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1
RT 124 SPRINGWEEK 1 – Part 1CHEST & ABD
A “Self Study” Review
Rev Spring 2010
2
RT 124 - WEEK 1 (Part 2)is the Lecture Presentation for:
Chest II AP: SUPINE, SEMI-UPRIGHT – UPRIGHT
R & L DECUBITUSLATERAL – PT ON GURNEY OR IN W/C
ABDOMENAP SUPINE, UPRIGHT, LLD
RT 124 – Wk 1 – Part 1 Lecture on web can be reviewed for basic CHEST & ABD anatomy.
3A quick review of CHESTDedicated Chest Unit
• X-ray machine designed to perform routine chest imaging– tube has fixed alignment with
imaging plate (IP)
– when tube moves, IP moves
– Non-CR has film unit• includes stationary grid• magazine to hold unexposed
film• direct hook-up to processor
[or magazine for exposed film]
• ID flasher on unit
Digital Chest Unit
4Body Habitus
5
6CASSETTES W/ GRID CAPS
7
8
9Grids
• Allow primary radiation to reach the image receptor (IR)
• Absorb most scattered radiation
• Primary disadvantage of grid use – Grid lines on film
10
11CR GRIDS
12
CHEST
ANATOMY REVIEW
13
Chest Anatomy• Thoracic cavity
(chest)– Surrounded by
boney thorax– Separated from
abdomen by diaphragm
• Muscular partition• Dome shaped• Lungs drape over
diaphragm
14
Bony Thorax
• ENCLOSE THE ORGANS– STERNUM (breast bone)– 12 PAIR OF RIBS– 12 THORACIC
VERTEBRA
• ATTACH UPPER EXTREMITY– 2 CLAVICLES– 2 SCAPULA
AnteriorPosterior
15
Thoracic Cavity• Sections of the thoracic cavity
– Pleural portion (lungs)– Mediastinum (between lungs)
– Pericardial portion (heart)
16
Respiratory System
1. Lungs – Lobes
• Right 3 lobes• Left 2
lobes
– Terminology• Apex• Hilum• Base• Costophrenic angles
A A
H H
B B
C
C
17
Bronchial Tree2. Bronchi
– Air tubes leading into the lung
– Right more vertical than left
– Branching structure• Primary 2ndary
teritiary...
– Only primary visible on PA projection
P
18
Trachea3.Trachea
– In mediastinum– Passageway for air
to/from lungs– Approx. 4½" Long– Air visible on images
T
19
Circulatory System1. Heart
– 4 Chambered pump
2. Great blood vessels– Aorta– Vena cava– Pulmonary Artery
• Not seen on image
A
VC
VC
PA
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Miscellaneous• Mediastinum
contents– Trachea– Major vessels– Esophagus– Lymphatics– Heart– Thymus
21
Chest Examinations• Most common projections
– PA in an erect position– Right to left lateral in an erect position
• Less common projections– AP -- erect or recumbent position– Lateral decubitus
22
Routine PA & L Lateral1. Erect position
– Diaphragm moves more inferior– Demonstrates air-fluid levels– Prevents blood pooling in gr. vessels
2. 72" Sid– magnification of heart
23
Routine PA & L Lateral (cont.)
3. Breath held on inspiration– Expands lung fields– depresses
diaphragm– Provides contrast
(air vs. tissue)
4. Film (adult)14X17 lengthwise
(may be crosswise on broad chested male)
inspiration expiration
24
Routine PA & L Lateral (cont.)
5. Technical factors– High kVp (>100)
• long scale contrast
– High mA & short time• reduces motion
– AEC– Grid
• decrease scatter on image
25PA Projection
(erect anterior position)• Patient
– Standing -- weight on both feet
– Anterior chest against IP– MS plane perpendicular
to IP & floor– Chin raised– Posterior of hands on
hips or machine “hug”– Shoulders depressed &
rotated forward
26
PA Projection (cont.)
• X-ray beam– CR
• to film• in MS plane at T 7
• Collimation (very little)
– Full length of film– To lateral edges of
patient
27
PA Projection (cont.)
• Film evaluation– Complete anatomy shown
• apices (chin elevated)
• base (both costophrenic angles)
• scapulae out of lungs (shoulder rotation)
• respiration (10 posterior ribs)
28
PA Projection (cont.)
• Minimal rotation– Symmetry of SC
joints– MS plane to
lateral ribs = distance
29
PA Projection (cont.)
• Technique– Vertebra seen through
heart (kVp)– "Good" density
• Other– no film artifacts– no motion (blur)
30PA Chest Anatomy
31
Radiographic Anatomy -- PA
32
Erect Left Lateral Chest• Patient
– Standing with weight on both feet
– L side against film holder– Chin raised– Arms elevated &
immobilized– Align MS plane
• parallel to the film to the floor
33
Left Lateral Chest (cont.)
• X-ray beam– CR
to film• in midaxillary plane at
level of T7
(slightly lower than T7 ok)
– Collimation• full length of film• to anterior & posterior
surfaces of patient
34
Abdomen Anatomy• Abdominopelvic
cavity– Abdomen
• diaphragm to pelvic inlet
– Pelvic cavity• pelvic inlet to floor
muscles of the cavity
35
Abdomen Anatomy (cont.)
• Abdomen– Divisions
• 4 Quadrants (clinical)
• 9 Regions (anatomic)
36
Abdomen Anatomy (cont.)
• Boney anatomy– lower ribs & T11-T12– lumbar spine (5)– sacrum & coccyx– innominate (2)
• iliac portion• ischial portion• pubic portion
– femur• head & neck• trochanters
37
Abdomen Anatomy (cont.)
• Topographic (positioning) landmarks– Iliac crest (level of L4-5)
– Anterior superior iliac spine (ASIS)
– Greater trochanter of femur
– Pubic symphysis
Symphysis Pubis
GreaterTrochanter
LumbarVertebra
IliacCrest
ASIS
38
Abdomen Anatomy (cont.)
• Major muscles (radiographically)– Diaphragm– R and L psoas muscles
39Major Abdominal Organs
stomach
large bowel
spleen
small bowel• duodenum• jejunum• ileum
liver (triangular)gall bladder
pancreas
40Urinary Organs & Major Vessels
aorta
kidney
ureter
vena cava
urinary bladder
urethra
adrenal glandadrenal glandadrenal glandadrenal gland
47
Abdominal Radiography• Patient preparation
– KUB & acute abdomen• Remove radiopaque clothing & gown• Otherwise "as is“
• Breathing instructions– Expose after patient exhales– "Take deep breath, blow it all out, stop breathing"– Watch patient while giving instructions
– Contrast media exams• Dietary & bowel preps usually required
48
Abdominal Radiography (cont.)
• Exposure factors (non contrast media)– Medium kVp -- 70-80
• adequate penetration• moderate contrast
– Short exposure time• decrease involuntary motion on image
– Enough mAs for sufficient density• Film markers• Radiation protection
– Check for pregnancy on all women– Gonadal shielding (???)
• Collimation– to film edge top & bottom– to patient width on sides
49
Abdomen • AP projection, supine position
– KUB, flat plate, plain film, scout film
• Patient position -- Supine on table with– pillow for head– support sponge for knees– arms at but away from
sides– legs extended, internally
rotatedMidsagittal plane• perpendicular to table• parallel to table length
– R & L ASIS level– Shoulders level
50
Abdominal Radiography (cont.)
• Film & centering– 14X17 cassette
lengthwise in table bucky
– Center of film at level of iliac crests
– CR to center of film passing through the MS plane at level of iliac crests
• adjust to include pubic symphysis at lower edge of film
51
Abdominal Radiography (cont.)
• Film evaluation– No rotation
• symmetry of pelvis & spine
– Complete anatomy with no motion
• vertebral column in center of image
• symphysis pubis at bottom of image
• kidneys, liver, spleen at top of image
52
Abdominal Radiography (cont.)
– density & contrast adequate to see
• Psoas muscles• lumbar transverse
processes• ribs• kidney & liver margins
53
Other Abdominal Projections/Positions
– AP projection in an erect position
• CR 2" above iliac crests in MS plane
– AP or PA projection in a lateral decubitus position
• CR 2" above iliac crests in MS plane
54
Abdominal Radiography (cont.)
– Lateral in a recumbent or erect position
• Seldom done due to level of radiation
• lack of significant diagnostic information