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Chest A&P/Positions

chest anatomy/techniques

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