Posi Chest

Evolve.
Adapt.
Overcome.
CEFI is now ready.
CHEST
FOR LUNGS AND HEART
CHRISTY MAE ANNE SIBULO, RRT

College of Radiologic Technology
COLLEGE OF RADIOLOGIC TECHNOLOGY
THORACIC CAVITY
- Bounded by the walls of the thorax and extends from the superior thoracic aperture (where
structures enter the thorax) to the inferior thoracic aperture
DIAPHRAGM
- Separates the thoracic cavity
from the abdominal cavity
The thoracic cavity contains:

• Lungs
• Heart
• Organs of the respiratory, cardiovascular and lymphatic systems
• Inferior portion of the esophagus
• Thymus gland
3 separate chambers:
• Pericardial cavity
• Right pleural cavity
• Left pleural cavity
RESPIRATORY SYSTEM
• Pharynx
• Trachea
• Bronchi
• Lungs
PHARYNX
- Passageway where air pass through it before entering the

respiratory system
- Also referred to as the upper airway or the upper respiratory tract
- Located at the posterior area between the nose and mouth above
and the larynx and esophagus below
- Serves as a passageway for food and fluids as well as air
3 divisions:
• Nasopharynx
• Oropharynx
• laryngopharynx
PARENCHYMA
- Composition of lungs that are light, spongy, highly elastic substance and
are covered by a layer of serous membrane
COSTOPHRENIC ANGLE
- Deep recesses of the parietal pleura
HILUM
- The mediastinal surface is concave with a depression called hilum
- Accommodates the bronchi, pulmonary blood vessels, lymph vessels and
nerves
CARDIAC NOTCH
- The inferior mediastinal surface of the left lung contains a concavity
called cardiac notch
- This notch conforms to the shape of the heart
VISCERAL PLEURA
- Inner layer of the pleural sac
- Closely adheres to the surface of the lung, extend into the
interlobar fissures and is contiguous with the outer layer of the
hilum
PARIETAL PLEURA
- Outer layer
- Lines the wall of the thoracic cavity occupied by the lung and
closely adheres to the upper surface of the diaphragm
PLEURAL CAVITY
- The space between the two pleural walls
MEDIASTINUM
• Heart
• Great vessels
• Trachea
• Esophagus
• Thymus
• Lymphatics
• Nerves
• Fibrous tissue
• Fat
FOUR PARTS OF THE RESPIRATORY SYSTEM PROPER

THAT ARE IMPORTANT IN CHEST RADIOGRAPHY
1. LARYNX (voice box) – cagelike, cartilaginous structure that is 1 ½ to 2 inches in length in an

adult. It serves as the organ of voice.
2. TRACHEA (windpipe) – fibrous, muscular tube with 16-20 C-shaped cartilaginous rings
embedded in its walls for greater rigidity. It is located anterior to the esophagus
3. RIGHT & LEFT BRONCHI – also known as right and left main stem bronchi. The right primary
bronchus is wider and shorter than the left bronchus. The right primary bronchus is also more
vertical; therefore, the angle of divergence from the distal trachea is less abrupt for the right
bronchus than for the left.
4. Lungs – two large, spongy lungs, which are located on each side of the thoracic cavity
PA CHEST RADIOGRAPH
- An enormous amount of medical information can be obtained from a properly exposed and carefully
positioned PA chest radiograph
- The technical factors are designed for optimal visualization of the lungs and other soft tissues and
the bony thorax can also be seen
- The lungs and trachea are well shown, although usually the bronchi are not seen easily
- The heart, large blood vessels and diaphragm also are well-visualized
Radiographically important parts of the lungs:

• APEX (B) – the rounded upper area above the level of clavicles.
- extend up into the lower neck area to the level of T1
• CARINA (C) – point of bifurcation, the lowest margin of the separation of the
trachea into the right and left bronchi
• BASE (D) – lower concave area of each lung that rests on the diaphragm
• COSTOPHRENIC ANGLE (F) – extreme outermost lower corner of each lung,

where the diaphragm meets the ribs
• HILUM (G) – also know as the root region, the central area of each lung, where
the bronchi, blood vessels, lymph vessels and nerves enter and leave the lungs
LATERAL CHEST VIEW

