Test 2 Flashcards
1
Q
What are the 3 divisions of chest anatomy
A
- Bony thorax
- Respiratory system
- Mediastinum
2
Q
Bony thorax
A
protects the thoracic viscera/organs
3
Q
what does the bony thorax consist of
A
sternum (manubrium, body, xiphoid process) clavicles scapula 12 pairs of ribs 12 thoracic vertebrae
4
Q
Topographic landmarks
A
reference points for positioning
5
Q
vertebra prominens
A
located at C7-T1
6
Q
jugular notch
A
located at T2-T3
notch in the manubrium
7
Q
Xiphoid tip
A
located at T9-T10
not a reliable landmark for chest positioning
at the level of the anterior portion of the diaphragm
8
Q
Respiratory system
A
Exchange of gaseous substances between the air and the blood
9
Q
Divisions of the respiratory system
A
Pharynx Larynx trachea bronchi lungs
10
Q
Diaphragm
A
muscular partition separating the thoracic cavity from the abdominal cavity
deep inspiration depresses the diaphragm to lowest level
11
Q
hemidiaphragm
A
each half of the diaphragm
12
Q
Pharynx
A
throat about 5 inches long posterior to nasal and oral cavities superior to larynx, anterior to cervical vertebrae passageway for food, air and fluids
13
Q
What are the 3 divisions of the pharynx
A
1 nasopharynx
2 oropharynx
3 laryngopharynx
14
Q
nasopharynx
A
superior portion of pharynx
posterior to nasal cavity and extends to plane of soft palate
ends at the uvula
15
Q
oropharynx
A
posterior to oral cavity
extends from uvula to hyoid bone
common passageway for air, food and drink
16
Q
laryngopharynx
A
also called hypopharynx
inferior portion of pharynx
connects esophagus with the larynx
a respiratory and digestive passageway
17
Q
esophagus
A
part of digestive system
connects the laryngopharynx to the stomach
posterior to the larynx and trachea
18
Q
respiratory system proper
A
comprised of 4 parts
no food passes through it
19
Q
what are the 4 parts of respiratory system proper
A
1 larynx
2 trachea
3 right and left bronchi
4 lungs
20
Q
larynx
A
voice box air passage between pharynx and trachea lies at midline of neck anterior to C3-C6 vocal chords located here has 9 pieces of cartilage
21
Q
3 single cartilages of the larynx
A
1 thyroid cartilage
2 epiglottis
3 cricoid cartilage
22
Q
thyroid cartilage
A
two fused plates of cartilage that form the anterior wall of the larynx
butterfly shape
23
Q
Laryngeal prominence
A
adams apple
anterior projection of the thyroid cartilage
located at C5
24
Q
epiglottis
A
leaf shape piece of cartilage
flips down to cover the trachea during swallowing so food/drink doesn’t go down airway
25
cricoid cartilage
ring of cartilage that forms the inferior and posterior wall of larynx
attaches to first ring of cartilage of the trachea
26
trachea
windpipe
tubular passage for air
about 5 inches long
anterior to the esophagus
shifted right of midline due to arch of aorta
from C6-T4/T5
has 20 c shaped rings of cartilage to prevent trachea from collapsing
27
thyroid gland
located inferior to the larynx
part of the endocrine system
stores and releases hormones that aid in and regulate metabolism
28
parathyroid glands
4 raisin sized glands embedded in the thyroid gland
| secrete hormones that aid in specific blood functions
29
thymus gland
distal to the thyroid gland
primary control organ of lymphatic system
consists of 2 lobes that lie in lower neck
temporary organ
atrophies until it almost disappears as an adult
30
AP projection of upper airway
visualizes air filled trachea and larynx
| enlargement/abnormalities of thyroid could be demonstrated
31
lateral projection of upper air way
air filled trachea and larynx
