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Radiographic Positioning > Test 2 > Flashcards

Test 2 Flashcards

1
Q

What are the 3 divisions of chest anatomy

A
  1. Bony thorax
  2. Respiratory system
  3. Mediastinum
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2
Q

Bony thorax

A

protects the thoracic viscera/organs

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3
Q

what does the bony thorax consist of

A 
sternum (manubrium, body, xiphoid process)
clavicles
scapula
12 pairs of ribs
12 thoracic vertebrae
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4
Q

Topographic landmarks

A

reference points for positioning

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5
Q

vertebra prominens

A

located at C7-T1

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6
Q

jugular notch

A

located at T2-T3

notch in the manubrium

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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

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8
Q

Respiratory system

A

Exchange of gaseous substances between the air and the blood

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9
Q

Divisions of the respiratory system

A 
Pharynx
Larynx
trachea
bronchi
lungs
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10
Q

Diaphragm

A

muscular partition separating the thoracic cavity from the abdominal cavity
deep inspiration depresses the diaphragm to lowest level

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11
Q

hemidiaphragm

A

each half of the diaphragm

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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
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13
Q

What are the 3 divisions of the pharynx

A

1 nasopharynx
2 oropharynx
3 laryngopharynx

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14
Q

nasopharynx

A

superior portion of pharynx
posterior to nasal cavity and extends to plane of soft palate
ends at the uvula

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15
Q

oropharynx

A

posterior to oral cavity
extends from uvula to hyoid bone
common passageway for air, food and drink

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16
Q

laryngopharynx

A

also called hypopharynx
inferior portion of pharynx
connects esophagus with the larynx
a respiratory and digestive passageway

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17
Q

esophagus

A

part of digestive system
connects the laryngopharynx to the stomach
posterior to the larynx and trachea

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18
Q

respiratory system proper

A

comprised of 4 parts

no food passes through it

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19
Q

what are the 4 parts of respiratory system proper

A

1 larynx
2 trachea
3 right and left bronchi
4 lungs

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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
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21
Q

3 single cartilages of the larynx

A

1 thyroid cartilage
2 epiglottis
3 cricoid cartilage

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22
Q

thyroid cartilage

A

two fused plates of cartilage that form the anterior wall of the larynx
butterfly shape

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23
Q

Laryngeal prominence

A

adams apple
anterior projection of the thyroid cartilage
located at C5

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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

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25
Q

cricoid cartilage

A

ring of cartilage that forms the inferior and posterior wall of larynx
attaches to first ring of cartilage of the trachea

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26
Q

trachea

A

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

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27
Q

thyroid gland

A

located inferior to the larynx
part of the endocrine system
stores and releases hormones that aid in and regulate metabolism

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28
Q

parathyroid glands

A

4 raisin sized glands embedded in the thyroid gland

secrete hormones that aid in specific blood functions

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29
Q

thymus gland

A

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

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30
Q

AP projection of upper airway

A

visualizes air filled trachea and larynx

enlargement/abnormalities of thyroid could be demonstrated

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31
Q

lateral projection of upper air way

A

air filled trachea and larynx

region of the esophagus

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32
Q

right and left main primary bronchi

A

at T4-T5
Right primary bronchus goes into right lung
Left primary bronchus goes into left lung

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33
Q

right primary bronchus

A

wider and shorter and more vertical

foreign bodies entering the trachea are more likely to pass into the right bronchus than the left

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34
Q

carina

A

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

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35
Q

The right bronchus has how many secondary bronchi

A

3 secondary bronchi

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36
Q

the left bronchus has how many secondary bronchi

A

2 secondary bronchi

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37
Q

how many lobes in the right lung

A

3 lobes

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38
Q

how many lobes in the left lung

A

2 lobes

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39
Q

secondary bronchi

A

subdivide into smaller branches called bronchioles

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40
Q

terminal bronchiole

A

terminates in small air sacs called alveoli

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41
Q

alveoli

A

between 500-700 alveoli contained in the 2 lungs

oxygen and carbon dioxide are exchanged by diffusion within the walls of the alveoli

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42
Q

lungs

A

on each side of the thoracic cavity
extend from diaphragm to slightly superior of the clavicles
lie against the ribs

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43
Q

apex of the lung

A

top of the lung

rounded upper portion above clavicles

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44
Q

base of the lung

A

inferior portion

concave and fits over convex area of the diaphragm

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45
Q

3 lobes of the right lung

A

1 superior lobe
2 middle lobe
3 inferior lobe

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46
Q

2 fissures of the right lung

A

1 oblique

2 horizontal

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47
Q

2 lobes of the left lung

A

1 superior

2 inferior

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48
Q

fissure of the left lung

A

oblique

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49
Q

lingula

A

the portion of the left lung that corresponds to the right middle lobe

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50
Q

parenchyma

A

light, spongy, highly elastic substance that the lungs are composed of
the part thats important for that function of that organ

