Chapter 2

Chest

Bony Thorax

• 1 - __________ (Breastbone)• 2 - Clavicles (Collar bones)• 2 - ________ (Shoulder Blades)• 12 - Rib Pairs• 12 - ________Vertebrae

2 Lungs

• Right has _______ lobes– Superior, middle, ___________– Separated by two deep fissures

• Left has ________ lobes– _________ and inferior– Separated by one deep fissure

Lungs• _________

– Rounded superior area

• ___________– Inferior concave area. – Rests on the diaphragm

• ____________ angle– Inferiolateral corners where the diaphragm

meets rib

Lung Tissue

• ___________– Functional tissue

– Spongy and elastic– Allows lungs to ______________(Breathing)

Pleura

• _____________– Sac the lungs are held in

– Two parts• __________Pleura - Outer layer• __________ (Visceral) Pleura - Inner layer

– Pleural cavity • ________space between parietal and pulmonary

pleura

Pleura Problems• _______________

– Air in the Pleural cavity

• Pleural ____________– Accumulation of fluid in the pleural cavity

• Hemothorax – Blood • Empyema - Pus

Diaphragm

• Primary muscle of breathing– Two ________________

• 3 openings– Aorta– ___________– Inferior Vena Cava

Pharynx(Upper Airway)

• Three Parts – ____________ - Posterior to nasal cavity– ___________ - Posterior to oral cavity

(mouth)– ____________ - At the junction between

larynx and esophagus

Accessory Parts– Hard & Soft Palate, Uvula,

Larynx(Voice Box)

• Cartilaginous structure• From _____________• Suspended by _____________• Contains 3 cartilage structures

– _____________– Thyroid Cartilage– Cricoid Cartilage

Trachea(Windpipe)

• Inferior to __________• Fibrous Muscular structure

– 3/4 inch diameter– 4 1/2 inches long– Surrounded by 20 cartilaginous rings – From ______________

• Branches into right and left at the distal trachea at the ____________

Bronchi

• Right Bronchi– Wider and __________ than left– Branches into the three right lobes

• Left Bronchi– Smaller and ___________ than right– Branches into the two lobes of the left

Mediastinum

• Part of the _______________cavity between the lungs.

• Extending from the _____________ column and contains all thoracic organs excepts the lungs.

Mediastinum Organs

• Thymus Gland

• __________and great vessels

• ___________

• Esophagus

Hilum

• A ____________________at that part of an organ where vessels and nerves enter.

• In the lungs:– __________– Blood Vessels – Lymph Vessels– ___________

Taking a Chest X-ray

• Consider body habitus– _____________

• short and wide - 14 X 17 crosswise

– Sthenic• Agerage - 14 X 17 cross or lengthwise

– _____________• longer and more narrow - 14 X 17 lengthwise

– Asthenic• long and narrow - 14 X 17 lengthwise

Topographical Landmarks

• Vertebra Prominens– ________– Apex of lungs

• Jugular Notch– __________– Top of Sternum

• Xiphoid Tip– ____________– Anterior Diaphragm

Technical FactorsAdult CXR

• Erect• High kV ____________

– Long scale– Low _________

• mAs determined by pt• ____________

Pediatric CXR

• Use immobilizer for erect image.

• Decrease kV to __________

• CR to mid thorax (___________)

• Crying is ____________!

Patient Prep

• Remove all _________ around neck area• Remove shirts with ______, snaps, etc..• Remove _________ with clips• Look for anything around lung field

– Oxygen tubes, hair braids, etc..• Nipple markers*

Patient Instructions• Typically done on ___________

– To get the best inspiration – “Breath in and blow it out take another

breath in and ________________”• Can do on expiration

– Pneumothorax, foreign body, lack of diaphragm movement, comparisons.

– “Take in a breath blow it all the way out and ______________.”

Patient PositioningPA

• Erect• ____________• No rotation• Chest against bucky• Hands on hips• Shoulder “__________” forward• Chin up

Left Lateral

• Left side against IR• Erect• 72” SID• No rotation• ___________

CR Positioning

• Mid ___________ (T7)

• 7-8” __________ to Vertebra Prominens (C7)

• Hand spread method (pg 83)

• Once CR is positioned, center _________

Guidelines for a perfect CXRPA and Lt Lat

• No rotation– PA - look at ____________

• Equidistance from spine

– Lateral - look at ___________ posterior ribs• No more than 1/4” to ______ separation

CXR Guidelines

• Adequate Inspiration– Minimum of ____________on PA

• Adequate technique PA– T-Spine vertebrae seen with ____________

Other Chest Projections

• AP - Supine or Semi erect– Slight ____________(5 degrees)

– CR to be perpendicular to the ____________

– Center to mid sternum (_____ inferior to jugular notch)

Decubitus

• Lt/Rt Lateral Decubitus– Pt recumbent on lt/rt side

– CR shot AP/PA to mid sternum

– For _______________or fluid levels

Others continued

• AP Lordotic– To visualize apices _____________– Pt stands ______ away from bucky an leans

back– Hand positioned as per _________ chest– CR straight at mid sternum

• Can do supine– ____________degree cephalad angle at mid

sternum

LAO and RAO

• LAO– 45 degree anterior

oblique– Left side closest to

bucky– Rt arm up – Lt arm on hip– ________seen

best• CR

– Level of T7– Mid body

• RAO– 45 degree anterior

oblique– Right side closest

to bucky– Lt arm up– Rt arm on hip– ________seen

best• CR

– Level of T7– Mid body

LPO and RPO

• LPO– 45 degree

posterior oblique– Lt side closest to

bucky– Lt arm up– Rt arm on hip and

rolled back– _______seen

best• CR

– T7– Mid body

• RPO– 45 degree

posterior oblique– Rt side closest to

bucky– Rt arm up– Lt arm on hip and

rolled back– _________seen best

• CR– T7– Mid body

S.T. Neck Factors

• _________SID for Lateral• _________SID for AP• 75 - 80 kVp • Slow deep inspiration

– Fill __________ with air

S.T NeckUpper Airway

• Lateral– Rt or Lt– Recumbent or

erect– Chin slightly

elevated– Shoulders rolled

back• CR

– Between thyroid cartilage and ________

• AP– Recumbent or

erect– Pt to look straight

ahead• CR

– Between thyroid and jugular notch

– _____above jugular notch