| region of the esophagus
32
right and left main primary bronchi
at T4-T5
Right primary bronchus goes into right lung
Left primary bronchus goes into left lung
33
right primary bronchus
wider and shorter and more vertical
| foreign bodies entering the trachea are more likely to pass into the right bronchus than the left
34
carina
specific prominence of the last tracheal cartilage
where the trachea divides into right and left bronchi
to the left of the midline when viewed from above
at T5
used in CT as a reference point
35
The right bronchus has how many secondary bronchi
3 secondary bronchi
36
the left bronchus has how many secondary bronchi
2 secondary bronchi
37
how many lobes in the right lung
3 lobes
38
how many lobes in the left lung
2 lobes
39
secondary bronchi
subdivide into smaller branches called bronchioles
40
terminal bronchiole
terminates in small air sacs called alveoli
41
alveoli
between 500-700 alveoli contained in the 2 lungs
| oxygen and carbon dioxide are exchanged by diffusion within the walls of the alveoli
42
lungs
on each side of the thoracic cavity
extend from diaphragm to slightly superior of the clavicles
lie against the ribs
43
apex of the lung
top of the lung
| rounded upper portion above clavicles
44
base of the lung
inferior portion
| concave and fits over convex area of the diaphragm
45
3 lobes of the right lung
1 superior lobe
2 middle lobe
3 inferior lobe
46
2 fissures of the right lung
1 oblique
| 2 horizontal
47
2 lobes of the left lung
1 superior
| 2 inferior
48
fissure of the left lung
oblique
49
lingula
the portion of the left lung that corresponds to the right middle lobe
50
parenchyma
light, spongy, highly elastic substance that the lungs are composed of
the part thats important for that function of that organ
51
pleura
double walled serous membrane that encloses each lung
52
parietal pleura
outer layer
| attaches lung to wall of thoracic cavity
53
visceral pleura
also called pulmonary pleura
inner layer
covers the surface of the lungs and in between fissures
54
pleural cavity
potential space between the parietal and visceral pleura
| contains serous fluid to prevent friction between membranes
55
pneumothorax
an accumulation of air in the pleural cavity resulting in collapse of the lung
have to be upright or in a decubitus position to be seen
56
pleural effusion
accumulation of fluid in the pleural cavity
57
hemothorax
if the fluid in the pleural cavity is blood
58
empyema
if the fluid creating the pleural effusion is pus
59
pleurisy
inflammation of the pleura
| when the visceral and parietal pleura are rubbing during respiration
60
air in lungs =
affected side up
61
fluid in lungs =
affected side down
62
emphysema
irreversible lung disease when alveolar air spaces become greatly enlarged as a result of alveolar wall destruction and loss of alveolar elasticity
air gets trapped in alveoli and causes labored breathing
63
what does emphysema look like on an x ray
lungs appear very dark
lungs are bigger
may need to reduce exposure factors
64
pericardial sac
double walled membrane that surrounds the heart
65
important parts to see on a PA chest x ray
clavicles, ribs, scapula, trachea, apex, carina, base, diaphragm, costophrenic angles, hilum
66
lateral chest
of the left lung so you only see 2 lobes
| right lung is shorter than the left because the liver pushes on the right hemidiaphragm
67
what is seen on a lateral chest x ray
right and left hemidiaphragm, apex, upper/lower lobe, hilum, base
68
mediastinum
medial portion of the thoracic between the lungs.
