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what is the thorax
aka the chest, is the upper portion of the trunk between the neck and the abdomen
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what is the bony thorax
the part of the skeletal system that provides a protective framework for the parts of the chest involved with breathing
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what are topographical landmarks
they are parts of the body that are easily palpated and consistently located on patients
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what are the two landmarks for chest positioning
vertebral prominens (C7) and the jugular notch of the sternum
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what can you see on the bony thorax when the patient gives you a good inspiration
ten ribs above the diaphram on a radiograph
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Why is the right lung is shorter than the left
b/c the diaphragm has to rise higher on the right side to accomodate the liver
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How many breaths is optimal for a chest x-ray procedure
one deep inspiration and expiration followed by an inspiration and hold it
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How many inches muct the IR when doing a chest xray
1.5-2 inches above the shoulders
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what is the position of the shoulders in the chest xray?
depressed and rolled forward to keep the scapulae out view of other important
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if you cannot perform a PA projection what other option is
AP
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how many inches must you lower the CR when taking the lateral position of the chest rather than the PA
1 inch below minimum from PA
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what is the hypersthenic body type
it is when the person is very stocky, has very broad and very deep thorax from front to back but is shallow in the vertical dimension
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how must the xray be taken on a hypersthenic person
the IR should be used with the landscape and and to make sure that the costophrenic angles are not cut off
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what is the asthenic body habitus
a person who is off extreme slender build, long narrow thorax in width and shallow from the front to back but long invertical dimension
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what is the hyposthenic body
it is a person of near average build and ensure that the costophrenic angles are not cut off
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what is the most important reasoning of an erect chest
visualizes possible air fluid levels
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what is the proper SID for a chest
72'' SID the further the tube, the better the detail for chest
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What are true ribs and what do they attach to?
1-7 and attach to the sternum
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ribs 8-12 are called what
false ribs
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ribs 11 and 12 are?
floating ribs
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what is a topographical land mark for an AP chest
jugular notch and go 3-4in down to locate the center of the thorax
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how far does the lung tissue extend to
around the length of all thoracic vertebrae (t1-t12)
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where is the pharynx located and how long is it
behind the nasal cavity, mouth and larynx 12.5cm long
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what are the four parts of the respiratory system
larynx, trachea, R & L bronchi, lungs
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what is aspiration
happens when something goes down the wrong pipe i.e. food or foreign body goes down into the right bronchi
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where is the esophagus located
posterior to the trachea
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what area does the trachea extend from and to
from c6 to t4 or t5
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what glands are located near the trachea
thyroid, parathyroid and thymus
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what technical factor must you adjust in order to notice soft tissue and achieve differential absorption of radiation in different tissue?
lower kVp
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why do we use lower kVp when looking at certain situations of the trachea
to locate certain foreign bodies
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what is another name for an Upper Airway Radiograph
soft tissue neck radiograph
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can we see glands radiographically
no but we have to know location
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- a = air filled trachea
- b = esophagus
- c = region of thyroid gland
- d = region of thymus gland
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what is the bifurcation of the trachea called
the carina
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what is the parenchyma of the lungs
it is the functional tissue of the lungs made of light, spongy elastic substance
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what is each lung encased by on its perimeter?
