larynx located?
anterior to C3-6 (approx 5 cm) to the inferior margin of the cricoid cartilage. (superior margin of the trachea)
Where is the epiglottis found
lateral view, base at level of the hyoid bone, cartilage doesn’t calcify
What are the valleculae
small pockets anterior to the epiglottis, seen on lateral view, seen on AP only with contrast as small paired midline collections
What are the aryepiglottic folds
tissues extending from epiglottis to the level of the vocal folds, form the walls of the vestibule
What is the vestibule
chamber about false vocal folds formed by aryepiglottic folds
What is the piriform sinus
potensal spaces with the aryepiglottic folds and lateral walls of the pharynx
What is the ventricle
space between false and true vocal folds
What are some of the cartilages found in the neck
Thyroid (lateral view, horns posterior, laminae can calcify)
Cricoid (lateral, posteriorly taller and slopes)
Arytenoid (small triangular, seen on Lateral view)
Tracheal rings (lateral usually seen as small oval at anterior and posterior margins)
Does epiglottic cartilage calcify
no
What are additional view for the chest
Apical lordotic and inspiration/expiration
What is laryngeal constriction
normal narrowing of tracheal air shadow at the vocal folds may not be notable if patient is breathing
where should the tracheal air shadow be
should be midline, look for deviations, normal small right deviations at the level of the aortic arch
What are the airspaces found in the neck
tracheal, laryngeal and pharyngeal
Where is the retrotracheal interspace measured?
anteroinferior to C6
What are the two phrenic sulci
costophrenic (r/l lateral and r/l posterior) and cardiophrenic sulci (right and left and posterior)
Where is the retropharyngeal interspace measured
anteroinferior to C2
What are the anterior landmarks of these interspaces
posterior margin tracheal airspace, posterior margin laryngeal airspace, posterior margin pharyngeal airpace
Where is the espophagus located
lower margin of cricoid to stomach and is only seen if air in it.
What is seen in the Chest, Thoracic Cage?
- Pulmonary structures (conducting systems like trachea, bronchi and parenchyma like the lung field),
- Cardiovascular system (heart shadows, aorta, vena cava’s)
- Mediastinum (divided into superior, inferior anterior, inf middle and inf posterior)
What does the mediastidum contain
trachea, esophagus, arteries, veins, lymph, nerves and heart
What is the minimal diagnotic series of the chest
PA and Left lateral
What are additional view for the chest
Apical lordotic and inspiration/expiration
Which hemidiaphragm is higher
right
where is the left hemidiaphrgam located
by the fundus of the stomach
where is the right hemidiaphragm located
by the right lobe of the liver
At what vertebral level to the hemidiaphragms cross?
T12 on full inspiration (lateral view)
Rib 10 on full inspiration (AP view)
What are the two phrenic sulci
costophrenic (r/l lateral and r/l posterior) and cardiophrenic sulci (right and left and posterior)
What are the lung fields divded into
apex, base, middle, peripheral and central
Describe the lung apices
conical, dome shaped, begin at rib 1 inferior margin, have a pleural capping. Overlying rib 1 cartilage may simulate pathology
Describe lung bases
semilunar shaped, concave, rests on convext diaphragm, most prominent vasculature, lateral corners= lower lobe
What is Pleura
coverings of the lungs, not visible on the xray except as fissures. two types: parietal and visceral
What does the parietal pleura line?
chest wall, diaphragm, mediastinum
What does the visceral pleura line?
lungs
What is the hila
root of the lung covered by pleura, left is higher than right or equal. should be similar size, shape and density
What does the hila contain
primary bronchus, pulm artery, two pulm veins, bronchial arteries and veins, pulmonary plexus of nerves, lymph nodes an vessels
What is the difference between right and left hilum
left: higher, rounder, horizontal
right: lower, oblong, vertical
How many lung fields are there
upper, middle, lower (right and left of each), so 6
How many lobes (fissures) does a right lung have versus a left lung?
right: 3 (seperated by oblique fissure and horizontal fissure) left: 2 (seperated by horizontal fissure)
Where does the oblique fissure begin? how does it travel?
at level of T5, extends down (obliquely) and foward. right is less vertical can left
Where does the horizontal fissure begin? how does it travel?
begins at the right oblique fissure and extends anteriorly to anterior end of the 4th rib
What are the accessory lobes and fissures
azygous lobe/fissure. inferior and superior accessory fissure. in right upper lobe only. seen in 1/200 normal chest films. forms due to azygous vein going lateral to medial along the interior chest wall and dropping superior to inferior at right mediastinum and pulling pleural layers with it.
What are the inferior accessory fissures
seperal medial basal segment from rest of the lower lobe. Seen on RIGHT more then left. Seen in 5% of people and on PA film only
What are the superior accessory fissures
seperate superior segment of lower lobe from rest of the lower lobe. seen right OR left. Seen in 5% of people and on PA OR LATERAL view.
