Chest and Abdomen Department of Radiology

							Introduction to Clinical
     Radiography

Unit VI -- Chest and Abdomen
         Examinations
                    Chest Anatomy
   Thoracic cavity
    (chest)
     – Surrounded by
       boney thorax
     – Separated from
       abdomen by
       diaphragm
        Muscular partition
        Dome shaped
        Lungs drape over
         diaphragm




                              UNIT VI   2
                    Boney Thorax
   ENCLOSE THE ORGANS
    – STERNUM (breast bone)
    – 12 PAIR OF RIBS
    – 12 THORACIC VERTEBRA
   ATTACH UPPER
    EXTREMITY
    – 2 CLAVICLES
    – 2 SCAPULA                         Anterior
                                                   Posterior




                              UNIT VI                          3
             Thoracic Cavity
 Sections   of the thoracic cavity
  – Pleural portion (lungs)
  – Mediastinum (between lungs)
  –Pericardial portion (heart)




                     UNIT VI          4
                 Respiratory System
1.      Lungs
     – Lobes
        Right 3 lobes
        Left 2 lobes

     – Terminology
        Apex                              A           A

        Hilum
                                               H   H
        Base

        Costophrenic   angles




                                 UNIT VI                   5
                Bronchial Tree
2. Bronchi
  – Air tubes leading
    into the lung
  – Right more vertical
    than left
                                       P
  – Branching structure
     Primary    2ndary 
      teritiary...
  – Only primary visible
    on PA projection


                             UNIT VI       6
                       Trachea
3.     Trachea
     – In mediastinum
     – Passageway for air            T
       to/from lungs
     – Approx. 4½" Long
     – Air visible on images




                           UNIT VI       7
              Circulatory System
1. Heart
  – 4 Chambered pump
                                           A
                                      VC        PA
2. Great blood
  vessels
  – Aorta
  – Vena cava
  – Pulmonary Artery                       VC
     Not   seen on image



                            UNIT VI                  8
            Miscellaneous
 Mediastinum
 contents
 – Trachea
 – Major vessels
 – Esophagus
 – Lymphatics
 – Heart
 – Thymus

                   UNIT VI   9
          Chest Examinations
 Most   common projections
  – PA in an erect position
  – Right to left lateral in an erect position

 Less   common projections
  – AP -- erect or recumbent position
  – Lateral decubitus



                      UNIT VI                    10
       Routine PA & L Lateral
1. Erect position
  – Diaphragm moves more inferior
  – Demonstrates air-fluid levels
  – Prevents blood pooling in gr. vessels
2. 72" Sid
  –  magnification of heart




                     UNIT VI                11
      Routine PA & L Lateral (cont.)
3.Breath held on
  inspiration
   – Expands lung fields
   – depresses
     diaphragm
   – Provides contrast
     (air vs. tissue)

4. Film (adult)                 inspiration   expiration
   14X17 lengthwise
      (may be crosswise on
      broad chested male)



                             UNIT VI                       12
   Routine PA & L Lateral (cont.)
5. Technical factors
  – High kVp (>100)
     long   scale contrast
  – High mA & short time
     reduces   motion
  – AEC
  – Grid
     decrease   scatter on image


                          UNIT VI   13
                   Dedicated Chest Unit
   X-ray machine designed to
    perform routine chest imaging
    – tube has fixed alignment with
      imaging plate (IP)
    – when tube moves, IP moves
    – Non-CR has film unit
           includes stationary grid
           magazine to hold unexposed
            film
           direct hook-up to processor
              [or magazine for exposed film]
           ID flasher on unit


                                                         Digital Chest Unit

                                               UNIT VI                        14
                   PA Projection
              (erect anterior position)
   Patient
    – Standing -- weight on
      both feet
    – Anterior chest against IP
    – MS plane perpendicular
      to IP & floor
    – Chin raised
    – Posterior of hands on
      hips or machine “hug”
    – Shoulders depressed &
      rotated forward



                              UNIT VI     15
                    PA Projection (cont.)
   X-ray beam
    – CR
              to film
             in MS plane at T 7
   Collimation         (very
    little)
    – Full length of film
    – To lateral edges of
      patient



                                   UNIT VI   16
               PA Projection (cont.)
   Film evaluation
    – Complete anatomy
      shown
       apices
         (chin elevated)
       base
         (both costophrenic angles)
       scapulae   out of lungs
         (shoulder rotation)
       respiration
         (10 posterior ribs)



                                  UNIT VI   17
               PA Projection (cont.)
   Minimal rotation
    – Symmetry of SC
      joints
    – MS plane to
      lateral ribs =
      distance




                        UNIT VI        18
              PA Projection (cont.)
   Technique
    – Vertebra seen through
      heart (kVp)
    – "Good" density
   Other
    – no film artifacts
    – no motion (blur)




