RT 124 SPRING WEEK 1 – Part 1 CHEST & ABD A “Self Study” ReviewRT 124 - WEEK 1 (Part 2) is the Lecture Presentation for:A quick review of CHEST Dedicated Chest UnitBody HabitusSlide 5CASSETTES W/ GRID CAPSSlide 7Slide 8GridsSlide 10CR GRIDSCHESTChest AnatomyBony ThoraxThoracic CavityRespiratory SystemBronchial TreeTracheaCirculatory SystemMiscellaneousChest ExaminationsRoutine PA & L LateralRoutine PA & L Lateral (cont.)Slide 24PA Projection (erect anterior position)PA Projection (cont.)Slide 27Slide 28Slide 29PA Chest AnatomyRadiographic Anatomy -- PAErect Left Lateral ChestLeft Lateral Chest (cont.)Abdomen AnatomyAbdomen Anatomy (cont.)Slide 36Slide 37Slide 38Major Abdominal OrgansUrinary Organs & Major VesselsAbdominal RadiographyAbdominal Radiography (cont.)AbdomenSlide 50Slide 51Slide 52Other Abdominal Projections/PositionsSlide 541RT 124 SPRINGWEEK 1 – Part 1CHEST & ABDA “Self Study” Review Rev Spring 20102RT 124 - WEEK 1 (Part 2)is the Lecture Presentation for:Chest II AP: SUPINE, SEMI-UPRIGHT – UPRIGHTR & L DECUBITUSLATERAL – PT ON GURNEY OR IN W/C ABDOMENAP SUPINE, UPRIGHT, LLDRT 124 – Wk 1 – Part 1 Lecture on web can be reviewed for basic CHEST & ABD anatomy.3A 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 Unit4Body Habitus56CASSETTES W/ GRID CAPS789Grids•Allow primary radiation to reach the image receptor (IR)•Absorb most scattered radiation•Primary disadvantage of grid use –Grid lines on film1011CR GRIDS12CHESTANATOMY REVIEW13Chest Anatomy•Thoracic cavity (chest)–Surrounded by boney thorax–Separated from abdomen by diaphragm•Muscular partition•Dome shaped•Lungs drape over diaphragm14Bony Thorax•ENCLOSE THE ORGANS–STERNUM (breast bone)–12 PAIR OF RIBS–12 THORACIC VERTEBRA•ATTACH UPPER EXTREMITY–2 CLAVICLES–2 SCAPULAAnteriorPosterior15Thoracic Cavity•Sections of the thoracic cavity–Pleural portion (lungs)–Mediastinum (between lungs)–Pericardial portion (heart)16Respiratory System1. Lungs –Lobes•Right 3 lobes•Left 2 lobes–Terminology•Apex•Hilum•Base•Costophrenic anglesAAHH B  B CC 17Bronchial Tree2. Bronchi–Air tubes leading into the lung–Right more vertical than left–Branching structure•Primary  2ndary  teritiary...–Only primary visible on PA projectionP18Trachea3. Trachea–In mediastinum–Passageway for air to/from lungs–Approx. 4½" Long–Air visible on imagesT19Circulatory System1. Heart–4 Chambered pump2. Great blood vessels–Aorta–Vena cava–Pulmonary Artery•Not seen on imageAVCVCPA20Miscellaneous•Mediastinum contents–Trachea–Major vessels–Esophagus–Lymphatics–Heart–Thymus21Chest 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 decubitus22Routine PA & L Lateral1. Erect position–Diaphragm moves more inferior–Demonstrates air-fluid levels–Prevents blood pooling in gr. vessels2. 72" Sid–  magnification of heart23Routine 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)inspiration expiration24Routine PA & L Lateral (cont.)5. Technical factors–High kVp (>100) •long scale contrast–High mA & short time•reduces motion–AEC–Grid•decrease scatter on image25PA 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 forward26PA 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 patient27PA Projection (cont.)•Film evaluation–Complete anatomy shown•apices (chin elevated)•base (both costophrenic angles)•scapulae out of lungs (shoulder rotation)•respiration (10 posterior ribs)28PA Projection (cont.)•Minimal rotation–Symmetry of SC joints–MS plane to lateral ribs = distance29PA Projection (cont.)•Technique–Vertebra seen through heart (kVp)–"Good" density•Other–no film artifacts–no motion (blur)30PA Chest Anatomy31Radiographic Anatomy -- PA32Erect 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 floor33Left 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 patient34Abdomen Anatomy•Abdominopelvic cavity–Abdomen•diaphragm to pelvic inlet–Pelvic cavity•pelvic inlet to floor muscles of the cavity35Abdomen Anatomy (cont.)•Abdomen–Divisions•4 Quadrants (clinical)•9 Regions (anatomic)36Abdomen Anatomy (cont.)•Boney anatomy–lower ribs & T11-T12–lumbar spine (5)–sacrum & coccyx–innominate (2)•iliac portion•ischial portion•pubic portion–femur•head & neck•trochanters37Abdomen Anatomy (cont.)•Topographic (positioning) landmarks–Iliac crest (level of L4-5)–Anterior superior iliac spine (ASIS)–Greater trochanter of femur–Pubic symphysisSymphysis PubisGreaterTrochanterLumbarVertebraIliacCrestASIS38Abdomen Anatomy (cont.)•Major muscles (radiographically)–Diaphragm–R and L psoas muscles39Major Abdominal Organsstomachlarge bowelspleensmall bowel• duodenum• jejunum• ileumliver (triangular)gall bladderpancreas40Urinary Organs & Major Vessels aortakidneyuretervena cavaurinary bladderurethraadrenal glandadrenal glandadrenal glandadrenal gland47Abdominal 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 required48Abdominal