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Chest A&P/Positions
chest anatomy/techniques
| Question | Answer |
|---|---|
| what are the systems of the thoracic cavity | *cardiovascular system *respiratory system *digestive system *endocrine glands *nervous system *lymphatics |
| what are the three chambers of the thoracic cavity | *right pleural cavity or space *left pleural cavity or space *pericardium |
| opening at he top of the ribcage | superior thoracic aperture |
| opening the base of the ribcage, bordered by the diaphragm | inferior thoracic aperture |
| air in pleural cavity | pneumothorax |
| blood in pleural cavity | hemathroax |
| fluid in pleural cavity | pleural effusion |
| pus in pleural cavity | empyema |
| surrounds lungs *no nerve endings | visceral pleura |
| surrounds visceral pleura and is in contact with parietal wall (there is a serous layer between the two layers that prevents friction) | parietal pleura |
| what two structures make up the pleura | *visceral pleura *parietal pleura |
| what are the vessels that supply the lungs with blood (dual blood supply) | *bronchial artery *pulmonary artery |
| what structures make up the mediastinum | *heart *aorta *svc *esophagus *thymus *trachea |
| *primary control of lymphatic system *produces thymosin *develops immune system | thymus |
| what three structures pass through the diaphragm | *aorta *svc *esophagus |
| what are the structures that make up the respiratory system | *nasal cavities *pharynx *larynx *trachea *bronchi *two lungs |
| opening to trachea, between vocal cords | glottis |
| what are the four sets of sinuses | *frontal *ethmoidal *sphenoidal *maxillary |
| bones of the nasal cavity that act as a turbine to cool or warm body temp. | nasal conchae |
| what does the pharynx consist of | *nasopharynx *oropharynx *laryngopharynx |
| behind nasal cavity and consist of: *hard palate(maxilla) *soft palate *uvula *tonsils and adenoids *auditory tubes | nasopharynx |
| behind oral cavity, extends to hyoid bone | oropharynx |
| laryngopharynx extends from what vertebral level | from C3-C6 |
| flap that prevents food from going into trachea, by forming a seal when swallowing and opens up to take air into trachea when breathing | epiglottis |
| two fused platelike structures of cartilage that form anterior wall of the larynx | thyroid cartilage |
| in what order does the air flow through the structures of the lungs | trachea bifurcates at the carina-->primary bronchi-->secondary bronchi-->tertiary bronchi-->primary brochioles-->terminal brochioles-->alveolar duct-->alveoli |
| contains silia to clean the air, as well as cooling and heating air that enters | mucous membrane |
| simple ring of cartilage(the only complete ring around the trachea), attachment for muscles | cricoid cartilage |
| these vibrate to help phonate sound | vocal cords |
| hollow tube that sits midline and measures 1/2 inch in diameter, 4 1/2 inches long. the posterior aspect is flat. | trachea |
| last ring of cartilage that surrounds trachea, at the level of T5, this is where trachea bifurcates and becomes the two primary bronchi. | carina |
| how many primary bronchi | 1 on each side, the bronchi on the right is shorter and more transverse than the left bronchi |
| how many secondary brochi | 3 on the right and 2 on the left |
| how many tertiary bronchi | 10 on the right and 8 on the left |
| what are the divisions of the brochi | *primary bronchi *secondary(lobar)bronchi *tertiary(segmental)bronchi *primary bronchioles *terminal bronchioles |
| what is the functional unit of the lungs | alveoli- the respiratory zone *where oxygen and carbon dioxide are exhanged(there are millions of alveoli in each lung) |
| what is the anatomy of the alveoli | *alveolar ducts *alveolar sacs *alveoli |
| pulmonary arteries | carry deoxygenated blood from the heart to the lungs |
| pulmonary veins | carry oxygen rich blood to the left atrium |
| lungs | organs of respiration |
| parenchyma | spongy elastic material that the lungs are made of |
| apex | top pointed portion of the lungs |
| base | inferior, broad portion of the lungs that boarders the diaphragm |
| costophrenic angles | bottom lateral angles of the lungs |
| cardiophrenic angles | bottom medial angles of the lungs |
| hilum | indention on medial portion of lungs, that allows vessels to enter and exit |
| cardiac notch | indentation in the lung where the heart sits |
| costal surface of lungs | in contact with ribs |
| diaphragmatic surface of lungs | touches diaphragm |
| mediastinal surface of lungs | touches mediastinum |
| how many fissures are there in each lung | *2 in the right lung *1 in the left lung |
| how are the fissures of the lungs positioned | *horizontal *oblique |
| lingula | region of left lung that would be the middle lobe if there were a second fissure in that lung |
| inspiration | lungs fill with air and get longer, diaphragm moves down |
| expiration | lungs get shorter as air is pushed out, diaphragm moves up |
