CHEST RADIOGRAPHY

Speaker: Mr. Aditya Thakur 2nd Year B.Sc RADIODIAGNOSIS AND IMAGING

Moderator: Mr. S.R CHOUDHRY Department of Radiodiagnosis & Imaging P.G.I.M.E.R., C andigar .

INTRODUCTION
C est !"ra# is t e most $ommon%# performed diagnosti$ !" ra# e!amination. &ppro!imate%# a%f of a%% !"ra#s o'tained in medi$a% instit(tions are $ est !"ra#s. & $ est !"ra# is (s(a%%# done for t e e)a%(ation of %(ngs, eart and $ est *a%%. Pne(monia, eart fai%(re, emp #sema, %(ng $an$er and ot er medi$a% $onditions $an 'e diagnosed or s(spe$ted on a $ est !"ra#. +raditiona%%#, $ est !"ra# a)e 'een ta,en prior to emp%o#ment, prior to s(rger# or d(ring immigration. + e (se of ro(tine $ est !"ra# is 'eing re"e)a%(ated 'e$a(se t ere is a %a$, of e)iden$e for t eir (sef(%ness. Ro(tine !"ra#s are o'tained in a'sen$e of spe$ifi$ signs s#mptoms or Medi$a% $onditions.

ANATOMY

+ e tr(n, of 'od# is di)ided '# t e diap ragm into an (pper and %o*er part. Upper part is $a%%ed t ora! and %o*er part is $a%%ed a'domen. + ora! is formed '# fo%%o*ing 'ones : &nterior%# '# stern(m : Posterior%# '# t e -. t ora$i$ )erte'ra and inter )erte'ra% dis$ : On ea$ side '# -. ri's

THORACIC CAVITY: + e $a)it# of t e t ora! $ontains t e rig t and %eft p%e(ra% $a)ities * i$ are $omp%ete%# in)aginated and o$$(pied '# t e %(ng. + e rig t and t e %eft p%e(ra% $a)ities are separated '# a t i$, median portion $a%%ed t e mediastinum. + e eart %ies in t e midd%e mediastin(m.

/

Structure lies inside t e !ediastinu!
+ra$ ea and its 'ron$ (s . Oesop ag(s 0 M(s$%es / Heart en$%osed in peri$ardi(m 1 &orta Trachea: It is fi'ro e%asti$ t('e a'o(t --$m %ong e!tending from t e %ar#n! at t e %e)e% of 2t $er)i$a% )erte'ra to %o*er 'order of /t t ora$i$ )erte'ra * ere it is di)ided in t e rig t & %eft 'ron$ i one for ea$ %(ng.

Lung: + e %(ngs are pair of respirator# organs and spong# in te!t(re. Ea$ %(ng is $oni$a% in s ape. + e rig t %(ng is di)ided into 0 %o'es a3 S(perior '3 Midd%e $3 Inferior '# t e t*o fiss(re a3 O'%i4(e '3 Hori5onta%

2

Structure lies inside t e !ediastinu! C"ntd#
6eft %(ng is di)ided into t*o %o'es '# t e o'%i4(e fiss(re. &. S(perior 7. Inferior Heart: + e eart is a $oni$a%, o%%o* m(s$(%ar organ sit(ated into t e midd%e mediastin(m. It is en$%osed *it in peri$ardi(m. + e eart is p%a$ed o'%i4(e%# 'e ind t e 'od# of t e stern(m so t at -80 of its %ies t e rig t and .80 to t e %eft of t e median p%ane.

Indicati"ns "$ t e C est Radi"%rap &
-. P(%monar# diseases s($ as

9o$ :s disease.

.. P%e(ra% disease ; P%e(ritis.
 

P%e(ris# " inf%ammation of p%(ra%. P%e(ra% eff(sion " f%(id in p%e(ra% $a)it#..

0. /. 1. 2. <. =.

