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Positioning
Chapter 3
| Question | Answer |
|---|---|
| What is the name of the structure that serves as a passageway for both food and air? | pharynx |
| The jugular notch is located on the? | Superior portion of the sternum |
| What is the correct anatomical name for the Adam's apple? | thyroid cartilage or laryngeal prominence |
| What is the name of the structure that serves as a lid over the larynx to prevent aspiration of food and fluid? | epiglottis |
| Which one of the following are considered to be more posterior? The Larynx, Esophagus, Trachea, or Hyoid Bone. | Esophagus |
| The lower concave area of the lung is termed? | The base |
| Which of the following structures is considered to be most inferior? Epiglottis, Hyoid Bone, Carina, Vocal cords | Carina |
| The internal prominence or ridge where the trachea bifurcates into the right and left bronchi is termed the? | Carina |
| The inner membrane of the pleura that encloses the lungs and heart is called the: | pulmonary or visceral pleura |
| Air or gas that escapes into the pleural cavity results in a condition known as? | Pneumothorax |
| Which one of the following structures is NOT considered part of the mediastinum? Thymus gland, Aorta, Trachea, Bronchi | Bronchi |
| The CR for an AP supine chest should be? Centered to level of T7, Centered 8 to 10 cm below jugular notch, Angled 5 degrees caudad, or all of the above? | All of the above |
| List the three divisions of the structures located proximally to the larynx that serve as a common passageway for both food and air. | Nasopharynx, oropharynx, laryngopharynx |
| The thyroid dose on an average adult AP chest with correct collimation is? | Approximately 1 mrad |
| The female breast dose for a correctly collimated lateral chest is? | Between 10 and 15 mrad |
| The female breast dose for an AP chest is approximately how many times that for a PA chest? A. 30 times B. 10 times C. 2 times or D. 50 times | 4 times |
| The carina is located at the approximate level of? | T5 |
| Which type of body habitus requires that the cassette be placed crosswise rather than lengthwise for a PA chest? | Hypersthenic |
| Which of the following is not true? The right lung contains 3 lobes, The left bronchus is larger in diameter than the right, The right bronchus is shorter than the left, The angle of divergence of the left bronchus is greater than that of the right. | The left bronchus is larger in diameter than the right bronchus. |
| A well inspired PA projection will have a minimum _____ posterior ribs seen above the diaphragm? | 10 |
| Which of the following objects do not have to be removed or moved prior to chest radiography? A. Necklace, B. Bra, C. Tee shirt, D. Glasses | |
| What technical factors are most ideal for chest radiography? | 120 kVp, 400 mA, 1/40 sec, 72 in. SID |
| A PA chest radiograph reveals that only 8 ribs are seen above the diaphragm. What suggestion would improve the inspiration of lungs? | Take exposure on the second inspiration. |
| A correctly positioned lateral chest radiograph demonstrates some separation of the posterior ribs due to the divergenct x-ray beam. A separation of more than _____ indicates objectionable rotation from a true lateral. | 1 cm |
| What is the primary disadvantage of performing an AP projection of the chest rather than a PA? | Increased magnification of the heart |
| Which factor must be observed to demonstrate possible air and fluid levels in the chest? | Patient in erect position |
| A PA chest radiograph reveals that the pendulous breasts of the patient are obscuring the base of the lungs. What should be done to lessen the effects of the breast shadow? | Ask patient to lift breats up and outward. |
| A PA chest radiograph reveals that the left sternoclavicular joint is closer to the spine that the right joint. What specific positioning error has been committed? | Rotation into LAO postition |
| Which one of the following factors must be observed to minimize magnification of the heart? | 72 inch SID |
| What action will remove the scapulae from the lung field? | Roll shoulders forward |
| For a female patient, where is the CR placed for a PA projection of the chest? | 7 inches below vertebra prominens |
| When using Automatic Exposure Controls, which ionization chambers are activated for a left lateral projection of the chest? | Center chamber only |
| How much CR angle is required for the AP semi-axial projection for the apices? | 15 to 20 degrees cephalad |
| A patient enters ER with possible pneumothorax in left lung. Due to trauma, the patient can't stand or sit erect. Which position would best demonstrate this condition? | Right lateral decubitus. |
| Which set of chest oblique positions will best demonstrate the right lung? | LAO and RPO |
| A patient enters ER due to severe trauma. The physician orders an AP supine chest to evaluate lungs. What can the technologist do to reduce the magnification of the heart? | Increase SID as much as possible |
| An ambulatory patient comes to radiology with a clinical history of possible pneumonia. The patient complains of pain in the center of her chest. What positioning routine should be performed on this patient? | PA and left lateral |
