Chapter TwoChapter TwoChapter TwoChapter Two

The Chest and AbdomenThe Chest and Abdomen

PA Chest • Facility Identification• Marker• Artifacts• Film Size

PA Chest• Density:

• Should be able to see Lung markings, diaphragm, heart borders hilum, bony cortical outlines.

Contrast: to see the thoracic vertebra

and posterior ribs through the heart shadow. KVP 110-130

PA Chest• Positioning:

• Erect • CR to T-7• Done on 14x17• Anatomy : apices both lungs,

costophrengic angels.• Lungs expands in 3 direction.

PA Chest Rotation• SC joints:

• Equal distance from vertebral column• Right and left corresponding ribs are

equal• Air filled trachea in center of vertebral

column

PA CHEST• Clavicle on same plane.• Depress shoulders• Rotate scapula out of lung field.

PA foreshortening• A correct view will have the T-4

superimposed by manubrium and about 1 inch of lungs above clavicles.

• Foreshortening is caused by leaning towards or away from the IR.

PA Chest• Good inspiration is demonstrated

when there is 10-11 posterior ribs above the diaphragm.

• 2nd deep inspiration• Note: a pneumothorax maybe

done on expiration.

Lateral Chest Positioning

• Mid-coronal plane against IR• The posterior and anterior ribs

nearly superimposed.• Sternum in profile• Intervertebral foramina are open.

Lateral rotation• Ribs• Find the hemi-diaphragms• If heart shadow is over sternum• Lung over sternum

Lung Foreshortening• Both diaphragms nearly

superimposed• Foreshortening caused by leaning

towards or away from IR.• If hip is on the IR the right

diaphragm is lower than the left.

Right v/s LEft• Id a right lateral is done it is to

better see the right lung detail.

Lateral Positioning• Arms out of the way• Note: if pacemaker was installed

24 hours prior don’t raise left arm.• Obtain the anteroinferior lung

Inspiration• 11th Thoracic vertebra in

superimposing the lung field.• Find: 12th rib and follow it to the

vertebra count up one

AP Chestsupine or portable

• Air-fluid levels• Artifacts; monitor lines• Time and date if mulitple exams

are performed

AP chest• Contrast and density:• Adequate to see any tubes and lines.• ET tube: 1-2” above carina• Chest tube:5-6th ribs• CV line;2-3 cm above aterial junction• Pulmonary lines: pulmonary artery• Pacemaker: Under clavicle on left

side

Heart • The heart will me magnified• Deceased SID: 40-48’

Rotation• Same as the PA except it is

opposite• Right SC joint has less imposition

it is closer to bed.

Positioning • CLavilce same• Scapula will be in lung filed• Arms are abducted out of way

Angels• Caudal: Manubrium inferior to 4th. More

than 1 inch above clavicle, and ribs are vertical, elongates heart

• Cephalic: manubrium superior to t-4, less than 1 inch above clavicles, ribs are horizontal, foreshortens the heart.

• Supine patient: 5 degree angel caudal to allow for gravitational pull.

Inspiration• 9-10 ribs above diaphragm.• Unconscious patient; watch chest

movement

Lateral Decubitus• Patient on side: mark side up • Position for laterals.

– For air place affected side away from table. Decrease KV by 8 %

– For fluid place affected side down. Increase mAs by 35 %

Lateral Chest• Same Anatomy• Same rotation• Same foreshortening• Same inspiration for portable• No imposition of bed pad

AP Lordotic• Contrast and density: see clavicle,

superior t-spine, ribs

• CR is centered to superior lung field midway between manubrium and xiphoid tip

Anatomy seen• Apices at level of T-1, clavicles

above lung field, 2/3 of lungs, ribs 1-4 are nearly superimposed, foreshortened heart shadow.

• Not enough arch: clavicles superimpose lungs and anterior ribs inferior to posterior ribs.

AP and Supine Abdomen

• Facility identification• Marker• Artifacts• Motion Involuntary and voluntary

Contrast and density• Contrast; see the psoas muscles,

kidneys, inferior ribs and transverse process of lumbar.

• Gas: decrease KVP by 5-8% or mas 30-50%• Fliud increase KVP by 5-8% or mas 30-50%• Density: to light to dark.• Compensate for larger patients

Rotation• Spinous process aligned to midline

of vertebral bodies.• Equal distance from pedicles to

spinous processes.• The sacrum in the inlet of

pelvisand align with symphysis pubis.

Positioning

• Long axis of body with long axis of IR

• Patient erect or supine( erect for at least 5 min. for air to rise)

• With shoulders and hip equal distance from table or bucky

Expiration• The domes of diaphragm is

superior to 9th posterior rib.

Anatomy• Supine: 11th vertebra lateral soft

tissue, iliac wings, symphysis pubis.

• Erect: 9th vertebra, diaphragm, soft tissue, wings.

Left lateral decub.• Same criteria, • marker upside.• Weight sifts, may need a

compensating filter.

Rotation• Same as abdomen• Wing with least amount is the side

farthest away from film.

• Expiration• Anatomy

Pediatric Chest• Same facility information• Marker• Artifacts• Contrast and density• KVP 65-75

AP Chest• CR- T-4• Rotation same• Caudal angel for supine• 8 posterior ribs above diaphragm

Lateral Ped. Chest• CR: T-5• Cross table or roll on side.• Cross table is preferred because of

less disturbance to infant • and the inflation of lungs of the

lungs

• Rotation same. • Arms and chin up• Inspiration

Ped. Abdomen• Facility information same• Marker• Artifacts• Contrast and density; to see boewl

gases, diaphragm, outline of bony structures KVP 65-75

• Rotation same• Expiration diaphragm is at 8th rib.

Left lateral decub• Same as adults