Thoracic Viscera Projections PDF

# **Trachea** ## **Technique:** - GRID - Collimation ## **Projection:** - **AP:** - Supine / Upright - Manubrium - Air-filled trachea - Neck slightly extended - MSP || IR - Respiration: slowly inspiration - **Lateral:** - Seated / Standing - Clasps hands behind...

# **Trachea** ## **Technique:** - GRID - Collimation ## **Projection:** - **AP:** - Supine / Upright - Manubrium - Air-filled trachea - Neck slightly extended - MSP || IR - Respiration: slowly inspiration - **Lateral:** - Seated / Standing - Clasps hands behind - Shoulder posteriorly - Extend the neck - MSP || IR - Respiration: slowly inspiration ## **Trachea & Superior Mediastinum** - **Lateral projection:** - Horizontal - Midway - Air-filled trachea - Superior mediastinum - Between the jugular notch and MCP - 4-10.5 cm in lower ## **Demoo:** - Retrosternal extension of Thyroid Gland - Thymic enlargement - In infants (recumbent) - Opacified pharnyx - Upper esophagus - Outline of trachea & bronchi - Foreign body localization # **Trachea & Pulmonary Apex** ## **Axiolateral Projection:** - **Twining Method:** - Upright - Rest shoulder IR - 15° caudad at supraclavicular - Air-filled trachea - Apex of the lungs (near IR) - Elevate arm; flex elbow - Forearm behind head - Opposite shoulder depress - MSP || to IR - Body: True lateral - **Trachea:** Slowly inspiration - **Lung apex:** End of full inspiration ## **Respiration technique:** 1. Air-filled trachea - slowly inspiration 2. Lungs - end of full inspiration # **Chest: Lungs & Heart** ## **PA Projection:** - Upright - Arms on side - MSP || IR - Chin upward - Flex arms rest on hips (scapulae lateral) - Depress shoulder; rotate forward (below lung apices) - SID: 72 in (183cm) 6ft - Magnification ↓ - Recorded detail ↑ ## **Respiration:** 1. End of second full inspiration 2. End of expiration ## **1. PA Projection:** - Air-filled trachea - Lungs: - Diaphragmatic domes - Heart - Aortic knob ## **2. Lateral:** - Enlarged - Thyroid/Thymic gland - Bronchial tree ## **Oblique Angle:** ## **Contrast:** - Esophagus (barium suspension) # **Large Female Breasts:** - Pull breasts upward and lateral # **CXR PA Projection Evaluation** ## **Evaluation Criteria:** - Entire lung fields from the apices to the costophrenic angles - No rotation - Trachea visible in the midline - Scapulae projected outside the lung fields - Ten posterior ribs visible above the diaphragm - Sharp outlines of heart and diaphragm - Faint shadow of the ribs and superior thoracic vertebrae visible through the heart shadow - Lung markings visible from the hilum to the periphery of the lung - With inspiration and expiration chest images, diaphragm demonstrated on expiration at a higher level so that at least one fewer rib is seen within the lung field # **Lateral Projection** - **Upright:** - True lateral - (Left lateral) - (♡ + Left lung) - Right lateral - Right lung - MSP || IR - MCP || IR - Arm extend upward - Elbow flex - Forearm rest on elbows - Use IV stand - **Left Lateral:** - Heart - Aorta - (Left) pulmonary lesion - **Right Lateral:** - (Right) Pulmonary lesion ## **Demonstrate:** 1. Interlobar fissures 2. Differentiate lobes 3. Localize pulmonary lesion # **PA Oblique Projection** - **Upright:** - RAD or LAD - 45° - **Position:** - (Side farthest in) - LAO - Right lung - RAO - Left lung ## **LAO - Right Lung:** - Thoracic viscera - Trachea & carina - Bronchial tree (R) - Heart - Descending aorta - Arch of aorta ## **RAO - Left Lung:** - Thoracic viscera - Trachea - Bronchial tree (L) - Left atrium - Apex left ventricle (anterior) - Right retrocardiac space ## **Evaluation Criteria:** - Both lungs in their entirety - Trachea filled with air - Visible identification markers - Heart and mediastinal structures within the lung field of the elevated side in oblique images of 45 degrees - Maximum area of the right lung on the LAO - Maximum area of the left lung on the RAO ## **For pulmonary diseases - RAO / LAO 10° to 20°:** - Display: - Medial part - Right middle lobe - Lingula of upper lobe # **AP Oblique Projection** - **Upright / supine:** - RPO / LPO 45° - **Position:** - (Side closest to IR) - if patient can't prone - **LPO - Left Lung** - **RPD - Right Lung** ## **Evaluation criteria:** - Both lungs in their entirety - Trachea filled with air - Visible identification markers - Heart and mediastinal structures within the lung field of the elevated side in oblique images of 45 degrees - Maximum area of the right lung on the LAO - Maximum area of the left lung on the RAO # **Chest: Thoracic Viscera** - **AP Projection:** - Supine / Upright - 17 - Thoracic viscera magnified - Heart & - Great vessels (engorged) - Lung fields shorter - Clavicle higher - Ribs horizontal ## **Resnick Recommended:** - 30° caudal - Basal lung fields free of imposition - Differentiates middle lobe - Lingular processes - Lower lobe diseases. ## **Evaluation Criteria:** - Medial portion of the clavicles equidistant from the vertebral column - Trachea visible in the midline - Clavicles lying more horizontal and obscuring more of the apices than in the PA projection - Equal distance from the vertebral column to the lateral border of the ribs on each side - Faint image of the ribs and thoracic vertebrae visible through the heart shadow - Entire lung fields, from the apices to the costophrenic angles - Pleural markings visible from the hilar regions to the periphery of the lungs # **Pulmonary Apices** - **AP Axial Projection:** - Upright - Stand 1 foot in front of IR - Lordotic position - MSP || IR - **AP Axial Oblique Projection:** - Oblique lordotic position - RPO / LPO 30° - Affected side center IR - Extreme lordosis ## **Demonstrate:** - Apices - Interlobar effusions - (Tuberculosis) ## **Evaluation Criteria:** - Lordotic posion - Clavicles lying superior to the apices - Sternal ends of the clavicles equidistant from the vertebral column - Apices and lungs in their entirety - Clavicles lying horizontally with their medial ends overlapping only the first or second ribs - Ribs distorted with their anterior and posterior portions somewhat superimposed - Oblique lordotic position - Dependent apex and lung of the affected side in its entirety ## **PA Axial Projection:** - **Seated/Upright:** - MSP || IR - Depress shoulders - Rotate forward - Inspiration: 10-15° cephalad - **T3:** Apices above the shadow of clavicle - **Inspiration:** ↑ clavicles - **Expiration:** ↓ clavicles # **AP Axial Projection** - **Upright / supine:** - Elbow flex - Hand pronated on hip - 15 to 20° cephalad - Manubrium - Apices below clavicles ## **For hypersthenic patients:** - Separate apical & clavicular shadow ## **Evaluation Criteria:** - Clavicles lying superior to the apices - Sternal ends of the clavicles equidistant from the vertebral column - Apices in their entirety - Superior lung region adjacent to the apices - Clavicles lying horizontally with their medial ends overlapping only the first or second ribs - Ribs distorted, with their anterior and posterior portions somewhat superimposed # **Lungs & Pleurae** - **AP or PA projection:** - R or L lateral - Decubitus position - **Lateral decubitus:** - Fluid in (Pleural effusion) - Pleural cavity - affected side - Free air in (Pneumothorax) - Pleural cavity - unaffected side - **Horizontal:** - 17 - 3 in below jugular notch - Pneumothorax - Pleural effusion ## **Air:** - Tend to go up ## **Fluid:** - Tend to go down (gravity) ## **Remain position in 5min before exposure** # **Upright PA Projection:** - Fluid levels in pulmonary cavities (pleural effusion) ## **Ekimsky recommended:** - Patient lean laterally 45° - Small pleural effusion # **Lateral Projection:** - Prone / supine - Use decub box - Arms above head - Affected side IR - Horizontal - 17 - Dorsal - 3-4 in below jugular notch - Ventral - Pulmonary areas obscured by fluid ## **Evaluation Criteria:** - Both lungs in their entirety - Trachea filled with air - Visible identification markers - Heart and mediastinal structures within the lung field of the elevated side in oblique images of 45 degrees - Maximum area of the right lung on the LAO - Maximum area of the left lung on the RAO