Peri$arditis C est !"ra# are done for fo%%o* (p pts. Pre"operati)e and post"operati)e $ases +o see t e eart disease %i,e $ardiomega%%# +o see diap ragm mo)ement. 7%(nt +ra(ma C est

>. 7ron$ ia% ast ma -?. 7ron$ ia% pne(monia

E'uip!ent and Access"ries
  

@"ra# Unit Hig Po*er Generator C est stand or )erti$a% '($,#, &ir Gap Stand Cassettes

- X-Ray Unit: + e eart $#$%e is $omp%eted in a'o(t ?.?= se$ond. So t e e!pos(re time s o(%d 'e %esser t an ?.?= se$ to pre)ent t e '%(rring of eart s ado* d(e to in)o%(ntar# mo)ement of eart. + is t#pe of e!pos(re $an 'e a$ ie)ed '# ig m& and ig 9A @"ra# (nits *it o(tp(t in t e range. =??m& ; -???m& /?9A " -1? 9A  E!pos(re time $an 'e red($ed f(rt er '# t e (se of ig speed s$reen faster fi%m $om'ination.  It $an a%so 'e a$ ie)ed *it t e added ad)antage of se%e$ting a sma%%er fo$a% spot *it in t e t('e rating.

- High Power Generators: + e essentia% f(n$tion of H.+ generator in !"ra# t('e is to pro)ide s($ po*er * i$ is needed '# @"ra# t('e so an important spe$ifi$ation in t e des$ription of an# generator is a statement on its po*er o(t p(t. Unit <?9B ; -??9B generator is (sed * i$ $an gi)e -???" -.1?m& and (pper )o%tage %imit -1?9A.

( CHEST STAND OR )ERTICA* +UC,Y + e $ est stand is a o%der for $assettes t at is (sed to e!amine patients in ere$t position, for $ est or ot er radiograp #. It m(st o%d t e si5e of $assette (sed for $ est e!amination and rigid%#.

Preparati"n -"r T Radi"%rap

e C est &

+ is pro$ed(re re4(ires no spe$ia% preparation. 7(t a 'rief e!p%aination to patients *it a re earsa% of t e pro$ed(re s o(%d ens(re a satisfa$tor# res(%t. Respirator# mo)ement s o(%d 'e repeated se)era% times 'efore t e performan$e Is $onsidered to 'e satisfa$tor#. Patients *i%% a%so 'e as,ed to remo)e a%% meta%%i$ Ce*e%%er# or (ndergarments t at ma# $ontain meta% t at ma# interfere *it !"ra#s.

+asic Pr".ecti"ns
  

P& DPostero "anterior3 Ere$t &P D &ntero ;posterior 3 Ere$t or s(pine 6atera% DEre$t or sitting3

Additi"nal Pr".ecti"ns
O76IEUE a. P& O'%i4(e " 6eft P& O'%i4(e " Rig t P& O'%i4(e '. &P O'%i4(e " 6eft &P O'%i4(e " Rig t &P O'%i4(e .. &pi$ogram 0. 6ordoti$ /. De$('it(s

PA )ie/
Position o !atient :  Patient is made to stand in P& position, fa$ing t e $assette, in front of )erti$a% $ est stand.  C in of t e patient is p%a$ed o)er t e $assette  + e $assette is adC(sted - FG a'o)e t e (pper 'order of t e s o(%der. Position of part :  Hands of t e patient s o(%d 'e p%a$ed on *aist %e)e% 'e%o* t e ips , so t at t e# *i%% not 'e s(perimposed on CP ang%es.  Pa%ms s o(%d fa$e (p*ards and arms are rotated interna%%# to t ro* o(t t e s$ap(%a o(t of %(ngs.  S o(%ders so(%d %ie in t e same trans)erse p%ane and depressed to $arr# t e $%a)i$%es 'e%o* t e api$es.