- The image shows the left lung as seen from the medial aspect
- Only two lobes are seen (because left lung has 2 lobes)
- Some of the lower lobe (D) extends above the hilum (C) posteriorly
- Some of the upper lobe (B) extends below the hilum anteriorly
- The posterior portion of the diaphragm is the most inferior part of the
diaphragm
- The right lung is usually about 1 inch shorter than the left lung. Because of the
space occupying by the liver which pushes up on the right hemidiaphragm
- The right and left hemidiaphragms are seen
- The right hemidiaphragm is more superior than the left
BODY HABITUS
- Determines the size, shape, position and movement of the internal organs
• HYPERSTHENIC
• STHENIC
• HYPOSTHENIC
• ASTHENIC
- a massively built HYPERSTHENIC patient has a thorax that is very broad and very deep from front
to back but is shallow in vertical dimension
- Therefore, care must be taken that the sides or the costophrenic angles are not cutoff on PA chest
- Which must be taken with IR placed crosswise
- Careful centering is also required in lateral projection to ensure the anterior or posterior margins
are included
- a slender ASTHENIC patient. With this build, the thorax is narrow in width and shallow from front
to back but is very long in its vertical dimension
- Therefore, tech must ensure that the IR is long enough to include both the upper apex and the
lower costophrenic angles
BREATHING MOVEMENTS
- Movements of the bony thorax during inspiration and expiration

greatly change the dimensions of the thorax and the thoracic volume
- To increase the volume of the chest during inspiration, the thoracic

cavity increases in diameter in three dimensions
1. Vertical diameter – increased primarily by contraction and moving
downward of the diaphragm, increasing the thoracic volume
2. Transverse diameter – the ribs swing outward and upward, and
this increases the transverse diameter of the thorax
3. Anteroposterior diameter – raising of the ribs, especially the 2nd
through 6th ribs
DEGREE OF INSPIRATION
- To determine the degree of inspiration in chest radiography, one should be

able to identify and count the rib pairs on a radiograph.
- The first and second pairs are the most difficult to locate
- The best method that can be used to determine the degree of inspiration is
to observe how far down the diaphragm has moved by counting the pairs of
posterior ribs in the lung area above the diaphragm
- A general rule for average adult patients is to show a minimum of 10 on a

good PA chest radiograph
NOTE: Patients with pulmonary diseases and trauma may be unable to inspire
deeply. Therefore, it may be impossible to demonstrate 10 ribs above the
diaphragm for these chest projections.
GENERAL POSITIONING CONSIDERATIONS

- For radiography of the heart and lungs the patient is placed in an upright
position whenever possible to prevent engorgement of the pulmonary
vessels and to allow gravity to depress the diaphragm
- Upright also demonstrates air and fluid levels
- In recumbent position, gravitational force causes the abdominal viscera and

diaphragm to move superiorly; it compresses the thoracic viscera, which
prevents full expansion of the lungs
- The left lateral position is most commonly employed because it places the
heart closer to the IR, resulting in a less magnified heart image
- Patient preparation for chest radiography includes the removal of all opaque objects from the
chest and neck regions, including clothes with buttons, snaps, hooks or any object that would be
visualized on the radiograph
- To ensure that all opaque objects are removed, ask the patient to remove all clothing including
bras and necklaces and put on a hospital gown
- Long hair tied up with pony tails or clam
- Oxygen lines should be moved to the side and ECG leads are removed if possible
PA 72” SID
• AP radiographs increases heart magnification at 72 inches, which complicates the diagnosis of
possible heart enlargement (cardiomegaly)
• The reason for this increased magnification is the anterior location of the heart within the
mediastinum
• Placing the heart closer to the IR on PA position results in less magnification
• A longer SID such as 72 inches, magnifies less
ERECT CHEST RADIOGRAPH

