Chest Outline - Lecture notes 2 PDF

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Chest positioning notes- exam 1 Beasley...

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General positioning criteria of CHEST 1. Patient should be examined in erect position to prevent heart enlargement and stretch out organs, allows diaphragm to drop and lungs expand, and show air fluid level. Pleural effusion or interlobar effusion 2. Use 72 SID ideally (if can’t get 72 do 40) 3. Weight evenly distributed on both feet 4. Avoid rotations. Rotation results in: a. (for PA) asymmetry of sternoclavicular joint and distortion of heart b. (for LAT) posterior ribs and costophrenic angles not superimposed. (most repeated image) 5. Breathing: exposure made at end of second full inhalation 6. Should see 10 ribs on right side of PA projection 7. Exposure should be less than 1/10 sec. to stop heart motion 8. Remove all opaque objects waist up and have patient in gown 9. Shield 10. Markers go at top of IR. Choose large focal spot 11. Put marker out of anatomy and at shoulder for PA 12. Measure patient thickness in CM, include breast. Measure the path of CR. This is for setting technique. mAs depends on thickness.

1. PA PROJECTION (routine) a. 14 x 17 LW (CW for hypersthenic) b. 72 SID grid or no grid. (grid for parts 10 cm thick or more) c. 110-130 kVp w/ grid 70-90 kVp w/o grid d. Shield gonads e. CR at T7 i. Female: 7in below vertebral prominence(c7). Dist. btw pinky and thumb ii. Male: 8in below vertebral prominence iii. Or make sure you have 1.5-2 in of light above shoulder f. Have patient stand with posterior hands on hips and roll shoulders forward to remove scapula from lung field g. Center MSP to midline of film, elevate chin to bucky h. If female with large breast have her move them to the side i. (T-7) is inferior to scapula j. Structures shown: i. air filled trachea ii. lungs and heart iii. aortic knob iv. diaphragmatic domes k. Eval Criteria: i. Entire lungs from apices to costophrenic angles. NO ROTATION

ii. Trachea visible in midline w/ 10 posterior ribs on right side iii. When labeling anatomy say left or right iv. Can do inspiration or expiration chest 1. Inspiration is routine 2. Expiration- diaphragm rises do only see 9 ribs, 3. Shows pneumothorax or atelectasis (lung collapse) or foreign body

2. AP PROJECTION (alternative) a. Supine or semi erect on stretcher, in department, or in room. b. Same cassette size and KVP c. 40 SID for supine but 60-72 for semi erect d. Patient supine with shoulder rolled forward by rotating arms medially e. IR placed behind or under patient f. CR at T7 perpendicular to sternum (3”below jugular notch) g. Same shield & exposure, h. Structures shown i. Air filled trachea & diaphragm ii. Lungs, heart, and great vessles iii. Bony thorax and costophrenic angles iv. Heart shadow magnified due to closer SID i. Eval Criteria: entire lung, NO ROTATION, 3. WHEELCHAIR CHEST (Alternative) – when patient cant get out of wheelchair do AP a. SAME CRITERIA AS PA

4. LEFT LATERAL PROJECTION a. SAME CRITERIA AS PA b. Can use moving or stationary grid c. Marker goes on anterior surface d. Arms above head e. T7 inferior to scapula, and center to mid coronal plane f. Structures shown: i. Entire lungs, heart, and aorta ii. Costophrenic angles and left pulmonary lesions g. Do Right lateral to show right lesions h. Increase mAs by factor of 4. For child just double i. Eval criteria: superimposition of posterior ribs, arms not in lung field, NO ROTATION, demonstrate lungs in entirety, hilum in center

