Chest : Special Views

Chest Special projections/positions

• Ap supine or semierect

• Lateral decubitus

• Ap Lordotic

• Anterior Oblique

• Posterior Oblique

AP chest positioning 

Position: Supine , Semi-upright , Upright

CR: ± 5 degrees caudad perpendicular with long axis of sternum

CR centering: Level of T7 3-4 inches below jugular notch

Top of IR 1.5 inches above shoulders

AP Chest : Evaluation criteria

• Scapula not completely out of lung field

• 8-9 ribs

• 2/3 posterior ribs above clavicles if proper caudad angle

How to find centering for AP chest

• Find jugular notch and xiphoid process

• The centering is the halfway between the two

AP Semi-erect chest

Left Lateral Decubitus 

• Support patient to build them up so they are even and we don’t clipped anything

• 14×17 CW center T7

• Look for air/fluid levels since patient can’t stand →

• To determine if patient has air/fluid in lungs 

Lateral Decubitus : What are you looking for air or fluid?

• Fluid is heavier than water (Pleural effusion) 

• When looking for air → Side up 

• Looking for fluid → Side down 

Lateral Decubitus : Evaluation criteria

• Entire lung included

• no rotation 

• arms up not superimposed over lungs 

• Full inspiration 

• No motion 

• exposure factors

• If you mark side up also put upright marker. Most put side down

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AP Lordotic 

• Patient steps a foot away from wall bucky and leans back 

• Allows clavicles to be high enough to see apices

AP axial Lordotic Supine 

CR: 15-20 degrees cephalad as it achieves the same as AP Lordotic 

Lordotic position evaluation criteria 

• No rotation

• No motion

• Clavicles above apices

• center at T-7 

• Exposure factors

Anterior Obliques : ( Side away is elongated) 

• Left arm up/ right arm down ( RAO)

• Light field to frame chest

• thyroid is behind lots of tissues

• CR perpendicular level of T7

• RAO → Left side elongated 

• LAO → Right side elongated

How to measure which side is elongated?

• Measure the of spine to lateral ribs to determine elongation/foreshortening

Posterior Obliques : Side down is elongated

• Arms away ; Right down/left up ( LPO)

• LPO → Left side elongated

• RPO → Right side elongated

Posterior Obliques : Evaluation criteria

• Correct side elongated

• no motion

• both lungs demonstrated

• LAO/RPO Identical

• RAO/LPO identical 

Dyspnea

Difficulty breathing

SOB

Shortness of breath

Hyperventilation

Rapid/fast breathing

Aspiration

food or liquid entering the lungs instead of the stomach

Pneumothroax

Excess air in pleural cavity

→ pushes lungs can’t fully expand

Atelectasis

Collapse of lung tissue

• collapses on itself

Pleural effusion / Hemothorax

Fluid/blood in pleural cavity

Pulmonary emphysema

chronic lung disease that damages the air sacs (alveoli) in the lungs, making it difficult to breathe

Pneumonia

an inflammation of the lungs caused by an infection.

Bronchogenic Carcinoma

Lung cancer

TB

an infectious disease, caused by the bacterium Mycobacterium tuberculosis, that primarily affects the lungs but can also spread to other parts of the body

What type of CR angle is required for the AP semiaxial projection for the apices of the lungs ? 

15-20 degrees cephalad 

What chest projections/positions should be performed to demonstrate a pneumothorax in the left lung if the patient cannot stand ?

Right lateral decubitus 

What chest projection/positions should be performed to demonstrate a pleural effusion ibn the right lung if the patient cannot stand ? 

Right lateral Decubitus

Anterior Obliques - PA RAO/PA LAO 

• Patient erect

• 45 degree oblique standard 

• 45-60 degrees for heart and great vessels

• 15-20 degrees for possible pulmonary disease

• Air filled trachea , great vessels and heart outline 60 degree LAO