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Introduction to Clinical Radiography

Introduction to Clinical Radiography. Unit VI -- Chest and Abdomen Examinations. Chest Anatomy. Thoracic cavity (chest) Surrounded by boney thorax Separated from abdomen by diaphragm Muscular partition Dome shaped Lungs drape over diaphragm. Anterior. Posterio r. Boney Thorax.

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Introduction to Clinical Radiography

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  1. Introduction to Clinical Radiography Unit VI -- Chest and Abdomen Examinations

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

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

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

  5. 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 UNIT VI

  6. 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 UNIT VI

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

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

  9. Miscellaneous • Mediastinum contents • Trachea • Major vessels • Esophagus • Lymphatics • Heart • Thymus UNIT VI

  10. 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 UNIT VI

  11. 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 UNIT VI

  12. 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) UNIT VI

  13. 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 UNIT VI

  14. 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 UNIT VI

  15. 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 UNIT VI

  16. 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 UNIT VI

  17. 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) UNIT VI

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

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

  20. PA Chest Anatomy UNIT VI

  21. Radiographic Anatomy -- PA UNIT VI

  22. 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 UNIT VI

  23. 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 UNIT VI

  24. Left Lateral Chest (cont.) • Film evaluation (lateral) • Complete anatomy shown • Apices (chin elevated & arms raised) • Posterior costophrenic angles UNIT VI

  25. Rotation Superimposition of posterior ribs Edge of sternum Technique See through heart (kVp) "Good" density (Retrosternal & retrocardiac areas not "black") Left Lateral Chest (cont.) UNIT VI

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

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

  28. 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

  29. 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

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

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

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

  33. Abdominal Radiography • Patient preparation • KUB & acute abdomen • Remove radiopaque clothing & gown • Otherwise "as is" • Contrast media exams • Dietary & bowel preps usually required

  34. Abdominal Radiography (cont.) • Breathing instructions • Expose after patient exhales • "Take deep breath, blow it all out, stop breathing" • Watch patient while giving instructions

  35. 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

  36. Abdominal Radiography (cont.) • Film markers • Radiation protection • Check for pregnancy on all women • Gonadal shielding (???) • Collimation • to film edge top & bottom • to patient width on sides

  37. 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 rotated

  38. Abdominal Radiography (cont.) • Patient position (continued) • Midsagittal plane • perpendicular to table • parallel to table length • R & L ASIS level • Shoulders level

  39. 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

  40. 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

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

  42. 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

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

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