middle portion, soft palate to hyoid bone respiratory and digestive
Laryngopharynx
inferior portion, hyoid bone to esophagus/larynx
(respiratory and digestive)
Where does the alimentary canal begin for the neck
begins at the oral cavity
continues as the pharynx,
esophagus,
stomach, small intestine,
large intestine and terminates as the anus
What projection is usaully done for a Soft Palate, Pharynx and Larynx
Usually only Lateral View is performed
Why is a Soft Palate, Pharynx and Larynx projection/views done
Often done for foreign bodies
epiglottitis
stenosis of the trachea
swelling of adenoids
What other name is there for a soft palate,Pharynx and larynx
Also known as ‘soft tissue neck’
Is there and increase in dose to a patient and what can be done to help
Yes an increased dose to patient’s thyroid: be sure to collimate well
Soft Palate, Pharynx and Larynx
Anteroposterior Projection
Patient postion
Patient upright or supine
Neck extended slightly
What is the respiration for an anteroposterior projection of the soft palate,pharynx and larynx
slow inspiration
What is an anteropostier projection of the soft palate,pharynx and larynx used for
Useful for barium studies
(swallowing),
phonation/stress studies
What is the central ray for an anteroposterior projection of the soft palate,pharynx and larynx
CR: ┴ to laryngeal prominence
Soft Palate, Pharynx and Larynx
Lateral View
SID
SID 72”
Soft Palate, Pharynx and Larynx
Lateral View
Patient position
Pull shoulders back and extend neck to prevent superimposition of mandible
Soft Palate, Pharynx and Larynx
Lateral View
respiration
slow inspiration
Soft Palate, Pharynx and Larynx
Lateral View
Central ray for Nasopharynx
CR: ┴ to…
1” below EAM
Soft Palate, Pharynx and Larynx
Lateral View
Central ray for the Oropharynx
•Oropharnyx – gonion (C2/3)
Soft Palate, Pharynx and Larynx
Lateral View
Central ray for the Larynx,pharnyx and upper esophargus
Larnyx, pharnyx and upper esophagus laryngeal prominence (C5)
Soft Palate, Pharynx and Larynx
Variations to study
Phonation of vowel sounds
to demonstrate vocal cords and cleft palate
Soft Palate, Pharynx and Larynx
Variations to study
Valsalva Maneuver
to show complete closure of the glottis. Patient is instructed to take a deep breath and bear down
to increase both the intrathoracic and intrabdominal pressure
used with esophageal varicies (bleeding)
Soft Palate, Pharynx and Larynx
Variations to study
Modified Valsalva
to test the elatisity of the laryngral pharnyx. Patient pinches nostrils together with the thumb and forefinger.
Patient tries to blow their nose
their cheeks will puff out in this procedure
Soft Palate, Pharynx and Larynx
Variations to study
Swallowing barium
may be used to visualize foreign bodies
Phonation in a soft palate,pharynx and larynx demonstrates
The vocal cords and cleft palate
Valsalva Maneuver
Soft palate demonstrates
To distend the subglottic larynx and laryngeal pharynx with air
Soft palate
Hieght of barium bolus demonstrates
helps visualise pharyngeal structures
Soft palate
swallowing a ball of cotton/marshmellow soaked in barium demonstrates
non opague foreign bodies in the pharynx or upper esophagus
Trachea
Anteroposterior Projection and Lateral View
Demonstrate
trachea, thyroid gland, thymus gland and associated pathologies
Demonstrate an enlarged thymus or abnormalities in the thymus
Trachea
Anteroposterior Projection and Lateral View
Detect
localization of foreign body
Trachea
Anteroposterior Projection
Patient Position
Patient supine or upright
Neck extended slightly
Trachea
Anteroposterior Projection
Respiration
slowly inhale (air filled trachea)
Area from midcervical to the midthoracic region
Trachea
Anteroposterior Projection
Central Ray
CR: ┴ to manubrium
Trachea
Lateral View
Patient Postion
Patient upright
Hands clasped behind back
Rotate shoulders posteriorly
Extend neck
Why do you rotate shoulders posteriorly in a lateral view of the trachea
to prevent superimposition over superior mediastinum
Trachea
Lateral View
Repiration
slow inspiration
Trachea
Lateral View
Central Ray
CR: ┴ midway between the jugular notch and the midcoronal plane
How is the Trachea visualized in lateral view
Air filled trachea
To demonstrate the superior mediastinum center 4-5” lower
Modified Barium Swallow
A fluoroscopy exam preformed with a speech pathologist to view and assess the swallowing mechanism
Recorded on video tape
•Patient is sitting and speech pathologist or technologist feeds them different amounts and consistencies of barium and barium coated food.
