Bontrager Chapter 2 Workbook

The bony thorax consists of (A) the single _______________ anteriorly, (B) two ______________, (C) two ______________, (D) twelve pairs of ____________, and (E) twelve ______________ posteriorly.

A. Sternum
B. Clavicles
C. Scapulae
D. Ribs
E. Thoracic vertebrae

The two important bony landmarks of the thorax that are used for locating the central ray on a posteroanterior and anteroposterior chest projection are the (A) ___________________ and the (B) __________________, respectively.

A. Vertebra prominens [spinous process on seventh cervical (C7) vertebrae]
B. Jugular notch (upper portion of sternum)

The four divisions of the respiratory system are:

Pharynx, Trachea, Bronchi, Lungs

Identify correct anatomic term: Adam's apple

Thyroid cartilage

Identify correct anatomic term: Voice box

Larynx

Identify correct anatomic term: Breastbone

Sternum

Identify correct anatomic term: Shoulder

Scapula

Identify correct anatomic term: Collarbone

Clavicle

List the three divisions of the structure located proximally to the larynx that serve as a common passageway for both food and air.

1. Nasopharynx
2. Oropharynx
3. Laryngopharynx

What is the name of the structure that acts as a lid over the larynx to prevent foreign objects such as food particles from entering the respiratory system?

Epiglottis

The trachea is located ____________________ (anteriorly or posteriorly) to the esophagus.

Anteriorly

The ______________ bone is seen in the anterior portion of the neck and is found just below the tongue or floor of the mouth.

Hyoid

If a person accidentally inhales a food particle, which bronchus is it most likely to enter, and why?

A. The Right bronchus
B. Why? It is larger in diameter and more vertical.

A. What is the name of the prominence, or ridge, seen when looking down into the bronchus where it divides into the right and left bronchi?

Carina

B. This prominence, or ridge, is approximately at the level of the ________________ vertebra.

T5

What is the term for the small air sacs located at the distal ends of the bronchioles, in which oxygen and carbon dioxide are exchanged in the blood?

Alveoli

A. The delicate, double-walled sac or membrane that contains the lungs is called the ___________________.

Pleura

B. The outer layer of the pleura (membrane adhering to the inner surface of the chest wall and diaphragm) is the ______________.

Parietal pleura

C. The inner layer (of the pleura) adhering to the ______________, or ______________.

Pulmonary or visceral pleura

D. The potential space between the parietal pleura & visceral pleura is called the ___________________.

Pleural Cavity

E. Air or gas that enters the pleural cavity results in a condition called ________________.

Pneumothorax

Correct term for this portion of the lungs:
Lower, concave portion

Base

Correct term for this portion of the lungs:
Central area in which bronchi and blood vessels enter the lungs

Hilum (hilus)

Correct term for this portion of the lungs: Upper, rounded portion above the level of the clavicles

Apex (apices)

Correct term for this portion of the lungs:
Extreme, outermost lower corner of the lungs

Costophrenic angle

Explain why the right lung is smaller that the left lung and the right hemidiaphragm is positioned higher than the left hemidiaphragm.

Presence of liver on right

List the four important structures located in the mediastinum

A. Thymus gland
B. Heart and great vessels
C. Trachea
D. Esophagus

The three parts of the aorta are the:

A. Ascending aorta
B. Arch
C. Descending aorta

Which type of body habitus is associated with a broad and deep thorax?

Hypersthenic

Which of the following types of body habitus may cause the costophrenic angles to be cut off if careful vertical collimation is not used?
A. Hypersthenic
B. Hyposthenic
C. Sthenic
D. Hyposthenic and asthenic

D. Hyposthenic and asthenic

What is the minimum number of ribs that should be demonstrated above the diaphragm on a PA radiograph of an average adult chest with full inspiration?

10 ribs

Which of the following objects should be removed (or moved) before chest radiography? (Choose all that apply.)
A. Necklace
B. Bra
C. Religious medallion around neck
D. Dentures
E. Pants
F. Hair fasteners
G. Oxygen lines

A. Necklace
B. Bra
C. Religious medallion around neck
F. Hair fasteners
G. Oxygen lines

True/False: Long hair may produce an artifact when imaging with digital radiographic systems.

True

True/False: Chest radiography is the most commonly repeated radiographic procedure because of poor positioning or exposure factor selection errors.

