X-RAY OF CHEST

X-Ray Chest P/A View

Indications

respiratory disease
cardiac disease
hemoptysis
suspected pulmonary embolism
investigation of tuberculosis
pneumonia
pneumothorax
suspected metastasis
follow up of known disease to assess progress
chronic dyspnea
trauma
pneumoperitoneum
evaluation of symptoms that could relate to abdominopelvic pathology
thoracic disease processes
monitoring of patients in intensive care units
post-operative imaging
pre-employment medical fitness
immigration screening
check position of nasogastric tubes, endotracheal tubes, PICCs etc.
exclude radiopaque foreign bodies (accidental aspiration, MRI safety screen)

Preparation: Wear cotton clothing or change into a gown before the X-ray, Remove metal objects like jewelry

Region: lung, trachea, bronchus, heart, diaphragm, mediastinum, costophrenic angle

Indication/Pathology: lung disease, mediastinal disease and heart disease

Contraindication: Pregnancy Women.

FFD: 180 cm (72 inches)

Central Ray: The level of the 7th thoracic vertebra, approximately the inferior angle of the scapulae

Respiration: suspended with deep inspiration

Position:

The patient is in an erect position.
Place the chin on the vertical image receptor device. Place the hands either on the hip region or on the back of the device with arms surrounding the receptor device, and place the shoulders firmly on the image receptor.
Place the midsagittal plane of the body at the center of the IR and make sure the chest is not rotated.

Collimation: Include the entire lung field.

Grid: yes

Evaluation:

Bilateral sternoclavicular joints (S-C joint) should be at the same level with spinal column.
Lung apex should be superior to the clavicle.
Scapula must not overlap with lungs.
Patient's heart and aortic arch must be visible with the diaphragm below the 12th rib.
Bilateral lung field must be clearly demonstrated in long scale contrast state.

Factor: kVp-74, mAs-25

Tip:

1. Larger contrast of subject among surrounding pulmonary blood vessels can be obtained after putting air in Pulmonary Alveoli if the X-ray inspection is implemented holding a breathe when second inspiration is over.
2. Move big breast to lateral sides of lung field.
3. Place image receptor (IR) widthwise for patient with big body shape.
4. In order to reduce density differences between heart shadow and lung shadow, high voltage shooting is recommended.
5. If patient do not have consciousness or cannot move, Chest AP Supine Projection can be used.

X-ray Chest Lateral View

Preparation: Wear cotton clothing or change into a gown before the X-ray, Remove metal objects like jewelry.

Region: lung, trachea, bronchus, heart, diaphragm, mediastinum, costophrenic angle

Indication/Pathology: lung disease, mediastinal disease and heart disease

Contraindication: Pregnancy Women.

SID: 180 cm (72 inches)

Central Ray: perpendicular beam directed at the center point of the chest, 8~10cm inferior to the jugular notch at the level of 7th thoracic vertebra.

Respiration: suspended with deep inspiration

Position:

1. The patient is in an erect position.

2. Place the filming side on the image receptor (IR), and raise the arms to put hands on the head and slightly extend the head.

3. Place the midsagittal plane of chest at the center of IR.

4. Adjust the upper margin of IR to be 2.5 cm above the shoulders.

Evaluation:

1. Ribs and costophrenic angles should be superimposed.

2. Chin and arms should be lifted to avoid superimposition of the lung apex.

3. Hilum region should be placed at the center of image.

4. Bilateral lung field must be clearly demonstrated in long scale contrast state.

5. Patient's heart and aortic arch must be visible with diaphragm below the 12th rib.

6. Bilateral lung field must show clearly in long scale contrast state.

Factor: kVp:110, mAs: 8

Tip:

1. Height of 7th thoracic, T7 is 8 ~10 cm below jugular notch.

2. Larger contrast of subject among surrounding pulmonary blood vessels can be obtained after putting air in Pulmonary Alveoli if the X-ray inspection is implemented holding a breathe when second inspiration is over.

X-ray Chest A/P View (Erect)

Preparation: Wear cotton clothing or change into a gown before the X-ray, Remove metal objects like jewelry

Region: lung, trachea, bronchus, heart, diaphragm, mediastinum, costophrenic angle

Indication/Pathology: pleural effusions, pneumothorax and atelectasis

FFD: 100 cm (40 inches)

Central Ray: perpendicular beam directed at the center point of the chest, 8~10cm inferior to the jugular notch at the level of 7th thoracic vertebra.

Respiration: suspended with deep inspiration

Position:

1. The patient is placed in a supine position.
2. Adjust the upper margin of the image receptor to be 5cm above the shoulders (IR) and align the center plane of the chest on the centerline of the IR.
3. If possible, flex both arms to protract both shoulders anteriorly.

Evaluation:

1. Enlargement of heart shadow can be seen.
2. For patient with chest effusion or other pathological legion, it should be vaguely observed on the structure of the great vessel and the lung.
3. The diaphragm should be under the eighth and ninth ribs because lung is not fully filled with air.
4. Bilateral sternoclavicular joints (S-C joint) should be at the same line with spinal column.
5. Lung apex should be superior to the clavicle.
6. Scapula must not overlap with lungs.

Factor: kVp: 100, mAs: 4

Tip: