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

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.

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

Body Habitus

CASSETTES W/ GRID CAPS

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

CR GRIDS

CHEST ANATOMY REVIEW

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

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

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

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

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

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

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

Miscellaneous Mediastinum contents Trachea Major vessels Esophagus Lymphatics Heart Thymus

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

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

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)

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

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

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

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)

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

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

PA Chest Anatomy

Radiographic Anatomy -- PA

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

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

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

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

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

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

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

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

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

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

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

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

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

2. Circulatory System Vessels & Spleen Aorta Vena Cava

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

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

Abdominal Radiography (cont.) Exposure factors (non contrast media) Medium kVp -- 70-80 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

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

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

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

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

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

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