Radiography of The Chest

RADIOGRAPHY OF THE CHEST (LUNGS
AND HEART)
PA PROJECTION
PT POSN: standing infront - VGD/VCH -
anterior thorax - dependent
COMFORT & PART POSN:
- both UE-raised-flexed at elbows with
dorsum of hands in contact with hips and
rotated forward to draw the scapula laterally
and prevent superimposition with the lungs
- both LE-extended - separated and weight
distributed equally
- shoulders - depressed to prevent clavicles
to superimpose with lung apices
- chin - raised and placed on top of the VGD
- MSP - to coincide with the MP - IR
RP: the level of T7 (inferior border of scapulae)
IR SIZE AND PLACEMENT:
- CXT: 14X17-VGD/VCH-longitudinal-MP-
coincide-RP
- Upper border of the IR-is approximately 1
1/2 - 2 inches from shoulder level
CRD: Perp- 72-distance-towards the RP-exits at
the MP-IR
OBJECTIVE:
- Demo thoracic viscera, the air-filled
trachea, well expanded lungs, diaphragmatic
dome, heart and aortic knob
NOTE:
- Exposure is made at the end of second full
suspended inspiration
- Collimate x-ray beam to cxt size
- Use ID marker (R/L)
- Shield gonads
- Vascular markings are prominent at the end
of full expiration/exhalation
- For certain conditions, such as
pneumothorax and the presence of a
foreign body, radiographs are sometimes
made at the end of full inspiration and
expiration
- 10 posterior ribs should be visible
- For cardiac studies, patient is given a
bolus of barium sulfate and instructed take
a deep breath and to swallow upon
instruction by the technologist. This will
outline the posterior heart and aorta.
- Grid technique is used for opaque areas
(foreign body) within the lung fields
- Chest x-ray can be done in seating/
bedside radiography
- Chest x-ray is primarily done in upright to
prevent pulmonary engorgement/dilatation
ADDED PROJECTIONS:
LATERAL PROJECTION: (upright-standing)

PT POSN:
- Standing-Left/right lateral position-infront
of VGD/VCH
Comfort position:
- Both UE-raised-flexed at elbows-placed on
top of head with hands grasping the elbows to
avoid superimposition
- Both LE-extended-wt. distributed equally
PART POSN:
- thorax-adjusted in lateral
- MCP-coincide with MP of IR/CXT
- Chin is raised
- Establish the RP at T7
- Avoid body rotation
IR SIZE/PLACEMENT:
- 14X17-placed in VGD/VCH-longitudinal
with MP - coincide with MCP-level of
T7
- Upper edge of IR is approx. 1 1/2 -2 from
shoulder level
CRD: Perpendicular-at 72-distance-towards-
MCP-at T7-exits at-MP- of IR
OBJECTIVE:
- To demo the lateral image of the lungs
- For left lateral position- it will demonstrate
the heart, aorta, left sided pulmonary lesions
- For right lateral position- it will
demonstrate right sided pulmonary lesions
- Lateral projection demonstrate interlobar
fissures, differentiate lobes, and A/pos location
of tumor
NOTE:
suspended inspiration/inhalation
- Collimate x-ray beam to cassette size
- Observe gonadal shielding
- Use IV stand to support weak patients
- Avoid patient to lean, it will distort the
lung image
- Use left lateral position for demonstration
of heart
- For cardiac studies, same principle is
applied in PA projection
- The procedure can be done in seating or
recumbent position
RECUMBENT POSITION
PT POSN:
- Patient to assume either left/right lateral
position on top of RT
COMFORT POSN:
- both UE raised, flexed at elbows and FA
(forearm) placed against the head
- both LE flexed at knees with
sandbag/pillow placed in between knees and
ankles for support
PART POSN:
- thorax in lateral position
- MCP-coincide with MP of IR
- RP at level of T7
IR SIZE/PLACEMENT:
- 14X17-placed inside the BD-longitudinal
with MP - coincide with RP
- Upper edge of IR approx. 1 1/2 -2 from
shoulder level
CRD: Perp- 72--SID-MCP-level-T7-exit at MP
of IR
PA OBLIQUE PROJECTION:
PT POSN:
- Stand infront-VGD/VCH-anterior thorax
dependent
- Adjusted either in RAO/LAO position
Comfort position:
- Dependent UE flex at elbow-dorsum of
hand-in contact with hip
- Opposite UE raised-grasp the top edge of
VGD
- Both LE extended-wt. distributed equally
PART POSITION:
- Body obliquity-approx. 45 degrees
- Midline of body-coincide with MP of IR
- Chin is raised
RP: T7
IR SIZE/PLACEMENT:
- 14X17-placed in the VGD/VCH -
longitudinal - MP - coincide with-RP
- Top edge of IR- 1 1/2 -2 -from shoulder
level
CRD: Perpendicular-72 SID-midline of the
body-level-T7-exit-MP-IR Objective:
DEMO: To demo the oblique image of the heart
and lungs
For LAO position:
- right lung field (side farther from the IR) is
demonstrated
- the trachea and it bifurcation (the carina)
and the entire right branch of the bronchial
tree
- heart, descending aorta and arch of the
aorta
For RAO position:
- the left lung field (side farther from the l
R) is demonstrated
- trachea and the entire left branch of the
bronchial tree
- gives the best image of the left atrium, the
anterior portion of the apex of the left
ventricle, and the right retrocardiac space
NOTE:
- For cardiac studies-body obliquity is 55-60
degrees
- PA BOLIQUE PROJECTION can be done
in recumbent
AP OBLIQUE PROJECTION:
PT POSN:
- Stand infront-VGD/VCH-posterior thorax
dependent
- Adjusted either in RPO/LPO position
Comfort position:
- Dependent UE-raised- flex at elbow- hand-
in contact with the head
- Opposite UE flexed at elbows-dorsum of
hand-in contact with hip
- Both LE extended-wt. distributed equally
PART POSN:
- Body obliquity-approx. 45 degrees
- Midline of body-coincide with MP of IR
- Chin is raised
RP: T7
IR SIZE/PLACEMENT:
- 14X17-placed in the VGD/VCH -
longitudinal - MP - coincide with-RP
- Top edge of IR- 1 ½ -2-from shoulder level
CRD: Perpendicular-72 SID-midline of the
body-level-T7 (3 below jugular notch)-exit-
MP-IR Objective:
- similar with PA OBLIQUE PROJECTION,
but elevated side usually appear shorter
because of magnification of the diaphragm
- heart and great vessels also cast magnified
shadows as a result of being farther from
the IR
NOTE:
- RPO position corresponds with LAO
position while LPO position corresponds
with RAO position
- The side of interest in APO is usually the
dependent side
- can be done in recumbent
AP PROJECTION
- This projection is done if the patient is too
ill to be positioned in upright
PATIENT POSITION:
- Supine on top of RT COMFORT
POSITION:
- Both UE extended-abducted-hands
pronated
- Both LE extended-sandbag placed under
ankles for support
PART POSITION:
- MSP-coincide with midline of RT/coincide
with MP of IR
- Shoulders on same transverse plane
RP: T7
IR SIZE/PLACEMENT:
- 14X17-inside BD-longitudinal-MP-
coincide-MSP-level of T7
CRD: Perp-72SID-MSP-level of T7 (3 below
jugular notch)-exit at MP of IR
OBJECTIVE:
- Similar with PA projection except that
heart and great vessels are magnified and
engorged
- Lung fields appear shorter due to
abdominal compression
- Clavicles are projected higher
- Ribs in horizontal appearance
NOTE:
- Resnick recommendation - AP axial
projection to free the basal part of the lungs
from superimpositions
- this projection also differentiates middle
lobe and lingular processes from lower lobe
disease
- CRD - 30 degrees caudal- 40 SID-MSP-
level of midsternal region
DEMONSTRATION OF AIR-FLUID LEVEL

