Chest-X-Ray

erect pa projection and erect lateral chest x ray procedure

ERECT CHEST X RAY PROCEDURE PA PROJECTION

ANATOMIC STRUCTURES
Heart
Lungs
FILM SIZE
14 x 17 in. (35 x 43 cm), lengthwise
NOTE: If the patient is too large for all of the chest to be included on one 14 x 17 in, film lengthwise, the cassette may be turned cross.
wise.

PATIENT POSITION

NOTE: The erect position is preferred, since the diaphragm moves to its lowest position, allowing the lungs to be fully aerated. The
erect position also permits demonstration of air-fluid levels or free intra peritoneal air
(under the diaphragm),
Secure lead shield around patient to protect gonads.

– Have patient stand distributing weight of body
equally on both feet) or sit facing vertical
grid device.

Adjust height of cassette (in Bucky tray) to
place top border about 2 in. above shoulders.

For women with large, pendulous breasts, have patient pull breasts upward and laterally to
prevent them from casting dense shadows
over the lower lungs.

Have patient lean against grid device to hold breasts in place.
Extend chin, and rest it on grid device (to pre
vent superimposition with lung apices)

Flex elbows, and place hands on hips (about level of greater trochanters) with palms rotated outward
Depress and rotate shoulders forward to place clavicles below apices and to move scapulae
laterally away from lungs (to prevent superimposition)

PART POSITION 

Alien midsagittal plane of chest to midline of grid device.

-Adjust patient in PA position with both shoul ders next to grid device (no rotation) and in
same transverse plane

CENTRAL RAY

Direct borizontal central ray perpendicular to plane of film to enter midsagittal plane of body at level of T6 or tip of scapula
SID = 72 in (to minimize magnification and distortion of the heart)

PATIENT INSTRUCTION

Instruct patient to suspend respiration at end of 2nd full inspiration

NOTE Certain conditions may require that an additional radiograph also be taken in expiration (eg, pneumothora fixation of diaphragm)

IMAGE CRITERIA

Entire lungs (from apices to costophrenic angles) should be included and seen without
motion
lungs and heart should be seen without rotation (as evidenced by equal distance between sternal ends of clavides and vertebral
column or equal distance from vertebral column to lateral border of ribs on both sides).

10 pairs of posterior ribs should be seen projected above the diaphragm (if full inspiration) Scapulae should not superimpose us if
shoulders rotated forward adequately Lungs should be demonstrated with an optimum scale of contrast and exposure thoracic inter vertebral disk spaces and the should be faintly visualized through the heart shadow)
Air-filled trachea is generally seen

ERECT CHEST X RAY PROCEDURE LATERAL PROJECTION

ANATOMIC STRUCTURES

Lungs
Heart
FILM SIZE
14 x 17 in. (35 X 43 cm) lengthwise

PATIENT POSITION IN CHEST X RAY PROCEDURE

Secure lead shield around patient to protect gonads

Have patient stand or sit with left side chest next to vertical grid device.

NOTE: The left lateral projection should be used to reduce magnification of the beart

unless the right chest is the area of interest Adjust height of cassette (in Bucky tray) to
place top border is about 2 in. above shoulders.

Raise arms directly upward, flex elbows, and rest forearms on head’ (grasping elbows to hold arms in position)
NOTE: If patient is unsteady place an IV standard in front of patient and barepatienten tend both arms and grasp standart asbigbas  possible for support

PART POSITION

Adjust patient to place midsagittal plane of chiest parallel to plane of film Have patient extend chin
-Make certain that adjacent shoulder is touching grid device

-To prevent distortion in a patient with broad shoulders, make certain that the midsagittal plane is vertical (lower border of chest will be some distance from grid device Adjust body to place mid line of chest to midline of grid device with chest and pelvis not to rotated (shoulders and hips superimposed)

Adjust patient into lateral position so that anterior surface of sternum is perpendicular to
plane of grid device

CENTRAL RAY

Direct horizontal central ray perpendicular to plane of film to enter midline of chest at level of To (tip of scapula when arms are raised)
SID = 72 in. (to minimize magnification and distortion of the heart).

PATIENT INSTRUCTION CHEST X RAY PROCEDURE

Instruct patient to suspend respiration at end of 2nd full inspiration

IMAGE CRITERIA

Ribs posterior to vertebral column should be superimposed, and sternum should be seen in lateral position (assures no rotation).
Costophrenic angles and apices of lungs should be included.

Apices and upper lungs should be well visualized without overlying shadows of bone or soft tissue of arms.
Hilum of lungs should be approximately in center of radiograph
Lungs, heart, and diaphragm should be seen with sharp outlines and without motion.
Long axis of lungs should be in vertical axis
(without forward or backward leaning).

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