Ch.2 - Chest

• The 3 divisions of the chest:

  • Bony Thorax
  • Respiratory System
  • Mediastinum
• The bony thorax is made up of:

  • Sternum
  • Clavicles
  • Scapulae
  • 12 pairs of ribs
  • 12 thoracic vertebrae
• Positioning landmark for C7 is the vertebral prominens
• Positioning landmark for T2-3 is the jugular notch
• Positioning landmark for T7 is the inferior angle of scapulae
• Positioning landmark for T10 is the xiphoid tip
• The purpose of the respiratory system is to exchange gases between air and blood
• The four divisions of the respiratory system are:

  • Pharynx
  • Trachea
  • Bronchi
  • Lungs
• The pharynx is the passageway for food/fluids and air.

  
• The larynx is also known as the voicebox and it contains the Laryngeal prominence

  
• The laryngeal prominence aka the adams apple is the landmark for C5
• The trachea is positoned anterior to the esophagus and is 3/4 in diameter and 4.5 in long.
• The trachea extends from level C6 to T4-5
• The right bronchi is wider, shorter, and more vertical than the left one so food often gets stuck in it.
• When taking a chest image for pneumothorax or foreign bodies, a second image on expiration is needed
• AP Lordotic recumbent is angled at 15 - 20 degrees
• Pneumothorax: Air in the pleural cavity
• Pleural effusion: Fluid in the pleural cavity
• Hydrothorax: Water in the pleural cavity
• Hemothorax: Blood in the pleural cavity
• Empyema: Pus in the pleural cavity
• Pleurisy: Inflammation of pleura causes rubbing/pain
• The hilar: the large blood vessels going to and from the lung where it meets the heart.
• The mediastinum contains:

  • Trachea
  • Esophagus
  • Thymus gland
  • Heart and great vessels

  
• The diaphragm is the primary organ/muscle that assists in inspiration and expiration
• The diaphragm is separated into left/right hemi-diaphragms
• The pharynx is a common passageway for both food and respiration.
• The “Adam’s apple” is formally referred to as the


  Laryngeal prominence
• The trachea extends from C6 to approximately T4-5
• The left bronchus is smaller in diameter than the right but is approximately twice as long.
• There must be a minimum of 10 posterior ribs above the diaphragm for chest x-rays or 9 for supine and pediatric patients.
• Patient preparation includes

  • Introduction
  • Verify identity
  • Verify exam
  • Obtain patient history
  • Remove any foreign objects
  • Explain the procedure
• The SID for a chest x-ray is 72”
• Chest x-rays in a wheelchair/stretcher may be done with SID of 40”, 60”, or 72”
• Body habitus refers to the general shape of the human body.
• The 4 body habitus from widest to thinnest:

  • Hypersthenic
  • Sthenic
  • Hyposthenic
  • Asthenic
• The lungs increase in 3 dimensions ( Vertical, Transverse, AP ) during inspiration.
• In chest X-rays, we count the ribs on the right side due to the liver
• The 3 W's in patient history ask What, Where, and When
• PA Chest has CR to T7