Chapter 2 Chest

Bony Thorax 1 - __________ (Breastbone) 2 - Clavicles (Collar bones) 2 - ________ (Shoulder Blades) 12 - Rib Pairs 12 - ________Vertebrae

2 Lungs Right has _______ lobes Left has ________ lobes Superior, middle, ___________ Separated by two deep fissures Left has ________ lobes _________ and inferior Separated by one deep fissure

Lungs _________ ___________ ____________ angle Rounded superior area Inferior concave area. Rests on the diaphragm ____________ angle Inferiolateral corners where the diaphragm meets rib

Lung Tissue ___________ Functional tissue Spongy and elastic Allows lungs to ______________(Breathing)

Pleura _____________ Sac the lungs are held in Two parts __________Pleura - Outer layer __________ (Visceral) Pleura - Inner layer Pleural cavity ________space between parietal and pulmonary pleura

Pleura Problems _______________ Pleural ____________ Air in the Pleural cavity Pleural ____________ Accumulation of fluid in the pleural cavity Hemothorax – Blood Empyema - Pus

Diaphragm Primary muscle of breathing 3 openings Two ________________ Aorta ___________ Inferior Vena Cava

Pharynx (Upper Airway) Three Parts ____________ - Posterior to nasal cavity ___________ - Posterior to oral cavity (mouth) ____________ - At the junction between larynx and esophagus Accessory Parts Hard & Soft Palate, Uvula,

Larynx (Voice Box) Cartilaginous structure From _____________ Suspended by _____________ Contains 3 cartilage structures _____________ Thyroid Cartilage Cricoid Cartilage

Trachea (Windpipe) Inferior to __________ Fibrous Muscular structure 3/4 inch diameter 4 1/2 inches long Surrounded by 20 cartilaginous rings From ______________ Branches into right and left at the distal trachea at the ____________

Bronchi Right Bronchi Left Bronchi Wider and __________ than left Branches into the three right lobes Left Bronchi Smaller and ___________ than right Branches into the two lobes of the left

Mediastinum Part of the _______________cavity between the lungs. Extending from the _____________ column and contains all thoracic organs excepts the lungs.

Mediastinum Organs Thymus Gland __________and great vessels ___________ Esophagus

Hilum A ____________________at that part of an organ where vessels and nerves enter. In the lungs: __________ Blood Vessels Lymph Vessels ___________

Taking a Chest X-ray Consider body habitus _____________ Sthenic short and wide - 14 X 17 crosswise Sthenic Agerage - 14 X 17 cross or lengthwise longer and more narrow - 14 X 17 lengthwise Asthenic long and narrow - 14 X 17 lengthwise

Topographical Landmarks Vertebra Prominens ________ Apex of lungs Jugular Notch __________ Top of Sternum Xiphoid Tip ____________ Anterior Diaphragm

Technical Factors Adult CXR Erect High kV ____________ Long scale Low _________ mAs determined by pt ____________

Pediatric CXR Use immobilizer for erect image. Decrease kV to __________ CR to mid thorax (___________) Crying is ____________!

Patient Prep Remove all _________ around neck area Remove shirts with ______, snaps, etc.. Remove _________ with clips Look for anything around lung field Oxygen tubes, hair braids, etc.. Nipple markers*

Patient Instructions Typically done on ___________ To get the best inspiration “Breath in and blow it out take another breath in and ________________” Can do on expiration Pneumothorax, foreign body, lack of diaphragm movement, comparisons. “Take in a breath blow it all the way out and ______________.”

Patient Positioning PA Erect ____________ No rotation Chest against bucky Hands on hips Shoulder “__________” forward Chin up

Left Lateral Left side against IR Erect 72” SID No rotation ___________

CR Positioning Mid ___________ (T7) 7-8” __________ to Vertebra Prominens (C7) Hand spread method (pg 83) Once CR is positioned, center _________

Guidelines for a perfect CXR PA and Lt Lat No rotation PA - look at ____________ Equidistance from spine Lateral - look at ___________ posterior ribs No more than 1/4” to ______ separation

CXR Guidelines Adequate Inspiration Adequate technique PA Minimum of ____________on PA Adequate technique PA T-Spine vertebrae seen with ____________

Other Chest Projections AP - Supine or Semi erect Slight ____________(5 degrees) CR to be perpendicular to the ____________ Center to mid sternum (_____ inferior to jugular notch)

Decubitus Lt/Rt Lateral Decubitus Pt recumbent on lt/rt side CR shot AP/PA to mid sternum For _______________or fluid levels

Others continued AP Lordotic Can do supine To visualize apices _____________ Pt stands ______ away from bucky an leans back Hand positioned as per _________ chest CR straight at mid sternum Can do supine ____________degree cephalad angle at mid sternum

LAO and RAO LAO CR RAO CR 45 degree anterior oblique Left side closest to bucky Rt arm up Lt arm on hip ________seen best CR Level of T7 Mid body RAO 45 degree anterior oblique Right side closest to bucky Lt arm up Rt arm on hip ________seen best CR Level of T7 Mid body

LPO and RPO LPO CR RPO CR 45 degree posterior oblique Lt side closest to bucky Lt arm up Rt arm on hip and rolled back _______seen best CR T7 Mid body RPO 45 degree posterior oblique Rt side closest to bucky Rt arm up Lt arm on hip and rolled back _________seen best CR T7 Mid body

S.T. Neck Factors _________SID for Lateral _________SID for AP 75 - 80 kVp Slow deep inspiration Fill __________ with air

S.T Neck Upper Airway AP Lateral CR CR Recumbent or erect Rt or Lt Pt to look straight ahead CR Between thyroid and jugular notch _____above jugular notch Lateral Rt or Lt Recumbent or erect Chin slightly elevated Shoulders rolled back CR Between thyroid cartilage and ________