| space between the lungs
69
heart and great vessels
enclosed in pericardial sac
heart is posterior to the sternum
T5-T8
2/3 of the heart lies to the left of the midsagittal plane
70
great vessels include:
superior/inferior vena cava, aorta, pulmonary arteries, and veins
71
superior vena cava
returns blood to the heart from upper half of body
72
inferior vena cava
returns blood to the heart from the lower half of body
73
aorta
largest artery in the body
| carries blood to all parts of the body through its various branches
74
ascending aorta
comes up out of the heart
75
aortic arch
makes a turn downward here
76
descending aorta
continues downward
77
abdominal aorta
what it becomes when it passes through the diaphragm
78
pulmonary arteries and veins
supply blood and return blood to and from all segments of the lungs
79
body habitus
refers to the common variations in the shape of the human body
80
body habitus directly affects the location of
the heart, lungs, diaphragm, stomach, gallbladder, large intestine
81
4 types of body habitus
1 sthenic
2 hyposthenic
3 asthenic
4 hypersthenic
82
hypersthenic
```
massive build
thorax is broad and deep
need more room side to side
5% of people
IR placed crosswise
```
83
asthenic
slender build
thorax narrow and shallow
IR must be long enough to include costophrenic angles
10%
84
Sthenic
average patient
| 50%
85
inspiration
act of drawing air into lungs
| inhalation
86
expiration
breathing out
| exhalation
87
during inspiration the thoracic cavity increases in what 3 dimensions
1 vertical
2 transverse
3 anteroposterior
88
vertical diameter
diaphragm moves down and increases thoracic volume
89
transverse diameter
ribs swing outward and upward
90
anteroposterior diameter
raising the ribs
91
how many ribs are needed in a PA chest radiograph
10 ribs minimun
92
patient prep
remove opaque objects
clothing artifacts
long hair fastened
93
radiation protection
limit repeat exposures
collimate
use lead shielding
94
kilovoltage
(kVp) 110-125 kV
Demonstrates may shades of gray needed to visualize lung markings
high kV needs grids
95
exposure time and miliamperage
high mA and short exposure times reduce motion
| sufficient mAs is needed to provide optimum density of lungs and mediastinal structures
96
optimal density
able to see faint outlines of at least mid and upper vertebrae and ribs through the heart
97
Pediatric applications of chest x rays
Newborns: AP supine or Dorsal decubitus
when child is able to support their head you can do erect PA and lateral using a pigg-o-stat
lower kVp
lower mAs
98
Geriatric patients
higher Central ray location because older people have less inhalation capacity
99
pneumonia
inflammation of lungs resulting in an accumulation of fluid within certain sections of the lung creating increased radiodensities in these regions
need an increase in exposure factors to penetrate and visualize the area
100
geriatric patient handling
more care, time and patience
| supporting them in the positioning process
101
breathing instructions
chest radiographs are take on full inspiration
| hold breath on second full inspiration
102
reasons you may need to do an inhalation and expiration radiograph
small pneumothorax
presence of foreign body
atelectasis
103
atelectasis
a condition in which collapse of all or portion of a lung occurs as a result of an obstruction of the bronchus or a puncture of an air passageway
causes the region to appear more dense and trachea and heart may shift to the affected side
104
3 main reasons for erect chest position
1. allows diaphragm to move down farther
2. demonstrates air fluid levels
(need a minimum of 5 mins to allow fluid to settle and air to rise )
3. prevents engorgement and hyperemia of pulmonary vessels
105
engorgement
distended or swollen with fluid
106
hyperemia
an excess of blood partially resulting from a relaxation of the distal small blood vessels
107
what is the SID for a PA chest projection
minimum of 72 inches of SID should be used to minimize magnification of the heart and to obtain greater recorded detail of the delicate lung structures
sometimes a 120 inch SID is used
108
evaluation criteria
goal: optimal radiograph
definable standard so every chest radiograph can be evaluated
established standards as stated for each projection/position
109
Rotation
proper positioning prevents rotation
weight must be evenly distributed
rotation can be detected by the asymmetric appearance of the sternoclavicular joints
110
lateral chest position
place side of interest closest to the IR
left lateral is the most common