•Starts with small quantities of thin and thick barium and then pudding, applesauce, fruit cup all coated with barium •Different techniques used to demonstrate pathologies and aspiration (from penetration of liquid through vocal cords)
Modified Barium Swallow
3 phases of swallowing
Phase 1,Oral phase
moving the food/liquid to the back of the mouth
Modified Barium Swallow
3 phases of swallowing
Phase 2,Pharyngeal phase
moving the food/liquid over the back of the tongue and down to the pharynx or throat
Modified Barium Swallow
3 phases of swallowing
Phase 3,Esophageal phase
the food/liquid enters the esophagus
When would you do a modified barium swallow
To identifies problems that occur in the mouth, at the base of the tongue, in the pharynx, or in the esophagus
modified barium swallow is suited for
patients with complains of swallowing, choking or regurgitating,
patients who have had past episodes of pneumonia which have yet to be diagnosed
What other information does a modified barium swallow provide
information about tongue motion and coordination and timing of the swallow
How material is managed orally just prior to the swallow and evaluates the mechanical aspects of the swallowing mechanism including airway protection and how well the material moves through the different phases of swallowing
Lung Biopsy
Thoracic Needle Aspiration
usually performed when the abnormal condition is near the surface of the lung, in the lung itself, or on the chest wall
Biopsy (tissue sample) is collected for analysis
Lung Biopsy
When is it performed
when a suspicion of primary or metastatic malignancy exists, usually based on interpretation of a chest x-ray (previously performed)
Lung Biopsy provides what kind of information on
the stage and extent of disease
What ways can a lung biopsy be done
fluoroscopy, CT or angiography
Lung Biopsy
Three risks for this procedure
Collapsed lung
(pneumothorax)
Bleeding
Infection
Lung Biopsy
Post-Procedure
Patient is monitored for 2-4 hrs for signs of pneumothorax
PA chest is taken immediately post procedure and then 2-4 hrs afterward
Signs of complications – shortness of breath, or chest pain
- Chest tube may be required if patient has a large pneumothorax
What is required if Patient has a large pneumothorax
Chest x ray
Nasopharynx
Superior portion
From nose to soft palate
Oropharynx
middle portion
From soft palate to hyoid bone
Laryngopharynx
inferior portion
From hyoid bone to esophagus
The esophagus is anterior to the trachea
True or false
false
What is the Valsalva Maneuver and why do we use it?
Forcibly blowing air against a closed airway (a closed glottis)
Done to increase venous pressure to demonstrate pathologies such as esophageal varicies
Why are initial images of the pharynx performed during inhalation
To fill the pharynx with air to provide visualization of its structures
If the results for a lung needle biopsy are positive for a malignant tumor, what are possible steps for procedure and treatment?
Surgery to remove tumor
Radiation therapy
Chemotherapy
What step is done should the tumor be secondary
If tumor is secondary the primary site needs to be established to determine next step
Deglutition
the act of swallowing
Dysphagia
difficultly swallowing
Aspiration
inhalation into the airways of fluid or foreign body
Valsalva Maneuver
any forced expiratory effort against a closed airway
What four parts or areas are demonstrated on trachea radiographs
Trachea
thyroid gland
parathyroid glands
thymus gland
What is another name for a needle biopsy
Transthoracic needle aspiration
Name 6 contraindications for this procedure
Emphysema bullae
cysts
blood coagulation disorders
pulmonary hypertension
severe hypoxia
uncooperative patient
What are two major requirements for this examination with regards to patient preparation
A through explanation of examination
Patient should be on clear liquid diet 6 to 8 hours pior to procedure