Chest Radiography Lecture Review

Flashcards generated from lecture notes on chest radiography techniques and anatomy, covering positioning, technical factors, anatomical considerations, and special projections.

What are the four main reasons to prefer erect chest imaging, if possible?

To visualize possible air-fluid levels, detect free air under the diaphragm, better assess the thoracic cavity as organs fall, and reduce vascular congestion around the heart for a clearer outline.

When performing a routine PA chest X-ray, what should be the patient's foot and weight distribution?

Feet spaced about shoulder width apart with equal weight on both feet.

Where should the upper border of the image receptor be placed for a routine PA chest X-ray?

About one and a half to two inches above relaxed shoulders.

How is rotation checked during PA chest positioning?

By checking the shoulders and hips for symmetry.

Why are the patient's hands placed with the back of their hands on their hips for a PA chest X-ray?

This position helps roll the shoulders forward and rotate the scapulae out of the lung fields, allowing for better assessment of the apical portions of the lungs.

What is the standard SID (Source-to-Image Distance) for chest imaging and why is it used?

72 inches SID is used to minimize magnification of thoracic structures due to OID (Object-to-Image Distance).

At what vertebral level should the central ray be centered for a PA chest X-ray?

At the level of T7.

What are two methods to locate the T7 vertebral level for central ray centering in a PA chest X-ray?

Going down about seven inches for females or eight inches for males from the vertebral prominence, or finding the inferior angle of the scapula.

Why is patient preparation (removing jewelry, bras, ensuring hair is out of the lung field) important for chest imaging?

To prevent artifacts that could obscure anatomy and diagnostic information on the image.

What is the typical kV range used for chest imaging when using AEC (Automatic Exposure Control)?

Somewhere in the 110 to 120 kV range.

What are the breathing instructions for a routine PA chest X-ray?

Hold breath on the second inspiration (take a deep breath, blow it out, then take another deep breath and hold it).

Under what specific scenario might a chest X-ray be done on suspended expiration instead of inspiration?

For a 'rule out pneumothorax' order.

What is a good way to determine if a patient has achieved full inspiration on a PA chest radiograph?

By being able to visualize the tenth rib in its entirety above the diaphragm.

On a PA chest radiograph, which portion of the ribs (anterior or posterior) is closer to the receptor and appears more crisp?

The anterior portion.

How can rotation of the patient's trunk be determined on a PA chest radiograph?

By examining the sternoclavicular (SC) joints and comparing their equidistant appearance from the midline.

What anatomical structure is also known as the bronchial bifurcation?

The carina.

On a PA chest radiograph, what are the costophrenic angles?

The angles that occur at the junctions of the diaphragm and the ribs (costo meaning ribs).

What are the cardiophrenic angles on a PA chest radiograph?

The angles of the lungs near the heart (cardio meaning heart).

Why is a true left lateral position preferred for lateral chest imaging?

To keep the heart closer to the image receptor and consequently reduce its magnification.

When centering for a lateral chest X-ray, should the technologist center to the breast tissue or the thorax?

Center to the thorax itself, as breast tissue is not the primary area of examination.

What are the arm positioning instructions for a lateral chest X-ray?

Arms should be raised way up, ideally straight above the head, to ensure they are out of the lung fields.

What is the standard SID for a lateral chest X-ray?

72 inches.

At what vertebral level should the central ray be centered for a lateral chest X-ray?

At the level of T7.

Regarding the control panel for a lateral chest X-ray, which AEC chamber should be used?

The center AEC chamber.

Why is a small amount of offset in the lung bases and differentiation between posterior ribs sometimes normal in a lateral chest radiograph?

This appearance is due to the divergence of the X-ray beam as it passes through the patient.

Define 'retrosternal space.'

The anatomical space located behind the sternum.

Define 'retrocardiac space.'

The anatomical space located behind the heart.

Which hemidiaphragm is typically more defined on a lateral chest radiograph and why?

The left hemidiaphragm is more defined because it is closer to the image receptor.

What are some scenarios where a supine AP chest X-ray might be necessary instead of an erect position?

If the patient has broken hips, a venous catheter in the groin, or unstable blood pressure, making it unsafe to sit or stand them up.

What is the appropriate image receptor placement for a supine AP chest X-ray?

The upper border of the image receptor should be about one and a half to two inches above the shoulders.

Where is the central ray centered for a supine AP chest X-ray?

About three inches inferior to the jugular notch.

Why is mobile AP chest imaging not the preferred method for routine chest X-rays?

It results in magnification of the heart structure because it is an AP projection, unlike the PA projection which reduces magnification.

What is important to document when performing mobile AP chest X-rays, especially regarding distance?

It is crucial to document the specific SID used, as it may vary from the standard 72 inches.

When performing mobile AP chest X-rays, what should be done with wires or other obstructions on the patient's chest?

As much of them as possible should be moved out of the way to prevent obscuring anatomical structures.

What is the most common reason for performing an AP lordotic chest X-ray?

To rule out tuberculosis (TB) or an apical lesion (e.g., a tumor) in the apices of the lung.

What is the primary advantage of the lordotic view for chest imaging?

It projects the clavicles up and out of the way, allowing for a clearer, unobstructed view of the upper portion of the lungs (apices).

For an AP lordotic chest X-ray, how is the image receptor positioned relative to the patent's shoulders?

About three inches above the shoulders.

What are some indications for performing a lateral decubitus chest X-ray?

Fluid accumulation (e.g., pleural effusions), often done bilaterally, pre or post thoracentesis procedures, or for challenging patients who cannot stand.

For a lateral decubitus chest X-ray, if fluid accumulation affects only one lung, how should the patient be positioned?

The affected side should be positioned down.

For a lateral decubitus chest X-ray, how long should the patient remain in position before the exposure and why?

Approximately five minutes to allow any fluid to settle due to gravity, which improves visibility on the radiograph.

Why is a sponge typically placed under the thoracic cavity for a lateral decubitus chest X-ray?

To elevate the patient off the bed, preventing the bed from appearing in the image and obscuring lateral lung tissue.

How is a decubitus chest X-ray named for proper marking?

By the side that is down (e.g., 'left lateral decubitus' means the left side is down).

When marking a decubitus chest X-ray, which side is typically marked on the image with the anatomical marker?

The side that is up (e.g., if the right side is down, the image will be marked with a left marker).

What is the centering point for a lateral decubitus chest X-ray?

Approximately three inches inferior to the jugular notch.

In a decubitus chest X-ray, why is the side that is down considered the priority?

Because all fluid will fall to that side due to gravity, making its clear visualization critical for diagnosis.

How can rotation be checked in a decubitus chest X-ray?

By checking the sternoclavicular (SC) joints for symmetry, similar to other chest projections.

What are two types of additional, non-routine chest projections mentioned?

Obliques (LAO or RAO, often at 60 or 45 degrees) and projections that might utilize a nipple marker for shallower angles.