arms raised, weight evenly distributed, raise chin
MSP parallel to the IR
111
Lateral with no rotation
the separation of the posterior ribs should only be 1/4 to 1/2 inches or about 1 cm apart
any more separation indicates rotation
112
Lateral chest with tilt
can be demonstrated by closed intervertebral disk spaces
113
central ray positioning
two bony landmarks can provide a consistent and reliable means of determining CR location
can use vertebra prominens or jugular notch
114
C1
mastoid tip
115
C2, C3
angle of mandible
116
C3, C4
hyoid bone
117
C5
thyroid cartilage
118
C7, T1
vertebra prominens
119
T1
aprox. 2 inches above the jugular notch
120
T2, T3
level of jugular notch
121
T4, T5
level of sternal angle
122
T7
level of inferior angles of scapula
123
T9, T10
level of xiphoid process
124
L2, L3
inferior costal margin
125
L4, L5
level of superior aspect of iliac crest
126
central ray chest positioning for PA
after palpating the vertebra prominens measure 7 inches down for females and 8 inches down for males
127
recumbant AP chest radiographs
usually taken at an SID of less than 72 inches
128
4 digital imaging considerations
1. collimation
2. accurate centering
3. exposure factors
4. post processing evaluation
129
1. collimation
reduces dose
| reduces scatter
130
2. accurate centering
important that the body part and central ray be accurately centered to the IR
131
3. exposure factors
use highest kV with lowest mAs
ALARA
radiation protection
132
4. post processing evaluation
the image will be critiqued for positioning and exposure accuracy
133
conventional and computed tomography
conventional is used for locating leisons found on chest films, but CT is used for such purposes
134
Bronchography
contrast media introduced into bronchial tree to rule out certain pathologies
been replaced by CT
135
sonography
may be used to detect pleural effusions
| ultrasound
136
echocardiogram
ultrasound of the heart
137
nuclear medicine
used to evaluate and diagnose pulmonary diffusion conditions or pulmonary emboli
138
magnetic resonance imaging MRI
used to evaluate and diagnose pathologies in the soft tissues
139
lateral projection on a cart
patient seated on cart
place support behind patient as necessary
ensure cart is locked
chin elevated
140
lateral projection in a wheelchair
```
remove armrests
place wheelchair close to IR
place support behind their back
chin elevated
arms not in the way
```
141
true or false don't put x ray tube in detent if the IR is underneath the patient
TRUE
142
special projections of the chest
```
AP supine or semierect
lateral decubitus
AP lordotic
anterior oblique position (PA oblique projection)
posterior oblique
```
143
PA projection Anterior oblique position
LAO will provide best visualization of RIGHT lung
| RAO will provide best visualization of LEFT lung
144
AP oblique projection posterior oblique positions
RPO will provide best visualization of RIGHT lung
| LPO will provide best visualization of LEFT lung
145
The RPO position corresponds to the
LAO position
146
The LPO position corresponds to the
RAO position
147
viewing lateral projections
marked by R or L by side of patient closest to IR
| common to view images from same perspective as xray tube
148
viewing PA/AP oblique projections
patients right to viewers left
| viewed the same as for AP and PA projections
149
viewing decubitus chest and abdomen
viewed the way the xray tube sees them
| the upside of the patient is at the top of the viewbod
150
viewing upper and lower limbs
viewed as if you were looking from xray tube
images with digits have digits facing up
viewed in anatomic position
151
viewing CT or MRI
axial images are viewed so patients right side is to viewers left
152
exposure factors
radiographer sets 3 exposure factors on control panel
1. kilovoltage
2. miliamperage
3. exposure time
153
radiographers are allowed how many milirem a year
5,000 milirem a year
154
Roentgen
used for measurements in air
| columbs/kg
155
RAD
radiation absorbed dose
used for patient dose purposes
gray
156
Rem
radiation equivalent man
used for worker protection purposes
sievert
157
pregnant technologists
can declare pregnancy but does not have to
second dosimeter is issued for the fetus
fetal dosimeter changed every month
fetus dose is 0.05 rem or 50 milirem a month
158
TLD
thermoluminescent dosimeter
159
OSL
optically stimulated luminescence
what we use
worn at waist or collar
160
cardinal rules of radiation protection
1. time
2. distance (most important)
3. shielding
161
fluoroscopy safety practices
bucky slot cover
lead drape
