Anatomy & Pathology
What are some clinical indications regarding Chest Radiography?
Chest pain, Pre-op Screening (40+ years old), Numerous Pathologies, Post Trauma, F.U.O. (Fever Unknown Origin)
Explain Patient Preparation for a Chest X-Ray?
1. Check for the Correct patient (Name, D.O.B, name of exam, ask what pain they are experiencing, etc.) CHECK FOR PREGNANCY!
2. Instruct Patient how to undress (Females from the waist up, remove ALL artifacts including bras and jewelry, Males OK with light T-shirt with NO PRINTING, watch for artifacts)
3. Give clear instructions and expectations- make eye contact!!!
4. Assist to Room- Assess Ability to stand unattended!!!
PA Projection
Criteria
-Erect @72"
- Top of Receptor 2" above shoulders
- CR @T6-7
- Shoulders rotated forward to move scapulae laterally, then depressed to move clavicles below apices
- DOUBLE Inhalation
- PA Erect reduces Cardiac Magnification
- Use of Horizontal Beam (better demonstration of air/fluid levels)
Evaluation
- All anatomy from lower cervical (Diaphragms included)
- Lung Aeration seen to 9-10th rib
- S-C joints symmetrical & in the same plane
- Scapulae moved laterally
- Symmetry of Ribs - No Distortion
What is Body Habitus?
The position of anatomy within the body and affects exposure.
*** Chest Radiography on Hypersthenic Males may require the receptor be placed crosswise, not lengthwise ***
What are some Chest Pathologies?
Apnea, Dyspnea, Asthma, COPD, CHF, Atelectasis, Pneumothorax, Foreign Bodies (FB), Bronchiectasis, Cardiomegaly, Pleural Effusion, Pneumonia, Pulmonary Embolism (Post VQ Scan), Acute Traumatic Aortic Injury (ATAI)
Apnea- lack of breathing
Dyspnea- difficulty breathing
COPD- Chronic Obstructive Pulmonary Disease
CHF- Congestive Heart Failure
Atelectasis- a collapse of the lung
Pneumothorax- accumulation of air in the pleural space
Bronchiectasis- irreversible dilation or widening of bronchi that may result from repeated pulmonary infection
Cardiomegaly- enlarged heart
Pleural Effusion- an abnormal collection of fluid in the pleural cavity (ex) emphysema
Pneumonia- inflammation of lungs that results in accumulation of fluid within the lungs
What is the routine procedure for Chest X-Ray?
-PA
-Left Lateral
-Erect whenever possible - reduces engorgement of cardiac and pulmonary structures, allows greater lung expansion
Left Lateral
Criteria
- Erect @72"
- Top of receptor 2" above shoulders
- LEFT SIDE to receptor as close as possible
- Arms @ chin elevated
- CR - Mid-Axillary Plane @T6/7 Level
- DOUBLE inhalation
Evaluation
- All anatomy is seen in true lateral from superimposed apices, posterior ribs to superimposed diaphragms
- Superioanterio Thorax is not superimposed by the soft tissue of the mandible or arms
- Thoracic Vertebrae are symmetrical with open intervertebral spaces & foramina
What size image receptors are used in adults? What about children?
Use 14 x 17 receptors for adults, use 8 x 10 or 10 x 12 for infants and children.
Name the anatomy within the Chest...
Lobes of the Lungs (3 on right, 2 on left)
Apex (Apices-Pleural) most superior, rounded region above the clavicle
Base - broader inferior region
Costophrenic angles (Lateral)
Cardiophrenic Angles (Medial)
*** Angles: Lateral Aspects of Base, ABOVE DIAPHRAGMS ***
Hilum (Hilus- Plural) medial aspect of each lung possesses an opening for passage of the primary bronchus, vessels & nerves
Carina- region of tracheal bifurcation (Level T4/5)
Pleura- the membrane that lines the lungs and thoracic cavity, membrane secretes serous fluid to decrease friction (increased production of this fluid=pleurisy)
Parenchyma- Lung tissue
What are the exposure considerations for a Chest X-Ray?
- All Chest Radiography requires HIGH kVp - 100+
- Most imaging centers use 120 kVp routinely
AP Axial
- Requires 15-20 degree cephalic angle (towards the feet)
- CR directed to the Mid-Sagittal plane (MSP) and 2" inferior to the jugular notch
- Use the same exposure & SID as for PA Chest (72") but with more collimation
- Single inhalation is OK
Why is it so important to collimate a Left Lateral Chest X-Ray on females?
To limit breast tissue exposure to radiation.
What are the Anatomic Landmarks for Chest X-Ray?
1. Jugular Notch @T2-3
2. Sternal angle @T4-5
3. Xiphoid @T9/10
4. Inferior Scapular Borders @T6/7
Obliques
- Usually preformed to R/O superimposed opacities/pulmonary nodes
- Usually 10-15 degrees RAO & LAO (45 degrees also done)
- RAO = Left Thorax
- LAO - Right Thorax (55-60 degree done for heart studies)
- May employ "Nipple" markers
Decubitus
- Left & Right Lateral
- Alternate to Erect positions for pleural fluid
- Patient should be in position 5-10 mins prior to exposure to allow increased delineation of air/fluid levels
-Side "Down" is Side of interest