all right thorax and abdomen is 21 questions out of thorax abdomen surgical gi and urology studies and i'll break down those for you in a couple parts here for chest x-ray you guys know chest x-ray you know your central rays you know double inspiration but do you know do you remember why do you remember how to evaluate rotation on a pa chest um do you remember why we do 72 inches for chest x-ray why do we do left lateral for chest x-ray do you know your anatomy the anterior to posterior on a lateral chest when do we do lordotic chest we're looking for tb we're going to use a cephalad angle to remove the clavicles we're looking at the apc's go back and review decubitus chest x-rays why do we do them we're looking for pleural effusion right as fluid just keep in mind air rises fluid drops so for decubitus chests we're most likely looking for fluid on the side down you'll want a horizontal beam and then textbook is patient in that position for five minutes oblique chest the 45 oblique is for localization a little bit steeper that 60 degree is for the heart shadow when we use ap supine um chest x-ray you might be looking for an et tube if the patient was just intubated do you know the level of the e.t tube and where it's supposed to be if you say two inches above the corona that's great but remember boards is in centimeters so make sure you're viewing centimeters so five cm or two inches um or t5 or sternal angle aspiration remember the most common um area for aspiration is the right main bronchus why it's higher and more vertical than the left and just something to keep in mind hi kvp for chest x-ray we want to produce an image with long scale of contrast reveal your anatomy pa test anatomy anterior to posterior for lateral chest go through thorax ribs sternum and all those landmarks for me ribs um your textbook separates out upper ribs versus lower ribs upper ribs is centered at t7 with inspiration lower ribs is centered at t10 expiration rib obliques for textbook is only elongated and remember when you're in a pa oblique to elongate the side of interest pull it away when you're in a posterior oblique to elongate the side of interest towards sternum usually a lateral and rao uh why do we use 72 inches for a lateral remember that oid between the sternum and the wall bucky that's a pretty big space so we're going to use 72 inches to compensate for that you want to get the shoulders out of the way rao why rio and not lao you want to use the heart shadow so it's a really um small oblique it's only 15 to 20 degrees it's um you know one of the most shallow obliques i think we do for anything and the thicker chest has actually less rotation than thinner chest so keep that in mind what would you use as an alternate and just remember the alternate for areo is lpo so say you had a trauma patient someone who couldn't stand you could do an lpo on the table a breathing technique so you can see in this image here everything around the sternum is blurry they used a breathing technique where they used a low ma and increased their seconds to blur out the ribs soft tissue neck what could they really ask you about soft tissue neck most often it's going to be the breathing instructions so what is the particular breathing instructions for soft tissue neck slow deep breath in through the nose you want your patient to take that slow deep breath in you want to fill that airway why do we do soft tissue neck epiglottitis strider sometimes foreign body would be your main reasons abdomen go back to abdomen go back to amp i want you to know your quadrants i want you to know which anatomy sits in what quadrant um breathing why do we use expiration for abdomen what does that do to your diaphragm where does it move your diaphragm um and upright abdomen you remember you're centering two inches above the crest you want to include above the diaphragm we're looking for free air we have a horizontal beam we're looking for air fluid levels decubitus abdomen we're going to use a left lateral decubitus why why do we use left because the liver is on the right the stomach is on the left the stomach has that gastric bubble in it which has air in it so if we use that side it might be hard to differentiate between the air and the gastric bubble and free air so we use the right side up left side down so the liver is right here it's a solid organ it doesn't contain a bunch of air so the free air will sit right over top of it remember a textbook they are supposed to be in that position for five minutes prior to exposure even though you may not see that at clinical um that's what you need to do so just keep in mind um the medical term for free air is that pneumoperitoneum rare in the abdomen uh horizontal beam you want the central ray parallel to the floor you might see that sort of terminology um and why we do left lateral prefer