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Chapter 2
Chest
Bony Thorax
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1 - __________ (Breastbone)
2 - Clavicles (Collar bones)
2 - ________ (Shoulder Blades)
12 - Rib Pairs
12 - ________Vertebrae
2 Lungs
• Right has _______ lobes
– Superior, middle, ___________
– Separated by two deep fissures
• Left has ________ lobes
– _________ and inferior
– Separated by one deep fissure
Lungs
• _________
– Rounded superior area
• ___________
– Inferior concave area.
– Rests on the diaphragm
• ____________ angle
– Inferiolateral corners where the diaphragm
meets rib
Lung Tissue
• ___________
– Functional tissue
– Spongy and elastic
– Allows lungs to ______________(Breathing)
Pleura
• _____________
– Sac the lungs are held in
– Two parts
• __________Pleura - Outer layer
• __________ (Visceral) Pleura - Inner layer
– Pleural cavity
• ________space between parietal and pulmonary
pleura
Pleura Problems
• _______________
– Air in the Pleural cavity
• Pleural ____________
– Accumulation of fluid in the pleural cavity
• Hemothorax – Blood
• Empyema - Pus
Diaphragm
• Primary muscle of breathing
– Two ________________
• 3 openings
– Aorta
– ___________
– Inferior Vena Cava
Pharynx
(Upper Airway)
• Three Parts
– ____________ - Posterior to nasal cavity
– ___________ - Posterior to oral cavity
(mouth)
– ____________ - At the junction between
larynx and esophagus
Accessory Parts
– Hard & Soft Palate, Uvula,
Larynx
(Voice Box)
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Cartilaginous structure
From _____________
Suspended by _____________
Contains 3 cartilage structures
– _____________
– Thyroid Cartilage
– Cricoid Cartilage
Trachea
(Windpipe)
• Inferior to __________
• Fibrous Muscular structure
– 3/4 inch diameter
– 4 1/2 inches long
– Surrounded by 20 cartilaginous rings
– From ______________
• Branches into right and left at the distal
trachea at the ____________
Bronchi
• Right Bronchi
– Wider and __________ than left
– Branches into the three right lobes
• Left Bronchi
– Smaller and ___________ than right
– Branches into the two lobes of the left
Mediastinum
• Part of the _______________cavity
between the lungs.
• Extending from the _____________
column and contains all thoracic organs
excepts the lungs.
Mediastinum Organs
• Thymus Gland
• __________and great vessels
• ___________
• Esophagus
Hilum
• A ____________________at that part of
an organ where vessels and nerves enter.
• In the lungs:
– __________
– Blood Vessels
– Lymph Vessels
– ___________
Taking a Chest X-ray
• Consider body habitus
– _____________
• short and wide - 14 X 17 crosswise
– Sthenic
• Agerage - 14 X 17 cross or lengthwise
– _____________
• longer and more narrow - 14 X 17 lengthwise
– Asthenic
• long and narrow - 14 X 17 lengthwise
Topographical Landmarks
• Vertebra Prominens
– ________
– Apex of lungs
• Jugular Notch
– __________
– Top of Sternum
• Xiphoid Tip
– ____________
– Anterior Diaphragm
Technical Factors
Adult CXR
• Erect
• High kV ____________
– Long scale
– Low _________
• mAs determined by pt
• ____________
Pediatric CXR
• Use immobilizer for erect image.
• Decrease kV to __________
• CR to mid thorax (___________)
• Crying is ____________!
Patient Prep
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Remove all _________ around neck area
Remove shirts with ______, snaps, etc..
Remove _________ with clips
Look for anything around lung field
– Oxygen tubes, hair braids, etc..
• Nipple markers*
Patient Instructions
• Typically done on ___________
– To get the best inspiration
– “Breath in and blow it out take another
breath in and ________________”
• Can do on expiration
– Pneumothorax, foreign body, lack of
diaphragm movement, comparisons.
– “Take in a breath blow it all the way out
and ______________.”
Patient Positioning
PA
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Erect
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No rotation
Chest against bucky
Hands on hips
Shoulder “__________” forward
Chin up
Left Lateral
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Left side against IR
Erect
72” SID
No rotation
___________
CR Positioning
• Mid ___________ (T7)
• 7-8” __________ to Vertebra Prominens
(C7)
• Hand spread method (pg 83)
• Once CR is positioned, center _________
Guidelines for a perfect CXR
PA and Lt Lat
• No rotation
– PA - look at ____________
• Equidistance from spine
– Lateral - look at ___________ posterior
ribs
• No more than 1/4” to ______ separation
CXR Guidelines
• Adequate Inspiration
– Minimum of ____________on PA
• Adequate technique PA
– T-Spine vertebrae seen with ____________
Other Chest Projections
• AP - Supine or Semi erect
– Slight ____________(5 degrees)
– CR to be perpendicular to the ____________
– Center to mid sternum (_____ inferior to
jugular notch)
Decubitus
• Lt/Rt Lateral Decubitus
– Pt recumbent on lt/rt side
– CR shot AP/PA to mid sternum
– For _______________or fluid levels
Others continued
• AP Lordotic
– To visualize apices _____________
– Pt stands ______ away from bucky an leans
back
– Hand positioned as per _________ chest
– CR straight at mid sternum
• Can do supine
– ____________degree cephalad angle at mid
sternum
LAO and RAO
• LAO
– 45 degree anterior
oblique
– Left side closest to
bucky
– Rt arm up
– Lt arm on hip
– ________seen best
• CR
– Level of T7
– Mid body
• RAO
– 45 degree anterior
oblique
– Right side closest to
bucky
– Lt arm up
– Rt arm on hip
– ________seen best
• CR
– Level of T7
– Mid body
LPO and RPO
• LPO
– 45 degree posterior
oblique
– Lt side closest to
bucky
– Lt arm up
– Rt arm on hip and
rolled back
– _______seen best
• CR
– T7
– Mid body
• RPO
– 45 degree posterior
oblique
– Rt side closest to
bucky
– Rt arm up
– Lt arm on hip and
rolled back
– _________seen best
• CR
– T7
– Mid body
S.T. Neck Factors
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_________SID for Lateral
_________SID for AP
75 - 80 kVp
Slow deep inspiration
– Fill __________ with air
S.T Neck
Upper Airway
• Lateral
– Rt or Lt
– Recumbent or erect
– Chin slightly
elevated
– Shoulders rolled
back
• CR
– Between thyroid
cartilage and
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• AP
– Recumbent or erect
– Pt to look straight
ahead
• CR
– Between thyroid and
jugular notch
– _____above jugular
notch