PA Projection - (1) ribs should be visible - Grid technique is used for (2) within the lung fields - Chest x-ray can be done in (3)/ (4) - Chest x-ray is primarily done in (5) to prevent (6)

1. 10 posterior 2. opaque areas (foreign body) 3. seating 4. bedside radiography 5. upright 6. pulmonary engorgement/ dilatation

Lateral projection (Upright-Standing) - Use (1) to support weak patients - Avoid patient to (2), it will distort the lung image - Use (3) for demonstration of heart - For (4), same principle is applied in PA projection - The procedure can be done in (5) or (6) position

1. IV stand 2. lean 3. left lateral position 4. cardiac studies 5. seating 6. recumbent

Radiography of the Chest Flashcards by Eun Woo

PA Projection Pt Position

Standing infront- VGD/VCH-anterior thorax dependent

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PA Projection Comfort and Part Position

Both UE-raised-flexed-elbows-dorsum of hands in contact-hips-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-top of the VGD

MSP-coincide-MP of IR

Establish-RP -T7 (inferior border of scapulae) by palpation

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PA Projection IR size and placement

CXT 14X17-VGD/VCH- longitudinal- MP- coincide- RP

Upper border of the IR-approximately 1 1⁄2 -2 inches from shoulder level

CRD- perpendicular- at 72”-SID-RP-exits-MP- IR/ cassette

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To demo thoracic viscera, the air-filled trachea, well expanded lungs, diaphragmatic dome, heart and aortic knob

PA Projection

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Why is exposure made at the end of second full suspended inspiration/ inhalation?

Allow the lungs to expand
Widen intercostal spaces
Depress the diaphragm
Costophrenic angles/sulci sharp

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PA Projection

Prominent at the end of full expiration/exhalation

Vascular markings

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PA Projection

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

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PA Projection

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 (1) and (2).

posterior heart
aorta

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PA Projection

(1) ribs should be visible
Grid technique is used for (2) within the lung fields
Chest x-ray can be done in (3)/ (4)
Chest x-ray is primarily done in (5) to prevent (6)

10 posterior
opaque areas (foreign body)
seating
bedside radiography
upright
pulmonary engorgement/ dilatation

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Lateral projection (Upright-Standing) Pt Position

Standing-L/R lateral position-infront of VGD/VCH

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Lateral projection (Upright-Standing) 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

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Lateral projection (Upright-Standing) Part Position

Thorax-adjusted in lateral

MCP-coincide with MP of IR/cassette

Chin is raised

Establish the RP at T7

Avoid body rotation

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Lateral projection (Upright-Standing) IR

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

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To demo the lateral image of the lungs

Lateral projection (Upright-Standing)

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Demos the heart, aorta, left sided pulmonary lesions

Lateral projection (Upright-Standing)

L lateral position

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Demos right sided pulmonary lesions

Lateral projection (Upright-Standing)

R lateral position

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Demonstrate interlobar fissures, differentiate lobes, and anterior/ posterior location of tumor

Lateral projection

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Lateral projection (Upright-Standing)

Use (1) to support weak patients
Avoid patient to (2), it will distort the lung image
Use (3) for demonstration of heart
For (4), same principle is applied in PA projection
The procedure can be done in (5) or (6) position

IV stand
lean
left lateral position
cardiac studies
seating
recumbent

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Lateral projection (Recumbent Position) Pt Position

Patient to assume either L/R lateral position on top of RT

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Lateral projection (Recumbent Position) 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

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Lateral projection (Recumbent Position) Part Position

Thorax in lateral position

MCP-coincide with MP of IR

RP at level of T7

Avoid body rotation

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Lateral projection (Recumbent Position) IR size/placement

14X17-placed inside the BD (BuckyDiaphragm/ tray)-longitudinal with MP-coincide with RP

Upper edge of IR approx. 1 1⁄2 -2” from shoulder level

CRD: Perpendicular- 72”-SID-MCP-level-T7-exit at MP of IR

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PA Oblique Projection Pt Position

Stand infront-VGD/VCH-anterior thorax dependent

Adjusted either in RAO/LAO position

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PA Oblique Projection Comfort Position

Dependent UE flex-elbow-dorsum of hand-in contact with hip

Opposite UE raised-grasp the top edge of VGD

Both LE extended-wt. distributed equally

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PA Oblique Projection Part Position

Body obliquity-approx. 45 degrees Midline-body-coincide-MP-IR RP-T7 Chin is raised

PA Oblique Projection IR size/placement

14x17-VGD/VCH-longitudinal-MP-coincide-RP Top edge of IR- 1 1⁄2 -2”-from shoulder level CRD: Perpendicular-72” SID-midline-body-level-T7-exit-MP-IR

