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RT 124 SPRING
WEEK 1 – Part 1
CHEST & ABD
A “Self Study” Review
Rev Spring 2010
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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
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Body Habitus
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5
CASSETTES W/ GRID CAPS
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7
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Grids
• Allow primary radiation to reach the image
receptor (IR)
• Absorb most scattered radiation
• Primary disadvantage of grid use
– Grid lines on film
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CR GRIDS
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CHEST
ANATOMY REVIEW
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Chest Anatomy
• Thoracic cavity
(chest)
– Surrounded by
boney thorax
– Separated from
abdomen by
diaphragm
• Muscular partition
• Dome shaped
• Lungs drape over
diaphragm
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Bony Thorax
• ENCLOSE THE
ORGANS
– STERNUM (breast bone)
– 12 PAIR OF RIBS
– 12 THORACIC
VERTEBRA
• ATTACH UPPER
EXTREMITY
– 2 CLAVICLES
– 2 SCAPULA
Anterior
Posterior
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Thoracic Cavity
• Sections of the thoracic cavity
– Pleural portion (lungs)
– Mediastinum (between lungs)
– Pericardial portion (heart)
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Respiratory System
1. Lungs
– Lobes
• Right 3 lobes
• Left 2 lobes
– Terminology
•
•
•
•
Apex
Hilum
Base
Costophrenic angles
A
H H
A
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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
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Trachea
3. Trachea
– In mediastinum
– Passageway for air
to/from lungs
– Approx. 4½" Long
– Air visible on images
T
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Circulatory System
1. Heart
– 4 Chambered pump
A
2. Great blood vessels
PA
VC
– Aorta
– Vena cava
– Pulmonary Artery
• Not seen on image
VC
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Miscellaneous
• Mediastinum
contents
– Trachea
– Major vessels
– Esophagus
– Lymphatics
– Heart
– Thymus
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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
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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
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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)
inspiration
expiration
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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
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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
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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)
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PA Projection (cont.)
• Minimal rotation
– Symmetry of SC
joints
– MS plane to
lateral ribs =
distance
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PA Projection (cont.)
• Technique
– Vertebra seen through
heart (kVp)
– "Good" density
• Other
– no film artifacts
– no motion (blur)
PA Chest Anatomy
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Radiographic Anatomy -- PA
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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
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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
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Abdomen Anatomy
• Abdominopelvic
cavity
– Abdomen
• diaphragm to pelvic
inlet
– Pelvic cavity
• pelvic inlet to floor
muscles of the cavity
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Abdomen Anatomy (cont.)
• Abdomen
– Divisions
• 4 Quadrants (clinical)
• 9 Regions (anatomic)
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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
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Abdomen Anatomy (cont.)
• Topographic (positioning)
landmarks
Iliac
Crest
– Iliac crest (level of L4-5)
– Anterior superior iliac
spine (ASIS)
ASIS
– Greater trochanter of
femur
– Pubic symphysis
Lumbar
Vertebra
Greater
Trochanter
Symphysis Pubis
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Abdomen Anatomy (cont.)
• Major muscles (radiographically)
– Diaphragm
– R and L psoas muscles
Major Abdominal Organs
liver
(triangular)
gall
bladder
pancreas
small
bowel
• duodenum
• jejunum
• ileum
stomach
spleen
large bowel
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Urinary Organs & Major Vessels
adrenal gland
kidney
vena cava
ureter
aorta
urinary bladder
urethra
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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
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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
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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
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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
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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
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Abdominal Radiography (cont.)
– density & contrast
adequate to see
• Psoas muscles
• lumbar transverse
processes
• ribs
• kidney & liver margins
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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
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Abdominal Radiography (cont.)
– Lateral in a recumbent or erect position
•
Seldom done due to level of radiation
•
lack of significant diagnostic information