BONY THORAX

PATHOLOGY
1.) Aspiration/Foreign Body
Inspiration of a foreign material into the
airway
2.) Atelectasis
A collapse of all or part of the lung
3.) Bronchiectasis
Chronic dilatation of the bronchi &
bronchioles
4.) Bronchitis
Inflammation of the bronchi
5.) Chronic Obstructive Pulmonary Disease
Chronic condition of persistent obstruction
of bronchial airflow
6.) Cystic Fibrosis
Widespread dysfunction of the exocrine
glands
Abnormal secretion of sweat & saliva &
accumulation of thick mucus in the lungs
7.) Emphysema
Enlargement of alveolar wall caused by
alveolar wall destruction & loss of elasticity
8.) Epiglottitis
Inflammation of the epiglottis
9.) Histoplasmosis
Infection caused by the yeastlike organism
Histoplasma capsulatum
10.) Sarcoidosis
Condition of unknown origin often associate
with pulmonary fibrosis
11.) Tubercolosis
Chronic infection of the lungs due to the
tubercle bacillus
12.) Hyaline Membrane Disease/Respiratory
Distress Syndrome
Underaeration of the lungs due to a lack of
surfactant
13.) Metastases
Transfer of a cancerous lesion from one area
to another

14.) Pleural Effusion/Hydrothorax

Collection of fluid in the pleural cavity
15.) Pneumoconiosis
Lung diseases resulting from inhalation of
industrial substances
Anthracosis
Coal miners lung or black lung
Inflammation caused by inhalation of coal
dust (anthracite)
Asbestosis
Inflammation caused by inhalation of
asbestos
Silicosis
Inflammation caused by inhalation of silicon
dioxide
16.) Pneumonia
Acute infection in the lung parenchyma
Aspiration
Pneumonia caused by inhalation of foreign
particles
Interstitial/Viral/Pneumonitis
Pneumonia caused by a virus & involving
alveolar walls & interstitial structures
Lobar/Bacterial
Pneumonia involving the alveoli of an entire
lobe without involving the bronchi
Lobular/Bronchopneumonia
Pneumonia involving the bronchi and
scattered throughout the lung
17.) Pneumothorax
Accumulation of air in the pleural cavity
resulting in collapse of the lung
18.) Pulmonary Edema
Replacement of air with fluid in the lung
interstitium & alveoli

BONY THORAX

A.) TRACHEA
AP PROJECTION
PP: Supine/upright; neck slightly extended; MSP
to IR; exposure during slow inspiration
RP: Manubrium
CR:
SS: Air-filled trachea
LATERAL PROJECTION
PP: Seated/upright; hands clasped behind the body;
shoulder
rotated
posteriorly
(prevents
superimposition of arms & superior mediastinum);
neck extended slightly; exposure during slow
inspiration
RP: Midway b/n jugular notch & midcoronal plane
(for trachea); 4-5 in. lower (for superior
mediastinum)
CR:
SS: Air-filled trachea & superior mediastinum
ER: described by Eiselbeg & Sgalitzer
Used to demonstrate restrosternal extensions
of the thyroid gland
Thymic enlargement in infants (recumbent
position)
Opacified larynx & upper esophagus
Outline of trachea & bronchi
For foreign body localization
B.) CHEST
PA PROJECTION
PP: Upright/seated-upright (always); chin extended
upward; dorsal aspect of hands against the hips
(rotates scapulae laterally; depress shoulder; pull
breast upward & laterally (female); exposure after
second full inspiration (general) or end of full
inspiration & expiration (for presence of
pneumothorax & foreign body)
RP: T7

CR:
SS: Entire lung field
Sharp outline of heart
Sharp outline of diaphragm (expiration)
Ten posterior ribs above diaphragm
Upright Position Rationale:
Diaphragm at its lowest position
Air-fluid levels are seen
Avoid engorgement of the pulmonary
vessels
AP PROJECTION
PP: Supine/upright; back against IR; place hands on
hips; elbow flexed; hand pronated
RP: 3 in. inferior to jugular notch
CR:
SS: Somewhat similar to PA but magnified
Magnified heart & great vessels
Lung fields appear shorter
Clavicle projected higher
Ribs assume horizontal position
Resnick Recommendation:
CR 30o caudad to midsternal region
Rationale: to free basal portions of the lung
fields from superimposition by anterior
diaphragmatic, abdominal & cardiac
structures
LINDBLOM METHOD
AP AXIAL PROJECTION
PP: Upright; step 1 foot in front; lean backward in
extreme lordosis; elbow flexed; pronate hands
beside the hips; shoulder against IR;
RP: Midsternum
CR: or 15-20o cephalad (no leaning backward)
SS: Lung apices inferior to shadow of clavicles
Demonstrate interlobar effusions
ER: Used in preference to PA axial projection in
hyperstenic patient & whose clavicles occupy a
high position