                          UNIT VI     19
PA Chest Anatomy




      UNIT VI      20
Radiographic Anatomy -- PA




           UNIT VI           21
            Erect Left Lateral Chest
   Patient
    – Standing with weight on
      both feet
    – L side against film holder
    – Chin raised
    – Arms elevated &
      immobilized
    – Align MS plane
        parallel to the film

         to the floor




                               UNIT VI   22
               Left Lateral Chest (cont.)
   X-ray beam
    – CR
        to film
       in midaxillary plane at
        level of T7
        (slightly lower than T7 ok)
    – Collimation
       fulllength of film
       to anterior & posterior
        surfaces of patient




                                UNIT VI     23
           Left Lateral Chest (cont.)
   Film evaluation (lateral)
    – Complete anatomy shown
       Apices (chin elevated &
        arms raised)
       Posterior costophrenic
        angles




                             UNIT VI    24
             Left Lateral Chest (cont.)
– Rotation
   Superimposition   of
    posterior ribs
   Edge of sternum

– Technique
   See through heart
    (kVp)
   "Good" density
    – (Retrosternal &
      retrocardiac areas
      not "black")




                           UNIT VI        25
                 Abdomen Anatomy
   Abdominopelvic
    cavity
    – Abdomen
       diaphragm   to pelvic
        inlet
    – Pelvic cavity
             inlet to floor
       pelvic
        muscles of the cavity
           Abdomen Anatomy (cont.)
   Abdomen
    – Divisions

      4   Quadrants (clinical)

      9   Regions (anatomic)
         Abdomen Anatomy (cont.)
   Boney anatomy
    – lower ribs & T11-T12
    – lumbar spine (5)
    – sacrum & coccyx
    – innominate (2)
        iliac portion

        ischial portion

        pubic portion

    – femur
        head & neck

        trochanters
           Abdomen Anatomy (cont.)
   Topographic
    (positioning) landmarks
                                   Iliac                 Lumbar
    – Iliac crest (level of L4-   Crest                  Vertebra
      5)
    – Anterior superior iliac ASIS
      spine (ASIS)
                                                              Greater
    – Greater trochanter of                                   Trochanter
      femur
    – Pubic symphysis
                                           Symphysis Pubis
      Abdomen Anatomy (cont.)
 Major   muscles (radiographically)
 – Diaphragm
 – R and L psoas muscles
          Major Abdominal Organs
liver (triangular)
                               stomach
gall bladder

      pancreas                   spleen

                               large bowel
  small bowel
  • duodenum
  • jejunum
  • ileum




                     UNIT VI                 31
 Urinary Organs & Major Vessels
adrenal gland


                                        kidney
        vena cava
                                   ureter

                                aorta
    urinary bladder



    urethra



                      UNIT VI                    32
      Abdominal Radiography
 Patient   preparation
 –KUB & acute abdomen
   Remove  radiopaque clothing & gown
   Otherwise "as is"

 –Contrast media exams
   Dietary   & bowel preps usually required
   Abdominal Radiography (cont.)
 Breathing   instructions
 – Expose after patient exhales
 – "Take deep breath, blow it all out, stop
   breathing"
 – Watch patient while giving instructions
   Abdominal Radiography (cont.)
 Exposure   factors (non contrast media)
 – Medium kVp -- 70-80
    adequate penetration
    moderate contrast

 – Short exposure time
    decrease   involuntary motion on image
 – Enough mAs for sufficient density
  Abdominal Radiography (cont.)
 Filmmarkers
 Radiation protection
  – Check for pregnancy on all women
  – Gonadal shielding (???)
 Collimation
  – to film edge top & bottom
  – to patient width on sides
                     Abdomen
   AP projection,
    supine position
    – KUB, flat plate, plain
      film, scout film
   Patient position --
    Supine on table with
    – pillow for head
    – support sponge for
      knees
    – arms at but away
      from sides
    – legs extended,
      internally rotated
      Abdominal Radiography (cont.)
   Patient position
    (continued)
    – Midsagittal plane
       perpendicular   to table
       parallel to table
        length
    – R & L ASIS level
    – Shoulders level
       Abdominal Radiography (cont.)
   Film & centering
    – 14X17 cassette
      lengthwise in table bucky
    – Center of film at level of
      iliac crests
    – CR to center of film
      passing through the MS
      plane at level of iliac
      crests
        adjust to include pubic
        symphysis at lower edge
        of film
      Abdominal Radiography (cont.)
   Film evaluation
    – No rotation
       symmetry    of pelvis &
        spine
    – Complete anatomy
      with no motion
       vertebral  column in
        center of image
       symphysis pubis at
        bottom of image
       kidneys, liver, spleen
        at top of image
   Abdominal Radiography (cont.)
– density & contrast
  adequate to see
   Psoas muscles
   lumbar transverse
    processes
   ribs

   kidney & liver margins
 Other Abdominal Projections/Positions
– AP projection in an erect
  position
   CR 2" above iliac crests in
    MS plane


– AP or PA projection in a
  lateral decubitus
  position
   CR 2" above iliac crests in
    MS plane
  Abdominal Radiography (cont.)
– Lateral in a recumbent or erect position

     Seldom done due to level of radiation

     lack of significant diagnostic information