True

Chest radiography for the adult patient usually uses a kilovoltage range of ______ to ______ kV.

110 to 125 kV

True/False: Generally, you do not need to use radiographic grids for adult patients for PA or lateral chest radiographs.

False

Optimal technical factor selection ensures proper penetration of the:
A. Heart
B. Great vessels
C. Lung regions
D. Hilar region
E. All of the above

E. All of the above

Describe the way optimum density (brightness) of the lungs and mediastinal structures can be determined on a PA chest radiograph

Should be able to see faint outlines of at least middle and upper vertebrae and ribs through heart and other mediastinal structures.

True/False: Because the heart is always located in the left thorax, the use of anatomic side markers on a PA chest projection may not be necessary.

False (heart may be located in right thorax)

What is another term for the condition termed visceral inversion?

Situs inversus

Which of the following devices should be used for the erect PA and lateral chest projections for an infant?
A. Upright chest device
B. Supine table Bucky
C. Pigg-O-Stat
D. Plexiglas restraint board

C. Pigg-O-Stat

Which of the following set of exposure factors is recommended for a chest examination of a young pediatric patient?
A. 70 to 85 kV, short exposure time
B. 90 to 100 kV, medium exposure time
C. 100 to 120 kV, short exposure time
D. 120 to 150 kV, long exposure time

A. 70 to 85 kV, short exposure time

True/False: Because they have shallower (superior-inferior dimension) lung fields, the CR is often centered higher for geriatric patients.

True

True/False: CR centering for the PA chest projection on an obese patient is 1 to 2" lower than for a sthenic patient.

False (centering for obese patient is at the same location - T7)

To ensure better lung inspiration during chest radiography, exposure should be made during the _________ inspiration.

second

List four possible pathologic conditions that suggest the need for both inspiration and expiration PA chest radiographs

A. Small pneumothorax
B. Fixation or lack of normal diaphragm movement
C. Presence of a foreign body
D. Distinguishing between opacity in rib or lung

List and explain briefly the three reasons chest radiographs should be taken with the patient in the erect position (when the patient's condition permits).

A. To allow diaphragm to move down farther
B. To show possible air and fluid levels in the chest
C. To prevent engorgement and hyperemia of the pulmonary vessels

Why do the lungs tend to expand more with the patient in an erect position than in a supine position?

Erect position allows abdominal organs to drop, allowing the diaphragm to move farther down and the lungs to aerate more fully.

Explain the primary purpose and benefit of performing chest radiography using a 72" SID.

Reduces distortion and magnification of the heart and other chest structures

Which of the following anatomic structures is examine to determine rotation on a PA chest radiograph?
A. Appearance of ribs
B. Shape of heart
C. Symmetric appearance and location of sternoclavicular joints
D. Symmetric appearance and location of costophrenic angles

C. Symmetric appearance and location of sternoclavicular joints

Which positioning tip will help prevent the patient's chin and neck from being superimposed over the upper airway and apices of the lungs for a PA chest radiograph?

Extend the neck upward

For patients with the following clinical histories, which lateral position would you perform - right or left?
A. Patient with severe pains in left side of chest
B. Patient with no chest pain but recent history of pneumonia in right lung
C. Patient with no chest pain or history of heart trouble

A. Left
B. Right
C. Left

Why is it important to raise the patient's arms above the head for lateral chest projections?

Prevents upper arm soft tissues from being superimposed over upper chest fields

The traditional CR centering technique for the chest is to place the top or the IR ______ inches above the shoulders

1.5 - 2"

A recommended CR centering technique for a PA chest projection requires the technologist to palpate the __________ and measure down from that bony landmark ______ inches for a male and ______ inches for a female patient.

Vertebra prominens; 8"; 7"

A. Should the 14 x 17" IR be aligned in portrait or landscape orientation for a PA chest projection of a hypersthenic patient?
B. For an asthenic patient?

A. Landscape
B. Portrait

Which of the following bony landmarks is palpated for centering of the AP chest projection?
A. Vertebra prominens
B. Jugular notch
C. Thyroid cartilage
D. Sternal angle

B. Jugular notch

True/False: With most digital chest units, the question of IR placement into either the portrait or the landscape position is eliminated because of the larger IR.

