Podcast
Questions and Answers
What is the primary purpose of the PA oblique projection conducted in a left anterior oblique (LAO) position?
What is the primary purpose of the PA oblique projection conducted in a left anterior oblique (LAO) position?
When the patient is in a recumbent position for a contrast study, which projection technique is employed?
When the patient is in a recumbent position for a contrast study, which projection technique is employed?
For a cardiac series, what body rotation angle is typically utilized?
For a cardiac series, what body rotation angle is typically utilized?
Which of the following is a correct statement regarding the right lateral projection?
Which of the following is a correct statement regarding the right lateral projection?
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What is the correct central ray positioning for a lateral projection of the sternum?
What is the correct central ray positioning for a lateral projection of the sternum?
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What anatomical landmarks are essential to position the radiograph beam for the PA oblique projections?
What anatomical landmarks are essential to position the radiograph beam for the PA oblique projections?
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In PA oblique projection of the sternum, what is the recommended rotation of the body?
In PA oblique projection of the sternum, what is the recommended rotation of the body?
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What position should a patient be in for the lateral recumbent projection if they have a severe injury?
What position should a patient be in for the lateral recumbent projection if they have a severe injury?
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What is the purpose of the lateral projection of the sternum?
What is the purpose of the lateral projection of the sternum?
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Where should the radiographic beam be directed in a PA projection of the sternoclavicular joints?
Where should the radiographic beam be directed in a PA projection of the sternoclavicular joints?
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What anatomical structures are primarily demonstrated using the AP projection at the level of the jugular notch or T7?
What anatomical structures are primarily demonstrated using the AP projection at the level of the jugular notch or T7?
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In which position should a patient be placed for the modified prone projection using the Moore method?
In which position should a patient be placed for the modified prone projection using the Moore method?
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What is the purpose of conducting a lateral projection in the right or left position?
What is the purpose of conducting a lateral projection in the right or left position?
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When performing an AP oblique projection in the left posterior oblique (LPO) position for trauma patients, what is the primary goal?
When performing an AP oblique projection in the left posterior oblique (LPO) position for trauma patients, what is the primary goal?
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What is the necessary adjustment to make when angulating the tube for larger patients during the lateral projection?
What is the necessary adjustment to make when angulating the tube for larger patients during the lateral projection?
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What is the recommended CR angle for the Resnick method to demonstrate retrosternal extensions of the thyroid gland?
What is the recommended CR angle for the Resnick method to demonstrate retrosternal extensions of the thyroid gland?
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In the PA projection, what is the primary purpose of extending the chin upward?
In the PA projection, what is the primary purpose of extending the chin upward?
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During the RAO position, which structure is best imaged due to this positioning?
During the RAO position, which structure is best imaged due to this positioning?
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What does the lateral projection mainly help to visualize?
What does the lateral projection mainly help to visualize?
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What is the recommended position for performing the Lindblom method?
What is the recommended position for performing the Lindblom method?
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For the lateral projection, what is critical about the patient's arm positioning?
For the lateral projection, what is critical about the patient's arm positioning?
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What do ribs assume in a lateral projection when positioning is correct?
What do ribs assume in a lateral projection when positioning is correct?
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What condition can the PA projection be used to assess effectively?
What condition can the PA projection be used to assess effectively?
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What is the correct RP for an AP axial projection?
What is the correct RP for an AP axial projection?
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Which projection has the CR angled 10-15 degrees cephalad?
Which projection has the CR angled 10-15 degrees cephalad?
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What is the positioning of the arms for a trauma patient during a sternum examination?
What is the positioning of the arms for a trauma patient during a sternum examination?
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For the best projection to demonstrate the sternoclavicular joints, which direction should the CR be angled?
For the best projection to demonstrate the sternoclavicular joints, which direction should the CR be angled?
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In the Kurzabauer method, how is the arm of the affected side positioned?
In the Kurzabauer method, how is the arm of the affected side positioned?
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When performing an AP projection for ribs above the diaphragm, how should the patient be positioned?
When performing an AP projection for ribs above the diaphragm, how should the patient be positioned?
