Radiographic Technique 2

RAD 1204
A . Tahani Ahmed AL-Hozeam

Breathing Movements

Two movement in chest during breathing :

a) Inspiration
b) expiration

a)
b)
c)

The thoracic cavity increases in diameter in three

dimensions :
Vertical diameter.
Transverse diameter.
Anteroposterior diameter.

Degree of Inspiration

To determine the degree of inspiration in chest radiography ,one

should be able to identify and count the rib pairs.

To take this number of ribs , the patient should be take deep

breath and hold it to fill the lungs, and take ascend deep breath
for deep inspiration.

In adult patient you should count at least 10 ribs pairs above

diaphragm ,and start count from top to dowm.

Technical aspects
Radiation Protection: For chest radiography, a lead-rubber gonadal shield should be
employed so to protect the abdomen below the chest (using vinyle-covered lead apron)
around the waist for all patients of reproductive age, children, and pregnant women.
Otherwise, an adjustable mobile lead shield screen must be used.

Exposure: Low contrast ( long-scale contrast) contrast must be adopted using High kV

Technique (100 - 130 kVp) with low mAs (3 mAs) at 72 inches (180 cm) FFD (SID) on full
second inspiration, to produce more shades of gray that shows fine lung markings behind
the heart and lung bases due to the higher penetration. Higher mA and short exposure
times (0.01 s) must be used to reduce movement blur (due to movement unsharpness, ( Um).
Overall optimum density with sufficient mAs is necessary, which can be proved by seeing
faint outlines of
mid and upper vertebrae and posterior ribs. A moving or high-lattice fineline) focused grids must be used with the high kV technique. Grids should not be used with
mobile and bed-side patients (mobile radiography).
For pediatrics, lower kV (60 70 KV) must be used with lower mAs (to reduce motion).
Higher-speed films and screens are also used for pediatrics to reduce motion and exposure
dose. Correct placement of patient ID and film markers are also important.

Technical aspects
For pediatrics ( small infants and newborns ), AP supine and laterals (using a horizontal beam,
that is dorsal decubitus, must to be done to exclude air-fluid levels. Erect PA and lateral are
advised if an immobilizing device is available. For geriatrics (old age) higher center point (CP)
must be used because of less inhalation capability of old people that produces shallow lung
fields.
X-ray chest must be taken in full arrested second inspiration to show the lungs well expanded
and full with contrasting air. In case of pneumothorax, another full exposure on (expiration)
must be done (on the same film) for diagnostic comparison purposes, with an increase of (+5
kVp) and half the usual mAs (that is 1.5 mAs, when using a high kVp technique).

Technical aspects

All chest radiographs must be taken in standing erect to allow the diaphragm to
move down to show greater areas of the lung fields and possible chest/subphrenic
abscess or air-fluid levels.
FFD for PA chest must be 72 inches (180 cm) to maintain the natural size of the
heart
which is usually less in PA than in AP, and prevent geometrical unsharpness and
magnification as a result of the increased OFD.
Patients neck must be sufficiently extended (chin up) to prevent superimposition of
chin or neck on lung apices. Also, large female breasts must be displaced away from
lung field to avoid creating breast shadows.

Technical aspects
A left lateral chest film must be done routinely as the heart is located on the left
side,
unless certain pathology in the right lung necessitates the need for a right lateral.
Proper CP for the chest is (T7) to avoid irradiating the eyes, thyroid gland, the
sternum,
and the mammary glands.
Basic (routine) views are: PA and lateral. Special views include: AP or PA apical,
lordatic, lateral decubitus, AP supine (or semi-erect), LAO, and LPO.
Rare-earth screens and fast films combinations must be used with the short
exposure
times used.

Patient preparation
Ask the patient to remove all objects from chest and neck
regions
(necklace , bra.).

Ask the patient to remove all that clothing and put

hospital gown .

Ask female patient about the pregnancy and last period.

PA Chest (Normal/ ambulance patients)

(Basic)
Erect film shows pleural effusions, infections, pneumothorax.
Patient erect, feet apart, chin rested on film top edge, hands
on lower hips, elbows partially flexed, the shoulders rotated
forward (to move the clavicles below apices), top of film 5 -7
cm above the shoulders (to include the apices), exposure on
2nd arrested (inspiration), collimation and protection should
be applied.
Film: HD 35x43 cm lengthwise or (crosswise for large
patients), and ( 35x35 cm for females) .
CP:
T7 (7 8 inches inferior to vertebra prominens, or 3
4 inch below the jugular notch).
CR:

Horizontally 90 to film center.

PA Chest (Normal/ ambulance patients)

(Basic)

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Lateral erect chest

(Basic)
Basic (additional) projection for localizing
position of a lesion for the posterior heart
,great vessels and sternum . A grid is used.
Patient erect, turned with side of interest in
close contact with the film, MSP parallel with
film, arms folded over the head.
Film: HD 35x43 cm longthwise.
CP: at level
CR:

T7.

90 horizontally through the chest.

Note/ in some patient CP have to be lowered

a minimum of 1inch from the PA or lateral to
prevent cutoff of costophrenic angle.

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Lateral erect chest

(Basic)

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Lateral chest (stretcher/wheelchair patients)

(Basic))
For pathology situated posterior to the heart
and great vessels (patients who cant stand for
an erect standing lateral) and for trauma.
Film: HD 35x43 cm longthwise.
CP:

at level T7.

CR:

Horizontally 90.

