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Ch. 3 Bontrager
Ch. 3 Bontrager - semester 1/ positioning
| Term | Definition |
|---|---|
| Chest or Thorax | the upper portion of the trunk between the neck and the abdomen |
| The 3 sections of Radiographic Anatomy of the Chest | bony thorax, respiratory system proper, mediastinum |
| Bony Thorax | the part of the skeletal system that Consists of the Sternum, Clavicles, Scapula,12 Thoracic Vertebrae and Ribs - provides the protective framework for the parts of the chest involved in respiration and blood circulation |
| Thoracic viscera | the parts of the chest consisting of the lungs and the remaining thoracic organs contained in the mediastinum |
| Sternum (breastbone)- Name the 3 parts | Manubrium(upper portion), Body (center), Xiphoid process(smaller inferior portion) |
| Vertebra Prominens (C7) | landmark to palpate for the CR on a PA chest xray |
| Jugular Notch | landmark to palpate for the CR on a AP chest xray |
| Respiratory System | The system that consists of the parts of the body thru which air passes as it travels from the nose and mouth into the lungs |
| The 4 divisions of the Respiratory System | Pharynx, trachea, R&L bronchi, lungs |
| Diaphragm | the primary muscle of inspiration |
| when we breathe in(inspiration), as the dome of the diaphragm moves down | when does the volume of the diaphram increase in volume? |
| Pharynx(upper airway) | Structure or passageway (posterior to the nose and mouth) for both food and fluid as well as food - common to both the digestive and respiratory systems (NOT considered part of Resp. Sys.) |
| Three Divisions of the Pharynx | nasopharynx, oroparynx, laryngopharynx |
| Roof of the Oral Cavity | Hard Palate and Soft palate |
| Uvula | the lower aspect of the soft palate that marks the boundary btw the naso and oropharynx |
| Epiglottis | the part of the larynx that closes during swallowing to prevent food from entering the larynx and bronchi |
| Esophagus | part of the digestive system that connects the pharynx with the stomach. (tube for food) |
| Larynx | cage-like, cartilaginous structure (1.5-2 in) located in anterior portion of the next suspended by the hyoid bone |
| Vocal cords | sounds are made with these as air passes thru them |
| C3-C6 | What vetrebre does the larynx correspond to? |
| Thyroid cartilage | the largest and least mobile of cartilages in the larynx |
| Laryngeal prominence (Adam's apple) | the prominent anterior projection of the Thyroid cartilage (important positioning landmark) |
| C5 | What vetrebre does the Thyroid Cartilage correspond to? |
| Cricoid Cartilage | the ring of cartilage that forms the inferior and posterior wall of the larynx - it is attached to the first ring of cartilage of the trachea |
| Trachea (windpipe) | a fibrous muscular tube (3/4 in diameter, 4.5 in long)with C shaped rings that keep it open. |
| C6 to T4 or T5 | What vetrebre does the trachea correspond to? |
| Thyroid Gland | vascular organ located anteriorly in the neck just below the larynx, with it's R and L lobes lying on each side and distal to the proximal trachea. |
| Parathyroid Gland | small , round glands that are embedded in the posterior surface of the later lobes of the thyroid gland |
| Thymus Gland | gland located distal to the thyroid gland (more active in youth) |
| Thyroid Gland | very radiosensitive gland - should be sheilded |
| Right Bronchi | bronchi that is wider in diameter and shorter, more vertical. where forign objects are more likely to e enter and get lodged |
| Left Bronchi | bronchi that is smaller in diameter and twice as long as the other one, more horizontal |
| Carina | specific prominence or ridge of the lowest tracheal cartilage - divides into the L & R bronchi |
| T5 | What vetrebra does the trachea carina to? |
| Two | How many branches does the Left bronchi have? |
| Three | How many branches does the Right bronchi have? |
| Two(Superior, inferior) | How many lobes does the Left lung have? |
| Three (Superior,Middle, Inferior) | How many lobes does the Right lung have? |
| Alveoli | where oxygen and carbon dioxide are exchanged in the blood thru the thin walls of the respiratory system (500 to 700 million) |
| Lungs | 2 spongy organs located on either side of the thoracic cavity |
| Pleura | double walled sac or membrane in the lungs |
| Parietal pleura | the outer layer of the pleural sac that lines the inner surface of the chest wall and diaphram |
