1. RT 124 SPRING WEEK 1 – Part 1 CHEST & ABD A “Self Study” Review
Rev Spring 2010

2. RT 124 - WEEK 1 (Part 2) is the Lecture Presentation for:
Chest II
AP: SUPINE, SEMI-UPRIGHT – UPRIGHT
R & L DECUBITUS
LATERAL – PT ON GURNEY OR IN W/C
ABDOMEN
AP SUPINE, UPRIGHT, LLD
RT 124 – Wk 1 – Part 1 Lecture on web can be reviewed for basic CHEST & ABD anatomy.

3. A quick review of CHEST 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

4. Body Habitus

6. CASSETTES W/ GRID CAPS

9. Grids Allow primary radiation to reach the image receptor (IR)
Absorb most scattered radiation
Primary disadvantage of grid use
Grid lines on film

11. CR GRIDS

12. CHEST
ANATOMY REVIEW

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

14. Bony Thorax ENCLOSE THE ORGANS ATTACH UPPER EXTREMITY Anterior
STERNUM (breast bone)
12 PAIR OF RIBS
12 THORACIC VERTEBRA
ATTACH UPPER EXTREMITY
2 CLAVICLES
2 SCAPULA
Anterior
Posterior

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

16. Respiratory System 1. Lungs Lobes Terminology Right 3 lobes
Left 2 lobes
Terminology
Apex
Hilum
Base
Costophrenic angles A H
 B  C
C 

17. 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

18. Trachea 3. Trachea In mediastinum Passageway for air to/from lungs
Approx. 4½" Long
Air visible on images T

19. Circulatory System 1. Heart 2. Great blood vessels 4 Chambered pump
Aorta
Vena cava
Pulmonary Artery
Not seen on image A VC PA VC

20. Miscellaneous Mediastinum contents Trachea Major vessels Esophagus
Lymphatics
Heart
Thymus

21. Chest Examinations Most common projections Less 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

22. Routine PA & L Lateral 1. Erect position 2. 72" Sid
Diaphragm moves more inferior
Demonstrates air-fluid levels
Prevents blood pooling in gr. vessels
2. 72" Sid
ê magnification of heart

23. Routine PA & L Lateral (cont.)
3. Breath held on inspiration
Expands lung fields
depresses diaphragm
Provides contrast (air vs. tissue)
inspiration
expiration
4. Film (adult)
14X17 lengthwise
(may be crosswise on broad chested male)

24. 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

25. 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

26. PA Projection (cont.) X-ray beam Collimation (very little) CR
 to film
in MS plane at T 7
Collimation (very little)
Full length of film
To lateral edges of patient

27. 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)

28. PA Projection (cont.) Minimal rotation Symmetry of SC joints
MS plane to lateral ribs = distance

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

30. PA Chest Anatomy

31. Radiographic Anatomy -- PA

32. 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

33. 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

34. Abdomen Anatomy Abdominopelvic cavity Abdomen Pelvic cavity
diaphragm to pelvic inlet
Pelvic cavity
pelvic inlet to floor muscles of the cavity

35. Abdomen Anatomy (cont.)
Divisions
4 Quadrants (clinical)
9 Regions (anatomic)

36. 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

37. 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

38. Abdomen Anatomy (cont.)
Major muscles (radiographically)
Diaphragm
R and L psoas muscles

39. Major Abdominal Organs
liver (triangular)
stomach
gall bladder
pancreas
spleen
large bowel
small bowel
duodenum
jejunum
ileum

40. Urinary Organs & Major Vessels
adrenal gland
kidney
vena cava
ureter
aorta
urinary bladder
urethra

41. Abdominal Organ Systems
Digestive System
(gastrointestinal; GI tract)
Stomach
Fundus
(gas bubble present in erect position)
Body
Pyloric antrum A B C

42. GI System (cont.) Small intestines (small bowel) duodenum
("c" shape; bulb)
jejunum
ileum A B C

43. GI System (cont.) Large intestine (colon) Cecum (valve; appendix)
Ascending colon
Hepatic flexure
Transverse colon
Splenic flexure
Descending colon
Sigmoid colon (flexure)
Rectum (valve) E C D B F A G H

44. 1. GI System (cont.) Other GI tract organs A B C D Liver Gall bladder
Bile ducts (liver > gall bladder > duodenum)
Pancreas A B C D

45. 2. Circulatory System Vessels & Spleen
Aorta
Vena Cava

46. 3. Urinary System Kidneys (R & L) T12 to L3 Ureters (R & L)
Urinary Bladder (pelvic organ)
Urethra A B C D

47. Abdominal Radiography
Patient preparation
KUB & acute abdomen
Remove radiopaque clothing & gown
Otherwise "as is“
Breathing instructions
Expose after patient exhales
"Take deep breath, blow it all out, stop breathing"
Watch patient while giving instructions
Contrast media exams
Dietary & bowel preps usually required

48. Abdominal Radiography (cont.)
Exposure factors (non contrast media)
Medium kVp
adequate penetration
moderate contrast
Short exposure time
decrease involuntary motion on image
Enough mAs for sufficient density
Film markers
Radiation protection
Check for pregnancy on all women
Gonadal shielding (???)
Collimation
to film edge top & bottom
to patient width on sides

49. 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 rotatedMidsagittal plane
perpendicular to table
parallel to table length
R & L ASIS level
Shoulders level

50. 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

51. 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

52. Abdominal Radiography (cont.)
density & contrast adequate to see
Psoas muscles
lumbar transverse processes
ribs
kidney & liver margins

53. 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

54. Abdominal Radiography (cont.)
Lateral in a recumbent or erect position
Seldom done due to level of radiation
lack of significant diagnostic information