double walled sac called a pleura
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what is the outer layer of of the sac that covers the inner layer of the chest and diaphragm
parietal pleura
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what is the layer that lines or covers the surface of the lungs
visceral pleura
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what is the area between the double walled pleura called
pleural cavity
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when doing a pa what position use for the cassette
- landscape pa
- portrait lateral
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what are the three dimensions of thorax when breathing
- vertical (goes down)
- transverse (expands from the sides)
- ap dimension (epands from front to back)
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what is the purpose of ordering a inspiration/expiration pa radiograph
better visualization of a small pneumothorax and diaphragm excursion
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where the CR located on geriatrics
lower than normal
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list all steps for the examination
- CR is t7
- top of the IR should be 1.5 to 2in above shoulders on most patients
- shoulder de[ressed and rolled forward
- feet spread slightly, weight distributed equally on both feet
- second full inspiration required
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label the basic steps of the lateral position
- left side has to be against IR
- CR at t7 (3-4 in) below jug. notch
- midsagittal plane parallel to IR
- lower CR a min of 1 inch from the PA
- portrait is cassette
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if there is a fluid in the lung, what is there difference between erect and recumbent
erect fluid drops to bottom of lungs and recumbent fluid is distributed all over lungs
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what are the 3 impt reasons of an erect chest radiograph
- allows diaphragm to move down farther
- visualize possible air fluid levels in chest
- prevents engorgement and hyperemia (the increase of blood flow to different tissues in the body) of pulmonary vessels
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what is the importance of a 72 in SID
keeps heart in detail and minimize magnification image of heart
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what is proof that a radiograph is a true PA
what happens when one clavicle is farther than the sternum or unequal
both the right and left sternal ends of the clavicles are the same distance from the center line of the spine
it means that the on side of shoulder was rotated away from the IR (i.e. if the clavicle is farther towards the right from the sternum the right shoulder was rotated away from IR )
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what is the minimum SID on AP chest
40
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what is the criteria for an AP chest
- heart appear larger
- there will not be full inspiration
- and 3 posterior ribs shud be visualized above the clavicles indicating the correct CR angle was used
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what is the special projection used to see foreign bodies located under the clavicle
apical lordotic projection
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what do you do if the patient cannot extend back for an apical lordotic projection
angle the CR 15-20 degrees cephalad
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what are the positioning considerations for a chest radiograph
- includes removal of all metals and opaque objects from the waist up
- long hair braided together in bunches
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how do we prevent no rotation on a pa chest
- ensure patients feet is shoulder width
- shoulders are down and rolled forward
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should the patients chine be extended upwards
yes so it is not in the way of the radiograph the neck is not superimposing the uppermost regions of lungs and apices
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how do minimize breast shadow
a person with large pendulous breast should be asked to lift them up and outward and to remove hands as she leans against the chest board (IR)
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how do we determine rotation on a L lateral chest
excessive rotation is spotted by poor positioning errors and on a radiograph the amount of separation of the right and left posterior ribs and separation of the two costophrenic angles
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how do ensure no tilt on a true lateral
- ensure patient is standing with weight evenly distributed on the feet
- arm raised high and above head
- and go behind and feel if the shoulders are lined up
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the level of c7 corresponds to what vertebrae
t1
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what are the collimation guidelines for PA chest
cr to t7 side outer skin margins; at the upper level of vertebra prominens
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if the patient is unable to stand what position would we use
and what is the purpose
- bilateral decubitus
- to visualize fluid in the left or rt lung amd the side up will show the air
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List steps for decubs
- center at t7
- top if IR 1.5-2in above the shoulders
- arms raised chin raised
- no rotation
- place sponge underneath the lung with the fluid (if left lung has fluid they should lie on left lateral decub )
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if radiologist suspects air in the left lung what position should you do
right lateral decubitus
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steps for lateral wheelchair?
- everything the same as regular lateral except:
- place sponge behind back to straighten the back for no rotation
- and should try to sit up as much as possible
- turn wheelchair 90 degrees clost to the IR
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list the requirements for an apical lordotic
- stand 1 ft from IR and lean back with shoulders neck and back of head against IR
- hands on hips palms out
- shoulders rolled forward
- top of IR 3in above shoulders
- CR to midsternum
- expose on second inspiration
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if the patient is unable to stand for an apical lordotic how must it be done
- patient must be lied down same principles as reg lordotic
- but CR is angled 15-20 degrees to the midsternum
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an RPO & LPO position best visualizes which lung
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RAO best visualizes which lung
left lung
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LAO best visualizes which lung
rt lung
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how much kvp do we need for lateral position upper airway
lower kvp
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what sized cassette do we need upper air way exam
where is the CR located
what are the breathing instructions
- 10x12
- between adams apple and jugular notch around C6
- slow deep inspiration
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where is the CR for AP upper airway exam
- CR to t1-t2
- and same other principles exposure breathing tech factors as lateral upper airway
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