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Introduction to Clinical Radiography. Unit VI -- Chest and Abdomen Examinations. Chest Anatomy. Thoracic cavity (chest) Surrounded by boney thorax Separated from abdomen by diaphragm Muscular partition Dome shaped Lungs drape over diaphragm. Anterior. Posterio r. Boney Thorax.

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introduction to clinical radiography

Introduction to Clinical Radiography

Unit VI -- Chest and Abdomen Examinations

chest anatomy
Chest Anatomy
  • Thoracic cavity (chest)
    • Surrounded by boney thorax
    • Separated from abdomen by diaphragm
      • Muscular partition
      • Dome shaped
      • Lungs drape over diaphragm

UNIT VI

boney thorax

Anterior

Posterior

Boney Thorax
  • ENCLOSE THE ORGANS
    • STERNUM (breast bone)
    • 12 PAIR OF RIBS
    • 12 THORACIC VERTEBRA
  • ATTACH UPPER EXTREMITY
    • 2 CLAVICLES
    • 2 SCAPULA

UNIT VI

thoracic cavity
Thoracic Cavity
  • Sections of the thoracic cavity
    • Pleural portion (lungs)
    • Mediastinum (between lungs)
    • Pericardial portion (heart)

UNIT VI

respiratory system

A

A

H

H

 B 

 B 

C 

C

Respiratory System

1. Lungs

  • Lobes
    • Right 3 lobes
    • Left 2 lobes
  • Terminology
    • Apex
    • Hilum
    • Base
    • Costophrenic angles

UNIT VI

bronchial tree
Bronchial Tree

2. Bronchi

  • Air tubes leading into the lung
  • Right more vertical than left
  • Branching structure
    • Primary è 2ndary è teritiary...
  • Only primary visible on PA projection

P

UNIT VI

trachea
Trachea

3. Trachea

  • In mediastinum
  • Passageway for air to/from lungs
  • Approx. 4½" Long
  • Air visible on images

T

UNIT VI

circulatory system
Circulatory System

1. Heart

  • 4 Chambered pump

2. Great blood vessels

  • Aorta
  • Vena cava
  • Pulmonary Artery
    • Not seen on image

A

PA

VC

VC

UNIT VI

miscellaneous
Miscellaneous
  • Mediastinum contents
    • Trachea
    • Major vessels
    • Esophagus
    • Lymphatics
    • Heart
    • Thymus

UNIT VI

chest examinations
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

UNIT VI

routine pa l lateral
Routine PA & L Lateral

1. Erect position

  • Diaphragm moves more inferior
  • Demonstrates air-fluid levels
  • Prevents blood pooling in gr. vessels

2. 72" Sid

  • ê magnification of heart

UNIT VI

routine pa l lateral cont

inspiration

expiration

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)

UNIT VI

routine pa l lateral cont13
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

UNIT VI

dedicated chest unit
Dedicated 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

UNIT VI

pa projection erect anterior position
PA 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

UNIT VI

pa projection cont
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

UNIT VI

pa projection cont17
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)

UNIT VI

pa projection cont18
PA Projection (cont.)
  • Minimal rotation
    • Symmetry of SC joints
    • MS plane to lateral ribs = distance

UNIT VI

pa projection cont19
PA Projection (cont.)
  • Technique
    • Vertebra seen through heart (kVp)
    • "Good" density
  • Other
    • no film artifacts
    • no motion (blur)

UNIT VI

erect left lateral chest
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

UNIT VI

left lateral chest cont
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

UNIT VI

left lateral chest cont24
Left Lateral Chest (cont.)
  • Film evaluation (lateral)
    • Complete anatomy shown
      • Apices (chin elevated & arms raised)
      • Posterior costophrenic angles

UNIT VI

left lateral chest cont25
Rotation

Superimposition of posterior ribs

Edge of sternum

Technique

See through heart (kVp)

"Good" density

(Retrosternal & retrocardiac areas not "black")

Left Lateral Chest (cont.)

UNIT VI

abdomen anatomy
Abdomen Anatomy
  • Abdominopelvic cavity
    • Abdomen
      • diaphragm to pelvic inlet
    • Pelvic cavity
      • pelvic inlet to floor muscles of the cavity
abdomen anatomy cont
Abdomen Anatomy (cont.)
  • Abdomen
    • Divisions
      • 4 Quadrants (clinical)
      • 9 Regions (anatomic)
abdomen anatomy cont28
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
abdomen anatomy cont29
Abdomen Anatomy (cont.)
  • Topographic (positioning) landmarks
    • Iliac crest (level of L4-5)
    • Anterior superior iliac spine (ASIS)
    • Greater trochanter of femur
    • Pubic symphysis

Iliac

Crest

Lumbar

Vertebra

ASIS

Greater

Trochanter

Symphysis Pubis

abdomen anatomy cont30
Abdomen Anatomy (cont.)
  • Major muscles (radiographically)
    • Diaphragm
    • R and L psoas muscles
major abdominal organs

liver (triangular)

stomach

large bowel

gall bladder

pancreas

spleen

  • small bowel
  • duodenum
  • jejunum
  • ileum
Major Abdominal Organs

UNIT VI

urinary organs major vessels

adrenal gland

vena cava

aorta

kidney

ureter

urinary bladder

urethra

Urinary Organs & Major Vessels

UNIT VI

abdominal radiography
Abdominal Radiography
  • Patient preparation
    • KUB & acute abdomen
      • Remove radiopaque clothing & gown
      • Otherwise "as is"
    • Contrast media exams
      • Dietary & bowel preps usually required
abdominal radiography cont
Abdominal Radiography (cont.)
  • Breathing instructions
    • Expose after patient exhales
    • "Take deep breath, blow it all out, stop breathing"
    • Watch patient while giving instructions
abdominal radiography cont35
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
abdominal radiography cont36
Abdominal Radiography (cont.)
  • Film markers
  • Radiation protection
    • Check for pregnancy on all women
    • Gonadal shielding (???)
  • Collimation
    • to film edge top & bottom
    • to patient width on sides
abdomen
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 rotated
abdominal radiography cont38
Abdominal Radiography (cont.)
  • Patient position (continued)
    • Midsagittal plane
      • perpendicular to table
      • parallel to table length
    • R & L ASIS level
    • Shoulders level
abdominal radiography cont39
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
abdominal radiography cont40
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
abdominal radiography cont41
Abdominal Radiography (cont.)
  • density & contrast adequate to see
    • Psoas muscles
    • lumbar transverse processes
    • ribs
    • kidney & liver margins
other abdominal projections positions
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
abdominal radiography cont43
Abdominal Radiography (cont.)
  • Lateral in a recumbent or erect position
    • Seldom done due to level of radiation
    • lack of significant diagnostic information