Review of Chest & Abdomen Anatomy for RT.124

1. RT 124 SPRINGWEEK 1 – Part 1CHEST & ABDA “Self Study” Review Rev Spring 2010

2. 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.

3. A quick review of CHESTDedicated 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

4. Body Habitus

6. CASSETTES W/ GRID CAPS

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

11. CR GRIDS

12. CHEST ANATOMY REVIEW

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

14. Anterior Posterior Bony Thorax • ENCLOSE THE ORGANS • STERNUM (breast bone) • 12 PAIR OF RIBS • 12 THORACIC VERTEBRA • ATTACH UPPER EXTREMITY • 2 CLAVICLES • 2 SCAPULA

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

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

17. 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

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

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

20. Miscellaneous • Mediastinum contents • Trachea • Major vessels • Esophagus • Lymphatics • Heart • Thymus

21. 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

22. Routine PA & L Lateral 1. Erect position • Diaphragm moves more inferior • Demonstrates air-fluid levels • Prevents blood pooling in gr. vessels 2. 72" Sid • ê magnification of heart

23. inspiration expiration 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)

24. 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

25. 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

26. 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

27. 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)

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

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

30. PA Chest Anatomy

31. Radiographic Anatomy -- PA

32. 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

33. 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

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

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

36. 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

37. 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

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

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

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

41. 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

42. 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

43. 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

44. 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

45. 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

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

47. 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

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