Cassette Si5e: + e $assette si5e is $ osen so t at it m(st in$%(de t e api$es and %o*er region of t e diap ragm and $ est *a%%. It m(st in$%(des t e $ostop reni$ ang%e DCP3 Centra% Ra#: C.R. is dire$ted at rig t ang%e to t e fi%m at t e H(n$tion of /t & 1t t ora$i$ )erte'ra, IID: genera%%# 1 feet D2 feet for Heart si5e3. 7reat ing Instr($tions: + e e!pos(re is gi)en in arrested inspiration p ase, to s o* t e greatest possi'%e area of %(ng str($t(re.

P.A Position

6

P.A. Resultant Image

Structures shown
    

&ir fi%%ed tra$ ea 6(ngs Diap ragmati$ domes Heart &orti$ ,no'

E0aluati"n Criteria
Position wise: It m(st in$%(de * o%e of t e %(ng fie%d.  &pi$es  C.P. &ng%e  &n# rotation is easi%# dete$ted '# t e position of media% end of t e $%a)i$%e.  S$ap(%a s o(%d not o)er s ado* t e %(ng fie%d "#!osure $ise a. +ra$ ea & 'if(r$ation of tra$ ea m(st 'e seen in t e mid%ine. '. Aerte'ra% 'odies s o(%d 'e faint%# )isi'%e '(t not inter )erte'ra% spa$e. $. Heart & diap ragm s o* a s arp o(t%ine. d. Perip era% %(ng )esse%s m(st 'e seen.

Processing wise: P(t a finger (nder t e dar,est area of t e fi%m. If finger is not seen proper%#, t en it is proper%# de)e%oped.

PA in e1pirati"n
+ is )ie* is done in t*o $onditions.  Ior pne(mot ora!, P& is done in e!piration to $onfirm t e disease. + is as effe$t of intra p%e(ra% press(re * i$ res(%t in $ompression of %(ng ma,ing a pne(mot ora! 'igger.  + is te$ ni4(e a%so demonstrates t e effe$t of in a%ed foreign 'od# o'str($ting t e passage of air in %(ng segment and e!tent of diap ragmati$ mo)ement.

AP Pr".ecti"n 2Erect "r sittin%3
+ is )ie* is done as an a%ternati)e to P& ere$t proCe$tion. B en t e patient:s s ape or medi$a% $ondition ma,es it diffi$(%t or (nsafe for t e patient to stand or sit for 'asi$ proCe$tion. Ior t e %atter, t e patient is (s(a%%# s(pported sitting ere$t on a tro%%e# or 'ed side.

P"siti"nin% "$ patient 4 $il! $"r AP erect pr".ecti"n
+ e patient ma# 'e standing or sitting *it t eir 'a$, against t e $assette * i$ is s(pported )erti$a%%# *it t e (pper edge of t e $assette a'o)e t e %(ngs api$es.  + e median sagitta% p%ane is adC(sted at rig t ang%e to t e $enter of t e fi%m.  + e s o(%ders are 'ro(g t do*n*ard & for*ard *it t e 'a$, of t e ands 'e%o* t e ip & e%'o* for*ard Centra% ray: Is dire$ted at rig t ang%e to t e fi%m and to*ards t e sterna% not$ . + e $entra% ra# is t en ang%ed (nti% it is $oin$iding *it t e midd%e of t e fi%m. + e e!pos(re is ta,en on norma% f(%% inspiration

AP Supine pr".ecti"n 2"n 5edside3
Positioning o !atient & i%': Bit assistan$e, a $assette is $aref(%%# positioned (nder t e pt:s 'a$, *it t e (pper edge of $assette a'o)e t e %(ng api$es. + e median sagitta% p%ane is adC(sted at rig t ang%e to t e midd%e of t e fi%m & pt:s pe%)is is $ e$,ed to ens(re t at it is not rotated. + e arms are %atera%%# rotated. C in s%ig t%# raised. Centra% Ra# : Is same as ere$t &P proCe$tion E!pos(re: is ta,en on norma% f(%% inspiration