| ageniesis | unformed lung |
| hypoplasia | under developed lungs |
| cysts | hollow cavities filled with fluid |
| bronchoesphageal fistula | abnormal communication between the bronchi and esophagus |
| tracheotomy | surgical procedure to open a direct airway into the trachea |
| lobectomy | surgical removal a lung lobe |
| pneumonectomy | surgical removal of a lung |
| segmental resection | removal of part of lobe or segment |
| thoracoplasty | removal of part of ribs(required for lung removal |
| thoracentesis | removal of fluid or air from thoracic cavity |
| bronchography | radiographic exam of bronchiole tree |
| atelactesis | collapsed lung |
| bronchitis | inflamation of the bronchi |
| laryngitis | inflamation of the larynx |
| pneumonitis | inflamation of lung tissue(pneumonia) |
| bronchopneumonia | inflamation of part of the lobe and bronchi |
| lobar pneumonia | infection of single lobe of lung |
| pleurisy | inflamation of the pleura |
| COPD | -chronic obstructive pulmonary disease *pathological obstruction of air flow |
| emphysema | aveoli lose elasticity and are unable to complete gas exchange, causing unusually long and dark lungs |
| empyema | pus in plural cavity |
| what procedural guidelines should followed when setting a pt up for an exam | *patient prep *general patient position *IR size *SID *ID markers *radiation protection *patient instructions |
| what should be done to prepare a patient for a procedure | *remove all artifacts from anatomy of interest *secure all pt belongings *obtain pertinent patient hx |
| what patient hx questions should we ask before a chest xray | *any chest pain *location of pain *hx of chest or heart problems/surgeries *pain level *smoker? *shortness of breath *onset of symptoms *if exam is preop, what for? |
| how should the patients general position be determined | *ambulatory patients- do upright *nonambulatory patients- do sitting up when possible. if it is not possible to sit patient up, decubitis can be performed |
| what factors should be considered for IR selection | *body habitus *use smallest IR that will demonstrate anatomy *collimate |
| what is the SID recommendation for chest radiography | longer SID to show true size of the heart |
| what are the ID markers that should be included in your images | *right or left markers and all other required markers should be included in final image |
| what radiation protection measures should always be taken | *shield patients *colimate *use optimal technique factors (high kVp/low mAs) |
| patient instructions should include what | *explanation and demonstration of positions when possible *respiration instructions *exposures should be made after second deep inspiration |
| in some instances two seperate radiographs may be taken, one on inspiration and one on expiration. why is this done | to demonstrate: *pneumothorax *diaphragm movement *presence of foreign body *atelectasis |
| what are the essential chest projections | *PA *lateral *PA oblique *AP oblique *AP *AP axial |
| position for PA chest | *upright, if possible *facing IR with MSP centered *MSP perpendicular and MCP parallel to IR *weight equally distributed on both feet *top of IR 1.5" to 2" above shoulders *depress shoulders into same transverse plane *roll shoulders forward |
| what is the path of the central ray for a PA chest | *perpendicular to the center of the IR *CR enters at T7 and MSP |
| what is the technique for PA chest | *105-120 kVp *two outer AEC cells should be selected(1 & 3) *exposure should be made at the end of second full inspiration |
| what can you look for on your image that will show that your patients lungs have fully expanded during inspiration | *10 posterior ribs can be visualized within the lungs above diaphragm on an adult *8 on a child |
| tension pneumothorax | spontaneous pneumothorax |
| position for lateral chest | *upright if possible *IR 1.5" to 2" above shoulders *MSP parallel and MCP perpendicular to the IR *shoulder in contact with board *extend arms over head, flex elbows, and rest forearms on head |
| what is the path of the central ray for a lateral chest | *directed perpendicular to the IR *enters at level of T7 and MCP |
| what is the technique for a lateral chest | *105-120 kVp *center AEC cell selected(2) *exposure should be made after second full inspiration |
| position for PA oblique chest | *upright or recumbent *45-degree LAO or RAO *top of IR 1.5" to 2" above vertebra prominens *arms positioned out of collimated field |
| what is the path of the central ray for a PA oblique chest | *perpendicular to the IR *enters at level of T7 |
| what is the technique for a PA oblique chest | *105-120 kVp, two outer cells of AEC are selected(1 & #) *exposure made after second full inspiration |
| position for AP oblique chest | *upright or recumbent *45-degree LPO or RPO *shoulders in same transverse plane *arms out of field |
