Bontragers ch 2 - Chest review
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Why is a chest radiograph performed PA?
To reduce the magnification of the heart by putting the heart closer to the film.
Why is a chest radiograph performed erect?
- you cannot use 72" when the patient is recumbent
- decreases heart and great vessel magnification
- allows diaphragm to move more inferior when erect
- demonstrates air-fluid level because of the horizontal beam
Why should you use full inhalation on a chest radiograph?
to fully expand lungs; with the lungs fully expanded you should be able to count 10-11 ribs on the radiograph
What would be the purpose of performing a chest radiograph with full expiration?
- to document excursion of diaphragm
- diagnose PTX
- locate foreign bodies
Why should you roll the shoulders forward for a PA chest radiograph?
To get the scapulae out of the way
Why should you raise the arms for a lateral of the chest?
To get the shadows of the arms out of the lung field
Why use a patient hospital gown for a chest radiograph?
- reduces artifacts
- makes palpation easier
How do you evaluate a PA chest radiograph for rotation?
The right and left sternal ends of the clavicles will be the same distance from the spine.
How do you evaluate a Lateral chest radiograph for rotation?
The posterior ribs should be superimposed. If there is any separation > 1/4 to 1/2 an inch the film should be repeated. This is about a fingers width.
How do I evaluate the completed chest radiograph for good alignment of the CR and part placment on the film
- The mid thorax should be centered to the film, and there should be no rotation as evaluted by the sternal ends of the clavicle. There should be good four sided collimation. Ten ribs should be visualized denoting a good inspiratory effort.
- To determine where the mid thorax is located use the method demonstrated on p. 89 of Bontrager's. He suggests that you center 7 inches inferior to the vertebral prominens for a female and 8 inches for a male.
Why would you perform an Apical Lordotic Projection?
To demonstrate the apices of the lungs without clavicular superimposition. This would be used to rule out calcifications and/or masses beneath the clavicles. The patient may be put in the lordotic position, or an Axial projection with a 15 to 20 degree cephalad angle could be used.
Which oblique of the chest would demonstrate the right lung?
will best demonstrate the Right lung
FYI on the other positions
- The RAO will best demonstrate the Left lung
- The RPO will best demonstrate the Right lung or the same anatomy as the LAO
- The LPO will best demonstrate the Left lung or the same anatomy as the RAO
How do you evaluate a chest radiograph for technique?
- The radiographer should use sufficient mass to see the faint outline of the vertebra through the heart.
- In addition the patient identification marker should always be placed toward the top with film/screen (analog) systems and toward the bottom with digital systems; If there is a question as to whether the patient will fit on the film lengthwise, turn the film crosswise.
Why should a chest radiograph be taken at 72" SID?
Using 72" decreases the magnification of the heart and great vessels.
Why should you have the patient roll his/her shoulders forward when taking a chest x-ray?
To prevent superimposition of scapulae on the lung fields
Why do you have a patient take in a deep breath during a CXR?
To enhance subject contrast by filling the patients lungs with air
If a patient goes into cardiac arrest while in your care, what should you do?
Know the area protocol for a code, assist patient to recumbent position, preferably the floor, call the code and begin CPR immediately until help arrives.
If a patient can not stand, what are other options for obtaining a chest PA and lateral?
Sit the patient down or if they can not sit, lie them down and shoot an AP supine chest with a cross-table lateral.
Why would a radiographer choose to take a chest film in the supine position?
If the patient can not stand, is bed ridden, or is a trauma case.
How would one take a chest radiograph of a patient in a wheelchair?
Put the cassette in a grid behind the patient, use an SID of 72" inches, and take the radiograph as normal.
What would be a good response if a patient with a central line comes in for a chest radiograph and during positioning for the lateral chest, you accidentally pull the patient's central line?
Lie the patient down, seal off the site by providing direct pressure, and put the patient in the left lateral trendelenburg position and then call for help.
What compensation would you make for a patient with pendulous breasts to prevent soft tissue shadows appearing on the PA radiograph?
Have the patient lift and separate her breasts then press her anterior chest against the board.
How far above the patient's shoulders should the top edge of the film appear for a chest radiograph?
One to two inches.
What central ray angle is necessary to demonstrate air fluid levels in the erect chest radiograph?
Use a horizontal beam.
If a patient cannot hold their arms up for a lateral chest x-ray, what can be done to move the arms out of the field?
You could place a 45 degree sponge under their arms, or have them hold on to an IV pole
If a patient presents with a fractured humerus would it be acceptable to raise the unaffected arm above the head for the lateral of the chest; thus leaving the fractured arm to the side?
Yes, if the arm is fractured and you do not have permission to move it then the lateral should be taken with the arm as is.
How do you demonstrate air fluid levels in the abdomen?
Any position that involves a horizontal CR could demonstrate an AFL in the abdomen. If the AFL is within the bowel, an erect abdomen or either decubitus abdomen could demonstrate it. If the purpose is to demonstrate free air (air outside the GI tract), you should do an erect chest or erect abdomen or left lateral decubitus abdomen.
How will a typical AP supine mobile chest radiograph taken at 40" SID appear different from a routine erect PA chest radiograph using 72" SID?
The heart will appear enlarged and if techniques are not changed the image will appear darker.
In a protective precaution situation, which radiographer should have contact with the patient?
The "clean" radiographer, the one who IS adjusting the equipment and who does not touch the patient. He takes the cassette from its protective cover when it is handed to him/her via the dirty technologist. Care should be taken to not contaiminate the imaging receptor..
How long is the exposure cord on a portable x-ray machine?
What is one example of patient care for portables?
Make sure you don't get the imaging receptor or yourself caught in the patient's lines because they could detach from the patient and cause problems and pain. It could also cause the patient to be in great danger, and it could be life-threatening
What are ways to reduce radiation exposure during portables?
For the radiographer: time, distance, and shielding. For others in the room; remove unneeded people from the area, shield the patient, collimate, and use appropriate technical factors.
During mobile radiography, what determines grid selection and use?
Larger parts and higher kVp settings generate more scatter radiation and require a grid with a higher ratio. To reduce the likelihood of grid cutoff, you should select the lowest ratio grid practical for the size of the part and kV selected.
For an AP chest radiograph, where do you place the patients hands while they're sitting in the bed if you are trying to roll their shoulders forward?
Place the backs of their hands on the sides of their hips and push their elbows towards the front.
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