*ateral pr".ecti"n
Positioning o !atient an( i%': Patient is made to stand in %at position in front of t e )erti$a% $assette o%der *it side to 'e e!amined to($ ing t e fi%m. 7ot arms are raised o)er t e ead. Distan$e 'et*een fi%m & !ip istern(m e4(a% to t e distan$e 'et*een %ine Coining spino(s pro$ess.  Mid a!i%%ar# %ine s o(%d 'e .G posterior to mid%ine of grid. Centra% Ray: Is dire$ted t ro(g a!i%%a at t e %e)e% of D1. IID is genera%%# /?.G Grid is (sed 'e$a(se 9AP is more t an <?. +o pre)ent t e s$atter RadG. )ote: Ior diap ragmati$ a's$ess Dto see t e mo)ement of diap ragm3  +*o e!pos(res are gi)en on sing%e fi%m.  -st in inspiration .80m&s.  .nd in e!piration -80 m&s.  &%ternate pro$ed(re " I%(oros$op#

*ateral pr".ecti"n C"nt#
Latera% *iew is (one to see the:
   

Dept of t(mors. Part of t e %(ngs o)er%apped '# eart. +o demonstrate t e inter %o'ar fiss(res +o %o$a%i5e t e p(%monar# %esion. Posterior ri' s(perimposed Stern(m s o(%d not 'e rotated C.P. &ng%e and api$es s o(%d 'e in$%(ded. Hi%(m s o(%d appro! in $entre. E!p. S o(%d penetrate t e %(ng fie%d of eart.

"*a%uation Criteria:
    

at. Position

Resultant Image

Penetratin% )ie/ O$ C est
It is done to see ri' & eart.  It is done * en one side appears opa4(e on norma% $ est radiograp . Opa$it# d(e to #drot ora! or p#ot ora!. + (s to penetrate t ro(g t ese densities more e!pos(re is re4(ired. Grid is (sed one side * i$ is norma% *i%% 'e o)er e!posed so *edge fi%ters $an 'e (sed to see 'ot sides *it same opa$it#.

O5li'ue pr".ecti"n
Mediastin(m & %(ng fie%ds, in$ase of as'estosis p%e(ra% p%a4(es not seen in P& proCe$tion.  Rt. Midd%e %o'e ; &nt. o'%i4(e  7ot %o*er %o'e " Post o'%i4(e

a+ Right anterior o,%i-ue: + e patient in P& position & t e Rt. Side of t e tr(n, is ,ept in $onta$t *it t e $assette & patient is rotated to 'ring t e %eft side a*a# from t e fi%ms so t at t e $orona% p%ane is at an ang%e at /1? to t e fi%m. Centra% rays: Dire$ting at rig t ang%e to t e midd%e of fi%m. or at t e %e)e% of 2t t ora$i$ )erte'ra. ,+ Le t anterior o,%i-ue: + e patient in P& position & t e %eft side of t e tr(n, is ,ept in $onta$t *it $assette & t e patient is rotated to 'ring t e rig t side a*a# from t e fi%m so t at t e $orona% p%ane is at an ang%e of /1? to t e fi%m. Centra% Ray: Is dire$ting at rig t ang%e to t e midd%e of fi%m or at t e %e)e% of 2t t ora$i$ )erte'ra.

.tructure shown: 6(ng fie%d (s(a%%# appear s orter d(e to magnifi$ation of diap ragm.

01

Le t !osterior o,%i-ue: + e patient in &P position & t e %eft side of t e tr(n, is ,ept in $onta$t *it t e $assette. Patient is rotated to 'ring t e rig t side a*a# from t e fi%m. So t e $orona% p%ane is an ang%e of /1? to t e fi%m. Centra% Ray: at rig t &ng%e to t e midd%e of t e fi%m or at t e %e)e% of 2t t ora$i$ )erte'ra. .tructure shown:  + e ma!im(m area of %(ng.  +ra$ ea & its 'if(r$ation.  Heart des$ending aorta and ar$ of &orta.

