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 mediastinalshadow formed by SVC and innominate vessels.

• Left superior mediastinalshadow 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 costophrenicangles, 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

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