Download 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