Chapter 2 Exam (week 2 radiographyic procedures one)

Level of vertebral prominens

C7

Level of jugular notch

T2-T3

Where is the jugular notch located?

On the sternum

What is the upper level of the lungs?

C7- vertebral prominens

The xiphoid process is located at the level of?

T9-T10

The inferior tip of the sternum corresponds to the anterior portion of?

The diaphragm

The non-medical name for the pharynx?

Throat

What is the pharynx (throat) the passageway of?

Food and air

The pharynx is made up of how many portions?

3

What are the 3 names of the portions of the pharynx

1. Nasopharynx

2. Oropharynx

3. Laryngopharynx

The epiglottis acts as a lid for what?

The larynx

Is the epiglottis up or down most of the time?

Up

Why does the epiglottis need to work properly?

To prevent aspiration

The esophagus is __________ to the larynx and trachea

Posterior

The esophagus is __________ to the pharynx

Anterior

The non-medical name for the larynx

Voice-box

The hyoid bone is where?

In the upper neck (not apart of the larynx)

The thyroid cartilage is apart of what?

The larynx

Another name for the laryngeal prominens?

Adam's Apple

What is the level of the laryngeal prominens?

C4-C5

Non-medical name for the trachea

Wind-pipe

The trachea is at the level of what?

C6 to T4 - T5

What is the name of the structure that bifurcates into right and left primary bronchi?

Carina

The thyroid gland is at the level of what?

C5-C7

What is different about the right bronchi and not the left?

The right is wider and shorter

Oxygen and carbon dioxide (gases) are exchanged through the thin wall called:

Alveoli

The right bronchi is more what than the left?

Vertical

There is an increase in what in the right bronchus because of it being more vertical?

Increase risk in aspiration

What is the visceral pleura?

Inner layer that covers and encloses the lungs (also one for the heart)

Pneumothorax:

Air or gas is present and escapes from the lung into the pleural cavity

How many lobes does the right lung have?

3 (superior, middle, inferior)

How many lobes does the left lung have?

2 (superior and inferior)

Lung Base:

The lower concave and broad area of each lung

How many structures are in the mediastinum?

4 structures

What are the 4 structures of the mediastinum?

1. Thymus gland

2. Heart and great vessels

3. Trachea

4. Esophagus

When is the Maximum size of the thymus gland?

At puberty

Heart is anterior to what level?

T5-T8

Hypersthenic PA chest:

IR is landscape. Pt needs more radiographic technique

What should you do to the technique for a sthenic patient?

Decrease radiographic technique

Hyposthenic

IR is portrait for slender patients

Asthenic

Slender, the thorax is more narrow, shallow and long. IR is portrat for PA. (10%)

What is Inspiration?

Breathing in

What is expiration?

Breathing out

What does a having a patient take a second breath do?

Deeper inspiration and lungs fill more

How many ribs should be visible above the diaphragm on a PA chest radiograph?

10 ribs is ideal (9-10)

What side do you count ribs on?

Left

Why do you count ribs on the left side?

Since the right side is shorter due to the liver being there. The left side goes down further.

Where should the diaphragm be on a PA chest?

Below the 10th rib

Positioning considerations for chest X-ray:

- remove necklace, bramp, tshirt, etc.

- undress from waist up, put on gown with opening in back

- clothing artifacts

- long hair fastener

- O2 lines and EKG leads not in lung fields

What increases in kVp?

An increase in kVp-increase beam penetration (110-125) >100 kVp requires a grid

mAs:

High mA= short exposure time

Situs inversus

Major Organs on the opposite side

For pediatric applications what should kVp be put at?

70 to 80 kVp

Where are a PA and Lateral pediatric preferred to be performed at?

In an immobilzation device called Pigg-o-stat

What do you palpate for bariatric patients?

Jugualr notch

Where should the IR be placed for a bariatric patient?

1-2ninches above the shoulders

Why are do some chest X-rays have to have an inspiration and an expiration?

Comparison images to check for a small pneumothorax, fixation of the diaphragm, FB, or calcification

label both images inspir or expir

What do Erect Chest Radiographs do/show?

Diaphragm to move further down

Visualize Air-fluid levels

Prevents engorgement of pulmonary vessels

Will the SID increase or decrease magnification of the heart for a PA chest?