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In a PA oblique projection, what is the body rotation angle toward the affected side?
In a PA oblique projection, what is the body rotation angle toward the affected side?
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Which of the following accurately describes the required respiratory phase when performing a rib projection in supine for ribs below the diaphragm?
Which of the following accurately describes the required respiratory phase when performing a rib projection in supine for ribs below the diaphragm?
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What is the correct RP for imaging the lower ribs using the AP projection?
What is the correct RP for imaging the lower ribs using the AP projection?
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Which ribs are best demonstrated in an AP projection while the patient is supine?
Which ribs are best demonstrated in an AP projection while the patient is supine?
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What is the purpose of the lateral decubitus position in radiographic imaging?
What is the purpose of the lateral decubitus position in radiographic imaging?
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What is the recommended patient position for performing a lateral projection of the sternum?
What is the recommended patient position for performing a lateral projection of the sternum?
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In a right lateral projection, which anatomical structures are most likely visualized?
In a right lateral projection, which anatomical structures are most likely visualized?
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What is the recommended patient positioning for a left anterior oblique (LAO) projection during imaging?
What is the recommended patient positioning for a left anterior oblique (LAO) projection during imaging?
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During the PA oblique projection, how much should the body be rotated to avoid superimposition of the sternum and vertebrae?
During the PA oblique projection, how much should the body be rotated to avoid superimposition of the sternum and vertebrae?
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When is the recumbent position typically employed in imaging?
When is the recumbent position typically employed in imaging?
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What should be the breathing technique during the lateral projection of the sternum?
What should be the breathing technique during the lateral projection of the sternum?
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What is the primary benefit of body rotation in PA oblique projections?
What is the primary benefit of body rotation in PA oblique projections?
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What anatomical area does the lateral projection of the sternum primarily reveal?
What anatomical area does the lateral projection of the sternum primarily reveal?
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Where should the central ray (CR) be directed in a lateral projection of the sternum?
Where should the central ray (CR) be directed in a lateral projection of the sternum?
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What condition is characterized by the accumulation of fluid in the pleural cavity?
What condition is characterized by the accumulation of fluid in the pleural cavity?
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Which lung disease is specifically caused by the inhalation of coal dust?
Which lung disease is specifically caused by the inhalation of coal dust?
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What is the main characteristic of emphysema?
What is the main characteristic of emphysema?
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Which type of pneumonia involves the alveoli of an entire lobe?
Which type of pneumonia involves the alveoli of an entire lobe?
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What condition is a result of a lack of surfactant in the lungs?
What condition is a result of a lack of surfactant in the lungs?
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What is Pneumothorax associated with?
What is Pneumothorax associated with?
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Which condition is characterized by inflammation caused by the inhalation of silicon dioxide?
Which condition is characterized by inflammation caused by the inhalation of silicon dioxide?
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What describes atelectasis?
What describes atelectasis?
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Which lung condition results specifically from inflammation due to the inhalation of asbestos?
Which lung condition results specifically from inflammation due to the inhalation of asbestos?
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What condition results from a chronic infection of the lungs due to the tubercle bacillus?
What condition results from a chronic infection of the lungs due to the tubercle bacillus?
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What is the preferred patient positioning for an AP oblique projection to image the sternoclavicular joints?
What is the preferred patient positioning for an AP oblique projection to image the sternoclavicular joints?
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During an upright PA oblique projection to image the ribs above the diaphragm, what should the patient's arm on the affected side be doing?
During an upright PA oblique projection to image the ribs above the diaphragm, what should the patient's arm on the affected side be doing?
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For an AP axial projection, how far should the radiographic beam be directed above the level of the jugular notch?
For an AP axial projection, how far should the radiographic beam be directed above the level of the jugular notch?
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In the PA projection of ribs below the diaphragm, what is the correct respiratory phase?
In the PA projection of ribs below the diaphragm, what is the correct respiratory phase?
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When performing a PA oblique projection in the RAO position, which ribs are primarily visualized?
When performing a PA oblique projection in the RAO position, which ribs are primarily visualized?
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What is the appropriate central ray angulation for the PA oblique projection of the sternoclavicular joints?