BONY THORAX

PA AXIAL PROJECTION
PP: Upright; chin rested against the IR; elbow
flexed; pronate hands on hips; depress shoulder &
rotated forward; exposure at end of full inspiration
RP: T3
CR: 10-15o cephalad
SS: Lung apices superior to shadow of clavicles
LATERAL PROJECTION
PP: Upright/seated-upright; left side against the IR
(for heart & left lung) or right side against the IR
(for right lung); MSP // to IR; MCP to IR; arms
extended directly upward; elbow flexed; forearm
resting on elbows
RP: T7
CR:
SS:
Heart, aorta & left-sided pulmonary lesions
(left lateral)
Right-sided pulmonary lesions (right lateral)
ER:
Employed to demonstrate the interlobar
fissures
To differentiate the lobes
To localize pulmonary lesions
PA OBLIQUE PROJECTION
PP: Upright/seated-upright; LAO/RAO (affected
side up); body rotated 45o toward unaffected side;
55-60o (for cardiac series; )10-20o (for study of
pulmonary diseases); shoulder of unaffected side
against IR
RP: T7
CR:
SS:
LAO:
o Maximum area of right lung
o Trachea & carina
o Entire right branch of bronchial tree
o Heart, descending aorta & aortic arch

o
RAO:
o
o
o
o

Esophagus (if barium filled)

Maximum area of left lung

Trachea
Entire left branch of bronchial tree
Best image of left atrium, anterior
portion of apex of left ventricle &
right retrocardiac space
o Esophagus (if barium filled)
Medial part of right middle lobe & lingula of
the left upper lobe free from hilum (CR 1020o)

AP OBLIQUE PROJECTION
PP: Upright/supine; LPO/RPO (affected side
down); body rotated 45o toward affected side;
shoulder of affected side against IR
RP: 3 in. inferior to jugular notch
CR:
SS:
LPO: maximum area of left lung; similar to
RAO
RPO: maximum area of right lung; similar
to LAO
ER:
Used when patient is too ill to be turned in
prone position
Supplementary position in investigation of
specific lesions
Used with recumbent patient in contrast
studies of the heart & great vessels
AP/PA PROJECTION
R or L Lateral Decubitus
PP: Lateral decubitus; patient lie on affected side
(for pleural effusion) or unaffected side
(pneumothorax); body elevated 2-3 in.; arms well
above the head; remain in position for 5 minutes
before exposure
RP: 3 in. inferior to jugular notch (AP) or T7 (PA)
CR: Horizontal

BONY THORAX
ER:

Used to demonstrate the change in fluid

position (pleural effusion)
Reveals any previously obscured pulmonary
areas
Demonstrate the presence of any free air
(pneumothorax)
Ekimsky Recommendation:
Patient leaning laterally 45o
Rationale: for demonstration of small
pleural effusions
LATERAL PROJECTION
R or L Position
Ventral/Dorsal decubitus Position
PP: Supine/prone; thorax elevated 2-3 in.; remain in
position 5 minutes before the exposure; extend arms
well above the head; affected side against the IR
RP: 3 in. inferior to jugular notch (ventral
decubitus) or T7 (dorsal decubitus)
CR: Horizontal
ER:
Used to demonstrate the change in fluid
position
Reveals pulmonary areas that obscured by
fluid in standard projection
C.) STERNUM
PA OBLIQUE PROJECTION
PP: Prone or upright (trauma patient); RAO; body
rotated 15-20o (prevents superimposition of sternum
& vertebrae); long exposure time: slow, shallow
breaths during exposure; short exposure time:
suspend breathing at the end of expiration
RP: T7 of elevated side of posterior thorax & 1 in.
lateral to MSP
CR:
SS: Best projection to demonstrate sternum
Sternum free of superimposition from
vertebral column

