Image critique of the chest RAD 188

Criteria for accurate positioning on a PA chest

• Thoracic vertebra and posterior ribs seen through mediastinal structures - technique was accurate

• Symmetrical anatomy

• Clavicles on the same plane

• Scapula out of lung fields

• 1inch of lung field is visible above clavicles

  • Clavicles should be located around T3-T4

• Superior angle of scapula should be within clavicles

• All anatomy included

• 10 ribs above diaphragm

Is this positioning accurate? If it is not well positioned what is wrong with the image?

Inaccurate positioning

• Patient is rotated into a LAO

  • SC joints asymmetrical

  • scapula in lung field on right side

  • Right lung appears wider

  • Right ribs are elongated

• Patient slightly kyphotic (leaning forward)

  • More than 1 inch above clavicles

  • Superior angles of scapula are above clavicle

Is this positioning accurate? If it is not well positioned what is wrong with the image?

Inaccurate positioning

• Elevated shoulders

• Clavicles are slightly lower than T3-T4 and more than 1 inch of apices above clavicles

  • Patient positioned slightly kyphotic

Is this positioning accurate? If it is not well positioned what is wrong with the image?

Inaccurate positioning

• Patient is kyphotic with MCP tilted anteriorly

  • Clavicles are projected lower than the level of T3-T4 with more than 1 inch of apices above them

• Poor inspiration

  • less than 10 ribs above diaphragm

Is this positioning accurate? If it is not well positioned what is wrong with the image?

Inaccurate positioning

• Patient is Lordotic with MCP tilted posteriorly

  • Clavicles are projected higher than the level of T3-T4 with less than 1 inch of apices above them

Is this positioning accurate? If it is not well positioned what is wrong with the image?

Inaccurate positioning

• Poor inspiration

  • less than 10 ribs above the diaphra

Criteria for accurate lateral chest Xray

• Right and left side posterior ribs nearly superimposed (no more than .5 inches)

• Sternum in profile

• No humerus soft tissue in lungs

• Costophrenic angles are superimposed

• All anatomy included

Is this positioning accurate? If it is not well positioned what is wrong with the image?

Inaccurate positioning

• Patient rotated toward wall bucky into an LAO (The gastric bubble is more posterior than normal and right lung is projected past the sternum)

Is this positioning accurate? If it is not well positioned what is wrong with the image?

Inaccurate positioning

• Patient rotated LAO

• Find the diaphragm that sits high on the pa/ap and follow it back to the costophrenic angle

Is this positioning accurate? If it is not well positioned what is wrong with the image?

inaccurate positioning

• Humerus soft tissue not elevated appropriately

Criteria for accurate positioning on a AP chest

• Thoracic vertebra and posterior ribs seen through mediastinal structures - technique was accurate

• Symmetrical anatomy

• Clavicles on the same plane

• Scapula out of lung fields

• 1inch of lung field is visible above clavicles

  • Clavicles should be located around T3-T4

• Superior angle of scapula should be within clavicles

• All anatomy included

• 10 ribs above diaphragm

Is this positioning accurate? If it is not well positioned what is wrong with the image?

Inaccurate positioning

• clavicles are higher than the level of T3-T4 with less than 1 inch of apices above them

• patient is lordotic or CR not angled caudally enough

• Patient rotated LPO

  • Left ribs are elongated

  • Left lung appears wider

Is this positioning accurate? If it is not well positioned what is wrong with the image?

Inaccurate positioning

• Patient is kyphotic or CR angled too caudally

  • Clavicles are lower than the level of T3-T4 with more than 1 inch of apices above them

Is this positioning accurate? If it is not well positioned what is wrong with the image?

Accurate positioning

• patient with scoliosis

When a patient is rotated which way do the ANTERIOR structures move

The sAme way as the rotation

When a patient is rotated which way do the POSTERIOR structures move

The oPposite way of rotation