3rd week(THU).ppt

8/12/2019 3rd week(THU).ppt

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Chest RadiographyLECTURE 2


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PLE SE TURN LL CELL PHONES TOSILENT MODE


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By the end of this Lecture the student will be able to:

Learning Objectives

List and identify the major anatomical structures of the chest

List the common indications for chest radiography

Identify the common technical factors for chest radiography

List the basic and Optional projections for chest radiography

Discus the correct body position, part position, central ray, and

center point for specific positions for each projection.Critique and evaluate chest radiographs based on position,

collimation and central ray, exposure, and structure best shown.


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References

Text book of radiographic positioning and related anatomy; byKenneth L.Bontrager

Positioning in Radiography: By k.C.Clarke.

Websites
http://www.e-radiography.net/http://www.e-radiography.net/http://www.e-radiography.net/


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Chest natomy Thoracic cavity (chest)

Surrounded by boney thorax

Separated from abdomen by diaphragm Muscular partition

Dome shaped

Lungs drape over diaphragm


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Boney Thorax ENCLOSE THE ORGANS

STERNUM (breast bone)

12 PAIR OF RIBS

12 THORACIC VERTEBRA

ATTACH UPPER EXTREMITY

2 CLAVICLES

2 SCAPULA

Anterior Posterior


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Respiratory System1. Lungs

Lobes

Right 3 lobes

Left 2 lobes Terminology

Apex

Hilum

Base

Costophrenic angles

H H


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Bronchial Tree2. Bronchi

Air tubes leading into the

lung

Right more vertical than

left

Branching structure

Primary 2ndary

Only primary visible on

PA projection

P


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Miscellaneous Mediastinum contents

Trachea

Major vessels

Esophagus

Lymphatic's

Heart

Thymus


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For chest radiography, a lead-rubber Gonad shield should be employed so to protectthe abdomen below the chest (using vinyl-covered lead apron) around the waist for all

patients of reproductive age, children, and pregnant women.

Technical Aspects

Low contrast ( long-scale contrast) contrast must be adopted using High kVTechnique (100 - 130 kVp) with low mAs (3 mAs) at 72 inches (180 cm) FFD (SID).

Higher mA and short exposure times (0.01 s) must be used to reduce movement blur(due to movement unsharpness,

.A moving focused grids must be used with the high kV technique.

For pediatrics and newborns

lower kV (6070 KV) must be used with lower mAs

Higher-speed films and screens are used to reduce motion and dose

AP supine and laterals (dorsal decubitus) must to be done to exclude air- fluid levels


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Technical AspectsFor geriatrics (old age) higher center point (CP) must be used because of lessinhalation capability of old people that produces shallowlung fields.

X-ray chest must be taken in full arrested second inspirationto show the lungs wellexpanded and full with contrastingair.

FFD for PA chest must be 72 inches (180 cm) to maintain the naturalsize of the heart

which is usually less in PA than in AP, and prevent geometrical unsharpness

and magnification as a result of the increased OFD.

All chest radiographs must be taken in standingerect to allow the diaphragm

to move down to show greater areas of the lung fields .


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Erect film shows pleural effusions, infections, Atelectasis, pneumothorax.

PA Chest (Erect)

Patient and Part Position

Patient erect, feet apart, chin rested on film top edge, hands on lower hips,

elbows partially flexed, the shoulders rotated forward (to move the clavicles

below apices), top of film 5 cm above the shoulders (to include the apices),

exposure on 2ndarrested (inspiration), collimation and protection should be

applied.

Instruct the patient to take in a breath, blow the breath out, and take another

deep breath and hold it ( 2ndrested inspiration)

Film:HD 35x43 cm (14x17 in) lengthwise

(crosswise for large patients)CR: Horizontally 90to film center.

CP: T7 (Approximately at the level of

inferior angle of the scapula)


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Image EvaluationThe lung apices, costophrenic angles, and lateral margin of the ribs should

be included in the film.

The spine should be centered on the film

The scapulae should be moved lateral to the lung fields

PA Chest (Erect)


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Image EvaluationThe heart should be adequately penetrated showing sharp outlines, with

vascular markings near lateral lung margins.

PA Chest (Erect)


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Image EvaluationThe distance between the medial end of the clavicle and sternum

( sternoclavicular joints ) should be equal in both sides.

PA Chest (Erect)


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Image Evaluation10 posterior ribs should be demonstrated above the diaphragm.

PA Chest (Erect)


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PA Chest (Radiographic Anatomy)

B


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For trolley and bedside patients to demonstrate pathology involving lungs, diaphragm,and the mediastinum. kV for bedside is 70-80 with a grid, for large patients 80-100

kV with grid , film cross-wise to eliminate possible lateral cutoff.

AP Chest (supine/semi erect)


Patient supine on trolley, trolley

head raised into a semi erect

position, film behind the patient.

Film:HD (14x17 in) crosswise.

CR: 5 caudal to prevent clavicles

from obscuring the apices,FFD100 cm, at least for supine.

CP: T7 (3-4 inches below the jugular notch).