Decrease

Does an AP chest increase or decrease magnification of the heart?

Increases

What should we make sure to do with the chin on chest X-rays?

Lifting the chin so that it does not superimpose the apices of the lungs

If breasts are large what should you do?

Have the patient lift their breats and then lean up against IR

Lateral chest positioning:

Side of interest closest to IR

Heart in left side will not magnifiy as much due to OID being close

True Lateral no rotation: what should we see?

No seperation

If seperation on 1cm. >1 indicates objectional rotation of the thorax

What should we do with the arms of the patient on a Lateral chest?

Raise arms to make sure soft tissue does not appear on scan

CR chest positioning method: (where to position)

Vertebral Prominens (C7)

Female 7/Male 8

Exceptions for athletic sthenic/hyposthenic center near T8 or 9 inch down

Where to center for an AP chest

Jugular notch T2-T3 (3-4 inch below)

Atelectasis:

A condition; collapse of all or a portion of a lung as the result of an obstruction in the bronchus.

Less air in the lung than usual.

Use +1 density

Bronchiectasis:

Irreversible dilation or widening of bronchi or bronchioles from repeated infection or obstruction

Bronchitis:

Acute or chronic condition with excessive mucus secretions into the bronchi causing cough and shortness of breath.

chronic obstructive pulmonary disease (COPD):

Obstruction of airways that cause difficulty emptying the lungs of air. Use -1 density

cystic fibrosis (CF):

Inherited disease occurs when secretions of heavy mucus clogs bronchi

Emphysema:

Irreversible, air spaces in the alveoli enlarge and lose elasticity.

Need to decrease radiographic technique

If a new growth is noted under the clavicle on a PA and Lateral chest what image shoulder be ordered next?

AP Lordotic

Occupational Lung Disease

Forms of pneumoconiosis. Arises from occupationak exposures

Anthracosis:

Black lung pneomoconiosis. Coal dust

Asbestosis:

Inhaled asbestos dust (fibers)

Silicosis:

Inhaled silica dust

Pleural effusion:

Abnormal fluid in the pleural cavity

What image best demonstrates a pleural effusion?

Best demonstrated on a horizontal beam lateral decubitus with affected side down

What are the different types of pleural effusion?

Empyema: fluid in pas

Hemothorax: fluid in blood

imaging will consist of an erect PA chest and an erect lateral chest with affected side closest to IR

Pleurisy:

Inflammation caused by a virus of bacterium of the pleura causing severe chest pain. Freuquently follows pneumonia or trauma of the chest. This condition may be demonstrated on chest image with associated pleural effusion.

Pneumonia:

Inflammation of the lungs that results in accumulation of fluid with certain sections of the lungs cresting increased radiodensities in these regions.

Should perform a PA and lateral chest.

Need to increase radiographic technique

Bronchiopneumonia:

Bronchitis of both lungs caused by Streptococcus or Staphylococcus bacteria

Pneumothorax:

An accumulation of air or gas in the pleural space that causes partial or complete collapse of the lung and results in immediate shortness of breath and chest pain due to air in the pleural cavity.

What image is taken to find a pneumothorax?

Erect or horizontal beam lateral decubitus with the affected side up. Erect PA inspiration/expiration images can be taken for a small pneumothorax.

Need to decrease radiographic technique

Pulmonary edema:

A condition of excess fluid in lung cause by a backup in pulmonary circulation

Respiratory Distress Syndrome (RDS):

(Hyaline membrane disease HMD) fluid and blood leaks into the spaces between alveoli

How is respiratory distress syndrome diagnosed?

Diagnosed with chest xray as increased density throughout the lungs in a granular pattern as the normally air-filled spaces are widened with fluid.

The common sign is an "air bronchogram."

Tuberculosis (TB):

Contagious disease caused by airborne bacteria

Does a chest X-rays require low contrast (long-scale contrast) or high contrast (short-scale contrast)?

Low contrast (long-scale contrast) for more shades of grey

What does a chest require the kVp to be?

110-125

AEC (what cells for what)

PA (side cells)

Lateral (center cells)

What is the AEC backup set to do?

To protect the patient from overexposure and the X-ray tube from heat

What are the routine chest X-rays?

PA and Lateral

What are the special chest projections?

Ap supine or semierect

Lateral decubitus

Ap lordotic

Anterior oblique

Posterior oblique