| Visceral pleura | the inner layer of the pleural sac that lines the surface of the lungs and between the fissures between the lobes |
| Pleural cavity | the potential space between the double-walled pleura |
| Pneumothorax | air or gas present in the pleural cavity results in a condition called that can cause a lung collapse(shows up as black in image): |
| Hemothorax | accumulation of fluid in the pleural cavity results in a condition called(shows up as white in image) |
| Apex | the rounded upper area of the lung above the level of the clavicles (at T1) |
| Base | lower concave area of the lung that rests on the diaphragm |
| Costophrenic Angle | the extreme outermost lower corner of each lung where the diaphram meets the ribs. |
| Costophrenic Angle & Apex | What anatomy of the lung must appear on each Chest xray? |
| Costophrenic Angle | Fluid collection appears in what part of the lung in an erect chest xray? |
| Hilum | The root region or central region of the lung where the bronchi,blood vessels,lymph vessels and nerves leave the lungs |
| because the liver is on the right side of the body | Why is the right hemidiaphram higher than the Left? |
| Mediastinum | the medial portion of the Thoracic cavity located between the lungs is called? |
| Pericardial Sac | What double walled sac encloses the heart and the great vessels? |
| Superior Vena cava | large vein that returns blood to the heart form the upper half of the body |
| Inferior Vena cava | large vein that returns blood to the heart form the lower half of the body |
| Aorta | largest artery in the body that carries blood to all parts of the body thru various branches |
| ascending aorta | artery that comes up out of the heart |
| descending aorta | artery that passes thru the diaphragn into the abdomen where it becomes the abdominal aorta |
| Hypersthenic Body Habitus | Body Habitus where a patient has a thorax that is very broad and very deep from front to back, but is shallow in vertical decisions. |
| Asthenic Body Habitus | Body Habitus where a patient has a thorax that is very narrow and very shallow from front to back, but is long in vertical decisions. |
| Hyposthenic Body Habitus | Body Habitus where a patient has a nearer to average dimesion. |
| Sthenic Body Habitus | Body Habitus where a patient has a athletic body-builder type dimesion. |
| Vertical, transverse, anteroposterior diameter | What are the 3 breathing movement dimensions during inspiration? |
| by counting the ribs | How does a RAD tech determine the degree of inspiration in a patient's chest xray image? |
| 10 | How many ribs should appear in the in a good chest xray? |
| smoking, high oxygen use indicates COPD | What can determine lung length other than body habitus? |
| remove opaque objects such as: clothes with buttons, snap or hooks, and necklaces, bras, piercings, thick braided hair, hair clips, oxygen leads and ECG monitors should be moved to the die | How do you prepare your patient for chest xray? |
| Repeat Exposures, Collimation,Gonadial Shielding, Backscatter protection | What should you take into consideration to protect patient from radiation? |
| on all patients of reproductive age | When should gonadal shielding be used? |
| Killovoltage Peak indicates the quality of the image, shades of gray needed to visualize the finer points of the image | What is kVp? |
| 110-125 | What kV should be used on a chest xray? |
| as a general runl a high kV above 100 (usually not used on portable chest) | When should you use a grid in an xray? |
| mAs - Milliamperage per second - is the Quantity of xrays (radiation) the patient receives | What is mAs? |
| patient's exposure to radiation AND improves images quality be reducing scatter radiation | What does correct collimation reduce? |
| to protect gonads from scatter and secondary radiation from the cassette or IR holder device | Why do you need back-scatter protection in a chest xray? |
| AP supine | What position is used for infants chest xray? |
| Pigg-O-Stat | What immobilization device is used in pediatrics for an erect PA and LAt. chest xray? |
| Lower kV (60 to 70)and less mAs with the shortest exposure time possible to prevent movement | What technical factors are used in pediatrics chest xray? |
| full 2nd inspiration | Should chest xrays be taken on inspiration or expiration? |
| both | Should chest xrays be taken on inspiration or expiration for supected pneumothorax? |