| A patient in ICU with multiple injuries. The attending physician is concerned about pleural effusion in left lung. The patient had surgery recently and cannot be placed in the erect position. What position would be best to rule out the pleural effusion? | Left lateral decubitus |
| A patient comes to radiology for routine chest study. On PA projection radiologist sees a possible calcification near a rib. But she can't tell if the calcification is in the lung or on the rib. What additional projections would assist with the diagnosis? | Inspiration/Expiration PA |
| A patient enters ER with a possible hemothorax in the right lung. With help the patient can sit erect on a cart. Which one of the following routines would best demonstrate this condition? | Erect PA and right lateral on cart |
| A patient comes to radiology with a possible mass beneath the right clavicle. The PA and left lateral projections are inconclusive. Which additional projection can be taken to demonstrate this possible mass? | Apical lordotic |
| True or False. For anterior obliques of the chest, the side of interest is generally farthest from the film. | True |
| True or False. The vertical dimesions of an average PA chest is greater than the horizontal dimesions. | False |
| A small pneumothorax may be detected by performing inspiration and expiration PA projections. | True |
| True and False. The greates amount of patient dose delivered to the patient during chest radiography is to the skin. | True |
| True or False. When performing the lateral projection of the upper airway, exposure should be made during a slow, deep inspiration rather than at the end of the inspiration. | True |
| When using Automatic Exposure Control, which ionization chamber should be activated on anterior obliques. | The upper outside chamber farthest from the chest |
| Why must the technologist slightly angle the CR cuadad for most AP projections of the chest? | Prevents clavicle from obscuring apices of lungs |
| When using Automatic Exposure Control, which ionization chambers are normally activated for the PA projection of the chest? | Two upper outside chambers |
| Which positioning line must be placed perpendicular to the plane of the cassette for an AP projection of the upper airway? | acanthiomeatal |
| The bony thorax consists of the single ______ anteriorly, two ________, two _______, twelve pair of ______ and twelve _______ ________ posteriorly. | sternum; clavicles; scapulae; ribs; thoracic vertebra |
| The two bony landmarks of the thorax that are used for locating the central ray on a posteroanterior (PA) and anteroposterior (AP) chest projection are the ________ and _______, respectively. | vertebra prominen and jugular notch |
| The four divisions of the respiratory system are: | Pharynx, Trachea, Bronchi, Lungs |
| Correct anatomic name for the adam's apple is? | Thyroid cartilage |
| Correct anatomic name for the voice box? | Larynx |
| Correct anatomic name for the breastbone? | Sternum |
| Correct anatomic name for the shoulder blade? | Scapula |
| Correct anatomic name for the collar bone? | Clavicle |
| The trachea is located anteriorly or posteriorly to the esophagus? | anteriorly |
| The ______ bone is seen in the anterior portion of the neck and is found just below the tongue or floor of the mouth. | Hyoid |
| If a person accidentally inhales a food particle, which bronchus is it most likely to enter and why? | The right because it is larger in diameter and more vertical. |
| What is the term for the small air sacs located at the distal ends of the bronchioles, in which oxygen and carbon dioxide is exchanged in the blood? | alveoli |
| The delicate double-walled sac or membrane containing the lungs is called the? | pleura |
| The outer layer of this membrane adhering to the inner surface of the chest wall and diaphragm is the? | parietal pleura |
| The inner layer adhering to the surface of the lungs is the ______ or _______ ? | visceral; pulmonary pleura |
| The potential space between the parietal pleura and the visceral pleura is called? | pleural cavity |
| Air or gas that enters the pleural cavity is called? | pneumothorax |
| The lower concave portion of the lungs is called? | the base |
| Central area in which bronchi and blood vessels enter the lungs: | hilum |
| Upper, rounded portion above the level of the clavicles: | Apex (Apices) |
| Extreme, outermost lower corner of the lungs: | Costophrenic Angle |
| Explain why the right lung is smaller than the left lung and the right hemidiaphragm is positioned higher than the left hemidiaphragm. | The prescence of the liver on the right |
| List the four important structures located in the mediastinum. | Thymus gland, trachea, heart and great vessels, and esophagus. |
| The heart is enclosed in a double-walled membrane called the? | pericardial sac, pericardium |
| The three parts of the aorta are the ______, _______ and ______. | ascending, arch, and descending |
| True or False. Chest radiography is the most commonly repeated radiograph procedure because of poor positioning or exposure factor selection errors. | True |
