Ch 2 Chest

Chest X-ray Overview

chest is the most common radiographic procedure

reasons?

trouble breathing, chest pain, trauma

the chest/thorax is divided into what 3 parts?

bony thorax

respiratory system

mediastinum

Bony Thorax

what does this provide? what does the framework include?

provides protection to respiratory + circulatory system

framework:

- sternum = 3 parts

a) manubrium = superior portion

b) body = center

c) xiphoid process = inferior

- 2 clavicles - 2 scapulae - 12 pairs of ribs

- 12 thoracic vertebrae

label parts

A - clavicle (2)

B - scapula (2)

C - ribs (12 pairs)

D - thoracic vertebrae (12)

E - xiphoid process (inferior)

F - body (center)

G - manubrium (superior)

H - sternum (3 parts, G/F/E, top to bottom)

What are the 3 positioning landmarks for chest x-ray?

1. vertebra prominens

spinous process of C7, may be easier to find if neck is flexed, good for PA chest positioning

2. jugular notch

deep notch on superior portion of sternum, good for AP chest positioning

3. xiphoid process

corresponds to level of T9-T10 + anterior portion of diaphragm, not reliable due to body habitus

Respiratory System

purpose?

what are the 4 respiratory system divisions?

p = exchange of gas bt air we breath + bloodstream

1) pharynx 2) trachea 3) bronchi 4) lungs

what is also part of the respiratory system, but not in the divisions?

diaphragm

primary, dome shaped, muscle

each half is a hemidiaphragm

creates pressure differences that allow for breathing

separates the thoracic + abdominal cavities

label system

A - trachea

B - diaphragm (right/left hemi diaphragms)

C - lungs

D - bronchi

E - pharynx

pharynx + oral cavity

description and purpose?

p = passageway for food, fluid, air + part of respiratory AND digestive system

pharynx = approx 5 inches long, contains 3 parts

a) nasopharynx b) oropharynx c) laryngopharynx

oral cavity = hard and soft palate form roof of mouth, posterior aspect of soft palate is the uvula

label parts

A = hard palate B = oral cavity

C = soft palate D = uvula E = hyoid bone

F = epiglottis G = thyroid cartilage of larynx

H = larynx I = thyroid gland

J = pharynx K = nasopharynx

L = oropharynx M = laryngopharynx

N = region of spinal cord

O = esophagus P = trachea

larynx

purpose? description? prominence?

purpose = organ of voice, protects airway

descript = approx. 1.5 - 2 inches, anterior portion of neck, suspended from hyoid bone, ranges from C3 to C6

laryngeal prominence = anterior projection of thyroid cartilage, located at C4 to C5

label parts

A = hyoid bone B = thyroid cartilage

C = cricoid cartilage D = epiglottis

E = true vocal cords F = trachea

G = level of C3 H = larynx

I = level of C6 J = trachea

K = epiglottis L = hyoid bone

M = laryngeal prominence (level of C5)

N = thyroid cartilage

O = cricoid cartilage

trachea

purpose? description? what type of rings?

p = connects larynx to main bronchi + provides structural rigidity

d = fibrous muscular tube, approx. ¾ inch diameter + 4 ½ inch long, extends from C6 - T4/T5

cartilage rings = 16-20 C shaped rings in anterior wall + provide rigidity to prevent collapse of trachea

label parts

A = larynx B = level of C6

C = trachea D = level of T4/T5

E = right bronchi (3) F = left bronchi (2)

G = region of thymus gland

H = parathyroid glands

I = thyroid gland J = thyroid cartilage

label image

A = trachea + larynx

B = esophagus

C = thyroid gland region

D = thymus gland region

trachea glands

what are the 3 glands? describe?

1) thyroid gland = located anteriorly in neck, below thyroid cartilage, very radiosensitive

2) parathyroid glands = embedded in posterior surface of each lobe of thyroid gland, assists in blood functions

3) thymus gland = inferior to thyroid gland + anterior and superior to heart

right and left bronchi

purpose? description?

p = allows air to enter each lobe of lung

d = right primary bronchus is wider + shorter than left

carina splits the trachea + primary bronchi

R bronchus contains 3 lobes, left contains 2 lobes

bronchi divide into bronchioles, bronchioles divide into alveoli

lungs

purpose? description?

p =

d = composed of parenchyma

right lung has 3 lobes: superior, middle, inferior which is divided by 2 deep fissures

left has 2 lobes: superior, inferior which is divided by 1 deep fissure

label parts

A = pleura B = parietal

C = pleural cavity D = pulmonary visceral

E = fissures F = right lung

G = left lung H = fissure

I = superior lobe J = inferior lobe

K = inferior lobe L = middle lobe

M = superior lobe

what are the 3 ‘pleuras’?

parietal pleura = outer layer of pleural sac

pulmonary/visceral pleura = inner layer pleura, covering surface of lungs + dipping into fissures

pleural cavity = potential space bt the double walled pleura

label parts

A = trachea (windpipe)

B = pleura (lung lining)

C = lung

D = pleural effusion (fluid bt pleural space)

what are the lung pathology for L and R?

L = pneumothorax

R = pleural effusion hemothorax

name position, projection, diagnosis

label chest radiograph

what projection?