All chest radiographs should be taken in an erect position if patient’s condition allows
THREE REASONS ARE:
1. The diaphragm is allowed to move down farther
- allows the diaphragm to move to its lowest position on full inspiration and allows the lungs to aerate
fully
2. Air and fluid levels in the chest may be visualized
- the heavier fluid such as blood or pleural fluid gravitates to the lowest position while the air rises
- in recumbent position, pleural effusion spreads out over the posterior surface of the lung producing
a hazy appearance on the entire lung
3. Engorgement and hyperemia of pulmonary vessels may be prevented
- engorgement means ‘distended or swollen with fluid’
- hyperemia is an excess of blood that results in part from the relaxation of the distal small blood
vessels
- erect position minimizes engorgement and hyperemia, while a supine position increases these
EVALUATION CRITERIA
PA CHEST POSITIONING
True PA, No Rotation
- Even a slight rotation of PA results in distortion of size and shape of the heart shadow because the heart is located
anteriorly in the thorax
- To prevent rotation, ensure that the patient is standing evenly on both feet with both shoulders rolled forward and
downward
- Check posterior aspect of shoulders and lower rib cage and the pelvis to ensure no rotaion
- Scoliosis and excessive kyphosis make it difficult to prevent rotation
Extending the chin

- Sufficient extension of the patient’s neck ensures that the chin and neck are not superimposing the uppermost lung
regions (apices of the lung)
Minimizing breast shadow

- A patient with large pendulous breasts should be asked to lift them up and outward and then to remove her hands as she
leans against the IR, to keep them in position
- This lessens the effect of breast shadows over the lower lung fields
LATERAL CHEST POSITIONING
Side Closes to IR
- A left lateral should be performed unless departmental protocol indicates or unless certain pathology in the right lung
indicates the need for right lateral
- A left lateral is more accurately demonstrates the heart region because the heart is located primarily in the left thoracic
cavity
True lateral, No rotation or tilt

- Ensure the patient is standing still with weight evenly distributed on both feet and arms raised
- Confirm that the posterior surfaces of the shoulder and the pelvis are directly superimposed and perpendicular to the IR
- Because of the divergent of the xray beam, the posterior ribs on the side farthest away from the IR are magnified slightly
and projected slightly posterior compared with the side closest to IR
Direction of Rotation
- The direction of rotation on lateral chest is sometimes difficult to determine
- This can be done by identifying the left hemidiaphragm by the gastric air bubble in the stomach or by the inferior border of
the heart shadow
No tilt
- There should be no tilt or leaning sideways
- The MSP must be parallel to the IR
- For broad-shouldered patients, the lower lateral thorax or hips or both may be 1 to 2 inches away from the IR
- Tilt is evident by closed disk spaces in the thoracic vertebra
Arms raised High

- To prevent superimposition on the upper chest field
- Patients who are weak or unstable may need to grasp a support
CR CHEST POSITIONING METHOD

VERTEBRAL PROMINENCE (PA CHEST)
- Vertebral prominence corresponds to the level of T1 and the uppermost margin of the apex of the lungs
- Can be palpated at the base of the posterior neck
- For adult female – down about 7 inches
- For adult male – down about 8 inches
- One method of determining the distance is by using average hand spread
CR CHEST POSITIONING METHOD

