Chest

RAD 371 Chest

Technical Factors

• SID: 72” 

• Collimation Field Size: 14 x 17 

• IR Alignment: Portrait or Landscape 

• Grid: Yes 

• kVp Range: 110 to 125 

Anatomy

• Apices

• Costophrenic Angles

• Mediastinum

• Sternum 

• Bases

• Cardiophrenic Angles

• Ribs

• T-spine 

• Clavicles

• Heart Shadow

• Scapulae

• Trachea 

• Hilum

• Diaphragm 

How many pairs of ribs (minimum) should be visible on a normal adult PA chest?

10

Topographical Landmarks

Vertebral Prominens (C7)

Jugular Notch (T2)

PA Chest - Patient Positioning

• Place patient upright facing the chest bucky 

• Chin is raised, resting against IR 

• Have the patient place their hands on their lower hips and roll their shoulders forward 

PA Chest Positioning/Instructions for:

• CR

• Collimation

• Inspiration

• CR: Mid-sagittal plane at the level of T7 (7 to 8 inches below vertebral prominence) 

• Collimation: Collimate to four sides to area of lung fields

• Respiration: Exposure is made at the end of second full inspiration 

Left Lateral Chest - Patient Positioning

• Patient erect, left side against the IR in true lateral 

• Arm raised above head, chin up 

Left Lateral Chest Positioning/Instructions for:

• CR

• Collimation

• Inspiration

• CR: Midthorax at level of T7 (3 to 4 inches below level of jugular notch) 

• Collimation: Collimate on four sides to area of lung fields 

• Respiration: Make exposure at the end of second full inspiration 

Anterior Oblique Patient Positioning: RAO & LAO

• Patient erect, rotated 45° anterior oblique 

• Slightly elevate their chin and move arms so they are not superimposed on the thorax 

• As viewed from the x-ray tube, center the patient to CR and to IR 

Anterior Oblique Chest Positioning/Instructions for:

• CR

• Collimation

• Inspiration

• CR: Perpendicular, level of T7; CR midway between midsagittal plane and lateral margin of thorax 

• Collimation: Collimate on four sides to area of lung fields 

• Respiration: Make exposure at the end of second full inspiration 

RAO Shoulder Position

Right anterior shoulder against IR

LAO Shoulder Position

Left anterior shoulder against IR

True/False: RAO will visualize the left lung best.

False. RAO will visualize the right lung best.

True/False: LAO will visualize the left lung best.

True.

Posterior Oblique Patient Positioning: RPO & LPO

• Patient erect, rotated 45° (up to 60°) posterior oblique 

• Slightly elevate their chin and move arms so they are not superimposed on the thorax 

Posterior Oblique Chest Positioning/Instructions for:

• CR

• Collimation

• Inspiration

• CR: Perpendicular, to level of T7; CR midway between mid-sagittal plane and lateral margin of thorax 

• Collimation: Collimate on four sides to area of lung fields 

• Respiration: Make exposure at the end of second full inspiration 

Which will visualize the right lung best, and which will visualize left lung best with RPO/LPO?

RPO will visualize the right lung best.

LPO will visualize the left lung best.

AP Lordotic Patient Positioning

• Patient standing about 1 foot away from the IR 

• Have the patient lean back with shoulders, neck and back of head against the IR 

• Both patient’s hands on hips and shoulders rolled forward 

• Center mid-sagittal plane to CR and to centerline of IR 

AP Lordotic Positioning/Instructions for:

• CR

• Collimation

• Inspiration

• CR: To mid-sternum (3 to 4 inches below jugular notch) 

• Collimation: Collimate on four sides to area of lung fields 

• Respiration: Make exposure at the end of second full inspiration 

PA Projection SID

72”

PA Projection Collimation Field Size - Landscape

17” x 14”

Chest kVp

110-125

Left Lateral Collimation Field Size - Portrait

14” x 17”

Left Lateral Projection IR Alignment

Portrait

PA Projection IR Alignment (for lab purposes)

Landscape

How far forward should the patient walk their feet for an AP Lordotic Projection?

About 1 foot away.

How are the patient’s shoulders positioned for an AP Lordotic Projectoin?

Shoulders are against the IR and rolled forward.

Which marker placed for a Left Lateral Projection?

Left

Which marker is placed if a patient’s right shoulder is on the IR for an oblique projection?

Right