| Chest radiography for the adult patient usually employs a kilovoltage peak of ______to _____ | 110 to 125 kV |
| True or False. Because the heart is always located in the left thorax, the use of anatomic side markers on a PA chest projection may not be necessary. | False |
| What device should be used for the erect PA and lateral chest for an infant? | The Pigg-O-Stat |
| What technical factors are recommended for a chest examination of a young pediatric patient? | 60 to 70 kV, short exposure time |
| True or False. Because they have shallower (superior-inferior dimension) lung fields, the central ray is often centered higher for geriatric patients. | True |
| To ensure better lung inspiration during a chest radiography, exposure should be made during what inspiration? | second |
| List the five pathologic conditions that would suggest the need for both inspiration and expiration PA chest radiographs | 1. small pneumothorax 2. fixation or lack of diaphram movement 3. prescence of foreign body 4. distiguishing between opacity in rib or lung 5. possible atelectasis |
| Explain the primary purpose and benefit of performing chest radiography using a 72-inch source image receptor distance (SID). | It reduces distortion and magnification of the heart |
| Why do the lungs tend to expand more with patient in an erect position than in supine postition? | In erect position abdominal organs drop allowing the diaphragm to move further down, allowing lungs to fully aerate |
| What is a common radiographic sign seen on a chest radiograph for a patient with respiratory distress syndrome (RDS)? | Air bronchogram |
| What anatomic structures are examined to determine rotation on a PA chest radiograph? | Symmetric appearance of sternoclavicular joints. |
| What positioning tip will help you prevent the patient's chin from being superimposed over the upper airway and apices of the lungs for f PA chest radiograph? | Extend and lift the chin upwards |
| Which lateral position would you perform for patients with clinical histories of severe pains in the left side? | left lateral |
| Which lateral position would you perform for patients with clinical histories of no chest pain but recent history of pneumonia in the right lung. | right lateral |
| Which lateral position would you perform for patients with clinical histories of no chest pain but history of heart trouble. | left lateral |
| Why is it important to raise a patient's arm above the head for a lateral chest projection? | to prevent upper arm soft tissue from being superimposed over upper chest fields |
| True or False. The traditional central ray centering technique for the chest is to place the top of the image receptor 1 1/2 to 2 inches (5 cm) above the shoulders. | True |
| A recommended central ray centering technique for a PA chest projection requires the technologist to palpate the ________? How far down from the answer up above do you measure for a male? for a female? | Vertebra prominens 8 inches (20 cm) for male, 7 inches (18cm)for female. |
| True or False. With most digital chest units, the question of IR placement into either vertical or crosswise positions is eliminated because of the larger IR. | True |
| What bony landmark is palpated for centering of the AP chest position? | the jugular notch. |
| True or False. In general, for an average patient more collimation should be visible on the lower margin of the chest image than on the top for a PA or lateral chest projection. | False, it should be equal |
| True of False. For most patients, the central ray level for a PA chest projection is near the inferior angle of the scapula. | True |
| True or False. The height, or vertical dimension, of the average-to-large person's chest is greater than the width, or horizontal dimension. | False |
| True or False. Single-photon emission computed tomography (SPECT) is frequently used to diagnose myocardial infarction. | True |
| True or False. Ultrasound is not an effective modality to detect pleural effusion. | False |
| True or False. Echocardiography and electrocardiograpby are basically the same procedure. | False |
| One of the most common inherited diseases where secretions of heavy mucus cause progressice clogging of the bronchi | Cystic Fibrosis |
| Condition of excess fluid within the lung most frequently cause by a backup in the pulmonary circulation, associated with congestive heart failure. | Pulmonary Edema |
| Coughing up blood | Homoptysis |
| Accumulation of air or gas in the pleural cavity. | Pneumothorax |
| Accumulation of pus in pleural cavity. | Empyema |
| The three different form ofs occupational lung disease. | Silicosis, Asbestosis, Anthracosis |
| A contagious disease caused by an airborne bacterium | Tuberculosis. At one time was responsible for 30% of all deaths. In the 40' and 50' nearly eliminated but with the increased incidence of aids, overcrowding and unsanitary conditions, occurance is on the rise. |
| irreversible dilation of widening of bronchi or bronchioles. | Bronchiectasis |
| Most common form is emphysema | Chronic obstructive pulmonary disease (COPD) |
| Acute or chronic irritation of bronchi. | Bronchitis |
