RAD111 Unit 2

Hyposthenic

slightly thinner than sthenic body habitus

Hypersthenic

• Broad body habitus

• special consideration to costophrenic angles

• landscape IR

Asthenic

• very long and slim body habitus

• IR= portrait

Left bronchus

longer, more lateral, smaller in diameter

right bronchus

• shorter, more vertical, wider in diameter

• food particles more likely to enter

left lung

2 lobes; superior and inferior

right lung

slightly higher and 3 lobes; superior, middle, inferior

parietal pleura

lines inner surface of thoracic cavity

pulmonary pleura

covers lung surface

hilum

• root area of the lung

• bronchi, blood vessels, lymph vessels

• nerves enter and leave

apex

• round upper area above clavicle

• extends up to T1

base

• lower concave area of lung

• rests on diaphragm

costophrenic angle

outermost lower corner of lung

mediastinum

• medial portion of thoracic cavity between lungs

  • trachea

  • esophagus

  • thymus gland

  • heart and great vessels

vertebral pominens

• C7

• 7-8 inches inferior

kVp range (chest)

110-125

SID (chest)

72in; less magnification

Degree of inspiration

10 ribs identifiable; on 2nd breath

Position (PA)

• erect, chin raised, shoulders rolled forward, no rotation

• align MSP with CR and midline of IR

• CR directed to midline at level of T7

  • 7-8 inches below vertebral prominens

• top of IR = 1 1/2 - 2 inches above shoulder

Position (Lateral)

• erect, left side against IR; arms raised over head, chin up

• middle cell

• coronal plane perpendicular to IR

• sagittal plane parallel to IR

• CR directed to midline at T7

• lower IR/CR 1 inch from PA

Position (AP Supine)

• supine

• head end of bed = semierect

• roll shoulders forward

• CR angled 5 degrees caudally (perpendicular to sternum)

• align center to IR to CR 1 ½ inch above shoulders

• CR directed to midline of patient at T7

  • 3-4 inches from jugular notch

fluid side

down

air side

up

Lateral Decubitus

• back against IR, chin raised, arms above head, pillow, knees slightly flexed

• radiolucent sponge under patients

• on right side = Right

• on left side = left

• center patient = midsagittal plane & T7

• top of IR = 1 inch above vertebral prominens

• horizontal beam

• AIR UP

• FLUID DOWN

AP Lordotic Position

• leaning shoulders/ neck onto bucky from about 1 foot away, back of hands on hips, roll shoulders forward

• IR = lengthwise or crosswise

AP Lordotic

• for visualizing area under clavicles

  • rules out califications and masses beneath clavicles

Semiaxial AP Lordotic

• lordotic laying down (supine)

• CR angled 15-20 degrees toward head

• used if patient cannot stand

Ant. Oblique Position

• 45 degree rotation (LAO or RAO)

• anterior shoulder against IR

• opposite arm raised on bucky

• chin raised straight ahead

Oblique

expands visual of side further from IR

Pneumothorax

• collapsed lung

  • usually only a portion of lung collapses

• air pushes on pleural space making it collapse

• no lung markings

• exposure remains the same

Pleural effusion

• fluid in the pleural space

  • fluid is thick and stays in place

• lateral decubitus

• increase exposure

Emphysema

• a condition in which the air sacs of the lungs are damaged and enlarged

• labored breathing

• lungs appear very radiolucent

• decrease exposure

COPD

• persistent obstruction of airways

• difficult to empty lungs

• asthma

• identified by

  • hyperexpansion

  • bronchovascular markings

• mild cases not visible on x ray

COPD

• caused by

  • emphysema

  • chronic bronchitis

  • smoking (predominant cause)

Atelectasis

• one or more areas of lung/lobes collapse or dont inflate

• caused by obstruction of bronchus or puncture of an air passageway

• increase exposure

Bronchiectasis

• permanent abnormal dilation of 1 or more large bronchi

  • due to destruction of the elastic and muscular component of the bronchial wall

• produces

  • mucus = chrronic cough

  • pus collection in dilated areas = densities

• most common in lower lobes

• viral or bacterial infection

Pulmonary edema

• accumulation of fluid in the lungs due to obstruction of pulmonary circulation

• increase exposure

Dyspnea

difficulty breathing

pneumonia

• lung inflammation due to bacteria, fungus, or virus

• different types depends on location and cause

cystic fibrosis

• genetic disorder causing progressive "clogging" of bronchi and bronchioles by heavy mucus

• could cause bronchiectasis

• most common inherited disease

• increase exposure (severe conditions)

hemothorax

blood in the space between pleural layers

thyroid cartilage

• laryngeal prominence/ adams apple

• level C5

carina

• where right and left bronchi bifurcate

• level T4-5

alveoli

tiny sacs of lung tissue specialized for the movement of gases between air and blood

Chest kVp (pediatric)