Sternum projected over the heart

AP Oblique Projection:
LPO position
For trauma patients in supine position
MOORE METHOD
PA OBLIQUE PROJECTION
PP: Modified prone position; tube positioned over
the patients right side; patient stand at the side of
table; bend at the waist; arms above shoulders;
palms down on table
RP: level of T7 & 2 in. to the right of spine
CR: 25o toward MSP; large patient (less
angulation); small patient (more angulation)
SS: Sternum free of superimposition from vertebral
column
ER: Perform on an ambulatory patient who is
having acute pain to provide comfort & to produce
high-quality sternum image
Sternum projected over the heart
LATERAL PROJECTION
R or L Position
PP: Lateral recumbent/upright or dorsal decubitus
(for patient with severe injury); patient in true
lateral position; broad surface of sternum to IR;
suspended deep inspiration
RP: Lateral border of midsternum
CR:
SS: Best demonstrate the entire length of sternum &
its surrounding tissue
D.) STERNOCLAVICULAR JOINTS
PA PROJECTION
PP: Prone or upright (trauma patient); arms along
the sides; palms facing upward; head turned facing
the affected side for unilateral examination (rotates
the spine slightly away from side of interest); head
rested on chin for bilateral examination
RP: T3

BONY THORAX
CR:
SS: Sternoclavicular joints
KURZBAUER METHOD
LATERAL PROJECTION
PP: Lateral recumbent; affected side against IR;
hips & knee flexed; arm of affected grasp the end of
table (for support); arm of unaffected side grasp the
dorsal surface of hip (depressed shoulder); anterior
surface of manubrium to IR
RP: Lowermost sternoclavicular articulation
CR: 15o caudad
SS: Unobstructed sternoclavicular joint
PA OBLIQUE PROJECTION
Body Rotation Method
PP: Prone or seated-upright (trauma patient);
RAO/LAO; body rotated 10-15o toward affected
side (projects vertebrae well behind the SC joint)
RP: Level of T2-T3 (3 in. distal to vertebral
prominens) & 1-2 in. lateral from MSP
CR:
Entrance: right side (left SC joint); left side
(right SC joint)
SS: Sternoclavicular joints
PA OBLIQUE PROJECTION
Central Ray Angulation Method
PP: Prone or seated-upright (trauma patient); chin
rested on table or rotated toward the side of interest
RP: Level of T2-T3 (3 in. distal to vertebral
prominens) & 1-2 in. lateral from MSP
CR: 15o toward MSP
Entrance: right side (left SC joint); left side
(right SC joint)
SS: Sternoclavicular joints
D.) RIBS
PA PROJECTION

PP: Upright/prone; hands rested against hips; palms

turned outward; chin rested on chin; suspend at full
inspiration (depresses diaphragm)
RP: T7
CR: or 10-15o caudad (to demonstrate 7th-9th
ribs)
SS: Anterior ribs (1st-9th) above the diaphragm
AP PROJECTION
PP:

Upright: to image ribs above diaphragm; IR

top board 1.5 in. above shoulder; shoulder
rotated forward; suspend at full inspiration
(to depress diaphragm)
Supine: to image ribs below diaphragm;
shoulder in the same transverse plane;
suspend at full expiration (to elevate
diaphragm)
RP: T7 (upper ribs) or T10 (lower ribs)
CR:
SS: Posterior ribs above the diaphragm (1st-10th) &
below the diaphragm (8th-12th)
AP OBLIQUE PROJECTION
PP: RPO/LPO; body rotated 45o (affected side
down); arm of affected side abducted; opposite
hand on hip
Upright: to image ribs above diaphragm;
hand rested on head; suspend at full
inspiration (to depress diaphragm)
Supine: to image ribs below diaphragm; hip
elevated; suspend at full expiration (to
elevate diaphragm)
RP: T7 (upper ribs) or T10 (lower ribs)
CR:
SS: Axilliary ribs closest from IR
PA OBLIQUE PROJECTION
PP: RAO/LAO; body rotated 45o (affected side up)
Upright: to image ribs above diaphragm;
forearm of affected side rested on grid

BONY THORAX
device; suspend at full inspiration (to
depress diaphragm)
Supine: to image ribs below diaphragm;
patient rested on forearm; knee of elevated
side flexed; suspend at full expiration (to
elevate diaphragm)
RP: T7 (upper ribs) or T10 (lower ribs)
CR:
SS: Axilliary ribs away from IR

RP: 2 in. superior to xiphoid process

CR: 20o cephalad
Increase 5-10o angle (patient w/ pronounced
dorsal kyphosis)
SS: Costal joints
Costovertebral & costotransverse joints

AP AXIAL PROJECTION
PP: Supine; head rested directly on table (to avoid
accentuating the dorsal kyphosis); arms along sides
of the body

04/09/14

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