RT 100 Unit 3 Ch. 2: Chest

Why are most chest x-rays PA (posteroanterior)?

minimizes heart magnification and sharpens details in the lungs

Which projection of the chest causes the heart to look enlarged?

AP (anteroposterior)

The path of the central ray is called ___.

projection

The general body orientation described by the body part closest to the IR is called ___.

position

The _____ provides a protective framework for the parts involved with breathing and blood circulation.

a. Respiratory system

b. Bony thorax

c. Mediastinum

d. Pleural cavity

b. Bony thorax

Name all of the parts of the bony thorax

sternum

clavicles

scapulae

12 pairs of ribs

12 thoracic vertebrae

The superior portion of the sternum is called the ____.

a. xiphoid process

b. body

c. manubrium

d. ribs

c. manubrium

The large center portion of the sternum is the ___.

a. xiphoid process

b. body

c. manubrium

d. ribs

b. body

The smaller inferior tip of the sternum is the ____.

a. xiphoid process

b. body

c. manubrium

d. ribs

a. xiphoid process

Which part of the bony thorax articulates with the manubrium and scapulae?

a. Clavicles

b. Upper ribs

c. Vertebrae

d. Diaphragm

a. Clavicles

The ____ lie posterior to the ribs

a. Clavicles

b. Scapula

c. Vertebrae

d. Lungs

b. Scapula

All 12 ribs connect to the ___.

a. Cervical spine

b. Thoracic spine

c. Lumbar spine

d. Sacrum

d. Thoracic spine

Which two landmarks are used for positioning the chest for imaging procedures?

a. Jugular notch and xiphoid process

b. Vertebra prominens (C7) and inferior costal rib margin

c. Sternal angle and jugular notch

d. Jugular notch and vertebra prominens (C7)

D. Jugular notch and vertebra prominens (C7)

Which landmark is important for positioning the CR on a PA chest?

a. Jugular notch

b. Xiphoid process

c. Vertebra prominens (C7)

d. None of the above

c. Vertebra prominens (C7)

How can you locate the vertebra prominens (C7)?

Palpate down the back of your neck when you bend your head down

Which landmark is important for positioning the CR on an AP chest?

a. Jugular notch

b. Xiphoid process

c. Vertebra prominens (C7)

d. None of the above

a. Jugular notch

Which two landmarks help locate the midthorax (T7) in order to center the CR for a PA chest?

a. Jugular notch and xiphoid process

b. Vertebra prominens (C7) and inferior costal rib margin

c. Sternal angle and jugular notch

d. Jugular notch and vertebra prominens (C7)

D. Jugular notch and vertebra prominens (C7)

True or False: The xiphoid process is a reliable positioning landmark for determining the lower margin of the lungs for chest positioning.

False: It varies with different body habitus that affect the position of the lower half of the lungs

The xiphoid process corresponds to the vertebral level of:

a. T7-T8

d. T8-T9

c. T9-T10

d. T11-T12

c. T9-T10

The xiphoid process corresponds to the approximate level of the anterior portion of the _____.

a. Lungs

b. Stomach

c. Heart

d. Diaphragm

d. Diaphragm

The lungs and airways are part of a system associated with gaseous exchanges between the air we breath and the bloodstream. What is this system called?

Respiratory system

Which of the following make up the respiratory system?

a. Pharynx

b. Trachea

c. Lungs

d. Esophagus

A, B, & C

The white space between the double-walled pleura that contains fluid and allows lung movement is referred to as the _____.

a. Parietal

b. Pulmonary-visceral

c. Pleural cavity

d. All of the above

c. Pleural cavity

Air or gas pressure present in the pleural cavity causing a collapsed lung is a condition called ___.

pneumothorax

Accumulation of blood in the pleural cavity is called ____.

hemothorax

Fluid within the pleural cavity is called ____.

pleural effusion

The ridge of the lowest part of the trachea that marks the division of the right and left bronchi is the ____.

carina

True or False: The right lung is made up of two lobes while the left lung is made up of three lobes

False: right has three lobes and left has two lobes

Where is a common spot for tuberculosis?

Apex of the lungs

Extreme outermost lower corners where the diaphragm meets the ribs are known as the ____.

Costophrenic angle

Lower concave area of the lung that rests on the diaphragm is the _____.

Base of the lung

The space between the lungs where the heart, great vessels, and trachea lie is called ____.

Mediastinum

The great vessels in the mediastinum include ___.

a. Bronchi

b. Superior vena cava

c. Inferior vena cava

d. Aorta

B, C, & D

True or False: Approximately two thirds of the heart lies to the left of the body

True

Which great vessel returns blood to the heart from the upper half of the body?