To demo the oblique image of the heart and lungs

PA Oblique Projection

- R lung field (side farther from the IR) is demonstrated - Trachea and carina and the entire R branch of the bronchial tree - heart, descending aorta and arch of the aorta

PA Oblique Projection LAO Position

- L lung field (side farther from the l R) is demonstrated - Rrachea and entire L branch of the bronchial tree

PA Oblique Projection RAO Position

Gives the best image of the: - L atrium - Anterior portion of the apex of the LV - R retrocardiac space

PAO Projection RAO Position

PA Oblique Projection - For cardiac studies- body obliquity is (1) degrees - Can be done in (2)

1. 55-60 2. recumbent

AP Oblique Projection Pt Position

Stand infront-VGD/VCH-posterior thorax dependent Adjusted either in RPO/LPO position

AP Oblique Projection 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

AP Oblique Projection Part position

Body obliquity-approx. 45 degrees Midline of body-coincide with MP of IR RP-T7 Chin is raised

AP Oblique Projection 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 (3” below jugular notch)-exit-MP-IR

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

AP Oblique Projection

AP Oblique Projection The side of interest in APO is usually the (1) side - can be done in (2)

1. dependent 2. recumbent

RPO position corresponds with LAO position while LPO position corresponds with RAO position

AP Oblique Projection

This projection is done if the patient is too ill to be positioned in upright

AP Projection

AP Projection Pt Position

Supine on top of RT

AP Projection Comfort Position

Both UE extended-abducted-hands pronated Both LE extended-sandbag placed under ankles for support

AP Projection Part position

MSP-coincide with midline of RT/coincide with MP of IR Shoulders on same transverse plane RP-T7

AP Projection IR size/placement

14X17-inside BD-longitudinal-MP-coincide-MSP-level of T7 CRD: Perpendicular-72”SID-MSP-level of T7 (3” below jugular notch)-exit at MP of IR

- Heart and great vessels are magnified and engorged - Lung fields appear shorter due to abdominal compression - Clavicles are projected higher - Ribs in horizontal appearance

AP Projection

Used to free the basal part of the lungs from superimpositions

Resnick recommendation- AP axial projection

This projection also differentiates middle lobe and lingular processes from lower lobe disease

Resnick recommendation- AP axial projection

Resnick recommendation- AP axial projection 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 LATERAL PROJECTION: Ventral/Dorsal decubitus position

AP/PA PROJECTION: R/L lateral decubitus position Pt position

Right/Left lateral decubitus position-top-RT

AP/PA PROJECTION: R/L lateral decubitus position 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

AP/PA PROJECTION: R/L lateral decubitus position Part position

Thorax in lateral position MCP-perpendicular with RT MSP-coincide with MP of IR/cassette RP at level of T7 Avoid body rotation Radiolucent support (2-3” thick) placed under the dependent side to elevate

AP/PA PROJECTION: R/L lateral decubitus position 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

To demo change in position of fluid and free air in the pleural cavity

AP/PA PROJECTION: R/L lateral decubitus position

AP/PA PROJECTION: R/L lateral decubitus position - Wait for (1) before making an exposure to allow the fluid to settle down and for air to rise - For fluid level- place the part of interest (2) - For air level- place the part of interest (3)

1. 5 minutes 2. dependent 3. elevated

LATERAL PROJECTION: Ventral/Dorsal decubitus position Patient position

Supine/prone on top of RT

LATERAL PROJECTION: Ventral/Dorsal decubitus position Comfort position

Both UE extended upward-hands placed over the head Both LE extended-sandbag placed under ankles for support

LATERAL PROJECTION: Ventral/Dorsal decubitus position Part position

MSP-perpendicular with RT MCP-coincide with MP of IR Shoulders on same transverse plane RP-T7 Radiolucent support (2-3”) thick-placed under the thorax to elevate

LATERAL PROJECTION: Ventral/Dorsal decubitus position IR size/placement

14X17-placed on top of RT-vertical-longitudinal-MP-coincide-MCP-level of T7 Back part-supported CRD: - Horizontal-72”SID-MCP-level of T7 (for ventral decubitus)-exit at MP of IR - Horizontal-72”SID-MCP-level of 3-4” below jugular notch (for dorsal decubitus)-exit at MP of IR

To demo. change in the position of fluid and reveals pulmonary area that are obscured by the fluid

LATERAL PROJECTION: Ventral/Dorsal decubitus position

LATERAL PROJECTION: Ventral/Dorsal decubitus position Wait for (1) before making an exposure to allow the fluid to settle down and for air to rise

1. 5 minutes