lead apron
exposure limit
162
patient protection
minimum repeat radiographs
clear instructions
position properly
163
one of the best ways to reduce patient exposure is
close four sided collimation
164
radiation protection practices
```
minimum repeat radiographs
correct filtration
accurate collimation
specific area sheilding
protection for pregnancies
```
165
2 types of collimators
manual type
| positive beam limitation
166
gonadal shielding
reduce dose 50-90%
| always shield the male but sometimes we need a picture where the ovaries are on females so we cannot shield them
167
PA chest pathology demonstrated
pleural effusions
pneumothorax
atelectasis
168
PA chest technical factors
35x43 cm IR
grid
110-125 kVp
minimum SID of 72 inches
169
PA chest shielding
shield between xray tube and patients pelvis
| shield the gonads
170
PA chest positioning
```
erect
weight evenly distributed
chin elevated
hands on lower hips palms out
roll shoulders forward to move scapulae
depress shoulders
make sure shoulders are parallel, no rotation
```
171
PA chest part positioning
Center MSP of body to midline of the IR
MSP perpendicular MCP parallel to IR
top of IR will be 1/2 to 2 inches above relaxed shoulders
172
PA chest central ray position
perpendicular to center of IR
| centered to MSP at level of T7
173
PA chest criteria
```
both lungs from apicies to sotophrenic angles
air filled trachea
hilum region
heart
great vessels
bony thorax
```
174
Lateral chest pathology demonstrated
90 degree perspective
| demonstrates pathology posterior to heart and great vessels
175
Lateral chest sheilding
shield around waist
| shield gonads
176
lateral chest technical factors
grid
110-125 kVp
minimum SID of 72 inches
IR size of 35x43 cm
177
lateral chest patient position
```
erect
left side against IR
weight evenly distributed
arms are raised above head
chin elevated
```
178
lateral chest part position
patient centered to the CR and IR anteriorly and posteriorly
MCP is perpendicular to IR
MSP is parallel to the IR
179
lateral chest central ray position
perpendicular to the midthorax at the level of T7
180
Lateral chest structures shown
entire lungs included
apices to costophrenic angles
sternum to posterior ribs and thorax
181
AP supine/semi erect chest pathology demonstrated
pathology involving lungs, diaphragm and mediastinum
182
AP supine/semi erect chest technical factors
with or without grid
35x43 IR
90-110 kVp with grid
70-80 kVp without grid
183
AP supine/semi erect chest patient position
when possible should be erect/semi erect
| roll shoulders when possible
184
AP supine/semi erect chest part positioning
IR placed under or behind patient
| center of IR aligned to the CR
185
AP supine/semi erect chest central ray position
angled caudad to be perpendicular to the long axis of sternum
minimum of 40 SID when supine
186
Lateral decubitus pathology demonstrated
small pleural effusions
| small pneumothorax
187
Lateral decubitus technical factors
35x43 cm IR
grid
110-125 kVp
72 inch SID when possible
188
Lateral decubitus patient positioning
lying on affected side or unaffected side as indicated
chin elevated
coronal plane parallel to IR
189
Lateral decubitus Central Ray
CR horizontal at the level of T7
| horizontal beam must be used
190
AP lordotic pathology demonstrated
rule out calcifications and masses beneath the clavicles
191
AP lordotic patient positioning
pt. stands about 1 foot away from IR
leans back with shoulders neck and back of head against the IR
hands on hips palms out
shoulders rolled foreword
192
AP lordotic part position
MSP centered to middle of IR
center IR to the CR
top of IR about 3 inches above shoulders
193
Lateral upper airway technical factors
10x12 inch IR
grid
80 kVp
194
lateral upper airway patient position
upright
| right of left
195
lateral upper airway part position
center area of interest to CR and center of IR
rotate shoulders posteriorly
raise chin
look straight ahead
196
lateral upper airway respiration
made during slow deep inspiration
197
lateral upper airway criteria
larynx and trachea filled with air and well visualized
| include EAM external auditory meatus (ear)
198
AP upper airway pathology demonstrated
air filled larynx and trachea
| pathology involving thyroid and thymus glands
199
AP upper airway technical factors
10x12 inch IR
grid
75-80 kVp
minimum 40 SID
200
AP upper airway patient position
upright if possible
| back against IR
201
AP upper airway part position
align MSP with CR and midline of grid
202
AP upper airway respiration
made during slow deep inspiration
