Alternative and Special Chest Projections, and Upper Airway

Upright - clear air/fluid levels (gives insight to volumes), Semi-Upright - gradient of air to fluid (gives an idea of volume but not very clear), Supine - only see fluid as it has settled (no information on volume)

How do the air/fluid levels appear for Upright, Semi-Upright, and Supine images?

To get a clear demonstration of the upper chest

Why are AP Lordotic Chest X-Rays used?

Above the apices

Where does an AP Lordotic Chest XR put the clavicals?

Same landmarks as for a normal upright AP CXR. BUT patient leans back until coronal plane of thorax is about 45 degrees from vertical

How should a patient be positioned for an AP Lordotic CXR?

Entire bilateral clavicle above apices, no rotation (use spinous process or ribs), Full inspiration, no motion

What is the evaluation criteria for a AP Lordotic CXR?

To further investigate pathology normally of the ribs

When is an Oblique CXR used?

positioned in 45 degree RAO, LAO, RPO, LPO. The patient is shifted the 45 NOT the tube

How is the patient positioned for an Oblique CXR?

What is closes to the IR, ex: RAO front right of patient is against IR

How are obliques named?

The central is still at T7 but it is centered between midway between the spine and lateral thoracic margin (NOT soft tissue) and is done so on the side farther than the IR

How is the positioning of the X-Ray different than a typical AP/PA CXR for an Oblique CXR?

raised and out of the field

Where are the arms for an Oblique CXR

farther

In a PA Oblique CXR the side that appears wider is ____ from the IR

closer

In a AP Oblique CXR the side that appears wider is ___ from the iR

The side of interest should be about 2x wider than the contralateral side

How should the size of the side of interest compare to the other side of the patient in an Oblique CXR?

Entirety of the Lungs (both sides) and there should be NO superimposition of upper extremities on the lung fields

What needs to be included in an Oblique CXR?

full inspiration, proper collimation, no motion, and optimal exposure factors

Other typical evaluation criteria for Oblique and normal chest X-rays include:

Seeing a shadow of the ribs through the heart

What is a good indicator of optimal exposure factors in an Oblique CXR?

For children 3.5 and under

When is a Pigg-o-Stat use?

Children has a thymus gland

Why might the heart look better on a pediatric image?

It is the best way to ensure no motion or rotation and if it causes infants to cry its helpful to time imaging when they take deep breaths between crying.

Why is the Pig-O-Stat so important for good images of infants?

A pediatric imaging chair used until children can understand directions for upright bucky.

What is used for pediatric patients over 3yr?

Best for soft tissue swelling of the neck, epiglottis, croup, and foreign bodies

When are Upper Airway or "soft tissue neck" X-Rays taken?

The exposure is taken while the patient is SLOWLY breathing in so that the trachea is dark (air is radiolucent) and this outlines swelling (radiopaque)

When is the exposure taken for an Upper Airway X-Ray?

MSP perpendicular to IR, Chin Raised (parallel to floor), SID: 40", Collimate to 1" of lateral structures (8x10), include C3-T4, Central Ray should be at Laryngeal Prominence (Adams apple c4/5),

What is the positioning for an AP Upper Airway?

75-85kV

What is the kV range for an AP Upper Airway?

MSP perpendicular to IR, Chin Raised (parallel to floor), SID: 40", Collimate to 1" of skin margins (8x10), include C3-T4, Central Ray should be at Laryngeal Prominence (Adams apple c4/5),

What is the positioning for Lateral Upper Airways?

EAM/ear/Eternal Auditory Meatus (this includes nasal and oral cavities

The top of the Lateral Upper Airway should include the?

75-85kV

What is the kV range for Lateral Upper Airway?

Swelling

A steeple or narrowed trachea indicates what?

air-filled trachea and larynx (if not repeat), shoulders should not superimposed over trachea, collimation evident, proper exposure factors

What is the evaluation criteria for an Upper Airway?