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chap. 3 chest
anatomy and procedures of the thoracic viscera
| Question | Answer |
|---|---|
| thoracic cavity | chest cavity |
| what are the thoracic cavity components? | cardiovascular, respiratory, digestive, endocrine, nervous, and lymphatic system |
| what are the three separate chambers of the thoracic cavity? | pericardium and the right and left pleural cavities |
| pleural | double layer membrane that surrounds the lungs (space between visceral and parietal membranes) |
| parietal pleural (lining) | the outer membrane, wall covering of the thoracic cavity |
| visceral pleural (lining) | the inner membrane, direct contact with the organ |
| name two thoracic cavity boundaries? | the superior thoracic aperture (STA) and the and the inferior thoracic aperture (ITA) |
| Superior Thoracic Aperture | apex of lungs |
| Inferior Thoracic Aperture | where diaphragm is |
| what position separates air and fluid best? | upright position |
| pneumothorax | air in pleural cavity/space seen on an image as pitch black |
| hemathorax | blood in the pleural cavity/space |
| pleural effusion | fluid in the pleural cavity/space |
| empyema | puss in the pleural cavity puss will appear lighter on image due to density |
| atelectasis | complete or partial collapse of a lung due to obstruction |
| CAB | coronary artery bypass graph (cabbage) |
| pleural cavity function and blood supply | adhesive of two membranes parietal/visceral. visceral is dual blood supply |
| mediastinum | area between the lungs right in the center |
| what are the three openings from the mediastinum through the diaphragm? | esophagus, vena cava, and the aorta |
| radiographically important mediastinum structures | heart shadow, thymus gland (only seen in children), trachea, esophagus, and great vessels |
| where is the thymus gland located? | right in front of the trachea in the superior mediastinum |
| function and size of thymus gland | primary control organ of the lymphatic system as a child its bigger but as you age it gets smaller (controls immune system) |
| glotis | is a slit or opening |
| what consists of the respiratory system? | nasal cavities, oral cavity, pharynx, larynx, trachea, bronchi and lungs |
| what are three divisions of the pharynx? | nasopharynx, oropharynx, and the laryngopharynx |
| larynx | voice box, vocal cords |
| esophagus | part of the digestive system that connects pharynx to stomach. posterior to larynx and trachea |
| trachea | windpipe which divides into or bifurcates into bronchi |
| right primary bronchus | wider and shorter than the left bronchus and divides into three secondary bronchi each entering into a separate lobe |
| left primary bronchus | smaller in diameter but about twice as long and divides into two separate secondary bronchi each entering into a separate lobe |
| carina | specific prominence or ridge that divides/ bifurcates into the right and left bronchi |
| terminal bronchioles | smaller branches that spread from secondary bronchi to all parts of each lobe |
| avioli | small air sacs where gas exchange take place (oxygen in c02 out) |
| NASAL CAVITIES | right and left chambers |
| nasal septum | made up of two bones, cranial bone where the appendicular plate of the ethmoid meets up with the vomer |
| sinuses | 4 sets which are interconnected and open up into nasal cavity |
| mucous membrane | contains scilia |
| nasal conchae | turbines 3 sets, inferior facial bones |
| PHARYNX | nasopharynx- hard plate- maxilla bone palatine process |
| soft palate | behind hard palate, connects to nasal cavity |
| uvula | |
| tonsils and adenoids | immune system |
| auditory tubes | hook up to nasal pharnyx |
| oropharnyx | behind mouth |
| laryngopharnyx | behind throat leads into trachea |
| LARYNX | glotis - slit or opening |
| epiglottis | fibrocartilage that sits atop the glotis. when down food goes to the esophagus |
| thyroid cartilage | palpable landmark at the level c4-c5 (adams apple)is part of the voice box |
| cricoid cartilage | sits below thyroid cartilage, does not articulate with anything |
| vocal cords | surrounded by voice box |
