Thorax and Abdomen
1 Chest
Anatomy
Alveoli, Aortic Arch, Apex, Base, Bronchi, Cardiophrenic angle, Carina, Clavicle, Costophrenic angle, Heart, Hilum, Hyoid bone, Jugular notch (manubrial or suprasternal notch). Larynx, Lobes, Lungs, Mediastinum, Pharynx, Pleura, Ribs, Scapulae, Sternum, Thoracic spine (12 vertebrae), Thyroid cartilage, Trachea, Vertebra prominens (seventh cervical vertebra), Xiphoid process
Projections
Chest, PA Upright
CR Location
PA Chest – CR perpendicular to IR and centered to midsagittal plane at level of T7 (7 to 8 inches [18 to 20 cm] below vertebra prominens, or to the inferior angle of scapula).
Evaluation Criteria
PA Evaluation Criteria – Sternoclavicular joints equal distance from the vertebrae (no rotation). 10 pair of ribs above the diaphragms (full inspiration). No motion. Scapulae out of the way. Visualization of fine vascular markings within lungs (sufficient long scale of contrast). Faint visualization of spine and ribs through the heart shadow (adequate kVp).
Chest, AP Upright
CR Location
AP Chest – CR angled caudad to be perpendicular to long axis of sternum (generally requires ~5 caudad angle, to prevent clavicles from obscuring the apices).
Evaluation Criteria
AP Evaluation Criteria: Sternoclavicular joints equal distance from the vertebrae (no rotation). 10 pair of ribs above the diaphragms (full inspiration). No motion. Scapulae out of the way. Visualization of fine vascular markings within lungs (sufficient long scale of contrast). Faint visualization of spine and ribs through the heart shadow (adequate kVp).
Chest, AP Supine
CR Location
AP Supine Chest – CR angled caudad to be perpendicular to long axis of sternum (generally requires ± 5° caudad angle, to prevent clavicles from R obscuring the apices) to level of T7, 3 to 4 inches (8 to 10 cm) below jugular notch
Evaluation Criteria
AP Supine Chest – inspiration is not as full, and only eight or nine posterior ribs are visualized above the diaphragm. The lungs appear more dense because they are not as fully aerated. Three posterior ribs should be seen above the clavicles, indicating an unobscured apical region.
Chest, AP Lordotic
CR Location
Apical Lordotic Chest – CR perpendicular to IR, centered to midsternum (3 to 4 inches [9 cm] below jugular notch)
Evaluation Criteria
Apical Lordotic Chest Evaluation Criteria – Clavicles should appear nearly horizontal and above or superior to apices, posterior ribs appear nearly horizontal, No rotation as evidenced by Sternal ends of the clavicles equidistant from the vertebral column.
Chest, Lateral Upright
CR Location
Lateral Chest – CR perpendicular, directed to midthorax at level of T7 (3 to 4 inches [7.5 to 10 cm] below level of jugular notch).
Evaluation Criteria
Lateral Evaluation Criteria – Square appearance of spine, minimum visualization of ribs behind spine (no rotation). Arms out of the way. No motion.
Chest, Lateral Decubitus
CR Location
Lateral Decubitus Chest – CR horizontal, directed to center of IR, to level of T7, 3 to 4 inches (8 to 10 cm) inferior to level of jugular notch. A horizontal beam must be used to show air-fluid level of pneumothorax.
Evaluation Criteria
Lateral Decubitus Evaluation Criteria: Sternoclavicular joints equal distance from the vertebrae (no rotation). 10 pair of ribs above the diaphragms (full inspiration). No motion. Scapulae out of the way.
Hows and Whys of Chest Radiography
How do you know that the patient took a big enough breath?
Ten pair of ribs are visible above the diaphragm
Why should chest x-rays be done upright if at all possible?
To show any fluid levels that might be present and to allow for full expansion of the lungs
Why do you roll the shoulders forward on the PA projection?
To keep the scapulae from overlying the lungs
Why do you lift the chin on PA or AP projections?
To keep it from overlying the apices of the lungs
How do you know if the body was rotated on a PA exam?
The sternoclavicular joints would be asymmetrical
Which way does the diaphragm move on inspiration? On expiration?
Down, Up
Why?
The diaphragm is a dome shaped muscle. When it contracts it becomes flatter, moving lower in the body. This movement creates a vacuum in the pleural space, so air rushes in through the nose or mouth. When it relaxes, it becomes dome shaped again, pushing out excess air.
Why do you use a 72” SID?
To reduce magnification of the heart.
Which lung will foreign bodies localize in?
The right, because the right bronchi is larger and more vertical than the left.
When would you perform a chest x-ray on full exhalation?
When you are looking for a pneumothorax (collapsed lung)