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51
Q

pleura

A

double walled serous membrane that encloses each lung

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52
Q

parietal pleura

A

outer layer

attaches lung to wall of thoracic cavity

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53
Q

visceral pleura

A

also called pulmonary pleura
inner layer
covers the surface of the lungs and in between fissures

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54
Q

pleural cavity

A

potential space between the parietal and visceral pleura

contains serous fluid to prevent friction between membranes

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55
Q

pneumothorax

A

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

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56
Q

pleural effusion

A

accumulation of fluid in the pleural cavity

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57
Q

hemothorax

A

if the fluid in the pleural cavity is blood

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58
Q

empyema

A

if the fluid creating the pleural effusion is pus

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59
Q

pleurisy

A

inflammation of the pleura

when the visceral and parietal pleura are rubbing during respiration

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60
Q

air in lungs =

A

affected side up

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61
Q

fluid in lungs =

A

affected side down

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62
Q

emphysema

A

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

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63
Q

what does emphysema look like on an x ray

A

lungs appear very dark
lungs are bigger
may need to reduce exposure factors

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64
Q

pericardial sac

A

double walled membrane that surrounds the heart

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65
Q

important parts to see on a PA chest x ray

A

clavicles, ribs, scapula, trachea, apex, carina, base, diaphragm, costophrenic angles, hilum

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66
Q

lateral chest

A

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

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67
Q

what is seen on a lateral chest x ray

A

right and left hemidiaphragm, apex, upper/lower lobe, hilum, base

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68
Q

mediastinum

A

medial portion of the thoracic between the lungs.

space between the lungs

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69
Q

heart and great vessels

A

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

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70
Q

great vessels include:

A

superior/inferior vena cava, aorta, pulmonary arteries, and veins

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71
Q

superior vena cava

A

returns blood to the heart from upper half of body

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72
Q

inferior vena cava

A

returns blood to the heart from the lower half of body

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73
Q

aorta

A

largest artery in the body

carries blood to all parts of the body through its various branches

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74
Q

ascending aorta

A

comes up out of the heart

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75
Q

aortic arch

A

makes a turn downward here

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76
Q

descending aorta

A

continues downward

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77
Q

abdominal aorta

A

what it becomes when it passes through the diaphragm

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78
Q

pulmonary arteries and veins

A

supply blood and return blood to and from all segments of the lungs

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79
Q

body habitus

A

refers to the common variations in the shape of the human body

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80
Q

body habitus directly affects the location of

A

the heart, lungs, diaphragm, stomach, gallbladder, large intestine

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81
Q

4 types of body habitus

A

1 sthenic
2 hyposthenic
3 asthenic
4 hypersthenic

82
Q

hypersthenic

A 
massive build
thorax is broad and deep
need more room side to side 
5% of people 
IR placed crosswise
83
Q

asthenic

A

slender build
thorax narrow and shallow
IR must be long enough to include costophrenic angles
10%

84
Q

Sthenic

A

average patient

50%

85
Q

inspiration

A

act of drawing air into lungs

inhalation

86
Q

expiration

A

breathing out

exhalation

87
Q

during inspiration the thoracic cavity increases in what 3 dimensions

A

1 vertical
2 transverse
3 anteroposterior

88
Q

vertical diameter

A

diaphragm moves down and increases thoracic volume

89
Q

transverse diameter

A

ribs swing outward and upward

90
Q

anteroposterior diameter

A

raising the ribs

91
Q

how many ribs are needed in a PA chest radiograph

A

10 ribs minimun

92
Q

patient prep

A

remove opaque objects
clothing artifacts
long hair fastened

93
Q

radiation protection

A

limit repeat exposures
collimate
use lead shielding

94
Q

kilovoltage

A

(kVp) 110-125 kV
Demonstrates may shades of gray needed to visualize lung markings
high kV needs grids

95
Q

exposure time and miliamperage

A

high mA and short exposure times reduce motion

sufficient mAs is needed to provide optimum density of lungs and mediastinal structures

96
Q

optimal density

A

able to see faint outlines of at least mid and upper vertebrae and ribs through the heart

97
Q

Pediatric applications of chest x rays

A

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
Q

Geriatric patients

A

higher Central ray location because older people have less inhalation capacity

99
Q

pneumonia

A

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
Q

geriatric patient handling

A

more care, time and patience

supporting them in the positioning process

101
Q

breathing instructions

A

chest radiographs are take on full inspiration

hold breath on second full inspiration

102
Q

reasons you may need to do an inhalation and expiration radiograph

A

small pneumothorax
presence of foreign body
atelectasis

103
Q

atelectasis

A

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
Q

3 main reasons for erect chest position

A
  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
Q

engorgement

A

distended or swollen with fluid

106
Q

hyperemia

A

an excess of blood partially resulting from a relaxation of the distal small blood vessels

