Chest

• Radiographic criteria


  Factors to be considered on all chest x-rays

  
• Radiographic criteria


  • Inspiration
  • Penetration
  • Rotation
  • Angulation
  • Orientation
• Inspiration


  • The volume of air in the hemithorax will affect the configuration of the heart with question of cardiac enlargement with a shallow level of inspiration
  • The vascular pattern in the lung fields will be accentuated with a shallow inspiration since the same amount of blood flow is now distributed to a smaller volume of lung
  • Visualization of nine posterior ribs, or seven anterior ribs projecting above the diaphragm on an upright PA radiograph would indicate a satisfactory inspiration
• Penetration


  Adequate photons traversing the patient to expose the radiograph
• Lack of penetration renders the area "whiter" than with an adequate film and can simulate pneumonia or effusion
• In an ideal radiograph the thoracic spine should be barely perceptual viewing through the cardiac silhouette
• Rotation


  • Distorts mediastinal anatomy and makes assessment of cardiac chambers and the hilar structures especially difficult
  • Chest wall tissue also contributes to increased density over the lower lobe fields simulating disease
  • Assessed by judging the position of the clavicle heads and the thoracic spinous process
• Orientation


  Position of the patient and the x-ray beam
• PA radiograph is obtained with the x-ray traversing the patient from posterior to anterior and striking the film

  
• AP radiograph is positioned with the x-ray traversing the patient from anterior to posterior striking the film

  
• Portable radiographs are typically obtained AP, as the patient is not able to stand
• Standing radiographs in the department are typically obtained PA with a corresponding lateral radiograph
• Angulation


  • With the patient in a more lordotic projection the clavicles will project superiorly relative to the upper thorax again causing some distortion of the normal mediastinal anatomy
  • With the lordotic projection of the ribs assume a more horizontal orientation
• Occasionally a lordotic x-ray can be obtained intentionally to better visualize structures in the thoracic apex obscured by overlying boney structures

  
• Characteristics of a good radiograph

  • Inspiration
  • Penetration
  • Rotation
  • Angulation
  • Orientation
• ALARA principles


  • Time
  • Distance
  • Shielding
• Personnel monitoring devices


  • Film badge
  • OSL dosimeter
  • Pen dosimeter
• Basic chest X-ray


  • Objectives:
  • Basic anatomy
  • Clinical indications
  • Surface landmarks
  • Patient positioning
  • Exposure factor
  • Basic radiographic examination + evaluation criteria
  • PA
  • Lateral
  • Technical adequacy
• The easiest and the most common radiographic procedures
• Provide a lot of information on general patient condition
• It is very important for radiographer to perform accurate examination, if not the radiograph produced will highlights false information or it will not carry any information at all
• Radiographic anatomy of the chest

  • Bony thorax
  • Clavicle
  • Scapula
  • Ribs
  • Thoracic vertebra
  • Floating rib

  Respiratory system

  • Nose
  • Pharynx
  • Larynx
  • Trachea
  • Bronchi
  • Lungs

  Mediastinum

  • Heart
  • Esophagus
  • Trachea
  • Abdominal aorta
  • Thymus gland

  Lung Pleural

  • Thin two-layered membrane that secretes fluid and lines the thoracic wall, diaphragm, and the lungs

  
• All chest views are taken at 180 cm SID to minimize magnification
• All chest view are taken using high kV to obtain a broad scale of contrast
• Clinical indications for chest X-ray

  • Medical Examination

  Pre-operation Assessment

  Pleural Effusion

  Pneumonia

  Pneumothorax

  Hemothorax

  Pneumohemothorax

  Tuberculosis

  Cardiomegally
• Surface landmarks


  • Vertebrae Prominence (Spinous process of C7) – T1

  Sternal/Suprasternal/Jugular Notch – T2/T3

  Sternal Angle – T4/T5

  Inferior Angle of Scapula – T7

  Xifisternum – T9

  Xiphoid Process – T10

  Lower Costal Margin – L3

  
• Patient preparation


  • Remove all radiopaque objects from the chest and neck regions

  2. Remove all clothing in the chest area, wear hospital gown

  3. Long hair should be braided or tied together

  4. Oxygen lines or pacemaker wires were carefully move aside temporarily from the chest area

  5. Briefly explain to the patient about the procedure
• Breathing instructions


  • To stop lungs movement during exposure

  2. Radiograph is taken on full/deep arrested inspiration

  3. Ask patient to hold the 2nd full inspiration

  4. Practice the breathing technique until patient can do it properly

  5. In cases where holding the breath is not possible, let patient breaths normally, expose quickly

  
• Erect chest radiograph


  • To get maximum of the lung field

  2. To allow visualization of the air and/or fluid levels

  3. To prevent engorgement and hyperemia of pulmonary vessels

  4. Easier and simple to position

  5. Control of respiration is more satisfactory

  6. To reduce magnification of the heart

  
• Objectives


  • Basic anatomy
  • Clinical indications
  • Surface landmarks
  • Patient positioning
  • Exposure factor
  • Additional radiographic examination + evaluation criteria
  • AP
  • Lordotic
  • Lateral Decubitus
  • AP Axial
  • Technical adequacy
• Surface landmarks


  • Vertebrae Prominence (Spinous process of C7) – T1
  • Sternal/Suprasternal/Jugular Notch – T2/T3
  • Sternal Angle – T4/T5
  • Inferior Angle of Scapula – T7
  • Xifisternum – T9
  • Xiphoid Process – T10
  • Lower Costal Margin – L3

  
• Make sure you know how to locate them because your accuracy of centring point localization and collimation depends on them
• Positioning Landmark


  • vertebra prominens (C7)
  • mid thorax
  • jugular notch
  • xiphoid tip

  
• AP Projection (Supine)


  • Demonstrates pathology involving the lungs, diaphragm and mediastinum
• Technical factors for AP Projection (Supine)

  • IR size – 35x43 cm lengthwise or crosswise
  • 90 – 110 kV (with grid)
  • 65 – 85 kV (without grid)
  • SID 180 cm
• Shielding for AP Projection (Supine)

  Secure lead shield around waist to shield gonads
• Patient position for AP Projection (Supine)

  • Patient is supine on cart; if possible, the head end of the cart or bed should be raised into a semierect position
  • Roll patient's shoulders forward by rotating arms medially or internally
• For semierect position, use 180 cm SID if possible
• Always place marker on the IR @ label the image to indicate the SID used
• Also indicate those projections obtained, such as AP supine or AP semierect