| Collapse of all or portion of lung. | Atelectasis |
| Inflammation of pleura | Pleurisy |
| What chest projection is recommended to detect calcifications or cavitations within the upper lung region near the clavicles. | AP Lordotic |
| Why is a PA chest preferred to an AP projection. | Because it places the heart closer to the image receptor. Reduces magnification |
| The CR is placed at the level of the ______ vertebra for a PA chest projection. | T7 |
| The shoulders need to be rolled forward for the PA projection to allow the _______ to move laterally and to be clear of the lung fields. | Scapula |
| When the automatic exposure control system (AEC) is being used for the PA projection, which ionizing chambers should be activated? | Left and right chambers. |
| True or False. The average breast dose and thyroid dose for a PA chest projection are approximately the same. | True |
| The average female breast dose on an AP chest projection is approximately ________ times that for a PA chest dose. | 4 |
| How much separation of the posterior ribs on a lateral chest projection indicates excessive rotation from a true lateral position? | Greater than 1 cm (1/2 to 3/4 inch). Less separation than this is caused by divergent x-rays) |
| To prevent the clavicles from obscuring the apices on an AP projection of the chest, the central ray should be angled ______ (caudad or cephalad) so that it is perpendicular to the _______. | + or - 5 degree caudad sternum |
| What is the name of the condition characterized by fluid entering the pleural cavity? | effusion |
| Which specific position would be used if a patient were unable to stand but the physician suspected the patient had fluid in the left lung? | left lateral decubitus |
| What is the name of the condition characterized by air entering the pleural cavity? | pneumothorax |
| Which specific position would be used if the patient were unable to stand but the physician suspected the patient had free air in the left pleural cavity? | right lateral decubitus - affected side up |
| What circumstances or clinical indications suggest that an AP lordoctic projection should be ordered? | rule out calcifications or maasses beneath the clavicles. |
| What position/projection would be used for a patient who is too ill or weak to stand for an AP lordotic projection? | AP semi axial projection, CR 15 to 20 degree cephalad. |
| Which anterior oblique postion would best demonstrate the left lung - right anterior oblique (RAO) or left anterior oblique (LAO)? | RAO |
| Which posterior oblique position would best demonstrate the left lung - RPO or LPO? | LPO |
| For certain studies of the heart, the _____ (right or left) anterior oblique requires a rotation of _____. | left; 60 degrees. |
| Which AEC ionization chamber(s) should be activated for an LAO chest projection? | Right upper chamber. |
| Where is the central ray placed for a lateral projection of the upper airway? | level of C6 & C7 midway between thyroid cartilage and jugular notch. |
| Which one of the following tissues receives the greatest dose during an AP projection of the upper airway? | Thyroid. |
| A radiograph of a PA view of the chest reveals that the sternoclavicular (SC) joints are not the same distance from the spine. The right SC joint is closer to the midline than is the left SC joint. What is the positioning error? | Rotation. Patient is rotated to a slight RAO position. |
| A radiograph of a PA projection of the chest shows only seven posterior ribs above the diaphragm. What caused this problem, and how could it be prevented on repeat exposures? | lungs underinflated. Patient needs to breathe deeply, take exposure on 2nd inspiration. |
| A radiograph of a PA & left lateral of the chest reveals the mediastinum of the chest is underpenetrated. The technologist used the following factors: a 72 inch SID, an upright bucky, a full inspiration exposure, 75 kv and 600 mA and a 1/60 exposure time. | kV is too low. Should be 110 - 125 kV Increase kV reduce mA |
| A radiograph projection of the chest reveals that the top apices are cut off and a wide collimation border can be seen below the diaphragm. What will correct this | Center CR to T7, 7 to 8 inches below vertebra prominens. IR centered to CR. collimation light border at vertebra prominens |
| A patient with clinical history of advanced emphyzema comes to radiology department for a chest x-ray. AED will not be used. How shoudl technologist alter manual exposure settings for this patient? | Decrease kV moderately (--) |
| A patient with severe pleural effusion comes to the radiology department for a chest x-ray. AEC will not be used. How should the technologist alter the manual settings? | Increase the kV slightly (+) |
| A patient comes to the radiology department for a presurgical chest examination. The clinical history indicates a possible situs inversus of the thorax (transposition of structures within the thorax). Which positioning step or action must be taken? | Place proper markers on image receptor because heart and other thoracic organs may be transposed from right to left. |
Created by:
Baker RAD 2012
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