107
Q

what is the SID for a PA chest projection

A

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
Q

evaluation criteria

A

goal: optimal radiograph
definable standard so every chest radiograph can be evaluated
established standards as stated for each projection/position

109
Q

Rotation

A

proper positioning prevents rotation
weight must be evenly distributed
rotation can be detected by the asymmetric appearance of the sternoclavicular joints

110
Q

lateral chest position

A

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
Q

Lateral with no rotation

A

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
Q

Lateral chest with tilt

A

can be demonstrated by closed intervertebral disk spaces

113
Q

central ray positioning

A

two bony landmarks can provide a consistent and reliable means of determining CR location
can use vertebra prominens or jugular notch

114
Q

C1

A

mastoid tip

115
Q

C2, C3

A

angle of mandible

116
Q

C3, C4

A

hyoid bone

117
Q

C5

A

thyroid cartilage

118
Q

C7, T1

A

vertebra prominens

119
Q

T1

A

aprox. 2 inches above the jugular notch

120
Q

T2, T3

A

level of jugular notch

121
Q

T4, T5

A

level of sternal angle

122
Q

T7

A

level of inferior angles of scapula

123
Q

T9, T10

A

level of xiphoid process

124
Q

L2, L3

A

inferior costal margin

125
Q

L4, L5

A

level of superior aspect of iliac crest

126
Q

central ray chest positioning for PA

A

after palpating the vertebra prominens measure 7 inches down for females and 8 inches down for males

127
Q

recumbant AP chest radiographs

A

usually taken at an SID of less than 72 inches

128
Q

4 digital imaging considerations

A
  1. collimation
  2. accurate centering
  3. exposure factors
  4. post processing evaluation
129
Q
  1. collimation
A

reduces dose

reduces scatter

130
Q
  1. accurate centering
A

important that the body part and central ray be accurately centered to the IR

131
Q
  1. exposure factors
A

use highest kV with lowest mAs
ALARA
radiation protection

132
Q
  1. post processing evaluation
A

the image will be critiqued for positioning and exposure accuracy

133
Q

conventional and computed tomography

A

conventional is used for locating leisons found on chest films, but CT is used for such purposes

134
Q

Bronchography

A

contrast media introduced into bronchial tree to rule out certain pathologies
been replaced by CT

135
Q

sonography

A

may be used to detect pleural effusions

ultrasound

136
Q

echocardiogram

A

ultrasound of the heart

137
Q

nuclear medicine

A

used to evaluate and diagnose pulmonary diffusion conditions or pulmonary emboli

138
Q

magnetic resonance imaging MRI

A

used to evaluate and diagnose pathologies in the soft tissues

139
Q

lateral projection on a cart

A

patient seated on cart
place support behind patient as necessary
ensure cart is locked
chin elevated

140
Q

lateral projection in a wheelchair

A 
remove armrests 
place wheelchair close to IR 
place support behind their back
chin elevated
arms not in the way
141
Q

true or false don’t put x ray tube in detent if the IR is underneath the patient

A

TRUE

142
Q

special projections of the chest

A 
AP supine or semierect
lateral decubitus
AP lordotic
anterior oblique position (PA oblique projection)
posterior oblique
143
Q

PA projection Anterior oblique position

A

LAO will provide best visualization of RIGHT lung

RAO will provide best visualization of LEFT lung

144
Q

AP oblique projection posterior oblique positions

A

RPO will provide best visualization of RIGHT lung

LPO will provide best visualization of LEFT lung

145
Q

The RPO position corresponds to the

A

LAO position

146
Q

The LPO position corresponds to the

A

RAO position

147
Q

viewing lateral projections

A

marked by R or L by side of patient closest to IR

common to view images from same perspective as xray tube

148
Q

viewing PA/AP oblique projections

A

patients right to viewers left

viewed the same as for AP and PA projections

149
Q

viewing decubitus chest and abdomen

A

viewed the way the xray tube sees them

the upside of the patient is at the top of the viewbod

150
Q

viewing upper and lower limbs

A

viewed as if you were looking from xray tube
images with digits have digits facing up
viewed in anatomic position