| what is the path of the central ray for an AP oblique chest | *perpendicular to IR *enters 3" below jugular notch |
| what is the technique for AP oblique chest | *105-120 kVp, two outer AEC cells are selected(1 & 3) *exposure made after second fall inspiration |
| position for AP chest | *supine or sitting up *center MSP to IR *top of IR 1.5" to 2" above shoulders *roll shoulder forward if patient is able *shoulders in same transverse plane |
| what is the path of the central ray for AP chest | *perpendicular to long axis of sternum and center of IR *enters 3" below jugular notch |
| what is the technique for AP chest | *manual(high mA, low time)- use of grid if patient is larger than 12cm *exposure made after second full inspiration |
| position for lordotic chest | *upright, facing tube *about 1 foot in front of grid *top of IR placed 3" above shoulders when patient in lordotic position *MSP centered to midline of grid *assist pt to lean backward until shoulders rest on grid |
| what is the path of the central ray for a lordotic chest | *perpendicular to IR *enters MSP at midsternum(T7) |
| what is the technique use for lordotic chest | *105-120 kVp, two outer AEC cells selected(1 & 3) *exposure made after second full inspiration |
| AP/PA(projection) lateral decubitus chest position | *to demonstrate fluid levels patient should be positioned on affected side *to demonstrate free air patient should be positioned on unaffected side *elevate body 5 to 8 cm if lying on affected side *no rotation *arms over head *chest against grid |
| for lateral decubitus, how long should patient be in position before exposure to obtain an optimal image | 5 minutes |
| what is the path of the central ray for lateral decubitus chest | *horizontal to floor and perpendicular to IR *enters MSP at 3" below jugular notch for AP, T7 for PA *exposure made on second full inspiration |
| Lateral(projection) Ventral or Dorsal decubitus chest positions | *prone or supine *body elevated 2" to 3" *no rotation *affected side against grid device *arms above head *top of IR at level of thyroid |
| what is the path of the central ray for a ventral or dorsal chest | *horizontal to the floor and perpendicular to the IR *enters at level of MCP, 3" to 4" below jugular notch for dorsal, T7 for ventral |
| what is the technique used for ventral or dorsal decubitus chest | *105-120 kVp, center AEC cell is selected(2) *exposure made after second full inspiration |
| what should be visible in a PA chest image | *entire lung fields from apices to costophrenic angles *no rotation *trachea in midline *scapulae out of lung fields *10 posterior ribs visible above diaphragm *heart and diaphragm outlines sharp *ribs and t-spine visible in heart shadow *lung mrkn |
| what should be visible in a Lateral chest | *superimposition of ribs posterior to vertebral column *arm or its soft tissue not seen in lung field *long axis of lungs vertical without forward or backward leaning *lateral sternum *Costophrenic angles and apices *pentration of lungs and heart |
| what should be visible in a lateral chest...contd | *open thoracic intervertebral disk spaces and foramina, except in pt with scoliosis *sharp outlines of heart and diaphragm *hilum in center |
| what should be visible in a PA oblique chest | *both lungs seen in their entirety *air-filled trachea *visible ID markers *heart and mediastinal structures within lung field of elevated side in 45-degree obliques *maximum area of right lung seen on LAO *maximum area of left lung seen on RAO |
| what should be visible on an AP olblique chest | *both lungs seen in their entirety *air filled trachea *visible ID markers *lung fields and mediastinal structures *maximum area of left lung seen on LPO *maximum area of right lung seen on RPO |
| what should be visible on an AP chest | *medial portion of clavicles equidistant from vertebral column *trachea in midline *clavicles lying more horizontal and obscuring more of apices than in PA *equal distance from vertebral column to lateral border of ribs on each side |
| what should be visible on an AP chest contd. | *ribs and thoracic vertebra vesible through heart shadow *entire lung fields from apices to angles *pleural markings visible |
| what should be visible on Lordotic chest | *clavicles lying superior to apices *sternal ends of clavicles equidistant from vertebral column *apices and lungs in their entirety *clavicles horizontal with medial ends overlapping first or second ribs *ribs distorted and almost superimposed |
| what should be visible in an AP/PA(projection) lateral decubitus chest | *no rotation *Entire affected side demonstrated *apices *proper ID to indicate decubitus performed *arms not visible in anatomy of interest |
| what should be visible on a Lateral(projection) ventral or dorsal Decubitus chest | *entire lungs *no rotation *arms not seen in upper lungs *proper markers to indicate decubitus performed *T7 in center of IR |
Created by:
bigad1982
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