| TRACHEA | hollow tube/ conducting zone. measurements diameter 1/2 inch/ length 4 1/2 inches long posterior aspect: flat location mediastinum, anterior to esophagus |
| carina | hook like process where trachea splits |
| subdivisions of bronchial tree | bronchus/bronchi/bronchioles |
| primary bronchus | right and left primary bronchus |
| how many lobar or secoundary bronchi are there in the body? | 3 on the right and 2 on the left |
| how many segmental or tertiary bronchi are there in the body? | 10 on the right and 8 on the left |
| primary bronchioles | |
| terminal bronchioles | respitory zone leads to aviolar ducts to alveolar sacs to aveoli |
| parenchyma | spongy, elastic material that makes up the lungs |
| alveoli | functional unit of the lungs/ oxygen and carbon dioxide exchange. millions in each lung |
| pulmonary arteries | carry oxygenated blood from the heart to the lungs |
| pulmonary veins | carry oxygenated blood from lungs to heart (left atrium) |
| LUNGS | organs of respiration |
| apex | top portion (of lungs) |
| base | flat and bottom portion (of lungs) |
| costophrenic angles | angles at the base of lungs on lateral sides, by ribs |
| cardiophrenic angles | angles at the base in direct contact with the heart |
| hilum | hilar region, where all bronchi enter at middle of lungs also blood vessels |
| cardiac notch | indentation in left lung where the heart sits |
| costal surface | surface that is in contact with the ribs, visceral surface of the ribs |
| diaphragmatic surface | in contact with diaphragm |
| mediastinal surface | in contact with mediastinum, where hilar region is |
| what is the position of the right lung? | the righ lung is higher becuase of the liver. |
| how many lobes are in each lobe? | 3 right/ 2 left |
| fissures | deep grooves which divides the lobes |
| how many fissures are in each lobe and what are there names? | the left lobe has 1 oblique fissure and the right has 2 a horizontal and oblique |
| lingula | not a fissure, an area of left lung near the heart, if it had a middle lobe that is where it would be |
| inspiration | inhalation. lung movement when lungs move down, becuase diaphragm contracts and moves down. lungs expand, maximum capacity of lungs is reached |
| expiration | exhalaation. diaphragm moves up and lungs contract, gert shorter |
| ageniesis | lung number formed |
| hypoplasia | lung under developed |
| cysts | hollow cavity filled with fluid |
| broncheosphageal fistula | abnormal communication between structures or organs (can be born with or created) |
| tracheotomy | a hole put in trachea so patient can breath |
| lobectomy | to take out portion of lung |
| pneumonectomy | complete removal of a lung |
| segmental resection | to remove a tumor from the lung |
| thoracoplasty | a portion of the rib is removed to get to the lung |
| thoracentesis | fluid drained from thoracic cavity |
| bronchography | an injection of contrast in bronchiole tree |
| bronchitis | inflammation of the bronchi |
| laryngitis | inflammation of the voice box |
| pneumonitis | inflammation of the lungs, infection |
| bronchopneumonia | inflammation of part of a bronchi |
| lobar pneumonia | inflammation of the lobe |
| pleurisy | inflammation of the pleura, also called pleuritis |
| COPD | chronic obstructive pulmonary disease |
| emphysema | disease of aviola, aviola loose elastic ability, longs are long and dark |
| general guidelines for chest | patient preparation- remove artifacts bra/ earrings etc, IR size 14x17 for adults, dependant on body habitus/3 yr old 10x12 SID- 72" CHEST to get true size, ID markers, sheild, patient instructions (double breathing for chest) |
| general patient position | ambulatory - upright nonambulatory patients- sitting upright in a stretcher |
| IR size | depends on body habitus, use the smallest IR that will demonstrate anatomy, do not forget to collimate |
| what is the SID for chest xrays? | 72" for chest |
| ID markers | right or left side markers must be included on each image. other required ID markers must be must be in the blocker or elsewhere on the final image |
| radiation protection | always shield patients |