True

True/False: In general for an average patient, more collimation should be visible on the lower margin of the chest image than on the top for a PA or lateral chest projection.

False (should be equal)

True/False: The height, or vertical dimension, of the average-to-large person's chest is greater than the width, or horizontal dimension.

False (greater width)

True/False: Multi-detector CT can produce high-resolution images of the heart on one breath-hold.

True

True/False: Single-photon emission computed tomography (SPECT) is frequently used to diagnose myocardial infarction.

True

True/False: Ultrasound is not an effective modality to detect pleural effusion.

False

True/False: Echocardiography and electrocardiography are basically the same procedure.

False

Clinical indication described?
One of the most common inherited diseases

Cystic fibrosis

Clinical indication described?
Condition most frequently associated with congestive heart failure

Pulmonary edema

Clinical indication described?
Shortness of breath

Dyspnea

Clinical indication described?
Accumulation of air in the pleural cavity

Pneumothorax

Clinical indication described?
Accumulation of pus in pleural cavity

Empyema

Clinical indication described?
A form of occupational lung disease

Silicosis

Clinical indication described?
A contagious disease caused by an airborne bacterium

Tuberculosis

Clinical indication described?
Irreversible dilation of bronchioles

Bronchiectasis

Clinical indication described?
Most common form of emphysema

Chronic obstructive pulmonary disease (COPD)

Clinical indication described?
Acute or chronic irritation of bronchi

Bronchitis

Clinical indication described?
Collapse of all or portion of lung

Atelectasis

Clinical indication described?
Inflammation of pleura

Pleurisy

What is a common radiographic sign seen on a chest radiograph for a patient with respiratory distress syndrome (RDS)?
A. Enlargement of heart
B. Fluid in apices
C. Sail sign
D. Air bronchogram

D. Air bronchogram

Change in manual exposure factors?
Left lung atelectasis

increase (+)

Change in manual exposure factors?
Lung neoplasm

none (0)

Change in manual exposure factors?
Severe pulmonary edema

increase (+)

Change in manual exposure factors?
Respiratory distress syndrome (RDS) or adult respiratory distress syndrome (ARDS), known as hyaline membrane disease (HMD) in infants

increase (+)

Change in manual exposure factors?
Reactivation (secondary) tuberculosis

slight increase (+)

Change in manual exposure factors?
Advanced emphysema

decrease (-)

Change in manual exposure factors?
Large pneumothorax

none (0)

Change in manual exposure factors?
Pulmonary emboli

none (0)

Change in manual exposure factors?
Primary tuberculosis

none (0)

Change in manual exposure factors?
Advanced asbestosis

none (0)

Which of the following is not a form of occupational lung disease?
A. Anthracosis
B. Emphysema
C. Silicosis
D. Asbestosis

B. Emphysema

Which of the following chest projections/positions is recommended to detect calcifications or cavitations within the upper lung region beneath the clavicles?
A. Left lateral decubitus
B. PA
C. RPO and LPO
D. AP lordotic

D. AP lordotic

Why is a PA chest preferred to an AP projection?

Places the heart closer to the IR to reduce magnification of the heart

The CR is placed at the level of the _____ vertebra for a PA chest projection.

T7

The shoulders need to be rolled forward for the PA projection to allow the _________ to move laterally and be clear of the lung fields.

Scapulae

Why should a left lateral be performed unless departmental protocol indicates otherwise?

A left lateral better demonstrates the heart region

How much separation of the posterior ribs on a lateral chest projection indicates excessive rotation from a true lateral position?

Greater than 1 cm (1/2-3/4")

To prevent the clavicles from obscuring the apices on an AP projection of the chest, the central ray should be angled (A) _________ so that it is perpendicular to the (B) ___________.

A. Caudad (+/- 5 degrees)
B. Sternum

What is the name of the condition characterized by fluid entering the pleural cavity?

Pleural effusion

Which specific position would be used if a patient were unable to stand but the physician suspected that the patient had fluid in the left lung?

Left lateral decubitus

What is the name of the condition characterized by free air entering the pleural cavity?

Pneumothorax

Which specific position would be used if the patient were unable to stand but the physician suspected that the patient had free air in the left pleural cavity?

Right lateral decubitus (affected side up)

What circumstances or clinical indications suggest that an AP lordotic projection should be ordered?

Rule out calcifications or masses beneath the clavicles