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SilverSpoon
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Chest/Thorax is divided into 3 sections. Name the 3 sections.
Bony thorax- framework
Respiratory system- lungs and airways
Mediastinum- space between lungs
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The bony thorax consists of:
Sternum- manubrium, body, xiphoid process
Clavicles (2)
Scapula (2)
12 pairs of ribs
12 thoracic vertebra
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The vertebra prominens is located?
C-7 spinous process
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The jugular notch is located?
- suprasternal notch
- manubrial notch
- depression on upper sternum T2-T3 interspace
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The xiphoid process is located?
Anterior margin of diaphragm T9-T10
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what is the purpose of the Respiratory system?
To exchange gaseous substances between air and blood
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The Respiratory system has 4 divisions and a diaphragm. name the four divisions.
Pharynx
Trachea
Bronchi
Lungs
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The pharynx is an upper airway. what are the 3 pharynx?
nasopharynx
oropharynx
laryngopharynx
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What is the Larynx?
Organ of voice
1.5-2in. long
suspended from hyoid bone
Level of C3-C6
Thyroid cartilage forms anterior wall of larynx
Laryngeal prominence/ Adam's apple= C5
Cridoid cartilage forms inferior and posterior wall
epligottis
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What is the Trachea?
4.5 inches long
3/4 inch in diameter
16-20 ridges cartilagenous rings
Level of C6-T4
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Bronchi
Level of T5 trachea bifurcates into right and left main stem bronchi
Area of bifurcation is carina
Right bronchus is straight and larger
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The right lung has ___ lobes. The left lung has ___ lobes.
Right= 3 lobes Left= 2 lobes
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The pleura is a doublwall layers covering the lungs. Name the layers
Pulmonary/visceral layer= inner layer
Parietal layer= outer
Pleural cavity= space between the two layers
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Regions and specific:chest radiographic anatomy
trachea
apex(apices=2)
carina
base
Right and Left hemidiaphragms
costophrenic angles
hilum
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Regions and specific:radiographic anatomy (bones/joints)
clavicles
ribs (anterior/posterior)
sternum
sternoclavicular joints
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Regions and specific:left lateral position
apices
costophrenic angles
bases
hemidiaphragms
hilum
scapula
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Mediastinum: Medial portion of thoracic cavity between lungs
Be able to locate:
Trachea
Esophagus
Thymus gland
Heart
Great vessels: aorta, superior vena cava, inferior vena cava, pulmonary artery and veins
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Chest x-ray Pt. prep.
undress from the waist up
remove all opaque objects
always have patient wear shoes
caution: long hair
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PA projection of chest x-ray pt. positioning
pt. erect, feet spread slightly.
chin raised
hands on lower hips, palms out, elbows slightly flexed
shoulders rotated forward against IR to move scapula away from lung field
depress shoulders downward
align MSP to CR and to midline of IR with equal margins between lateral thorax and sides of IR.
Ensure no rotation of thorax
Raise or lower CR and IR to the level of T-7
Top of IR will be 1.5-2 inches above shoulders
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Breathing instructions for Chest x-ray
Inspiration
clear, concise directions
expose on 2nd breath
dont assume pt. can hold their breath
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Degree of Inspiration
minimum 10-11 ribs
count posterior ribs
3 dimensions: vertical, transverse, AP
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PA chest
14x17 lw/cw depending on pt's body habitus
pronate marker
pt faces IR with shoulders rotated forward
CR directed perpendicular to T7 and midcoronal plane
Top of IR 1 1/2-2 inches above top of shoulders
expose on inspiration
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AP chest positioning
position: supine, semi-upright, or upright
CR: angled caudad, perpendicular with long axis of the sternum. (+/- 5 degrees)
CR centering: Level of T7, 3 to 4 inches below the jugular notch
Top of IR 1.5 inches above shoulders
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AP chest criteria
Heart will appear larger due to increased OID. (magnification)
Inspiration will not be as full as erect , 8 to 9 posterior wibs visualized above the diaphragm
Scapula might not be all the way out of the lung fields
Correct CR Angle = Three posterior ribs should be seen above the clavicles
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Left lateral chest
14x17 lw
left side against film
both arms above pt's head
mid-coronal plane perpendicular to IR
Mid-saggital plane parallel to IR
CR perpendicular to T7 and mid-coronal plane
Top of IR at level of top of shoulders
expose on inspiration
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Radiation Protection
Limit repeat exposures
collimation
gonadal shielding
reduce back scatter
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