| other radiation protection measures | SID, technique factors and collimation |
| patient instructions | explain and demonstrate positions, when possible. respiration instructions are critical to image lung aeration. exposures are usually made after the second deep inspiration |
| why would two radiographs be taken, one on inspiration and one on expiration? | it demonstrates the presence of a foreign body, diaphragm movement, atelectasis (expiration) and pneumothorax |
| what are essential projections of the chest? | PA/LAT/AP- axial- lordotic if you want to see the appexes of the lungs |
| PA chest patient position | upright if possible to demonstrate air fluid levels and allow diaphragm to move to its lowest position |
| PA chest part position | patient faces vertical grid with MSP centered and perpendicular. MCP parallel with IR 1.5-2" above shoulders. elbows flexed with back of hands rested on low hips. shoulders depressed and rolled forward |
| PA/ CR | perpendicular to center of IR. enters at MSP and level of t7. technique 90-125 kv; automatic exposure control (AEC)two outer shells 1&3/ halifax 1&2. exposure should be made at end of second respiration |
| Lateral chest patient patient | upright if possible top of IR 1.5-2" |
| Lateral part position | MSP parallel with IR. MCP perpendicular to IR. extend IR over head, elbows flexed and forearms rested on head |
| lateral chest/ CR | perpendicular to IR. enters patient on MCP at level t7. technique 105 kv automatic exposure control (AEC) center cell. exposure made at end of second inspiration |
| what is the patient position for an AP chest? | supine used when patient is too ill for upright positions |
| what is the part position for an AP chest? | center MSP to IR top of IR 1.5 to 2" above the shoulders. if pt. condition permits, flex elbows, pronate hands on hips to draw scapulas laterally |
| where is the CR on an AP chest? | perpendicular to long axis of sternum and center of IR. 3" below jugular notch. technique high ma, low time. use grid if pt. is larger than 12 cm. expose after second full inspiration |
| what is the pt position of AP axial chest lordotic? | upright facing tube about one foot in front of the grid |
| part position for AP axial chest lordotic position | MSP centered to midline of grid. assist pt. to lean backwards until shoulders rest on grid. top of IR placed 3" above shoulders when pt. is in lordotic position |
| CR position for AP axial chest lordotic | CR perpendicular to IR, enters MSP at midsternum. AEC 1&3 /105 kv exposure made after second full inspiration. 15 to 20 degrees cephalic |
| for decubs which side do you mark? | the side that is up |
| AP/PA lateral decubitus pt. position | lateral decub on right or left side to demostrate fluid, pt. should lie on affected side. to demonstrate free air the pt. should be positioned on unaffected side. pt. needs to be in position for 5 minutes |
| part position for AP/PA lateral decubitus position | elevate body 5-8 cm if lying on affected side. true lateral without rotation(perpendicular to IR) extend arms over head. anterior or posterior surface of chest against vertical grid device. top of IR 1.5 to 2" above shoulders |
| what are the essential projections for lungs and pleurae? | AP or PA- right or left lateral decubitus position lateral- ventral or dorsal decubitus position |
| CR for AP/PA lateral decubitus position | horizontal and perpendicular to center of IR. enters MSP at 3" below jugular for AP, t7 for PA.exposure made on second full inspiration |
| patient and part position for lateral ventral or dorsal positions | pt. position- prone or supine. body elevated 2-3" part position- true prone or supine position without rotation. affected side against vertical grid device with arms above head. top of IR at level of thyroid cartilage |
| CR for lateral or dorsal decubitus positions | CR horizontal and perpendicular to IR. enters at level of MCP , 3 to 4" below jugular notch dorsal decubitus, t7 for ventral decubitus. technique 105 kv/ AEC center field 2 (@ chest bucky) otherwise manual technique with grid.expo sec inspir/ 5min flui/ai |
Created by:
eckoultd1972
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