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

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Presentation on theme: "1 RT 124 SPRING WEEK 1 – Part 1 CHEST & ABD A “Self Study” Review Rev Spring 2010."— Presentation transcript:

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

2 2 RT 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 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 4 Body Habitus

5 5

6 6 CASSETTES W/ GRID CAPS

7 7

8 8

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

10 10

11 11 CR GRIDS

12 12 CHEST ANATOMY REVIEW

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

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

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

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

17 17 Bronchial Tree 2. Bronchi –Air tubes leading into the lung –Right more vertical than left –Branching structure Primary  2ndary  teritiary... –Only primary visible on PA projection P

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

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

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

21 21 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

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

23 23 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) inspirationexpiration

24 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 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 26 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

27 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 28 PA Projection (cont.) Minimal rotation –Symmetry of SC joints –MS plane to lateral ribs = distance

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

30 30 PA Chest Anatomy

31 31 Radiographic Anatomy -- PA

32 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 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 34 Abdomen Anatomy Abdominopelvic cavity –Abdomen diaphragm to pelvic inlet –Pelvic cavity pelvic inlet to floor muscles of the cavity

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

36 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 37 Abdomen Anatomy (cont.) Topographic (positioning) landmarks –Iliac crest (level of L4-5) –Anterior superior iliac spine (ASIS) –Greater trochanter of femur –Pubic symphysis Symphysis Pubis Greater Trochanter Lumbar Vertebra Iliac Crest ASIS

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

39 39 Major Abdominal Organs stomachlarge bowelspleensmall bowel duodenum jejunum ileum liver (triangular) gall bladder pancreas

40 40 Urinary Organs & Major Vessels aortakidneyureter vena cavaurinary bladderurethra adrenal gland

41 41 Abdominal Organ Systems 1.Digestive System (gastrointestinal; GI tract) –Stomach A.Fundus (gas bubble present in erect position) B.Body C.Pyloric antrum A B C

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

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

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

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

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

47 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 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 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 rotated Midsagittal plane perpendicular to table parallel to table length –R & L ASIS level –Shoulders level

50 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 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 52 Abdominal Radiography (cont.) –density & contrast adequate to see Psoas muscles lumbar transverse processes ribs kidney & liver margins

53 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 CR 2" above iliac crests in MS plane

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


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