NB/ With this position it is impossible to

show any fluid levels.


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AP Chest (supine/semi erect) s


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Basic (additional) projection for localizing position of a lesion, or for the heart. A gridis used.

Lateral Chest (Erect)


Patient erect, turned with side of interest in close contact with the film,MSP parallel with film, arms folded over the head.

Instruct the patient to take in a breath, blow the breath out, and take

another deep breath and hold it ( 2nd

rested inspiration)

Film: HD 35x43 cm(14x17 in).

CR: 90horizontally.

CP: T7. (Approximately at the

level of inferior angle

of the scapula)

NB/ kV 125, at 6 mAs (with grid).


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Image Evaluation

The lung apices, costophrenic angles,

spine and sternum should be

included in the film.

The thorax should be in the center of

the collimated area

The heart should adequately

penetrated showing sharp outlines,

with vascular markings behind the

sternum and heart.

Patient arms and chin should not

superimposed over the upper lung

fields

Lateral Chest (Erect)


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Lateral Chest (Radiographic Anatomy)


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For ill patient who cant stand for an erect standing lateral

Lateral Chest (stretcher /Wheelchair Patient)


Patient seated on stretcher or wheelchair with side of interest in closecontact with the film, MSP parallel with film, arms folded over the head.

Instruct the patient to hold breathing on rested inspiration


CR: 90horizontally.

CP: T7.


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For patients who unable to stand to demonstrate small pleural effusions (air-fluid levels)

,pneumothorax. A (DECUBITUS) marker or (ARROW) should be used.

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Lateral Decubitus (AP Horizontal Beam)


Patient lying on one side on radiolucent pad, chin and arms raised above

head, patient back against a vertical cassette, knees flexed slightly, top of

the cassette approximately 1 inch above the vertebra prominens.

Film: HD 35x43 cm vertical

on the couch edge.

CR: Horizontally 90to

film center.

CP: T7(3-4 inches inferior to

jugular notch


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Image Evaluation

The lung apices, costophrenic angles, lateral margins of the ribs should be included

in the film.

The thorax should be in the center of the collimated area

The heart should adequately penetrated with sharp outlines without over exposure

of the lungsPatient arms and chin should not superimposed over the upper lung fields

Lateral Decubitus (AP Horizontal Beam)


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For pathology involving the lung fields, trachea, and mediastinum structures

(including the heart).

LAO/RAO Chest


Patient erect rotated 45(left anterior shoulder against film for LAO, and

right anterior shoulder against film for RAO).

Patient feet should be separated slightly with weight equally on feet

Arm away from the film raised with hand on top of unit

Arm nearest the film flexed at elbow with hand on the hip without

obscuring the lower lungs


CR: horizontally 90to film holder

CP: T7. (Approximately at the level of

inferior angle of the scapula)

NB/ For heart patient should be rotated55to 60in the LAO


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Image Evaluation

The lung apices, costophrenic angles, lateral

margins of the ribs should be included with out cut.

The heart should adequately penetrated with

showing sharp outlines and without over exposure

of the lungs

The width from the spine to the lateral margin of

the thoracic cage of the side away from the film

should be twice the width of the side contact with

the film

( This indicate true or correct oblique)

LAO/RAO Chest


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AP Lordatic Chest

To show right middle lobe collapse, interlobar pleural effusion.


Patient seated or standing in erect AP with feet slightly separated and about 1 ft

from the stand Bucky ,

The patient bends backward until the shoulders are supported by the stand Bucky.

The back of the patient hand on the hip with moving shoulder and elbow forward

to scapulae from the lung fields.

Film : HD 14x17 inches.

CR : Horizontally 90to the center of IR

CP: Level of mid sternum (3-4 inchesinferior to jugular notch


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If the patient unable to perform the Lordatic position angle the CR 20

cephalic for AP Lordatic or 20caudadfor PA Lordatic

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Lordatic Chest


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For pathology ( e.g. soft-tissue swellings ) involving air-filled larynx and the tracheaand their relation to thyroid, and the upper esophagus.

AP Upper Airway


Patient sitting or standing AP with MSP centered to the center of theBucky

Back of the head and shoulders against film, chin raised slightly so thatRBL is 20to the horizontal axis.

65-75 KV to visualize soft tissue, with 40 inches SID.

Film: 25x30 cm(10x12 in).


CP: At level of T.1-2

( I inch above the jugular notch)NB/ Exposure should be during slow inhalation to

fill the trachea with air.


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Lateral Upper Airway

For pathology ( e.g. soft-tissue swellings ) involving air-filled larynx and thetrachea and their relation to thyroid, and the upper esophagus.


Patient seated or standing upright in the lateral position

Patient arms positioned downside with dropping the shoulders back.

chin raised slightly without body rotation

65-75 KV to visualize soft tissue with 72 in.SID.

Film: 25x30 cm(10x12 in).


CP: C6-C7 Midway between thyroid

cartilage and jugular notch

NB/ Exposure should be during slow inhalation to fill

the trachea with air.


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3rd week(THU).ppt