| 1)Diaphram drops down allowing lungs to fully aerate. 2)Air and fluid levels in chest may be visualized - air rises and fluid drops to the btm. 3) Engorgement and hyperemia of pulmonary vessels may be prevented | List 3 reasons why chest xray should be taken erect. |
| 72 | What is normal SID for PA erect chest? |
| bc AP will cause an increased magnification of the heart shadow which complicates the diagnosis of possible cardiac enlargement. | Why is PA preferred to AP chest xray? |
| check to make sure that both the R and L sternal ends of the clavicles are the dame distance for the center line of the spine | How do you determine rotation in a PA chest xray? |
| Scoliosis | lateral or side to side curvature of the spine |
| Kyphosis | humpback curvature seen commonly in elderly patients |
| by noting which sternal end of the clavicle is closest to the spine | How do you determine the direction of the rotation in a PA chest xray? |
| the chin can neck can superimpose on the uppermost lung regions, the apices. | Why should you extend the chin on a chest xray? |
| ask them to life them up and out and lean against the IR to keep them in position. | How can you minimize a patient's large breast shadows? |
| Left b/c it will more accurately demonstrate the heart region(without as much magnification) bc the heart is mostly on the Left side | What is the most common Lateral chest xray? |
| the amount of separation of the R and L posterior ribs and separation of the two costophrenic angles | How can you tell that a Lateral chest xray has rotation? |
| Up, to prevent superimposition on the upper chest field. Weak patients may need to grasp a support. | Should patients arms be up or down in a lat chest xray? |
| to the center of the lung field with accurate collimation on both top and bottom | Where should the CR be positioned in a chest xray? |
| Using your hand spread: Female - 7 in, male 8 in., or locate the inferior angle of the scapula which corresponds with T7 | In PA chest xray how many inches down from the vertebra prominens should you measure to find the center of the lung field? and what other landmark can you use to find this location? |
| on most average patients - T7 is 3-4 in. below, using the technologists 4 fingers to measure | In AP chest xray how many inches down from the jugular nothch should you measure to find the center of the lung field? |
| 14x17 | What size cassette should be used for adult chest xray? |
| Exposure to patient As Low As Reasonable Acheivable | What is the ALARA principle? |
| Aspiration | pathology most common in children when a foriegn object is swallowed or aspirated into the air passages of the bronchial tree. In adults it may occur with food particles. |
| Atelectasis | A condition in which collapse of all or a portion of a lung occurs as a result of obstruction of the bronchus or puncture of an air passageway. |
| Bronchiectasis | an irreversible dilation or widening of bronchi that may result form repeated pulmonary infection of obstruction. |
| Bronchitis | an acute or chronic condition in which excessive mucus is secreted in the bronchi causing cough and shortness of breath. |
| 1)IR Cassette 14x17 lenthwise or crosswise (for hypersthenic patient)2)110-125 kV 3) moving or stationary grid | List technical factors in PA Chest Erect OR Wheelchair, Stretcher, Portable |
| Pleural effusions, pneumothorax, atelectasis, signs of infection | List pathology demonstrated in PA Chest Erect |
| Lead shield around waist or adjustable mobile shield behind patient | List shield used in PA Chest Erect |
| Feet slightly apart,weight equally distributed onfeet,chin raised,hands on lower hips,palms out,elbows partially flexed, shoulders rotated forward against IR to allow scapulae to move laterally clear of lung fields, shoulders depressed down to move clavic | Patient position in PA Chest /Erect |
| Align equally btw.midsagittal plane with CR and w/midline of IR, NO rotation of thorax - align midcoronal plane plane parallel to IR, CR should be at approx. T7, top of IR will be 1.5-2 in above shoulders | Part position in PA Chest /Erect |
| CR perpendicular to IR and centered to midsagittal plane at t7(7-8 in. below vertebral prominens),or to inferior level of scapula, IR centered to CR, SID of 72 inches | CR position in PA Chest /Erect |
| On 4 sides to area of lung fields - top at level of vertebral prominens/lateral border to skin margins | Collimation in PA Chest /Erect or stretcher |
| Both lungs from apices down to costophrenic angles, air filled trachea from T1 down, hilum region, heart, great vessels, bony thorax | PA Chest /Erect or Stretcher - List structures shown in image |