70-85

pulmonary emboli

sudden blockage of a lung artery

grid

used to reduce scatter radiation

bony thorax

• protective framework

  • sternum

  • clavicles

  • scapulae

  • 12 pairs of ribs

  • 12 thoracic vertebrae

• provides accurate & consistent positioning

• easy to locate

• used to center IR & get all anatomy

respiratory system

• exchange of gaseous substances between air and blood

  • pharynx

  • trachea

  • bronchi

  • lungs

ribs attach

to the manubirum

pharynx

• passageway for food, fluids and air

• digestive and respiratory system

• posterior between nose and mouth above larynx and esophagus below

esophagus

• digestive system

• connects pharynx with stomach

• most posterior

larynx

• voicebox

• suspended from hyoid bone

• anterior portion of neck

• adams apple

hyoid

• not apart of the larynx

trachae

• windpipe

• keeps airway open by preventing collapse during expiration

• C6→T4-5

• divides into right and left primary bronchi

thyroid gland

• rich in blood supply

• stores and releases hormones

lungs

composed of light spongy highly elastic substance called parenchyma

parenchyma

allows for expansion and contraction of the lungs

pleura

delicate double walled sac

thymus gland

largest in infants and shrinks over time

thyroid and parathyroid glands

NOT apart of the mediastinum

why is the right lung short than the left?

space is being occupied by the liver

sthenic

average in shape and internal organ location

why do we wait till 2nd full inspiration?

• allows the lungs to aerate fulle

• allows diaphragm to settle

inspiration

• increases in 3 dimensions

  • vertical

  • transverse

  • AP

Pediatrics

• erect whenever possible

• lower kV (70-85)

  • less mAs

newborns and infants

• AP supine and recumbent lateral with horizontal beam

• pigg o stat

chest technical factors

• kV ( 110-125)

• grid

• high mA

• short exposure time

• correct marker placement

• portrait or landscape IR (14×17in) (34×43cm)

• 72 inch SID

• assume heart is located in left thorax

why do we use a high kV?

to visualize finer lung markings (many shades of gray)

situs inversus

• perfect mirror image of normal organ position

• visceral inversion

geriatrics

• less inhalation ability

  • shallow lung field

  • center CR higher

• pathologic conditions more common

  • pneumonia & emphysema

  • adjust exposure factors

how to determine rotation of x ray images

• symmetric appearance and location of sternoclavicular joints

  • distance of sternal end of the clavicles from center line of spine should be equal

• whichever is closer to spine = direction of rotation

why do we do Left Lateral?

they are more accurate in showing the heart regionw

why are chest x rays done at 72 SID?

to reduce the magnification & distortion of the heart

True PA/ Lateral

No tilt or rotation

why is erect best for PA chest?

• diaphragm allowed to move down further

• air and fluid levels may be visualized

• engoregment and hyperemia of pulmonary vessels may be prevented

• lungs expand more

  • internal organs drop allowing lungs to fully aerate

bony land markings

• vertebral prominens

• jugular notch

jugular notch

CR 3-4 inches below

recumbent AP chest

• less than 72 inches SID

  • increases divergence of x ray beam

• IR = landscape

side to side collimation (lateral)

light field margins to outer skins margins on each side u

upper and lower collimation

adjust the upper border of the light field to vertebrae

upper collimation

1 ½ inches above vertebral prominens

lower collimation

1-2 inches below costophrenic angles

posterior ribs furthest from IR (lateral chest)

• magnified and projected slightly

• should only be ¼ to ½ inch or 1 cm

horizontal beam

demonstrates air fluid levels

PA evaluation criteria

• entire lungs included

• no rotation

• scapulae removed from lungs

• chin elevated

• full inspiration

• equal collimation top and bottom

• no motion

• exposure factors

• marker

• hilum region markings

  • heart

  • great vessels

• bony thorax

Lateral chest evaluation criteria

• entire lungs included

• no rotation

• chin and arms elevated

• correct collimation

• no motion

• exposure factors

• marker

• hilar region should be in center of IR

why do you angle the CR during AP Chest exams?

• to prevent the clavicles from obscuring apices

• CR should be perpendicular to the long axis of the sternum

AP supine/ semi-erect

• similar to PA

• magnification from shortre SID = increased OID of heart

• air fluid levels not well defined

Lateral Decubitis Evaluation Criteria

• entire lungs included

• no rotation

• arms not superimposed over lungs

• full inspiration

• marker

• no motion

• exposure factors

AP Lordotic Part/CR position

• center MSP to CR and centerline of IR

• Center IR to CR

  • top of IR 3 inches above shoulders

• CR perpendicular to IR

• center to midsternum

  • 3-4 inches below jugular notch

• 2 full inspirations

Anterior/ Posterior Oblique part & CR Position

• center patient to CR and IR

  • top of IR about 1 inch above VP

• CR perpendicualr at T7

• 2nd full inspiration

• marker

RAO

LAO