JUGULAR NOTCH (AP CHEST)
- Easily palpated jugular notch is the recommended landmark for location of CR
- The level of T7 on average adult is 3-4 inches below the jugular notch
- This distance is determined by hand width
TECHNICAL FACTORS
• kV should be high enough to result in sufficient contrast to demonstrate the many shades of gray needed
to visualize finer lung markings
• In general, chest radiograph uses low contrast (long scale of contrast / more shades of gray)
• This requires a high kV of 110 to 125
• Use of high mA and short exposure time to minimize the chance of motion and resultant loss of
sharpness
• Sufficient mAs should be used to provide optimum density (brightness) of the lungs and mediastinal
structures.
• A determining factor for this on PA chest is to be able to see faint outlines of at least the mid and upper
vertebrae and posterior rib through the heart and other mediastinal structures
BREATHING INSTRUCTIONS
• During normal inspiration, the costal muscles pull the anterior ribs superiorly and laterally, the shoulders
rise and the thorax expands from front to back and from side to side.
• Deep inspiration causes the diaphragm to move inferiorly, resulting in elongation of the heart.
• Radiographs of the HEART should be obtained at the end of normal inspiration to prevent distortion
• More air is inhaled during the second breath than the first breath
• When a PNEUMOTHORAX is suspected, one exposure is often made at the end of full inspiration and
another exposure at the end expiration to demonstrate small amounts of free air in the pleural cavity that
might be obscured on the inspiration exposure
• Also to demonstrate fixation or lack of normal movement of the diaphragm, the presence of a foreign body
and the need to distinguish between an opacity in the rib and one in the lung
RADIATION PROTECTION
• Patients should be protected from unnecessary radiation for all diagnostic radiographic examination, especially for chest
radiographs because these are the most common examination
REPEAT EXPOSURES
• Unnecessary radiation exposure from repeat exposures should be minimized by taking extra care in positioning, CR centering,
selecting correct exposure factors
COLLIMATION
• Restricting the primary beam by collimation not only reduces patient dose by reducing the volume of tissue irradiated but
also improves image quality by reducing scatter radiation
LEAD SHIELDING/ BACKSCATTER PROTECTION

• Lead shield should be used to protect the abdominal area below the lungs
• This is important for children, pregnant and all childbearing age
• Type of shielding is freestanding, adjustable mobile shield placed between the patient and the xray tube and a vinyl-covered
lead that ties around the waist
• Provide shielding from the level of iliac crest or slightly higher to the mid thigh area
PLACEMENT OF IMAGE MARKERS
• It is important to put markers prior to exposure

• There are conditions such as situs inversus, in which major organs are located on the opposite side
• With this condition the heart is located in the right thorax
OBESE PATIENT CONSIDERATION
• An obese patient may present positioning and centering challenges

• Because of large body girth, the technologist may place the top of IR 1 to 2 inches above the
shoulder
• Center the CR and IR to level of T7 rather than base centering on the shoulders
• T7 remains the centering point for most chest projections
• T7 is located at the level of inferior angle of the scapula, but due to obesity it cannot be located
• Use vertebral prominence as the landmark to assist locating the T7 (7” below vertebral
prominence)
• In AP projection, use jugular notch as the landmark. (T7 is apprx. 3-4” inferior to jugular notch)
CLINICAL INDICATIONS
• ASPIRATION – inspiration of a foreign material into the airway
• ATELECTASIS – a collapse of all or part of the lung
• BRONCHIECTASIS – chronic dilatation of the bronchi and bronchioles associated with secondary
infection
• BRONCHITS – inflammation of the bronchi
• CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) – chronic condition of persistent
obstruction ofbronchial airflow
• CYSTIC FIBROSIS – disorder associated with widespread dysfunction of the exocrine glands,
abnormal secretion of sweat and saliva and accumulation of thick mucus in the lungs
• EMPHYSEMA – destructive and obstructive airway changes leading to an increased volume of the
air in the lungs
• EPIGLOTTITIS – inflammation of the epiglottis

• DYSPNEA – shortness of breath which creates a sensation of difficulty in breathing
• GRANULOMATOUS DISEASE – condition of the lung marked by formation of granulomas
• TUBERCULOSIS – contagious and chronic infection of the lung due to tubercle bacillus
• HYALINE MEMBRANE DISEASE (HMD) in infants or ADULT RESPIRATORY DISTRESS SYNDROME
(ARDS) in adults - emergent condition in which the alveoli and capillaries of the lung are injured
or infected, resulting in leakage of fluid and blood into the spaces between alveoli or into the
alveoli themselves with formation of hyaline membranes
• PLEURAL EFFUSION – collection of fluid in the pleural cavity