| Parenchyma | The lungs are made up of this light,spongy, highly elastic substance: |
| COPD | persistent obstruction of the airways that usually causes difficulty in emptying the lungs of air |
| Cystic Fibrosis | heavy mucus causes progressive clogging of bronchi |
| Dyspnea | shortness of breath - in older persons |
| Emphysema | irreversible lung disease - air spaces in the alveoli become greatly enlarged as a result of alveolar wall destruction an los of elasticity |
| Epiglottitis | childeren - 2-5, life threatening swelling at the point of the epiglottis |
| Neoplasm | a growth or tumor - benign or malignant |
| Pleural Effusion | accumulation of fluid in the pleural cavity |
| Empyema | pus in the pleural cavity |
| Pleurisy | inflammation of the pleura surrounding the lungs - caused by virus or bacteria |
| Pneumonia | inflammation of the lungs that results in the accumulation of fluid in certain sections of the lungs |
| Aspiration pneumonia | aspiration of a foreign object or food in the lungs that irritates the bronchi resulting in edema |
| Bronchopneumonia | bronchitis in both lungs from strep or staph bacteria |
| Lobar pneumonia | pneumonia confined to one or two lobes of the lungs |
| Viral(interstitial) pneumonia | inflammation of the alveoli and connecting lung structures - shows up around the hila |
| Pulmonary edema | condition of excess fluid in the lung caused by a backup in the pulmonary circulation - associated with congestive heart failure |
| Tuberculosis | a contagious disease(possibly fatal) caused by airborne bacteria |
| Anthracosis | caused by coal dust |
| Abestosis | caused by inhalation of asbestos dust fibers |
| Silicosis | caused by inhalation of silica quartz dust, a form of sand dust |
| PA, Lateral (Left most common) | What are the 2 basic chest positions? |
| AP Supine or Semi-erect, Lateral decubitus, AP lordotic, Anterior Oblique, Posterior Oblique | What are the 6 special chest positions? |
| Lateral and AP | What are the 2 basic upper airway positions? |
| Patient erect, seated with legs over edge, Arms around cassette unless IR is used, shoulders rotated forward by rotating arms medially | Patient position in PA Chest - Stretcher |
| NO rotation of thorax - adjust height of IR so top is 1-1/2 to 2 in. above shoulders - if portable, place pillow in lap if needed, approx. T7 | Part position in PA Chest - on stretcher |
| CR perpendicular to IR and centered to midsagittal plane at T7(7-8 in. below vertebral prominens), or to inferior level of scapula, IR centered to CR, SID of 72 inches | CR position in PA Chest - on stretcher |
| Chin elevated, forward shoulder rotation to prevent scapula over lung fields, large breast shadows if present lateral to lung fields, both sternoclavicular joints same distance from center line of spine | PA Chest /Erect or Stretcher - Position criteria on image |
| visualization of fine vascular markings within lungs, faint outlines of at least midthoracic and upper thoracic vertebrae and posterior ribs visible thru heart and mediastinal sturctures | PA Chest /Erect or Stretcher - Exposure criteria on image |
| 14x17 - LW or CW based on body habitus | What size cartridge is used in a PA chest erect xray? |
| Left | What marker is typically used on a PA chest erect? |
| to allow scapulae to move laterally outside of lung field | Why do you rotate the shoulders forward against IR on a PA erect chest? |
| to move clavicles below apices | Why do you depress the shoulders down PA erect chest? |
| The sternoclavicular joints are same distance from center line of spine | HOw can you tell there is no rotation on PA erect chest? |
| the posterior ribs and costophrenic angles on side away from IR project slightly (1/4 to 1/2 inch is acceptable) | HOw can you tell there is no rotation on Lateral erect chest? |
| Left, unless the patient complaint involves Right side | Which side is typically against IR in a Lateral erect chest? |
| 72 inches(sometimes 60 in AP wheelchair/portable) | What is the SID for most chest xrays? |
| 40 inches | What is the SID for most table top xrays? |
| Source Image Distance | What is SID? |
| Watch breathing...take in inspiration. | If patient is unconscious how do you know when to take chest image? |
| Left lung, it will show up wider than right lung | In RAO oblique chest xray which lung is of primary interest? |
| Right lung, it will show up wider than left lung | In LAO oblique chest xray which lung is of primary interest? |