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Lateral chest (stretcher/wheelchair patients)

(Basic)

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AP Chest (supine/ semierect trolley/bedside)

(special)
For pathology involving lungs, diaphragm, and
the mediastinum. kV for bedside is 70-80 with a
grid, for large patients 80-100 kV with grid , film
cross-wise to eliminate possible lateral cutoff.
Patient supine on trolley, trolley head raised into
a semierect position, film behind the patient,
shoulders forward by rotating arms medially.
Film: HD 35x43 cm crosswise.
CP: at level T7 (3-4 inches below the jugular
notch).
CR:
5 caudal to prevent clavicles from
Obscuring the apices, FFD 100 cm, at least.
.
NB/ With this position it is impossible to show
any
fluid levels.

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AP Chest (supine/semierect trolley/bedside)

(special)

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Lateral decubitus chest (AP horizontal beam)

(special)
For small pleural effusions (air-fluid levels)
and for pneumothorax. A (DECUBITUS)
marker or (Arrow) should be used.
Patient lying on one side on radiolucent pad,
chin and arms raised above head, patient
back against a vertical cassette, knees flexed
slightly, top of the cassette approximately 1
inch above the vertebra prominens.
Film: HD 35x43 cm vertical on the couch
edge.
CP: at level T7.
CR:

Horizontally 90 to film center.

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Lateral decubitus chest (AP horizontal beam) (special)

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LAO, RAO chest (heart)

(special)

For pathology involving the lung fields, trachea, and

mediastinal structures (including the heart).
Patient erect rotated 45 (left anterior shoulder against
film for LAO, and right anterior shoulder against film
for
RAO), patients arm flexed , opposite arm raised to
clear
Lung field and rest hand on head , patient looking straight
ahead , chin raised.
Film: HD 35x43 cm ,lengthwise.
CP: at level T7.
CR:

horizontal 90 to film center.

NB/ 1-45 LAO left anterior shoulder contact to the

film, 45 RAO right anterior shoulder contact to the
film.

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LAO, RAO chest (heart)

(special)

NB/ 2- the side of interest is generally the side farthest from film ,45 RAO best viisulize for left lung and
45LAObest visulize For right lung and with increase rotation 60 best visulize for the heart.
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AP lordatic chest
(special)
For rule out calcifications and mass under the
clavicles , appical area.
Patient stands or sits about 1 foot away from
the film and leaning back with shoulders, neck
,and back of head contact the film , both
patients hands on hips , shoulders rolled
forward.
Film: HD 35x43 cm.
CP:

mid sternum (3 to 4 inches below

Jugular notch)
CR:

Horizontally 90 to film center.

NB/ if patient is weak and unstable put

AP semi-axial projection the patient supine
Position ,shoulder are rolled forward CR: 15 to 20
Cephalad to the mid sternum.

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PA lordatic chest
(special)
For a right middle lobe collapse, or an
interlobar pleural effusion. Patient standing in
erect PA , then bends backward at the waist
(30 40 degrees).
Film: HD 35x43 cm.
CP:

T7.

CR:

Horizontally 90 to film center.

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AP larynx, pharynx, and trachea (upper airway)

(Basic)
For pathology ( e.g., soft-tissue swellings )
involving
air-filled larynx and the trachea, thyroid, thymus
glands, and the upper esophagus. A contrast
medium (barium) is used to opacify these organs.
Patient sitting or standing , back of the head and
shoulders against film, chin raised so that
acanthiomeatal line is perpendicular to fim.
Film: HD 24x30 cm lengthwise.
CP:
at level T1-2 or 2.5 cm above the jugular
notch.
CR:

Horizontally 90 to film center.

NB/ the breathing should be slow during

exposure.

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AP larynx, pharynx, and trachea

(Basic)

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Lateral larynx, pharynx, and trachea (upper airway)

(Basic)
For pathology involving the air-filled larynx and the
trachea, thyroid, thymus glands, and upper
esophagus. A contrast medium (barium) is used to
opacify these organs (usually it is a soft-tissue
technique done to exclude epiglottitis in young
children).
Patient sitting or in erect lateral, shoulders rotated
posteriorly and depressed down, hands clasped
behind the back.
Film: HD 24x30 cm longthwise.
CP:

Midway between the thyroid cartilage and the

jugular notch through at level of C6-C7.

CR:

Horizontally 90 to film center.

NB/the FFD=180cm to minimize magification.

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Lateral larynx, pharynx, and trachea

(Basic)

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RAO sternum
(Basic)

For pathology of the sternum (fractures /other

inflammatory processes).
Patient erect with arms on sides, or:
Semiprone and slightly oblique (15 - 20, to
the right side ) with the left arm up and the
right arm down by the side.
Film: HD 24x30 cm longthwise.
CP:
Center of sternum (midway between
jugular notch and the xiphoid process).
CR:
on

Horizontally 90 to film center, exposure

(normal) quiet breathing, or else, during a
suspended expiration.

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RAO sternum
(Basic)

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Lateral sternum
(Basic)
For pathology of the sternum (#s, subluxation, and
other inflammatory processes).
Patient erect (arms drawn to back), or in a lateral
recumbent (lying on the side, arms above the head),
shoulders well back.
Film:

HD 24x30 cm longthwise.

CP:
Center of sternum (midway between jugular
notch
and xiphoid process).
CR:

90 to film center, exposure during a suspended

inspiration.

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Lateral sternum
(Basic)

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