• EMPYEMA – occurs when the fluid is pus
• HEMOTHORAX – occurs when the fluid is blood
• PNEUMOCONIOSIS – lung diseases resulting from inhalation of industrial substances
• Anthracosis (coal miner’s lung / black lung) – inflammation caused by inhalation of coal dust
• Asbestosis – inflammation caused by inhalation of asbestos
• Silicosis – inflammation caused by inhalation of silicone dioxide
• PNEUMONIA – acute infection in the lung parenchyma
• PNEUMOTHORAX – accumulation of air in the pleural space
UPPER AIRWAY
LATERAL POSITION
Clinical Indications:
Investigate pathology of the air-filled larynx and trachea, including the region of the
thyroid and thymus glands and upper esophagus for opaque foreign body or if contrast is
present
rule out epiglottitis
PATIENT POSITION
- Patient should be upright if possible, seated or standing in lateral position
PART POSITION
- position patient to center upper airway to CR and to center of IR
- Rotate shoulders posteriorly with arms hanging down and hands clasped behind back
- Raise chin slightly and have patient look directly away
- Adjust IR height to place top of IR at level of EAM
CR
- CR perpendicular to center of IR at level of C6 or C7, midway between the
laryngeal prominence of thyroid cartilage and the jugular notch
RESPIRATION
- Make exposure during a slow, deep inspiration to ensure filling trachea and
upper airway with air
AP PROJECTION
Investigate pathology of the air-filled larynx and trachea, including the region of the thyroid and
thymus glands and upper esophagus for opaque foreign body or if contrast is present
PATIENT POSITION
- Patient should be upright if possible,
seated or standing in lateral position
PART POSITION
- Align MSP with CR and with midline of grid or table
- Raise chin so that AML is perpendicular to the IR
- Adjust IR to place top of IR about 1 or 1 ½ inches below EAM
CR
- CR perpendicular to center of IR at level of T1-2, about 1 inch above the jugular
notch
RESPIRATION
- Make exposure during a slow, deep inspiration to ensure filling trachea and
upper airway with air
AXIOLATERAL PROJECTION – Trachea and Pulmonary Apex

TWINING METHOD
This projection is used to obtain an axiolateral image of the apex of the lung nearest
the IR and the trachea and superior mediastinum in patients who cannot rotate their
shoulders posteriorly enough for a true lateral projection.
PATIENT POSITION
- Seated or standing before VCH
with affected side toward the IR
PART POSITION
- Elevate arm adjacent to IR in extreme abduction, flex elbow and place the forearm across or behind
the head
- CR the IR to the region of trachea at the level of axilla
- Depress the opposite shoulder as much as possible
- Adjust the body in true lateral position with MSP parallel with plane of the IR
CR
- Direct CR to the center of IR through the adjacent
supraclavicular impression at an angle of 15 degrees
caudad
RESPIRATION
- Make exposure during a slow, deep inspiration to
ensure filling trachea and upper airway with air
CHEST
PA PROJECTION
when performed erect, demonstrates pleural effusion, pneumothorax, atelectasis and signs
of infection
PATIENT POSITION
- Patient erect, feet spread slightly, weight equally distributed on both feet
- Chin raised, resting on IR
- Hands on lower hips, palms out, elbows partially flexed
- Shoulders rotated forward against the IR to allow scapulae to move laterally clear of lung fields;
shoulders are depressed downward to move clavicles below the apices
PART POSITION
- Align MSP with CR and with midline of IR with equal margins between lateral thorax and sides of IR
- Ensure no rotation of thorax by placing MCP parallel to IR
- Top of IR is apprx. 1 ½ to 2 inches above shoulders
CR
- CR perpendicular to IR and centered to MSP at the level of T7 (7-8 inches
below vertebral prominence, or to the inferior angle of scapula)
RESPIRATION
- Make exposure at end of second full inspiration
PA PROJECTION
on stretcher if patient cannot stand
Clinical Indications
demonstrates pleural effusion, pneumothorax, atelectasis and signs of infection
PATIENT POSITION
- Patient erect, seated on stretcher, legs over the edge
- Arms around the cassette
- Shoulders rotated forward and downward
PART POSITION
- Top of IR is about 1 ½ to 2 inches above top of shoulders and CR at T7
- If portable IR is used, place pillow or padding on lap to raise and support IR
CR
- CR perpendicular to IR and centered to MSP at the level of T7 (7-8 inches
below vertebral prominence, or to the inferior angle of scapula)
RESPIRATION
LATERAL POSITION
A 90° perspective from PA projection may demonstrate pathology
situated posterior to the heart, great vessels, and sternum.
PATIENT POSITION
- Patient erect, left side against IR (unless patient complaint involves right
side)
- Weight equally distributed on both feet
- Arms raised above head, chin up
PART POSITION
- Center patient to CR and to IR anteriorly and posteriorly
- Position in a true lateral position (MCP is perpendicular and MSP is parallel
to IR
- Lower CR and IR slightly from PA if needed
CR
- CR perpendicular, directed to midthorax at level of T7
RESPIRATION
LATERAL POSITION
with wheelchair or stretcher if patient cannot stand
PATIENT POSITION on cart