PA

A = trachea

B = apex of lung

C = carina

D = base of lung

E = diaphragm

F = costophrenic angle of lung

G = hilum

label chest radiograph

what position

L lateral

A = apex of lung

B = upper lobe of lung (superior)

C = hilum

D = lower lob of lung (inferior)

E = base

F = diaphragm

what are the four important structures in the mediastinum

thymus gland, heart + great vessels + trachea + esophagus

label parts

A = esophagus

B = superior vena cava

C = ascending aorta

D = inferior vena cava

E = right F = abdominal aorta

G = left H = heart

I = pulmonary artery J = arch of aorta

K = thymus gland L = thyroid gland

M = trachea

thymus gland

purpose? description?

p = role in development of immune system

d = located behind upper sternum, prominent in infancy + decreases in size through aging, typically only seen on small children x=rays

heart and great vessels

what houses them?

what are the 3 sections of aorta?

pericardial sac = houses the heart + roots of great vessels

great vessels = inferior vena cava, superior vena cava, aorta, large pulmonary arteries + veins

aorta = largest artery in body, ¾ to 1 in diameter = ascending aorta, arch of aorta, descending aorta

label radiograph

A = superior vena cava

B = right atrium

C = inferior vena cava

D = left ventricle

E = left atrial appendage

F = main pulmonary artery

G = aorta

determine body habitus

L = PA chest for a sthenic patient

R = PA chest for hyposthenic patient

what are the 4 breathing movements/techniques?

1) suspended inspiration = take in deep breath + hold it - make exposure [chest, abdomen]

2) suspended expiration = take deep breath in, blow it all out, stop breathing - make exposure

3) suspended respiration = stop breathing, don’t breathe - make exposure once breathing has stopped

4) orthostatic = breath normally but don’t move - make exposure

what is the general rule for a full inspiration x-ray?

for average adult

need MINIMUM of 10 pairs of ribs seen on full inspiration x-ray

which is expiration and which is inspiration?

L = inspiration

R = expiration

what are technical considerations/selections for chest x-ray?

kVp = high (long scale, low contrast)

grid is utilized

mAs = high mA w short exposure time (s)

for centering for chest, you want to place top of IR where?

top of IR 1 ½ to 2 inches above shoulders

3-4 inches from jugular notch landing on T7

or

7-8 inches from C7 landing on T7

PA technical factors

IR, grid, kVp rang, SID, collimation, respiration

what about lateral technical factors?

IR = 14×17”, portrait or landscape (mainly L)

grid = yes kVp = 110-125

SID = 72”

Collimation = 4 sided to area of lung fluid

respiration = 2 deep breaths, hold on 2nd breath

LATERAL = everything the same except it is NOT landscape the IR is in portrait

criteria for PA chest structures on radiograph

• both lungs

• costophrenic angles + apices

• hilum markings

• heart + great vessels

• minimum of 10 pairs ribs

• long scale contrast

• NO rotation (look at clavicles)

label radiograh

(pa chest struct)

criteria for Lateral chest structures

• both lungs

• costophrenic angles + apices

• centered hilar region

• long-scale contrast

• no rotation

label radiograph

(lateral chest structure)

AP chest topography

which positioning landmark do you use?

jugular notch = 3-4 inches below notch

AP chest - supine, upright, semierect

what is the angle of the CR

angle caudal 5 inches

criteria of AP chest in supine, upright, semierect

• both lungs

• costophrenic angles + apices

• air filled trachea from T1 down

• hilum markings

• heart + great vessels = will be MORE enlarged than PA projection

• 8-9 (NOT TEN) pairs of ribs

• long scale contrast

• no rotation

technical factors of AP pedi chest

IR, grid, kVp range, SID, collimation, respiration

what about for lateral positioning?

IR = vary based on patient size

grid = NO kVp = 75-85 SID = 50-60”

collimation = close to outer chest margins

respiration = exposure on full inhale if possible

LATERAL = all same except for kVp 80-55

AP pedi chest

patient position, CR, parent instructions

position = utilize parent help, tech don’t hold unless necessary, supine w arms + legs extended, place patient in middle of IR w shoulders 2 inches below top of IR [lateral arms are extended above head]

CR = centered to MSP at level of midthorax (approx. mammillary/nipple line)

parent = remove chest clothing, wear lead apron + gloves, position will not obstruct image, hold patient’s legs + arms

criteria for AP pedi chest

• limited signs of motion

• entire lungs

• 9-10 rib pairs

• chin elevated

• no rotation

criteria for lateral pedi chest

• limited signs of motion

• entire lungs

• 9-10 rib pairs

• chin elevated

• no rotation

technical factors for lateral decubitus chest

IR, grid, kVp range, SID, collimation, respiration

IR = 14×17” landscape grid = yes

kVp = 110-125 SID = 72”

collimation = 4 sides to lung field

respiration = exposure on 2nd full inspiration

lateral decubitus chest

patient position, CR, extras

p place radiolucent material under patient, true lateral on R/L for 5 min prior to exposure, arms raised above head, chin extended back

CR = horizontal CR directed at T7

extra = mark the film up, use decub marker if available

lateral decubitus chest criteria

• true lateral position

• entire lungs

• arms not in field

• markers placed correctly

• no motion

AP lordotic chest tech factors

IR, grid, kVp, SID, collimation, respiration

IR = 14×17 landscape/portait

grid = yes kVp = 110-125 SID = 72

collimation = 4 sides to lung field

respiration = expose on 2nd full inspiration

AP lordotic chest

patient position, CR

p = stands roughly 1ft away IR, leaning shoulders/neck/back of head against IR

hands on hips, palms rolled out

shoulders rolled forward, center MSP to CR and center of IR

CR = midsternum, 3-4” below jugular notch

semiaxial AP lordotic chest

patient position, CR

p = lies supine, shoulders rolled forward + arms positioned for lordotic position

CR = midsternum (3-4” below jugular notch) + angled 15-20” cephalic

AP lordotic chest criteria

• entire lung field

• unobstructed apices

• clavicles nearly horizontal + superior to apices

• sternal end of clavicle equidistant

• no motion