What is the appropriate central ray angulation for the PA oblique projection of the sternoclavicular joints?
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In a supine position for imaging ribs below the diaphragm, how should the patient's knee be positioned?
In a supine position for imaging ribs below the diaphragm, how should the patient's knee be positioned?
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What adjustment should be made to the patient's arms when performing an upright PA projection of the ribs?
What adjustment should be made to the patient's arms when performing an upright PA projection of the ribs?
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What is primarily visualized in the Lindblom method?
What is primarily visualized in the Lindblom method?
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During a PA projection, which anatomical structure is expected to be imaged inferior to the shadow of the clavicles?
During a PA projection, which anatomical structure is expected to be imaged inferior to the shadow of the clavicles?
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In a lateral projection, how should the patient’s arms be positioned?
In a lateral projection, how should the patient’s arms be positioned?
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What adjustment is recommended for imaging hyperstenic patients during the PA axial projection?
What adjustment is recommended for imaging hyperstenic patients during the PA axial projection?
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In the AP oblique projection, where should the patient's shoulder of the affected side be positioned?
In the AP oblique projection, where should the patient's shoulder of the affected side be positioned?
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What significant characteristic is noted in the chest radiograph with the inferior positioned arm?
What significant characteristic is noted in the chest radiograph with the inferior positioned arm?
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What is the central ray direction for the RAO position to maximize visualization of lung areas?
What is the central ray direction for the RAO position to maximize visualization of lung areas?
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In which patient position is the thymic enlargement best visualized?
In which patient position is the thymic enlargement best visualized?
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What does the patient need to do during a lateral projection for optimal imaging?
What does the patient need to do during a lateral projection for optimal imaging?
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What anatomical landmarks should be positioned at T7 for an appropriate PA projection?
What anatomical landmarks should be positioned at T7 for an appropriate PA projection?
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What is the primary purpose of using a lateral projection for the sternum?
What is the primary purpose of using a lateral projection for the sternum?
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In the PA oblique projection of the sternum, how much should the body be rotated to prevent superimposition with the vertebrae?
In the PA oblique projection of the sternum, how much should the body be rotated to prevent superimposition with the vertebrae?
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Which patient position is optimal for conducting a PA projection of the sternoclavicular joints?
Which patient position is optimal for conducting a PA projection of the sternoclavicular joints?
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What is the orientation of the central ray when performing a lateral projection of the sternum?
What is the orientation of the central ray when performing a lateral projection of the sternum?
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Which technique is essential for achieving optimal imaging of the sternum during the RAO position?
Which technique is essential for achieving optimal imaging of the sternum during the RAO position?
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What positioning technique should be employed to demonstrate small pleural effusions?
What positioning technique should be employed to demonstrate small pleural effusions?
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In performing the Moore method, what is the correct recommendation for patient positioning?
In performing the Moore method, what is the correct recommendation for patient positioning?
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During a lateral projection of the sternum, what is the crucial factor regarding the positioning of the arms?
During a lateral projection of the sternum, what is the crucial factor regarding the positioning of the arms?
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What is the effect of positioning a patient for the ventral/dorsal decubitus lateral projection?
What is the effect of positioning a patient for the ventral/dorsal decubitus lateral projection?
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What is the correct central ray (CR) angle for larger patients during the lateral projection of the sternum?
What is the correct central ray (CR) angle for larger patients during the lateral projection of the sternum?
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What is the recommended arm position for a patient during the AP oblique projection?
What is the recommended arm position for a patient during the AP oblique projection?
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Which position is utilized for imaging ribs below the diaphragm during a PA projection?
Which position is utilized for imaging ribs below the diaphragm during a PA projection?
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What is the proper central ray entrance for a PA oblique projection performed on the left side?
What is the proper central ray entrance for a PA oblique projection performed on the left side?
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During an upright AP axial projection, how should the patient's head be positioned?
During an upright AP axial projection, how should the patient's head be positioned?
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In a PA oblique projection of the ribs, what is the recommended body rotation angle?
In a PA oblique projection of the ribs, what is the recommended body rotation angle?