151
Q

viewing CT or MRI

A

axial images are viewed so patients right side is to viewers left

152
Q

exposure factors

A

radiographer sets 3 exposure factors on control panel

  1. kilovoltage
  2. miliamperage
  3. exposure time
153
Q

radiographers are allowed how many milirem a year

A

5,000 milirem a year

154
Q

Roentgen

A

used for measurements in air

columbs/kg

155
Q

RAD

A

radiation absorbed dose
used for patient dose purposes
gray

156
Q

Rem

A

radiation equivalent man
used for worker protection purposes
sievert

157
Q

pregnant technologists

A

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
Q

TLD

A

thermoluminescent dosimeter

159
Q

OSL

A

optically stimulated luminescence
what we use
worn at waist or collar

160
Q

cardinal rules of radiation protection

A
  1. time
  2. distance (most important)
  3. shielding
161
Q

fluoroscopy safety practices

A

bucky slot cover
lead drape
lead apron
exposure limit

162
Q

patient protection

A

minimum repeat radiographs
clear instructions
position properly

163
Q

one of the best ways to reduce patient exposure is

A

close four sided collimation

164
Q

radiation protection practices

A 
minimum repeat radiographs 
correct filtration
accurate collimation 
specific area sheilding
protection for pregnancies
165
Q

2 types of collimators

A

manual type

positive beam limitation

166
Q

gonadal shielding

A

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
Q

PA chest pathology demonstrated

A

pleural effusions
pneumothorax
atelectasis

168
Q

PA chest technical factors

A

35x43 cm IR
grid
110-125 kVp
minimum SID of 72 inches

169
Q

PA chest shielding

A

shield between xray tube and patients pelvis

shield the gonads

170
Q

PA chest positioning

A 
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
Q

PA chest part positioning

A

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
Q

PA chest central ray position

A

perpendicular to center of IR

centered to MSP at level of T7

173
Q

PA chest criteria

A 
both lungs from apicies to sotophrenic angles 
air filled trachea
hilum region 
heart
great vessels 
bony thorax
174
Q

Lateral chest pathology demonstrated

A

90 degree perspective

demonstrates pathology posterior to heart and great vessels

175
Q

Lateral chest sheilding

A

shield around waist

shield gonads

176
Q

lateral chest technical factors

A

grid
110-125 kVp
minimum SID of 72 inches
IR size of 35x43 cm

177
Q

lateral chest patient position

A 
erect 
left side against IR 
weight evenly distributed
arms are raised above head
chin elevated
178
Q

lateral chest part position

A

patient centered to the CR and IR anteriorly and posteriorly
MCP is perpendicular to IR
MSP is parallel to the IR

179
Q

lateral chest central ray position

A

perpendicular to the midthorax at the level of T7

180
Q

Lateral chest structures shown

A

entire lungs included
apices to costophrenic angles
sternum to posterior ribs and thorax

181
Q

AP supine/semi erect chest pathology demonstrated

A

pathology involving lungs, diaphragm and mediastinum

182
Q

AP supine/semi erect chest technical factors

A

with or without grid
35x43 IR
90-110 kVp with grid
70-80 kVp without grid

183
Q

AP supine/semi erect chest patient position

A

when possible should be erect/semi erect

roll shoulders when possible

184
Q

AP supine/semi erect chest part positioning

A

IR placed under or behind patient

center of IR aligned to the CR

185
Q

AP supine/semi erect chest central ray position

A

angled caudad to be perpendicular to the long axis of sternum
minimum of 40 SID when supine

186
Q

Lateral decubitus pathology demonstrated

A

small pleural effusions

small pneumothorax

187
Q

Lateral decubitus technical factors

A

35x43 cm IR
grid
110-125 kVp
72 inch SID when possible

188
Q

Lateral decubitus patient positioning

A

lying on affected side or unaffected side as indicated
chin elevated
coronal plane parallel to IR

189
Q

Lateral decubitus Central Ray

A

CR horizontal at the level of T7

horizontal beam must be used

190
Q

AP lordotic pathology demonstrated

A

rule out calcifications and masses beneath the clavicles

191
Q

AP lordotic patient positioning

A

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
Q

AP lordotic part position

A

MSP centered to middle of IR
center IR to the CR
top of IR about 3 inches above shoulders

193
Q

Lateral upper airway technical factors

A

10x12 inch IR
grid
80 kVp

194
Q

lateral upper airway patient position

A

upright

right of left

195
Q

lateral upper airway part position

A

center area of interest to CR and center of IR
rotate shoulders posteriorly
raise chin
look straight ahead

196
Q

lateral upper airway respiration

A

made during slow deep inspiration

197
Q

lateral upper airway criteria

A

larynx and trachea filled with air and well visualized

include EAM external auditory meatus (ear)

198
Q

AP upper airway pathology demonstrated

A

air filled larynx and trachea

pathology involving thyroid and thymus glands

199
Q

AP upper airway technical factors

A

10x12 inch IR
grid
75-80 kVp
minimum 40 SID

200
Q

AP upper airway patient position

A

upright if possible

back against IR

201
Q

AP upper airway part position

A

align MSP with CR and midline of grid

202
Q

AP upper airway respiration

A

made during slow deep inspiration

Radiographic Positioning (2 decks)

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