Thoracic Review Flashcards
Function of filtration in thoracic films
Creates consistent radiographic density for anatomy shown.
What is the main difference between cervicals and thoracic films?
Thoracics = align film to part, then CR to film
Filtration = always place over the ______ portion of the anatomy as the CR goes through the part to maintain consistent radiographic density on the final image
Thinnest
-We use filtration to help protect the anatomy
Set-Up Flow for thoracic views
1) Measure for all set-ups in the series
2) Set control panel
3) Set SID
4) Set collimation and apply side marker
5) Apply lead shielding to patient
6) Positon patient at bucky
7) Align cassette to patient
8) Align CR to center of cassette
Thoracic spine series
- What if a patient is > 50?
- > 60?
AP Thoracic and Lateral Thoracic
> 50 = add PA chest if >50 and main complaint is thoracic
> 60 = add PA chest and lateral chest
AP Thoracic \_\_SID \_\_Film \_\_Collimate \_\_CR \_\_Filtration \_\_Breathing instructions
- 40”
- 14x17
- 7x17 (ID blocker down)
- Top of cassette 1.5 inches above VP
- CR to mid-film
- Filter upper vertebrae down to cross hairs of CR
- Inhale and hold
Image Criteria for AP Thoracic
- Spine in center of image, including T1 through T12
- Spinouses align with midline of vertebral bodies
- Distance between vertebral column to ends of clavicle equal
- Distance from pedicles to spinous processes are equal on both sides
- Uniform film density from top to bottom of thoracics
Lateral Thoracic \_\_SID \_\_Film \_\_Collimate \_\_CR \_\_Filtration \_\_Breathing instructions
- 40”
- 14x17
- 10x17
- Align film to part and horizontal CR to film (like AP)
- Vertical CR 1” posterior to humeral head
- Filter lower vertebrae (up to cross hair of CR)
- Place side marker and raise arms
- Breathing technique or inspiration and hold
Breathing Technique
- Patient breathes during exposure to blur ribs
- Need minimum 2 second exposure (compensate by decreasing MA)
Special considerations for C-spine and T-spine
- Do seated if possible (weight-bearing, wheelchair)
- Do recumbent if not tolerated
- Stabilizing accessories may be needed (like leaded assistants
- Adapt equipment to accommodate exaggerated curvatures
Lateral Thoracic Image criteria
- Include T1-T12
- IVF’s and disc spaces open
- Pedicles in profile
- Posterior borders of bodies and ribs superimposed
- Uniform density
Routine Rib series
- AP or PA rib (unilateral or bilateral)
- Posterior oblique ribs (one per injured side)
- PA chest (rule out pneumothorax)
Unilateral AP or PA Ribs \_\_SID \_\_Film \_\_Collimate \_\_CR \_\_Filtration \_\_Breathing instructions
- 40”
- 14x17
- Injured part closest to bucky
- Above Diaphragm = top of cassette 1.5” above VP
- Below Diaphragm = bottom of cassette at Iliac crest
- Place cassette to part and then CR to mid-film
- AD = inspire and hold,
- BD = expire and hold
Bilateral AP or PA Ribs \_\_SID \_\_Film \_\_Collimate \_\_CR \_\_Filtration \_\_Breathing instructions
- 40”
- 14x17
- Injured part closest to bucky
- AD = top of cassette 1.5” above VP
- BD = bottom of cassette at iliac crest
- AD = inspire and hold
- BD = expire and hold
Posterior Oblique Ribs (one side) \_\_SID \_\_Film \_\_Collimate \_\_CR \_\_Filtration \_\_Breathing instructions
- 40”
- 14x17
- Rotate unaffected side 45 degrees away from bucky
- AD = top of cassette 1.5” above VP
- BD = bottom of cassette @ iliac crest
- AD = inspire and hold
- BD = expire and hold
** Do both obliques if bilateral study **
Thoracic Stress Points
- Should be done weight bearing (standing or seated; seated helps stabilize the patient)
- Use sternal notch (T2 level) as double check for correct cassette placement
- “inhale and hold” for thoracic spine and ribs above the diaphragm
- “exhale and hold” for thoracic spine and ribs below the diaphragm
Introduction to Lumbosacral spine
- Standing or recumbent
- ID blocker up/away from anatomy
- R and L markers within collimation (mid-way along side edge of collimation)
- Breathing instruction is exhale and hold for ALL views
- CR –> center of part –> mid-film to CR
Set-Up flow for Lumbars
1) Set SID
2) Align cassette in bucky
3) Measure for all set-ups in the series
4) Set control panel
5) Apply gonad shield (APLP and AP full spine ONLY)
6) Position patient
7) Center CR, part, and cassette
Special considerations for Lumbar views
- May be done recumbent (stabilize patient, address comfort issues, better images for fat patients)
- Allow patient to use visual, hearing, and mobility aids as long as possible
- Allow patient to rest between set-ups
Center of anatomy for APLP and Lumbar spine with respect to the iliac crest
APLP = Areas below the iliac crest
Lumbar spine (lateral and obliques) = above the iliac crest
Placing the belt for APLP
- Red velcro goes in front
- Rests 1-2” below the iliac crests (between crest and greater trochanter)
- Locate top of greater trochanter (represents top of Pubic symphysis)
- Place top of shield just below the pubic arch (1.5” below GT/PS) for males
- Place bottom tip of shield just superior to PS/GT for females (position widest part just medial and inferior to the ASIS on each side)
APLP \_\_SID \_\_Film \_\_Collimate \_\_CR \_\_Filtration \_\_Breathing instructions
- 40”
- 14x17
- 1x17
- CR 1” below crest for females and 2” below crest for males
- Marker at mid film along edge of collimation
- Expire and hold
- Place bottom of film to include ischial tuberosities, then CR to mid-film
- Keep back of heels straight down from the front of bucky
What if we take an APLP and we clip L1, what do we do next?