Superior vena cava

Which great vessel returns blood to the heart from the lower half of the body?

Inferior vena cava

Which great vessel is the largest artery that supplies blood to all parts of the body?

Aorta

If a patient has a hypersthenic body habitus, which way are you turning the IR?

Landscape

If a patient has a hyposthenic or asthenic body habitus, which way are you turning the IR?

Portrait

Major organs of the body are on the opposite side is a condition known as ___.

situs inversus

How do you know if the degree of inspiration is optimal for demonstrating the anatomy of interest?

You can count at least 10 posterior ribs

How are you positioning a patient for a PA chest exam?

chest against board, feet shoulder-width apart with weight equally distributed, head forward and chin up, hands on hips with palms out, roll shoulders forward

If a patient has bigger breasts, the radiographer should ___.

a. Leave them in the image

b. Lead mask them off the image

c. Tell the patient to move them

d. Do a lateral instead of a PA

c. Tell the patient to move them

What are the technical factors for chest images?

High kVp range: 110-125

14x17 IR

Grid

72" SID

Short exposure time

High mAs: 300-500 (avg. 400)

True or False: Exposure is made at then end of the first full inspiration

False: it is made at the second full inspiration because you hold more air

Where do you center the CR for a PA chest?

T7

The CR and IR should be lowered to the level of T7 so that the top of the IR sits about ____ on an average patient.

a. 2-3 inches below

b. 1-1 1/2 inches above

c. 1 1/2 - 2 inches above

d. 1-2 inches below

c. 1 1/2 - 2 inches above

Why is a higher kV needed for chest xrays?

a. Helps see the finer details in the lungs and heart

b. Helps adjust contrast to better demonstrate the gray areas

c. Helps visualize any lesions, foreign bodies, or pathological conditions

d. Helps block out any tissue superimposing onto the anatomy of interest

A & B

Having a higher milliamperge and shorter exposure time helps ____.

a. Visualize vascular markings on the heart

b. Demonstrate fluid levels in the lungs

c. Reduces motion in the heart

d. All of the above

c. Reduces motion in the heart

Which of the following are reasons for why chest radiographs are taken erect?

a. Prevents engorgement of pulmonary vessels

b. Demonstrates air fluid levels

c. Easier to deeply inhale

d. Allows diaphragm to move further down

All are correct

To better visualize details in the lungs, the photocells need to be ___.

right and left

Why is a left lateral the standard way to take a lateral view of the chest?

Better demonstrates the heart since it mainly sits on the left side

A radiograph of a PA projection of the chest shows some asymmetry of the clavicles. What positioning error occurred?

Rotation

Which projections of the chest best demonstrate air fluid levels in the lungs?

a. PA erect

b. Lateral

c. AP supine

d. Lateral decubitus

A & D

A radiograph of a lateral projection of the chest shows supeimposition of the costophrenic angles and posterior ribs. Did the radiograph demonstrate a true lateral?

Yes

Which of the following are areas of interest to look for in a lateral chest image?

a. Sternum

b. Diaphragm

c. Heart

d. Clavicles

A & C

True or False: Arms should be moved out of the way to not obscure the image

True

Demonstraing air fluid levels in a semi-erect position requires a _____ on the CR to prevent clavicles from obscuring the pulmonary apices

a. 5* cephalad angle

b. 10* caudad angle

c. 3* cephalad angle

d. 5* caudad angle

d. 5* caudad angle

True or False: The decubitus position always requires a horizontal beam

True

Which projection of the chest can be used for look for pathological conditions in the pulmonary apices?

a. AP semi-erect

b. AP axial (lordotic)

c. Lateral decubitus

d. PA

b. AP axial (lordotic)

If a patient is unable to assume the erect lordotic position, what other position could be used?

AP semi-axial lordotic with a 15-20 cephalad angle

True or False: Anatomy demonstrated in a right anterior oblique projection will also be the same in a left posterior oblique projection

True

True or False: Anatomy demonstrated in a right posterior oblique projection will not be the same in a left anterior oblique project

False: it will be the same

Why do chest radiographs require a longer SID?

decreases divergence in x-ray beam resulting in less magnification of the heart

Which chest projections are difficult to achieve a 72” SID?

a. PA

b. Lateral

c. AP supine

d. AP semi-erect

C & D

What is a method to use to prevent the lungs from getting cut off during a lateral decubitus?

build up patient using radiolucent blocks

If you’re demonstrating free air in the lungs, your technique, which involves your kVp and mAs, should ____.

decrease

If you’re demonstrating free fluid in the lungs, your technique, which includes your kVp and mAs, should ____.

increase

What are you looking for in AP and lateral projections of the upper airway?

air in the trachea