5. PA OBLIQUE PROJECTION- LAO & RAO POSITION a. SAME CRITERIA AS PA b. LEFT ANTERIOR OBLIQUE – SHOWS RIGHT LUNG i. Rotate 45 degreed to right so left shoulder touches IR ii. Center chest to film iii. Place marker on left side by shoulder iv. Left hand on hip right hand on head v. CR under scapula at midline (T7) vi. Same breathing and shield vii. Structure shown: 1. RIGHT LUNG & heard shadow, trachea 2. Bony thorax and aorta in front of vertebral column viii. Eval criteria: 1. Lungs in entirety c. RIGHT ANTERIOR OBLIQUE- SHOWS LEFT LUNG i. SAME CRITERIA AS LAO 6. AP OBLIQUE PROJECTION- LPO & RPO POSITIONING a. SAME CRITERIA AS LAO b. Mark the side touching IR c. RAO & LPO = same image d. LAO & RPO = same image e. INCREASE MAS BY 2 FROM PA TO OBLIQUE f. DO OBLIQUES WHEN DR SEES SOMETHING g. IF YOU SEE IT YOU “P” IT 7. LATEAL DUCUB POSITION (RIGHT OR LEFT)- AP OR PA PROJECTION a. Used when you need to see air fluid levels but patient cant stand or sit b. For left lateral decub patient lays on left side c. Call it by side down but mark side up d. Patient lies on side with pleural effusion e. AP decub is easier f. IR 2in above shoulder g. Elevate patient 2-3 in on firm pad h. Patient should be in lateral position for 5 minutes to allow air/fluid to rise i. Structures shown: small pleural effusion by demonstrating air fluid levels on pleural space or small amount of air in pleural cavity for pneumothorax j. Eval criteria: NO ROTATION i. Entire lungs, proper density, demonstrate thoracic vertebrae behind heart shadow to show cardiac curvatures, calcifications k. KNOW: FOR POSSIBLE FLUID-AFFECTED SIDE DOWN l. KNOW: FOR POSSIBLE AIR- AFFECTED SIDE UP m. CALLED LEFT

8. VENTRAL/DORSAL DECUBITUS POSITION- LATERAL PROJECTION a. SAME AS LATERAL DECUB b. Structures shown: lateral projection in decub position c. Shows change in position of fluid and reveal pulmonary areas obscured by fluid in standard projection d. Eval criteria: proper collimation, entire lung field, upper lung field not obscured by arms, NO ROTATION of true lateral, T7 in center, proper marker, mark side touching IR 9. LORDOTIC POSITION- AP AXIAL PROJECTION- LINDBLOM METHOD a. Demonstrates apices of lungs lying below clavicles. Show interlobar effusion. Done for TB pateints. b. 1 ft away from IR in front of vertical grid c. Adjust height of cassette so it is 3in above shoulders d. CR horizontally and perpendicular to mid sternum 3” below jugular notch e. Structures shown: apices and interlobar effusion f. Eval criteria: clavicles above apices and apices and lungs in entirety and no rotation 10. AP AXIAL a. Demonstrates pulmonary apices without superimposition and interlobar effusion b. Used when patient cant get into lordotic position c. 10 x 12 or 11 x 14 IR d. Patient erect of supine with hands on hips with palms out e. Rotate shoulders forward f. Msp perpendicular and centered to IR g. CR 15-20 degrees cephalic at center at manubrium h. Structures shown ONLY apices below clavicles i. Eval criteria: clavicles superior to apices, apices entirely, no rotation, ribs appear distorted 11. PEDIATRIC CHEST- SHIELD SHIELD SHIELD a. Radiation protection to reduce dose= use high KVP and lower mAs b. Short exposure to reduce motion c. Gonadal shielding and breast shielding d. RECUMBANT UP TO 3 YEARS OLD i. IR depends on child size, most are 10x12 and collimate ii. 44-48 sid or all the way up iii. NO GRID NO GRID iv. AP 1.6 mAs; 60 kvp v. LAT 3.2 mAs; 60 kVP vi. Gonadal shield

e. SITTING ERECT UP TO 3 YEARS i. IR depends on child size 72 SID NO GRID ii. Child sit at end of table iii. PA projection-relative hold child and ir iv. Left lateral projection takes two people to hold use relatives v. PA- 1.6 mAs and 80 kVp vi. LAT- 3.2 -4 Mas; 80 kvp f. 3-10 YEARS OLD i. Can do AP so child can see ii. IR depends on child size iii. Child can sit on wooden box/stool or stand against ir iv. Grid v. 80-90 kvp; higher kvp impossible because corresponding mAs too low to get image vi. 9-10 posterior ribs visualized is indicator of radiograph taken with good inspiration

Positioning of the chest 1. PA Chest a. Position- erect anterior position b. Projection- PA c. View anterior 2. AP Chest a. Position- erect posterior position b. Projection- AP c. View- posterior 3. Decubitus position a. Left dorsal decub position i. Position-dorsal decub ii. Projection- right lateral to left lateral iii. View- left lateral b. Right ventral decub position i. Position- ventral decub ii. Projection- left lateral to right lateral iii. View- right lateral...