IN THE LUNGS
AP/PA PROJECTION: Right/Left lateral

decubitus position
PT POSN:
- Right/Left lateral decubitus position-top-
RT COMFORT POSITION:
- both UE raised, flexed at elbows and FA
(forearm) placed against the head
- both LE flexed at knees with
sandbag/pillow placed in between knees and
ankles for support
PART POSITION:
- thorax in lateral position
- MCP-perpendicular with RT
- MSP-coincide with MP of IR/cassette
- Radiolucent support (2-3 thick) placed
under the dependent side to elevate RP: T7
IR SIZE/PLACEMENT:
- 14X17-placed-top-RT-vertical-in contact
with either posterior/anterior surface of the
body - longitudinal with MP-coincide with
RP back part supported
- Upper edge of IR approx. 1 1/2 -2 from
shoulder level
CRD:
- Horizontal- 72-SID-MCP-level-T7-exit at
MP of IR for AP and 3 below jugular notch
for PA
OBJECTIVE:
- demo change in position of fluid and free
air in the pleural cavity
NOTE:
- Wait for 5 min before making an exposure
to allow the fluid to settle down and for air to
rise
- For fluid level- place the part of interest
dependent
- For air level- place the part of interest
elevated
- Ekimsky recommendation: Patient to
assume the conventional CXR or AP
projection in upright and to lean laterally at 45
degrees to demonstrate pleural effusion
LATERAL PROJECTION: Ventral/Dorsal

decubitus position
PT POSN:
- supine/prone on top of RT
COMFORT POSN:
- Both UE extended upward-hands placed
over the head
- Both LE extended-sandbag placed under
ankles for support
PART POSITION:
- MSP-perpendicular with RT
- MCP-coincide with MP of IR
- Shoulders on same transverse plane
- Radiolucent support (2-3) thick-placed
under the thorax to elevate
RP-T7

Radiography of The Chest

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Radiography of The Chest

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RADIOGRAPHY OF THE CHEST (LUNGS

LATERAL PROJECTION: (upright-standing)

DEMONSTRATION OF AIR-FLUID LEVEL

AP/PA PROJECTION: Right/Left lateral

LATERAL PROJECTION: Ventral/Dorsal

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