Basic Radiographic ProceduresCHEST - LAB

RT 123 – WK 4 & 5

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Lab this week

• Terminology quiz

• Begin CHEST positioning

• Exposures for upright Chest

• on Simulated Skeleton (?)

radiographic procedures

• Positioning (topographic landmarks, body positions, path of central ray, etc.)

• Anatomy (including physiology, basic pathology, and related medical terminology)

• Technical factors (including adjustments for circumstances such as body habitus, trauma, pathology, breathing techniques, etc.)

Review SERIES NOTESCHEST

PA & LAT

PROJECTIONS

↑ PA CHEST(DO SERIES NOTES)

• MSP PERPENDICULAR ┴ TO IR• MCP PARALLEL ║ TO IR• ARMS DOWN BY SIDES• BACK OF HANDS AGAINST HIPS• ROTATE ARMS FORWARD – FREES

SCAPULA FROM THE LUNG FIELDS

• C/R @ MSP + T-7

POSITIONING

PA CHEST

LUNGS WIDEST AT BASE

Topographical Landmarks

Positioning – KEY POINTS

• Chest - PA Upright

• Patient erect & facing IR

• chin raised,

• shoulders rotated forward and downward;

• CR to midsagittal plane at the level of T-7 (7" - 8" below the vertebra prominens);

• respiration suspended on full inspiration.

ANATOMY (Best Seen)

• Entire lungs must be included on image

• superior apices

• to the inferior costophrenic angles,

• air-filled trachea,

• heart

• aortic knob.

Top of collimation skims C-7 Vertebral Prominens

Too Open ! Better

Do not get distracted by size of shoulders –look at bases!

In some systems you can open the collimation this much – it doesn’t mean you should!

NO ROTATION VS ROTATION

BREATHING INSTRUCTIONS

• TAKE IN A DEEP BREATH –

• BLOW IT OUT

• TAKE IN ANOTHER DEEP BREATH

• HOLD IT

• “RESPIRE PROFUNDO DE TANGELO”

CASSETTE – IR POSTIONING

Center/Position cassette for

Differing Body Habitus

POSITIONING

LEFT LATERAL CHEST

↑ LATERAL CHEST(DO SERIES NOTES)

• MSP PARALLEL ║ TO IR

• MCP PERPENDICULAR ┴ TO IR

• ARMS EXTENDED OVER HEAD

• C/R @ MCP + T-7

Chest - Lateral Upright

• Patient erect,

• left side against IR,

• arms extended upwards,

• chin raised;

• C/R @ midcoronal plane & the level of T-7

• respiration suspended on full inspiration (2x)

Anatomy on Lateral

• Entire lungs must be included on image,

• superior apices

• to the inferior costophrenic angles,

• heart

• aorta.

TECHNIQUE

• PA• LAT ( 4x ↑ from PA) (see last week lecture)• SHORT SCALE CONTRAST• LONG SCALE CONTRAST• DENISTY CHANGES

• What are the average KVP ranges for CHEST?

RT 123

2007WK 3

Introduction to Positioning &Terminology

Merrill's Ch 1, (2) & 3

CHEST RADIOGRAPHY

• UPRIGHT - WITH GRID

• KVP RANGE (90 – 120 )

• MAS ( 1 – 3 PA) ( 5 – 20 LAT)

FOR CHEST – TO GO FROM PA TO LAT:

• ↑ Technique by 4 x = Double the MAS and go up 10 kvp

• INCREASE DENSITY BY 4 X you could: • Example: PA CHEST: 2 mas - 110 kvp

FOR LATERAL:

• Go up 4 X in mas 8 mas - 110 kvp

Go up 2 X MAS & ↑ 15% Kvp 4 mas - 125 kvp

THE “RULES”• WHILE “OBSERVING” –

• DO NOT PERFORM EXAMS ON PATIENTS (POSITIONING OR EXPOSE)

• DO NOT MAKE EXPOSURES AT THE CLINICS ON ANY PATIENTS

• YOU CANNOT BE SUPERVISED BY OTHER STUDENTS

• YOU CANNOT PERFORM ANY EXAMS ON ANYONE UNDER 18 YEARS OLD

“THE RULES” FOR CHEST IMAGING & COMPETENCIES

YOU CANNOT ATTEMPT TO PERFORM A CHEST EXAM ON A PATIENT UNTIL

• AFTER PERMANENT ASSIGNMENT• MUST HAVE A ROOM CHECK OFF FIRST (CI)• ONLY DIRECT SUPERVISION THIS SEMESTER –• NEED 25 exams FOR A CHECK OFF• CAN NOT GET A CHECK OFF UNTIL SPRING

SEMESTER• If EXAM (written or lab) not passed – must be

repeated successfully – original points for grade

CHEST IMAGINGsimulated competency

• 1ST LAB PRACTICE ON THURSDAY 9/24/09

• WRITTEN & LAB TEST FOR CHEST • THURS 10/8/09 –

Written Test includes CH. 1, 3 & 10 +

Rad Protection• AND SIMULATED Lab Eval 10/08/09

LAB PRACTICE

• Observe Lab Rules• Work with your

Partner & others• Share Time• Communicate• Collimate• Shiled

• Practice PREP for Exam when not using the BUCKY