-What if we clip Ischial tuberosities?
L1 clip = take separate AP shot
IT clip = move film and CR down
Look for symmetry of the iliac wings and obturator foramina
(male shield must NOT overlap top of PS or IT bottoms)
Lateral Lumbar \_\_SID \_\_Film \_\_Collimate \_\_CR \_\_Filtration \_\_Breathing instructions
- 40”
- 14x17
- 10x17
- Scoliosis? = place convexity next to the bucky
- Large hips? = add filter down to crest (measure side to side about 2-3” below the crest”
T/F Lateral Lumbar is the same film as Lumbo-pelvic
FALSE
-Lateral Lumbar has a higher center and does not include all of sacrum and pelvis
Why is it important to collimate to part size?
- Reduces scatter fog/higher contrast
- Critical for CR and DR
- Produces better image
- Large enough to accommodate hyperlordosis or XL patients
Critical Anatomy visualized on Lateral Lumbar
- Posterior ribs are superimposed
- IVF’s open
- Iliac crests superimposed and mid-film
- NO “hour-glassing” (shoot into the cave)
- IF L5/S1 is too light, do additional spot shot
Additional Lumbar Views
- L5/S1 Lateral Spot Shot (10x12 or 8x10)
- Oblique Lumbars (do set to view Pars)
L5/S1 Lateral Spot Shot \_\_SID \_\_Film \_\_Collimate \_\_CR \_\_Filtration \_\_Breathing instructions
- 40”
- 10x12
- 8x10
- Side next to bucky, arms up
- Center 2-3” below crest and 1” posterior to midline
- NO shield
Measure R to L 2-3” below the crest
Anterior Obliques Lumbar \_\_SID \_\_Film \_\_Collimate \_\_CR \_\_Filtration \_\_Breathing instructions
- 40”
- 10x12
- 10x12
- Begin with patient in a PA position and rotate the body either 45 degrees (upper segments) or 30 degrees (lower segments)
- CR 1” above crest and 1” lateral to spine toward side of interest
What is the only difference between standing anterior obliques and recumbent anterior obliques in the lumbars?
Recumbent compresses the soft tissues so it requires 30% less mAs
Posterior Obliques Lumbar \_\_SID \_\_Film \_\_Collimate \_\_CR \_\_Filtration \_\_Breathing instructions
- 40”
- Side of interest closest to film
- 10x12
- 10x12
- Begin with patient AP, then rotate 30-45 degrees
- CR 1” above the crest and 2” medial to ASIS closest to tube
Image Criteria for Obliques
- Scottie Dog should be apparent and appear similar from one level to the next
- NO IVF’s present
- Iliac crests will be asymmetrical
- Centering point is 1” above the crest
T/F Posterior Lumbar Obliques are preferred over Anterior Lumbar Obliques
FALSE.
Anterior Lumbar Obliques are preferred because they provide less exposure to the patient and allow us to shoot into the natural curvature of the lumbar spine
Makes up the sacrum series
- AP Sacrum (15 degree cephalic tilt)
- Lateral sacrum
AP Sacrum \_\_SID \_\_Film \_\_Collimate \_\_CR \_\_Filtration \_\_Breathing instructions
- 40”
- 10x12
- 10x12
- 15 degree cephalic tilt
- CR enters 2” below ASIS (or at level or mid pelvis 1/2 way between ASIS and PS)
- NO shield
- Don’t breathe, don’t move
Lateral Sacrum \_\_SID \_\_Film \_\_Collimate \_\_CR \_\_Filtration \_\_Breathing instructions
- 40”
- 10x12
- 10x12
- CR 3” below the crest and 1” posterior to mid-axillary line
- NO shield
Coccyx Series
- AP Coccyx
- Lateral Coccyx
AP Coccyx \_\_SID \_\_Film \_\_Collimate \_\_CR \_\_Filtration \_\_Breathing instructions
- 40”
- 10x12 film
- 4x4
- 10 degree caudal tilt
- Center to mid-pelvis
- NO shield
Lateral Coccyx \_\_SID \_\_Film \_\_Collimate \_\_CR \_\_Filtration \_\_Breathing instructions
- 40”
- 10x12 film
- To part size
- CR 2” posterior to GT
Sacrum/Coccyx Combo
- Lateral Combo
- 2 for 1
Takes place of AP Sacrum, AP Coccyx, and Lateral Sacrum and Coccyx
1) Lateral Combo
- Measure as for lateral sacrum (10x12 collimation)
2) 2 for 1
- Load cassette with 2 films or filter coccyx or adjust image digitally
AP Full Spine \_\_SID \_\_Film \_\_Collimate \_\_CR \_\_Filtration \_\_Breathing instructions
- 72”
- 14x36 (ID blocker up)
- Back to full spine on bucky (arms abducted and upper occlusal plane parallel to floor)
- Collimate below the eyes and 3” below the PS and 14” wide
- FILTER upper thoracics down to axilla
- Inhale and hold
Full Spine Series
- AP 14x36
- APOM (or AP C-spine)
- Lat C-spine
- Lat T-spine
- Lat L-Spine
Sectional Full Spine Series
- AP C-spine
- APOM C-spine
- Lat C-spine
- AP T-spine
- Lat T-spine
- APLP
- Lat L-spine
Lumbar stress points:
1) ___________ is best for biomechanics
2) Gonadal shielding is used for ____ and ____ only
3) CR _____ crest for lateral and obliques
4) CR ____ crest for AP and lateral L5-S1 spot
5) Breathing is ____________ for all
1) Standing
2) APLP and AP full spine
3) Above
4) Below
5) Exhale and hold