- Patient seated on cart, legs over the edge
- Arms crossed above head or hold on to arm support keeping arms high
- Chin extended upward
PATIENT POSITION on wheelchar

- Remove arm rests if possible
- Turn patient in wheelchair to lateral position as close to IR as possible
- Have patient lean forward and place support blocks behind back; raise arms
above head and have patient hold on to support bar-keeping arms high
PART POSITION
- Center patient to CR and to IR by checking anterior and posterior aspects of thorax; adjust CR and IR to
level of T7
- Ensure no rotation by viewing patient from tube position
CR
- CR perpendicular, directed to midthorax at level of T7
RESPIRATION
AP PROJECTION
supine or semierect
this projection demonstrates pathology involving the lungs, diaphragm and mediastinum
determining air-fluid levels requires a completely erect position with CR horizontal (decubitus)
PATIENT POSITION
- Patient is supine on cart
- if possible, the head end of the cart or bed should be raised into a semierect position
- Roll patient’s shoulders forward by rotating arms medially or internally
PART POSITION
- Place IR under or behind patient
- Align center of IR to Cr
- Top of IR about 1 ½ inches above shoulders
- Center patient to CR and to IR
CR
- CR angled caudad to be perpendicular to long axis of sternum (gen.requires 5 degrees
caudad angle, to prevent clavicles from obscuring the apices
- CR to level of T7, 3 to 4 inches below jugular notch
RESPIRATION
AP PROJECTION
LATERAL DECUBITUS POSITION
Small pleural effusions are demonstrated by air-fluid levels in pleural space.

Small amounts of air in pleural cavity may demonstrate a possible pneumothorax
PATIENT POSITION
- Radiolucent pad under patient
- Patient lying on right side for right lateral decubitus and on left
side for left lateral decubitus PART POSITION
- Patient’s chin extended and both arms raised above head to - Adjust height of IR to center thorax
clear lung field to IR
- Back of patient firmly against IR; - Adjust patient and cart to center
MSP and T7 to CR
- Secure cart locked to prevent moving
- Pillow under patient’s head
- Knees flexed slightly and MCP parallel to IR with no body
rotation
CR
- CR horizontal, directed to center of IR, to level of T7 (3-4 inches inferior to level of
jugular notch)
RESPIRATION
Alternative Positioning Some department protocols state that the head be 10°
lower than the hips to reduce the apical lift caused by the shoulder, allowing
the entire chest to remain horizontal (requires support under hips).
AP LORDOTIC PROJECTION
Rule out calcifications and masses beneath the clavicles.
PATIENT POSITION
- Patient standing about 1 foot away from IR and leaning back with
shoulders, neck and back of head against IR
- Both patient’s hands on hips, palms out
- Shoulders rolled forward
PART POSITION
- Center MSP to CR and to centerline of IR
- Top of IR should be about 3inches above shoulders
Exception
If patient is weak and unstable or is unable to assume the erect lordotic
position, an AP semiaxial projection may be taken with the patient in a
supine position. Shoulders are rolled forward and arms positioned as for
lordotic position. The CR is directed 15° to 20° cephalad, to the midsternum.
CR
- CR perpendicular to IR, centered to midsternum (3-4 inches below jugular notch
RESPIRATION
ANTERIOR OBLIQUE POSITIONS

