Chp 2: Chest

-Routine PA Chest -AP Chest -Soft Tissue Neck -Lordotic Chest

4 structures of the mediastinum

• heart & vessels

• thymus

• esophagus

• trachea

mediastinum

space between lungs

the bony thorax includes

• sternum

• clavicles

• scapulae

• 12 pairs of ribs

• 12 thoracic vertebrae

4 divisions of respiratory system

• pharynx

• trachea

• bronchi

• lungs

landmarks for chest AP & PA xray

• jugular notch

• vertebra prominens (C7)

density

• amount of blackness on an image

• controlled by mAs

15% density maintenance rule

• 15% increase in kVp approximately doubles receptor exposure, so mAs must be halved to maintain the same density

• 15% decrease in kVp approximately halves receptor exposure, so mAs must be doubled

density adjustment rule

a minimum of 25-30% change in mAs is needed to produce noticeable change in density

contrast

• variation in density (how black or white an image is)

• controlled primarily by kvp

low contrast

• long scale (grey elephant)

• lots of shades of grey

• caused by high kVp (e.g., chest requires higher kVp than hands, therefore image has lower contrast)

high contrast

• short scale (Mickey Mouse)

• black & white, no shades of grey

• caused by low kVp (e.g., hands require lower kVp than chest, results in higher contrast to be able to clearly see bone)

pneumonia

fluid/infection inside lung

• appear white within lung

pneumothorax

air in pleural space (outside lung between lung & chest wall) causing the lung to collapse

• appear black w/no lung markings

pleural effusion

fluid outside lung (in pleural space)

• appear white/hazy typically at the bottom of lungs

a specific prominence or ridge found at the point where the internal distal trachea divides into the right and left bronchi is called the

A. hilum

B. carina

C. epiglottis

D. alveoli

B. carina

the area of each lung where the bronchi and blood vessels enter and leave is called the

a. carina

b. apex

c. base

d. hilum

d. hilum

the structures within the lung in which oxygen and carbon dioxide gas exchange occurs are called

a. carina

b. alveoli

c. hilum

d. bronchi

b. alveoli

which of the following is NOT a valid reason to perform chest projections with the pt in the erect position?

a. to reduce pt dose

b. to demonstrate air & fluid levels

c. to allow diaphragm to move down further

d. to prevent hyperemia of pulmonary vessels

a. to reduce pt dose

why are the shoulders pressed downward and toward the IR for a PA projection of the chest?

a. to allow visualization of air filled larynx

b. to prevent hyperemia of pulmonary vessels

c. to allow diaphragm to move down farther

d. to reduce chest rotation

d. to reduce chest rotation

which of the following terms is defined as shortness of breath?

a. dyspnea

b. bronchiectasis

c. pleurisy

d. atelectasis

a. dyspnea

a condition in which all or a portion of the lung is collapsed is

a. atelectasis

b. pleural effusion

c. pneumothorax

d. pneumoconiosis

a. atelectasis

a condition in which excess fluid builds in the lungs as a result of obstruction of the pulmonary circulation is termed

a. pulmonary emboli

b. pneumothorax

c. pulmonary edema

d. bronchopneumonia

c. pulmonary edema

a sudden blockage of an artery in the lung is called

a. pleurisy

b. pulmonary emboli

c. adult respiratory distress syndrome (ARDS)

d. chronic obstructive pulmonary disease (COPD)

b. pulmonary emboli

which of the following is NOT a form of occupational lung disease?

a. asbestosis

b. silicosis

c. anthracosis

d. tuberculosis

d. tuberculosis

a PA chest radiograph shows left sternoclavicular joint is superimposed over spine. what specific positioning error is involved?

a. poor inspiration

b. rotation into right anterior oblique (RAO) position

c. rotation into left anterior oblique (LAO) position

d. tilting of chest toward left

c. rotation into left anterior oblique (LAO) position

an ambulatory pt with clinical history of advanced emphysema enters ER. pt is having difficulty breathing & is receiving oxygen. physician ordered PA & lateral chest study. should tech alter manual exposure factors for pt?

a. no. use standard exposure factors

b. yes. increase exposure factors

c. yes. decrease exposure factors

d. no. increase SID instead of changing exposure factors

c. yes. decrease exposure factors

pt enters ER with injury to chest. ER physician suspects pneumothorax may be present in right lung. pt unable to stand or sit erect. which specific position or projection can be performed to confirm presence of pneumothorax?

a. left lateral decubitus

b. inspiration & expiration PA

c. right lateral decubitus

d. AP lordotic

a. left lateral decubitus

pt with history of pulmonary edema comes to radiology dept & unable to stand. physician suspects fluid in left lung. which specific projection should be used to confirm diagnosis?

a. right lateral decubitus

b. AP axial

c. AP lordotic

d. left lateral decubitus

d. left lateral decubitus

pulmonary edema

excess fluid build up inside lung air sacs

• appear as batwing pattern of fluid (white) around heart

how do vascular markings differ in upper & lower lungs?

they are thinner in upper lungs

how do you know there is no rotation for AP/PA chest?

sternal ends (medial) of clavicles are the same distance to the spinous process

SID for AP soft tissue neck?

40 in

what is breathing instruction for soft tissue neck?

slow inspiration

collimation for lateral soft tissue neck

height of 12 in

CR for lateral soft tissue neck

laryngeal prominence

SID for lateral soft tissue neck?

72 in

how much should top margin of IR be above the shoulders for lordotic chest?

3 in

CR for lordotic chest?

mid sternum (3-4 in below jugular notch; same as AP chest)

breathing instructions for lordotic chest?

2nd inspiration (same as regular chest)

pt position for erect lordotic chest?

standing with back against IR. Have the patient push their shoulders against the IR and step forward one to two feet

how do you know if there is enough inspiration for routine chest (PA)?

9-10 ribs above diaphragm