Chest X-ray positioning

outline
• Plain films different views
• Positioning
• Interpretation of the plain film
Different views of Xray chest
• PA
• Lateral
• AP,decubitis,supine,oblique
• Inspiratory-expiratory
• Lordotic,apical
PA view
• Most frequently requested
• Visualization of the lungs excellent
PA view positioning
• The patient faces
towards the cassette
and the tube is 6 feet
away from the patient.
Technical aspect
• Inspiration
• On full inspiration the
diaphragm should lie
at the level of 8-10th
posterior rib or 5-6th
anterior rib.
Technical aspect

Inspiratory film
Technical aspects
• Penetration
Over penetrated Under penetrated
rotation
Rotated x ray
Interpretation of the PA films
1.request form:
name,age,sex,date and
clinical presentation
2.trachea
3.Heart and
mediastinum
4.Diaphragm
6.Pleural spaces
7.Lungs
8.Hidden areas
9.Hila
10.Below diaphragm
11.Soft tissues
12.Bones
Trachea
Examined for
• Position
• outline
• Caliber coronal diameter is
25mm for males and 21mm for
females
• Para tracheal stripe<5mm
• Azygos vein<10mm
• Carina angle:60-75degree.
Heart
• Size
• Shape
Transverse cardiac
diameter:<14.5cm in females
and <15.5cm in males. An
increase of 1.5 cm is significant
Cardiothoracic ratio<50%
mediastinum
• Right superior mediastinal
shadow formed by SVC and
innominate vessels.
• Left superior mediastinal
shadow formed by the
subclavian artery
• Ant junction line
• Post junction line
• Thymus
• Paraspinal lines 10 mm on
the left and 3mm on the
right
Ant and post junction lines
• Ant junction line
• Parietal and visceral pleurae
meeting
anteromedially.oblique course
• Post juction line.formed by
posteromedial surfaces of the
pleurae of the upper lobes post
to oesophagus
thymus
• Triangular sail-shaped
structure, well defined borders
projecting from one or both
side of the mediastinum.
Para spinal lines
Diaphragm
• Outline
• shape
• relative position
Pleural spaces

• Costophrenic angles
• Cardiophrenic angles
lungs
• Local,generalised abnormality
• Comparison of the
translucency
• Vascular markings of the lungs
Zones
Hidden areas
• The apices
• Mediastinum and hila
• Diaphragm
• bones
Hila
• Contain the following structures
• The inferior pulmonary ligament
• The pulmonary vessels
• The bronchial vessels
• the bronchi
• The lymphatic system
• The lymph nodes
Right hilum
Left hilum
Below diaphragms
• Gas shadows
• Calcifications
Soft tissues
• Breast shadows and nipple
shadows
• Skin folds
• Muscles
• Companion shadows
Nipple markers
Skin fold
Muscles and companion shadows
bones
• Sternum
• Clavicles
• Scapulae
• ribs
• spine
Lateral film
• positioning
Interpretation of lateral film
• The clear spaces
• Retrosternal space
• Retrotracheal space
• Vertebral translucency
• Diaphragm outline
• The fissures
• The trachea
• The sternum
Retrosternal space
Vertebral translucency
Diaphragm outline
• Right diaphragm continues
anteriorly
• Left is silhouetted posteriorly
by heart shadow
The fissures
AP view
• the patient back is towards the
cassette and tube is 40 inches
away from the patient.
• for patients unable to stand
Decubitus position
• The patient faces towards the
cassette while lying in
decubitus position and tube Is
towards the back
Decubitus position
• To asses the volume of
pleural fluid.
• Loculated pleural effusion or
mobile
Apical view
Oblique view
• positioning
Oblique view
• To visualize retro cardiac area,
the posterior costophrenic
angles, the chest wall and the
pleural plaques.
• Lordotic PA view
Paired inspiratory and expiratory
• Demonstrate air trapping and diaphragm
movements.
• Very important in diagnosis of inhaled foreign
body in children.
Paired inspiratory and expiratory view
Thank you