Chest x ray positioning

Plain films different views
Positioning

1. Chest X-ray positioning

2. outline Plain films different views Positioning Interpretation of the plain film

3. Different views of Xray chest PA Lateral AP,decubitis,supine,oblique Inspiratory-expiratory Lordotic,apical

4. PA view Most frequently requested Visualization of the lungs excellent

5. PA view positioning The patient faces towards the cassette and the tube is 6 feet away from the patient.

6. Technical aspect Inspiration On full inspiration the diaphragm should lie at the level of 8-10 th posterior rib or 5-6 th anterior rib.

7. Technical aspect Inspiratory film

8. Technical aspects Penetration

9. Over penetrated Under penetrated

10. rotation

11. Rotated x ray

12. Interpretation of the PA films 1.request form: name,age,sex,date and clinical presentation 2.trachea 3.Heart and mediastinum 4.Diaphragm

13. 6.Pleural spaces 7.Lungs 8.Hidden areas 9.Hila 10.Below diaphragm 11.Soft tissues 12.Bones

14. Trachea Examined for Position outline

15. Caliber coronal diameter is 25mm for males and 21mm for females Para tracheal stripe<5mm Azygos vein<10mm Carina angle:60-75degree.

16. 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%

17. 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

18. 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

19. thymus Triangular sail-shaped structure, well defined borders projecting from one or both side of the mediastinum.

20. Para spinal lines

21. Diaphragm Outline shape relative position

22. Pleural spaces Costophrenic angles Cardiophrenic angles

23. lungs Local,generalised abnormality Comparison of the translucency Vascular markings of the lungs

24. Zones

25. Hidden areas The apices Mediastinum and hila Diaphragm bones

26. Hila Contain the following structures The inferior pulmonary ligament The pulmonary vessels The bronchial vessels the bronchi The lymphatic system The lymph nodes

27. Right hilum

28. Left hilum

29. Below diaphragms Gas shadows Calcifications

30. Soft tissues Breast shadows and nipple shadows Skin folds Muscles Companion shadows

31. Nipple markers

32. Skin fold

33. Muscles and companion shadows

34. bones Sternum Clavicles Scapulae ribs spine

35. Lateral film positioning

36. Interpretation of lateral film The clear spaces Retrosternal space Retrotracheal space Vertebral translucency Diaphragm outline The fissures The trachea The sternum

37. Retrosternal space

38. Vertebral translucency

39. Diaphragm outline Right diaphragm continues anteriorly Left is silhouetted posteriorly by heart shadow

40. The fissures

41. AP view the patient back is towards the cassette and tube is 40 inches away from the patient. for patients unable to stand

42. Decubitus position The patient faces towards the cassette while lying in decubitus position and tube Is towards the back

43. Decubitus position To asses the volume of pleural fluid. Loculated pleural effusion or mobile

44. Apical view

45. Oblique view positioning

46. Oblique view To visualize retro cardiac area, the posterior costophrenic angles, the chest wall and the pleural plaques .

47. Lordotic PA view

48. Paired inspiratory and expiratory Demonstrate air trapping and diaphragm movements. Very important in diagnosis of inhaled foreign body in children.

49. Paired inspiratory and expiratory view

50. Thank you