Transcript Chapter Two
Chapter Two The Chest and Abdomen PA Chest • • • • Facility Identification Marker Artifacts Film Size PA Chest • Density: • Should be able to see Lung markings, diaphragm, heart borders hilum, bony cortical outlines. Contrast: to see the thoracic vertebra and posterior ribs through the heart shadow. KVP 110-130 PA Chest • Positioning: • • • • Erect CR to T-7 Done on 14x17 Anatomy : apices both lungs, costophrengic angels. • Lungs expands in 3 direction. PA Chest Rotation • SC joints: • Equal distance from vertebral column • Right and left corresponding ribs are equal • Air filled trachea in center of vertebral column PA CHEST • Clavicle on same plane. • Depress shoulders • Rotate scapula out of lung field. PA foreshortening • A correct view will have the T-4 superimposed by manubrium and about 1 inch of lungs above clavicles. • Foreshortening is caused by leaning towards or away from the IR. PA Chest • Good inspiration is demonstrated when there is 10-11 posterior ribs above the diaphragm. • 2nd deep inspiration • Note: a pneumothorax maybe done on expiration. Lateral Chest Positioning • Mid-coronal plane against IR • The posterior and anterior ribs nearly superimposed. • Sternum in profile • Intervertebral foramina are open. Lateral rotation • • • • Ribs Find the hemi-diaphragms If heart shadow is over sternum Lung over sternum Lung Foreshortening • Both diaphragms nearly superimposed • Foreshortening caused by leaning towards or away from IR. • If hip is on the IR the right diaphragm is lower than the left. Right v/s LEft • Id a right lateral is done it is to better see the right lung detail. Lateral Positioning • Arms out of the way • Note: if pacemaker was installed 24 hours prior don’t raise left arm. • Obtain the anteroinferior lung Inspiration • 11th Thoracic vertebra in superimposing the lung field. • Find: 12th rib and follow it to the vertebra count up one AP Chest supine or portable • Air-fluid levels • Artifacts; monitor lines • Time and date if mulitple exams are performed AP chest • • • • • • • Contrast and density: Adequate to see any tubes and lines. ET tube: 1-2” above carina Chest tube:5-6th ribs CV line;2-3 cm above aterial junction Pulmonary lines: pulmonary artery Pacemaker: Under clavicle on left side Heart • The heart will me magnified • Deceased SID: 40-48’ Rotation • Same as the PA except it is opposite • Right SC joint has less imposition it is closer to bed. Positioning • CLavilce same • Scapula will be in lung filed • Arms are abducted out of way Angels • Caudal: Manubrium inferior to 4th. More than 1 inch above clavicle, and ribs are vertical, elongates heart • Cephalic: manubrium superior to t-4, less than 1 inch above clavicles, ribs are horizontal, foreshortens the heart. • Supine patient: 5 degree angel caudal to allow for gravitational pull. Inspiration • 9-10 ribs above diaphragm. • Unconscious patient; watch chest movement Lateral Decubitus • Patient on side: mark side up • Position for laterals. – For air place affected side away from table. Decrease KV by 8 % – For fluid place affected side down. Increase mAs by 35 % Lateral Chest • • • • • Same Anatomy Same rotation Same foreshortening Same inspiration for portable No imposition of bed pad AP Lordotic • Contrast and density: see clavicle, superior t-spine, ribs • CR is centered to superior lung field midway between manubrium and xiphoid tip Anatomy seen • Apices at level of T-1, clavicles above lung field, 2/3 of lungs, ribs 1-4 are nearly superimposed, foreshortened heart shadow. • Not enough arch: clavicles superimpose lungs and anterior ribs inferior to posterior ribs. AP and Supine Abdomen • • • • Facility identification Marker Artifacts Motion Involuntary and voluntary Contrast and density • Contrast; see the psoas muscles, kidneys, inferior ribs and transverse process of lumbar. • Gas: decrease KVP by 5-8% or mas 30-50% • Fliud increase KVP by 5-8% or mas 30-50% • Density: to light to dark. • Compensate for larger patients Rotation • Spinous process aligned to midline of vertebral bodies. • Equal distance from pedicles to spinous processes. • The sacrum in the inlet of pelvisand align with symphysis pubis. Positioning • Long axis of body with long axis of IR • Patient erect or supine( erect for at least 5 min. for air to rise) • With shoulders and hip equal distance from table or bucky Expiration • The domes of diaphragm is superior to 9th posterior rib. Anatomy • Supine: 11th vertebra lateral soft tissue, iliac wings, symphysis pubis. • Erect: 9th vertebra, diaphragm, soft tissue, wings. Left lateral decub. • Same criteria, • marker upside. • Weight sifts, may need a compensating filter. Rotation • Same as abdomen • Wing with least amount is the side farthest away from film. • Expiration • Anatomy Pediatric Chest • • • • • Same facility information Marker Artifacts Contrast and density KVP 65-75 AP Chest • • • • CR- T-4 Rotation same Caudal angel for supine 8 posterior ribs above diaphragm Lateral Ped. Chest • CR: T-5 • Cross table or roll on side. • Cross table is preferred because of less disturbance to infant • and the inflation of lungs of the lungs • Rotation same. • Arms and chin up • Inspiration Ped. Abdomen • • • • Facility information same Marker Artifacts Contrast and density; to see boewl gases, diaphragm, outline of bony structures KVP 65-75 • Rotation same • Expiration diaphragm is at 8th rib. Left lateral decub • Same as adults