Right !osterior o,%i-ue: + e patient in &P position and rig t side of t e tr(n, is ,ept in $onta$t *it t e $assette and patient is rotated to 'ring t e %eft side a*a# from t e fi%m so t e $orona% p%ane is an ang%e of /1? to t e fi%m Centra% ray at rig t ang%e to t e midd%e of t e fi%m or at t e %e)e% of 2t t ora$i$ )erte'ra.

.tructure shown:  Ma!im(m area of rig t %(ng & mediastina% $ontent.  &%so s o*n tra$ ea & entire %eft 'ran$ of 'ron$ ia% tree.  6eft atri(m, %eft main 'ran$ of t e p(%monar# arter#.

0=

APICOGRAM
&pi$ogram is done * en t ere is do('t of +.7. +.7 most%# 'egins in ape! region * ere t e %esion is s(perimposed '# $%a)i$%e. A!icogra' can ,e (one in two ways:  +('e ang%e, patient straig t  Patient ang%e, t('e straig t Tu,e ang%e, !atient straight D&!ia% proCe$tion3 patient in &P position. Patient is made to stand in front of t('e & 'a$, to($ ing to t e fi%m. Ii%m is p%a$ed /G"1G a'o)e t e (pper 'order of s o(%der Centra% ray is dire$ted C(st 'e%o* sterna% not$ *it -1? to .?? ang(%ation to*ards ead.

Patient in PA Position : Patient is made to stand in P& position in front of )erti$a% $assette o%der. & $assette is p%a$ed / to 1G a'o)e t e 'order of s o(%der. Centra% ray is dire$ted at %e)e% of C< *it -1".? ang(%ation to*ard t e feet. Patient ang%e & tu,e straight 'etho( : + e patient is made to stand fa$ing t e t('e J2 to =G a*a# from t e fi%m. Patient is as,ed to %ean 'a$,*ard to($ ing t e ead and ne$, on t e $assette. So t e $%a)i$%e is t ro*n a*a# from t e ape! of t e %(ng. Centra% ray: is dire$ted at t e sterna% not$ . .tructure shown : + e api$es %#ing 'e%o* t e s ado* of $%a)i$%es.

"*a%uation criteria:  + e $%a)i$%es s o(%d %ie s(perior to t e api$es.  Sterna% ends of $%a)i$%e s o(%d e4(idistan$e from t e )erte'ra% $o%(mn.  + e api$es s o(%d 'e in$%(ded.

/-

A!icogram A"ial Pro#ection

$la%icle
A!e"

Resultant Image

*"rd"tic )ie/
+ is proCe$tion is done to see  Midd%e %o'e $o%%apse of R 6(ng  Demonstrate t e magnified inter%o'(%ar eff(sions Positioning o !atient & Cassette: Patient is made to stand in P& position in front of a )erti$a% $assette o%der, patient is as,ed to o%d stand *it and and e is made to %ean 'a$, Bard i.e. appro! ; 0?? in$%ination. Centra% ray: is dire$ted at %e)e% of D1

ordotic Position

Resultant Image

Decu5itus Pr".ecti"n
Lat /ecu,itus: Patient is made to %ie in %atera% position on affe$ted side, Ii%m is p%a$ed eit er to($ ing to anterior or posterior aspe$t. +('e is 'ro(g t ori5onta%. 7ot De$('it(s s o(%d 'e done. I%(id *i%% $ome to t e side * i$ is %o*ered. Cassette Position: + e $assette is p%a$ed posterior%# or anterior%# in $onta$t *it t e $ est and adC(sted appro!imate%# .G a'o)e t e s o(%der. Centra% ra# is dire$ted at rig t ang%e to D1 Ma,e t e e!pos(re at t e end of f(%% inspiration.