| Right lung (or side down), the one against the IR. | In RPO oblique chest xray which lung is of primary interest? |
| Left lung(or side down), the one against the IR. | In LPO oblique chest xray which lung is of primary interest? |
| 90 degrees | What is the degree of rotation of the patient in the Lateral chest xray? |
| 45 degrees | What is the degree of rotation of the patient in the RAO,LAO,RPO,LPO oblique chest xray? |
| Apical Lordotic Chest | What chest position xray is used on a patient suspected of having TB? |
| An arrow marker to show which side is up AND a L or R marker to show which side is up. ex: Left Lateral Decub would use a R marker. | What markers do you use with Lateral Decubitus chest xray? |
| perpendicular to IR and centered to midsagittal plane at T7 (7-8 in below vert. prominens) or to inferior angle of scapula | What is the Central Ray position on a PA chest xray? |
| 110-125 | What kV range is used on most chest xray? |
| LW | HOw should lateral chest cassette be placed for typical patient? |
| place wc laterally next to IR as close as possible, Remove armrests, place blocks behind back so wheelchair is not superimposed in image, raise arms over head | Describe patient position in wheelchair for Later chest xray. |
| place stretcher laterally next to IR as close as possible, sit up as erect as possible, place blocks behind back so wheelchair is not superimposed in image, raise arms over head for LAT, hands to side pronated in AP | Describe patient position in stretcher for Later or AP chest xray. |
| AP supine or semierect | What is the most common of the "special" chest projections? |
| 90 to 100 kV with grid | What is AP supine or semierect chest kV for large patients? |
| 70 to 80 kV without grid | What is AP supine or semierect chest kV for average patients? |
| behind back, placed crosswise | Where is cassette in AP supine or semierect chest? How is it placed? |
| angled caudad to be perpendicular to long asxis of sternum - usually 5 degree angle to prevent clavicles from obscuring apices. Also level of T7 - 3-4 in. below jugular notch | Where is CR in AP supine or semierect chest? |
| 40 inches | What is SID in AP supine or semierect chest? |
| 1) Heart will appear larger bc of shorter SID 2)inspiration will not be as full and only 8-9 ribs will show above diaphragm 3) possible pleural effusion will often obscure lung markings | What are the differences in Radiographic Critera between PA projection and AP supine or semierect chest? |
| air-fluid levels | What is the main pathology we are looking for in a Lateral Decubitus position? |
| 14x17 crosswise (CW) | How do you place the cassette in a Lateral Decubitus position? |
| the suspected side should be DOWN | How should patient be positioned in a Lateral Decubitus position if pleural effusion (fluid in pleural cavity) is suspected? |
| the suspected side should be UP | How should patient be positioned in a Lateral Decubitus position if pneumothorax(air in pleural cavity) is suspected? |
| AP Semiaxial with patient in supine position - CR 15 to20 degrees cephalad | What position can be substituted for AP Lordotic chest if patient is too weak to stand? |
| nearly horizontal and above apicies | How should clavicles appear in AP Lordotic chest? |
| in certain studies of the heart | When would a LAO be 60 degrees instead of the normal 45 degrees? |
| when pulmonary disease is suspected | When would a LAO be 15-20 degrees instead of the normal 45 degrees? |
| Closest | Posterior obliques provide best visualization of the side " " to the IR. |
| Farthest | Anterior obliques provide best visualization of the side " " to the IR. |
| 10x12 LW | What size cartridge is used in the Lateral Upper Airway xray? |
| Upright, seated or standing in lateral position | What is best patient position in the Lateral Upper Airway xray? |
| rotated posteriorly with arms down and clasped in back | How should shoulders be positioned in the Lateral Upper Airway xray? |
| Top of IR at EAM (opening of ear) | What is IR position in the Lateral Upper Airway xray? |
| level of C6 orC7 | What is CR position in the Lateral Upper Airway xray? |
| breathe in slowing so airway is filling trachea | What are breathing instructions in the Lateral Upper Airway xray? |
| raise chin so that acanthiomeatal line is perpendicular to the IR AND IR height is 1-1/2 in below EAM | What is IR position in the AP Upper Airway xray? |
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