Skills Labs 28/09/2023
What is the most common imaging examination?
A chest x-ray, accounts for 27% of all examinations
What common errors occur during a chest x-ray?
Errors in lung cancer diagnosis, 90% of them occur during chest x-rays
What is the area of interest in a chest x-ray?
From the apices to the costophrenic angles
What are the 3 parts of the sternum?
Manubrium, the body and the xiphisternum
What fissure does the left lung have?
Oblique fissure
What fissures does a right lung have?
Oblique fissure and horizontal fissure
Why does the right lung have two fissures but the left lung only has one?
Because the right lung has three lobes while the left lung only has two lobes
What is the bony anatomy included in a chest x-ray?
The clavicle, the posterior ribs, the anterior ribs, the sternum and the vertebral body
What is the difference between the anterior ribs and the posterior ribs?
The anterior ribs are oblique, running from lateral aspect downwards and medially. Posterior ribs are more horizontal, running from medial aspect laterally and downwards
In a chest x-ray, why should the medial borders of the scapulae be outside the lung fields?
Prevent their superimposition over the lungs
What does anterior mean?
The front of a body part
What does posterior mean?
The back
What is the lateral position?
Sideways
How many posterior ribs should you be able to see in a chest x-ray?
10
How many anterior ribs should you ideally be able to see in a chest x-ray?
9
What is the dorsal position?
The back of the hand or top of the foot
What does AP mean?
The x-ray beam is passing from the anterior aspect through to the posterior part of the body
What does PA mean?
Passing from the posterior to the anterior part of the body
What does medial mean?
Part of the body closest to the middle
What does proximae mean?
Nearest to the torso at the point of attachment
What does distal mean?
Furtherest away from the torso
What does palmar mean?
Palm side of the hand
What does DP mean?
Dorsi-plantar
Why is the PA position the most common position for chest x-rays?
The heart is less magnified, minimise rotation, reduce radiation to anterior radiosensitive organs, easier to move scapulae out of the lung fields, less chance of lordosis
What is the median sagittal plane?
Divides the body into left and right
What is the coronal plane?
Divides the body into anterior and posterior parts
What is the transverse / axial plane?
Divides the body into superior and inferior parts
What is the supine position?
The patient is laying on their back
What is the prone position?
The patient is lying on their front
What is the erect position?
The patient is either stood up or sat up
What is the semi-erect position?
The patient is halfway between erect and supine
What is the oblique position?
The body is positioned somewhere between 0 and 90 degrees to the image receptor
What is meant by the term external?
Increase angle of the joint
What is meant by term flex?
Decrease angle of the joint
What is meant by the term abduction?
Moving the body point / limb away from the midline
What is meant by the term adduction?
Towards the midline
What is meant by the term pronation?
To turn so the palm is facing downwards
What is meant by the term supination?
To turn so the palm is facing upwards
What is inversion?
The ankle rolls outwards
What is eversion?
The ankle rolls inwards
What is meant by the term caudal?
The x-ray beam is directed towards the patient's feet
What is meant by the term cranial?
The x-ray beam is pointed towards the head
What is meant by the term plantar?
The sole of the foot
How many anatomical planes are commonly used in radiography?
3 - median sagittal, transverse / axial & coronal
What type of bone is the sternum?
Flat bone
How many pairs of ribs are there?
12
What ribs are classed as true ribs?
1st rib to 7th rib, connected directly with the sternum
What ribs are classed as false ribs?
8th rib to 10th rib, indirectly connected to the sternum via the seventh costal cartilage
What are the floating ribs?
11th and 12th rib, do not reach the front of the body
How do the ribs attach to the thoracic spine?
Attach by the tubicles
What type of joint is the SCJ?
Synovial joint
Name the layers of the pleura
Visceral pleura and parietal pleura
How many lobes are there in the right lung and left lung?
Right lung: 3 lobes. Left lung: 2 lobes
What is the carina?
Angle that seperates the right main bronchus and the left main bronchus
Where is the sternal notch, sternal angle and xiphoid process?
The sternum
On which side does the heart normally lie?
Left
What is the trachea made of?
Cartilage
What does the trachea divide into?
Right main bronchus and left main bronchus
When is a CTR considered abormal?
If the CTR is greater than 50%
Why can a CTR not be fully assessed if the image is took in the AP position?
Magnification
Why should the patient be erect during a chest x-ray?
Greater depth of thorax, improved visualisation of pathologies, easier positioning
Where should the dorsum of the hands rest during a chest x-ray?
On the back of the patient's hips
Why is the patient asked to take a deep breath and hold it until the x-ray has been taken?
To ensure the scapulae is out of the lung fields
Why do we collimate?
Reduce the dose of radiation and improve image quality
Where should the ray be positioned during a lateral chest x-ray?
Directed to the mid-axillary line at the level of T7/8
What is the exposure factor used in a high kV technique?
125kV, 1-2 mAs
What is the exposure factor used for a standard technique?
80-90kV, 2-5 mAs
What is the exposure factor for a large patient?
90-95kV, 5-8 mAs
What is the effective dose for a chest x-ray?
0.02 mSv
What is the effective dose for a CT thorax?
7 mSv
Why do radiographers use the high kV technique during a chest x-ray?
Increased penetration through the ribs and increased penetration of the mediastinum and heart
Where should the sternoclavicular joints be in a chest x-ray?
Equidistant from the midline
What is lordosis?
The patient is leaning back too much
What is kyphosis?
The patient is hunched forwards too much
How can you ensure adequate inspiration during a chest x-ray?
Pause for a few seconds after asking the patient to breathe in and watch the patient to see if their chest rises
When is an x-ray of the chest not justified?
For fractured ribs
What is pleural effusion?
Accumulation of fluid within the pleural cavity
What is pulmonary oedema?
Accumulation of fluid in the interstital tissue of the lungs
What are the four classifications of pneumonia?
Community acquired, hospital acquired, ventilator acquired, healthcare acquired
What is primary lung cancer?
The cancer originated from the lung or bronchi
What is pneumothorax?
Accumulation of air in the pleural cavity
What is COPD?
Chronic bronchitis and emphysema, compromises air flow in and out of the lungs
What would you see on a chest x-ray of a patient with COPD?
Lungs appear hyperinflated with flattened hemidiaphragms