.tructures shown : + is proCe$tion demonstrates t e $ ange in f%(id position and re)ea%s an# pre)io(s%# o's$(red p(%monar# areas or in $ase of s(spe$ted pne(mot ora!, presen$e of an# free air. "*a%uation criteria  + e patient s o(%d not 'e rotated from a tr(e fronta% position.  + e affe$ted side s o(%d 'e in$%(ded.  + e api$es s o(%d 'e in$%(ded.  Proper identifi$ation s o(%d 'e )isi'%e.

Decu&itus Position

Resultant Image

)entral "r d"rsal Decu5itus p"siti"n
Patient is made to %ie do*n in prone or s(pine position. E%e)ate t e t ora! ."0G on foam pad. &rms are ,ept o)er t e ead, $assette is p%a$ed against t e affe$ted side. + e $assette is adC(sted so t at it e!tends to t e %e)e% of %ar#ngea% prominen$e. 0a1e the e#!osure at the en( o u%% ins!iration Centra% ray: is dire$ted $enter to t e mid a!i%%ar# %ine at t e %e)e% of t e 2t t ora$i$ )erte'ra.

PEDIATRIC CHEST RADIOGRAPHY
&%t o(g t ere are man# simi%arities in pediatri$ and &d(%t $ est radiograp # in 'asi$ positioning and image 4(a%it#. +o maintain t e proper positioning and image 4(a%it#, it is essentia% to immo'i%i5e t e $ i%d '# (sing immo'i%i5ation de)i$es.  Some time *e a)e to ta,e e%p '# parents for immo'i%i5ation of patient d(ring radiograp #.  Be a)e to pro)ide radiation prote$tion '# (sing %ead apron, t #roid s ie%ding to t e $ i%d:s parent as *e%% as $ i%d.  If patient is $ooperati)e t en immo'i%i5ation de)i$e is not (sed.  7asi$ positioning of $ i%d is as ad(%t P&. &P. 6&+.  E!pos(re time s o(%d 'e %esser a'o(t ?.?= se$.

AP Pro#ection

Resultant Image

Selecti"n O$ ,il"0"lta%e
In genera% 2?"<?,)p is ade4(ate for t e Posterio" anterior proCe$tion. In * i$ $ase t ere *i%% 'e minor penetration of t e mediastin(m and eart. &n in$rease in ,i%o)o%tage o*e)er is ne$essar# for penetration of t e denser mediastin(m and eart to s o* t e %(ng 'e ind t ose str($t(res and 'e ind t e diap ragm as *e%% as t e %(ng 'ases in a )er# %arger or ea)# 'reasted patient

Hi% ,) Tec ni'ue
Be (sed 9A in t e range of >?"-/?. B i$ red($e $ontrast 'et*een t e %(ng fie%d and mediastin(m. Ho*e)er, (sing t is te$ ni4(e t ere is %oss of in erent $ontrast and )is(a%i5ation sma%% %esion of soft tiss(e densit# 'e$a(se possi'i%it# of p otoe%e$tri$ effe$t is de$reased at t e same time possi'i%it# of Compton effe$t is in$rease. + e p(rpose of ig 9A te$ ni4(e, *e ma,e (se of Compton effe$t * i$ is independent of atomi$ n(m'er. Pur!ose: + e app%i$ation of ig ,i%o)o%gate te$ ni4(e is primari%# *it a )ie* to o'taining e!pos(re time in t e region of mi%%ise$onds. + e effe$t $ontro% to '%(r t e image '# in)o%(ntar# mo)ement.

Air%ap Tec ni'ue
+ e te$ ni4(e of %ea)ing a gap 'et*een t e patient and fi%m d(ring radiograp # is $a%%ed air gap te$ ni4(e. AI0 : + e aim of t is te$ ni4(e %i,e grid, is a%so red($e t e effe$t of s$attered radiation prod($ed on t e fi%m. Princi!%e : + e s$atter radiation arising in t e patient, from $ompton s$attering tra)e%s in a%% dire$tions. B en an air gap is %eft 'et*een t e patient. Some of s$atter radiation *i%% not 'e a'%e to rea$ t e fi%m. Some *i%% 'e red($ed in intensit# d(e to in)erse s4(are %a*, some *i%% 'e def%e$ted in ot er dire$tion 'efore rea$ ing t e fi%m e.g. in $ est !" ra#, $er)i$a% spine %atera% proCe$tion.

