Chapter Two The Chest and Abdomen

PA Chest Facility Identification Marker Artifacts Film Size

PA Chest Density: Should be able to see Lung markings, diaphragm, heart borders hilum, bony cortical outlines. Contrast: to see the thoracic vertebra and posterior ribs through the heart shadow. KVP

PA Chest Positioning: Erect CR to T-7 Done on 14x17 Anatomy : apices both lungs, costophrengic angels. Lungs expands in 3 direction.

PA Chest Rotation SC joints: Equal distance from vertebral column Right and left corresponding ribs are equal Air filled trachea in center of vertebral column

PA CHEST Clavicle on same plane. Depress shoulders Rotate scapula out of lung field.

PA foreshortening A correct view will have the T-4 superimposed by manubrium and about 1 inch of lungs above clavicles. Foreshortening is caused by leaning towards or away from the IR.

PA Chest Good inspiration is demonstrated when there is posterior ribs above the diaphragm. 2 nd deep inspiration Note: a pneumothorax maybe done on expiration.

Lateral Chest Positioning Mid-coronal plane against IR The posterior and anterior ribs nearly superimposed. Sternum in profile Intervertebral foramina are open.

Lateral rotation Ribs Find the hemi-diaphragms If heart shadow is over sternum Lung over sternum

Lung Foreshortening Both diaphragms nearly superimposed Foreshortening caused by leaning towards or away from IR. If hip is on the IR the right diaphragm is lower than the left.

Right v/s LEft Id a right lateral is done it is to better see the right lung detail.

Lateral Positioning Arms out of the way Note: if pacemaker was installed 24 hours prior don’t raise left arm. Obtain the anteroinferior lung

Inspiration 11 th Thoracic vertebra in superimposing the lung field. Find: 12 th rib and follow it to the vertebra count up one

AP Chest supine or portable Air-fluid levels Artifacts; monitor lines Time and date if mulitple exams are performed

AP chest Contrast and density: Adequate to see any tubes and lines. ET tube: 1-2” above carina Chest tube:5-6 th ribs CV line;2-3 cm above aterial junction Pulmonary lines: pulmonary artery Pacemaker: Under clavicle on left side

Heart The heart will me magnified Deceased SID: 40-48’

Rotation Same as the PA except it is opposite Right SC joint has less imposition it is closer to bed.

Positioning CLavilce same Scapula will be in lung filed Arms are abducted out of way

Angels Caudal: Manubrium inferior to 4 th. More than 1 inch above clavicle, and ribs are vertical, elongates heart Cephalic: manubrium superior to t-4, less than 1 inch above clavicles, ribs are horizontal, foreshortens the heart. Supine patient: 5 degree angel caudal to allow for gravitational pull.

Inspiration 9-10 ribs above diaphragm. Unconscious patient; watch chest movement

Lateral Decubitus Patient on side: mark side up Position for laterals. –For air place affected side away from table. Decrease KV by 8 % –For fluid place affected side down. Increase mAs by 35 %

Lateral Chest Same Anatomy Same rotation Same foreshortening Same inspiration for portable No imposition of bed pad

AP Lordotic Contrast and density: see clavicle, superior t-spine, ribs CR is centered to superior lung field midway between manubrium and xiphoid tip

Anatomy seen Apices at level of T-1, clavicles above lung field, 2/3 of lungs, ribs 1-4 are nearly superimposed, foreshortened heart shadow. Not enough arch: clavicles superimpose lungs and anterior ribs inferior to posterior ribs.

AP and Supine Abdomen Facility identification Marker Artifacts Motion Involuntary and voluntary

Contrast and density Contrast; see the psoas muscles, kidneys, inferior ribs and transverse process of lumbar. Gas: decrease KVP by 5-8% or mas 30-50% Fliud increase KVP by 5-8% or mas 30-50% Density: to light to dark. Compensate for larger patients

Rotation Spinous process aligned to midline of vertebral bodies. Equal distance from pedicles to spinous processes. The sacrum in the inlet of pelvisand align with symphysis pubis.

Positioning Long axis of body with long axis of IR Patient erect or supine( erect for at least 5 min. for air to rise) With shoulders and hip equal distance from table or bucky

Expiration The domes of diaphragm is superior to 9 th posterior rib.

Anatomy Supine: 11 th vertebra lateral soft tissue, iliac wings, symphysis pubis. Erect: 9 th vertebra, diaphragm, soft tissue, wings.

Left lateral decub. Same criteria, marker upside. Weight sifts, may need a compensating filter.

Rotation Same as abdomen Wing with least amount is the side farthest away from film.

Expiration Anatomy

Pediatric Chest Same facility information Marker Artifacts Contrast and density KVP 65-75

AP Chest CR- T-4 Rotation same Caudal angel for supine 8 posterior ribs above diaphragm

Lateral Ped. Chest CR: T-5 Cross table or roll on side. Cross table is preferred because of less disturbance to infant and the inflation of lungs of the lungs

Rotation same. Arms and chin up Inspiration

Ped. Abdomen Facility information same Marker Artifacts Contrast and density; to see boewl gases, diaphragm, outline of bony structures KVP 65-75

Rotation same Expiration diaphragm is at 8 th rib.

Left lateral decub Same as adults