RAO / LAO
• Investigate pathology involving the lung fields, trachea, and mediastinal
structures.
• Determine the size and contours of the heart and great vessels.
PATIENT POSITION
- Patient erect, rotated 45 degrees with left anterior shoulder against IR for
LAO
- 45 degrees with right anterior shoulder against IR for RAO
- Patient’s arm flexed nearest IR and hand placed on hip, palm out
- Opposite arm raised to clear lung field and hand rested on head or on chest
for support, keeping arm raised as high as possible
- Patient looking straight and chin raised
PART POSITION
- Center patient to CR and to IR with top of IR about 1 inch above vertebral
prominence
CR
- CR perpendicular, directed to level of T7
RESPIRATION
For anterior obliques, the side of interest generally is the side farthest from the IR.
Thus, the RAO provides the best visualization of the left lung.
Certain positions for studies of the heart and great vessels require oblique positions
with an increase in rotation of 45° to 60°.
Less rotation (15° to 20°) may be valuable for better visualization of the various areas of
the lungs for possible pulmonary disease.
POSTERIOR OBLIQUE POSITIONS

RPO / LPO
• Investigate pathology involving the lung fields, trachea, and mediastinal
structures.
• Determine the size and contours of the heart and great vessels.
PATIENT POSITION
- Patient erect, rotated 45 degrees with right posterior shoulder against IR for
RPO
- 45 degrees with left posterior shoulder against IR for LPO
- Arm closest to the IR raised resting on head
- Other arm placed on hip with palm out
PART POSITION
- Top of IR about 1inch above vertebral prominence or about 5 inches above
level of jugular notch
- Thorax centered to CR and to IR
CR
- CR perpendicular, directed to level of T7
RESPIRATION
Posterior obliques provide best visualization of the side closest to the IR.
Posterior positions show the same anatomy as the opposite anterior oblique
positions.
Thus, the LPO position corresponds to the RAO, and the RPO corresponds to the
LAO.

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Evolve.

CHRISTY MAE ANNE SIBULO, RRT

The thoracic cavity contains:

- Passageway where air pass through it before entering the

FOUR PARTS OF THE RESPIRATORY SYSTEM PROPER

1. LARYNX (voice box) – cagelike, cartilaginous structure that is 1 ½ to 2 inches in length in an

Radiographically important parts of the lungs:

• COSTOPHRENIC ANGLE (F) – extreme outermost lower corner of each lung,

LATERAL CHEST VIEW

- Movements of the bony thorax during inspiration and expiration

- To increase the volume of the chest during inspiration, the thoracic

- To determine the degree of inspiration in chest radiography, one should be

- A general rule for average adult patients is to show a minimum of 10 on a

GENERAL POSITIONING CONSIDERATIONS

- In recumbent position, gravitational force causes the abdominal viscera and

- Long hair tied up with pony tails or clam

ERECT CHEST RADIOGRAPH

Extending the chin

Minimizing breast shadow

LATERAL CHEST POSITIONING

True lateral, No rotation or tilt

Arms raised High

CR CHEST POSITIONING METHOD

CR CHEST POSITIONING METHOD

• This requires a high kV of 110 to 125

LEAD SHIELDING/ BACKSCATTER PROTECTION

PLACEMENT OF IMAGE MARKERS

• It is important to put markers prior to exposure

OBESE PATIENT CONSIDERATION

• An obese patient may present positioning and centering challenges

• EPIGLOTTITIS – inflammation of the epiglottis

• PLEURAL EFFUSION – collection of fluid in the pleural cavity

AXIOLATERAL PROJECTION – Trachea and Pulmonary Apex

PATIENT POSITION on cart

PATIENT POSITION on wheelchar

Small pleural effusions are demonstrated by air-fluid levels in pleural space.

ANTERIOR OBLIQUE POSITIONS

POSTERIOR OBLIQUE POSITIONS

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