1. Basic Radiographic Procedures CHEST - LAB RT 123 – WK 4 & 5 SHOW VIDEO

2. Lab this week Terminology quiz Begin CHEST positioning Exposures for upright Chest on Simulated Skeleton (?)

3. radiographic procedures Positioning (topographic landmarks, body positions, path of central ray, etc.) Anatomy (including physiology, basic pathology, and related medical terminology) Technical factors (including adjustments for circumstances such as body habitus, trauma, pathology, breathing techniques, etc.)

6. Review SERIES NOTES CHEST PA & LAT PROJECTIONS

7. ↑ PA CHEST (DO SERIES NOTES) MSP PERPENDICULAR ┴ TO IR MCP PARALLEL ║ TO IR ARMS DOWN BY SIDES BACK OF HANDS AGAINST HIPS ROTATE ARMS FORWARD – FREES SCAPULA FROM THE LUNG FIELDS C/R @ MSP + T-7

8. POSITIONING PA CHEST

9. LUNGS WIDEST AT BASE

10. Topographical Landmarks

11. Positioning – KEY POINTS Chest - PA Upright Patient erect & facing IR chin raised, shoulders rotated forward and downward; CR to midsagittal plane at the level of T-7 (7" - 8" below the vertebra prominens); respiration suspended on full inspiration.

12. ANATOMY (Best Seen) Entire lungs must be included on image superior apices to the inferior costophrenic angles, air-filled trachea, heart aortic knob.

13. Top of collimation skims C-7 Vertebral Prominens

14. Too Open ! Better Do not get distracted by size of shoulders –look at bases! In some systems you can open the collimation this much – it doesn’t mean you should!

16. NO ROTATION VS ROTATION

18. BREATHING INSTRUCTIONS TAKE IN A DEEP BREATH – BLOW IT OUT TAKE IN ANOTHER DEEP BREATH HOLD IT “RESPIRE PROFUNDO DE TANGELO”

20. CASSETTE – IR POSTIONING

21. Center/Position cassette for Differing Body Habitus

23. POSITIONING LEFT LATERAL CHEST

24. ↑ LATERAL CHEST (DO SERIES NOTES) MSP PARALLEL ║ TO IR MCP PERPENDICULAR ┴ TO IR ARMS EXTENDED OVER HEAD C/R @ MCP + T-7

25. Chest - Lateral Upright Patient erect, left side against IR, arms extended upwards, chin raised; C/R @ midcoronal plane & the level of T-7 respiration suspended on full inspiration (2x)

27. Anatomy on Lateral Entire lungs must be included on image, superior apices to the inferior costophrenic angles, heart aorta.

30. TECHNIQUE PA LAT ( 4x ↑ from PA) (see last week lecture) SHORT SCALE CONTRAST LONG SCALE CONTRAST DENISTY CHANGES What are the average KVP ranges for CHEST?

31. RT 123 2007 WK 3 Introduction to Positioning & Terminology Merrill's Ch 1, (2) & 3

32. CHEST RADIOGRAPHY UPRIGHT - WITH GRID KVP RANGE (90 – 120 ) MAS ( 1 – 3 PA) ( 5 – 20 LAT)

33. FOR CHEST – TO GO FROM PA TO LAT: ↑ Technique by 4 x = Double the MAS and go up 10 kvp INCREASE DENSITY BY 4 X you could: Example: PA CHEST: 2 mas - 110 kvp FOR LATERAL: Go up 4 X in mas 8 mas - 110 kvp Go up 2 X MAS & ↑ 15% Kvp 4 mas - 125 kvp

34. THE “RULES” WHILE “OBSERVING” – DO NOT PERFORM EXAMS ON PATIENTS (POSITIONING OR EXPOSE) DO NOT MAKE EXPOSURES AT THE CLINICS ON ANY PATIENTS YOU CANNOT BE SUPERVISED BY OTHER STUDENTS YOU CANNOT PERFORM ANY EXAMS ON ANYONE UNDER 18 YEARS OLD

35. “THE RULES” FOR CHEST IMAGING & COMPETENCIES YOU CANNOT ATTEMPT TO PERFORM A CHEST EXAM ON A PATIENT UNTIL AFTER PERMANENT ASSIGNMENT MUST HAVE A ROOM CHECK OFF FIRST (CI) ONLY DIRECT SUPERVISION THIS SEMESTER – NEED 25 exams FOR A CHECK OFF CAN NOT GET A CHECK OFF UNTIL SPRING SEMESTER If EXAM (written or lab) not passed – must be repeated successfully – original points for grade

36. CHEST IMAGING simulated competency 1 ST LAB PRACTICE ON THURSDAY 9/24/09 WRITTEN & LAB TEST FOR CHEST THURS 10/8/09 – Written Test includes CH. 1, 3 & 10 + Rad Protection AND SIMULATED Lab Eval 10/08/09

37. LAB PRACTICE

38. Observe Lab Rules Work with your Partner & others Share Time Communicate Collimate Shiled Practice PREP for Exam when not using the BUCKY