Ne/er De0el"p!ents
D(e to ig er radiation dose and $ost in)o%)ed as 'igger si5e of fi%ms are 'eing (sed. + ere is gro*ing need to %oo, into t is aspe$t. + (s ne*er de)e%opments a)e ta,en p%a$e as fo%%o*ing 0ass 'iniature ra(iogra!hy 2O(e%ca ca'era3 +o red($e t e $ost of fi%m 'e$a(se a sma%% fi%m is (sed D-??to <?mm3 for fo%%o* (p $ases at +.7. in spe$ia%i5ed +.7. Hospita%s.

A(*antage /isa(*antage a. It is %ess $ost%# a. Hig radiation dose '. Storage pro'%em '. Information is %ess so%)ed $. It is done for +7 s$reening .. High 4V Techni-ue 5+ I'age intensi ier syste' 2/+6+ .yste'3 7+ /igita% chest ra(iogra!hy
This is (one ,y two 'etho(s+  I%at pane% dete$tor s#stem  Using imaging p%ate s#stem

6+P+/+ .yste': + ere is dete$tion at t e o(ter end * i$ pi$,s (p signa% and passes to ana%og $on)ertor. In t is ana%og(e data is $on)erted as:

I'aging !%ate 0etho(: A(*antage :  Post pro$essing.  Radiation dose %ess.  +e%e radiograp #.  Image $an 'e store.  Cost red($e.  7etter edge en an$ement. /isa(*antage : Initia% in)estment $ost ig .

C"!puted t"!"%rap & A'ter de%elo!ment o' $( technolog) $( is done 'or chest to %isuali*e the mass lesion in the lung 'ield as well as mediastinal mass+ so we can distinguish+ (he tumour or !leural e''usion+ ca%itation &) gi%ing intra%enous contrast media to enhance the lesion 'or &etter %isuali*ation 'or diagnosis whether it is malignant or &enign tumor. Bronchogra!h) is re!laced &) the de%elo!ment o' ,R$( chest it is done to %isuali*e the &ronchiactasis+ as well as the interstitial !arench)mal lung lesion.

Radiati"n pr"tecti"n
+ e radiation prote$tion $an 'e a$ ie)ed '# app%#ing ALARA Prin$ip%e As %ow as reasona,%y achie*a,%e3  Distan$e  +ime  S ie%ding -. 6imitation of fi%ed si5e '# (sing $o%%imators. .. Dire$ting t e 'eam. 0. Use of gonad s ie%ds. /. Caref(% preparation of t e patient. 1. Use of t e ig speed fi%m, s$reen, ig m& and s ort e!pos(re time. 2. Presen$e of essentia% staff on%#. <. Use of prote$ti)e apron or prote$ti)e s$reen

C"nclusi"n
C est !"ra# is t e 'asi$ in)estigation * i$ ma# re)ea% more information a'o(t t e patients disease. &ppro!imate%# F of t e a%% !"ra# e!amination is o'tained in medi$a% instit(tion are $ est !"ra#. + e 4(a%it# of C est !"ra# is of (tmost importan$e '(t it is diffi$(%t to maintain it as s%ig t )ariation in e!pos(re fa$tors, pro$essing time and s%ig t rotation d(e to ma%positioning ma# res(%t into %oss of t e information. So t e $ est radiograp # is to 'e done )er# $aref(%%#.

*e $an sa# in ot er *ords t at proper $ est radiograp # is a $ a%%enge for Radio%ogi$a% te$ no%ogist. + is $ a%%enge is met more effe$ti)e%# *it t e e%p of digita% radiograp # and more information is 'eing gat ered '# ot er ne* moda%ities %i,e C+ s$an, MRI et$

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