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What is the main goal of suspending respiration at full inspiration during rib imaging above the diaphragm?
What is the main goal of suspending respiration at full inspiration during rib imaging above the diaphragm?
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Where should the central ray be directed when performing the AP oblique projection of the sternoclavicular joints?
Where should the central ray be directed when performing the AP oblique projection of the sternoclavicular joints?
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In which position should the patient be for the PA projection to image the upper ribs?
In which position should the patient be for the PA projection to image the upper ribs?
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What is the recommended rotation of the body for the PA oblique projection during evaluation of the sternum?
What is the recommended rotation of the body for the PA oblique projection during evaluation of the sternum?
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For an AP projection conducted when the patient is upright, where should the IR be positioned?
For an AP projection conducted when the patient is upright, where should the IR be positioned?
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What is the primary purpose of angling the CR 15 degrees caudad for the sternoclavicular joint projection?
What is the primary purpose of angling the CR 15 degrees caudad for the sternoclavicular joint projection?
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What positioning is required for a patient being examined in a lateral recumbent position?
What positioning is required for a patient being examined in a lateral recumbent position?
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Which of the following correctly describes the RP for an AP projection when imaging lower ribs?
Which of the following correctly describes the RP for an AP projection when imaging lower ribs?
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In the lateral projection of the sternum, how should the patient's arms be positioned?
In the lateral projection of the sternum, how should the patient's arms be positioned?
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What is the central ray orientation when performing the Limburg method?
What is the central ray orientation when performing the Limburg method?
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What type of projection is typically used to best demonstrate the anterior ribs above the diaphragm?
What type of projection is typically used to best demonstrate the anterior ribs above the diaphragm?
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What is a common cause of bronchiectasis?
What is a common cause of bronchiectasis?
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Which lung condition is associated with the accumulation of air in the pleural cavity?
Which lung condition is associated with the accumulation of air in the pleural cavity?
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Which condition is typically resultant from inhalation of asbestos fibers?
Which condition is typically resultant from inhalation of asbestos fibers?
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Which pneumonia type involves both the alveoli and interstitial structures in the lungs?
Which pneumonia type involves both the alveoli and interstitial structures in the lungs?
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What is the primary issue associated with chronic obstructive pulmonary disease (COPD)?
What is the primary issue associated with chronic obstructive pulmonary disease (COPD)?
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What is the main focus of treatment for pulmonary edema?
What is the main focus of treatment for pulmonary edema?
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Histoplasmosis is caused by which type of organism?
Histoplasmosis is caused by which type of organism?
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Which lung condition is characterized by a collapse of all or part of the lung?
Which lung condition is characterized by a collapse of all or part of the lung?
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Which of the following is an accurate description of silicosis?
Which of the following is an accurate description of silicosis?
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What condition is typically linked to chronic infections of the lungs?
What condition is typically linked to chronic infections of the lungs?
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What is the primary reason for using a lateral projection during sternum imaging?
What is the primary reason for using a lateral projection during sternum imaging?
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In the PA oblique projection of the sternum, how is the patient positioned to prevent superimposition with the vertebrae?
In the PA oblique projection of the sternum, how is the patient positioned to prevent superimposition with the vertebrae?
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Where is the CR aimed for the lateral projection of the sternum?
Where is the CR aimed for the lateral projection of the sternum?
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Which breathing technique is recommended during the PA oblique projection of the sternum?
Which breathing technique is recommended during the PA oblique projection of the sternum?
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What is the recommended position for a patient with a severe injury when performing the lateral projection of the sternum?
What is the recommended position for a patient with a severe injury when performing the lateral projection of the sternum?
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When performing a right lateral projection, which anatomical aspects are primarily demonstrated?
When performing a right lateral projection, which anatomical aspects are primarily demonstrated?
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What is the primary purpose of the lateral decubitus position during imaging?
What is the primary purpose of the lateral decubitus position during imaging?
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Which position is employed to achieve maximum visualization of the left lung?
Which position is employed to achieve maximum visualization of the left lung?
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What is the significance of rotating the body 10-20 degrees during a PA oblique projection?
What is the significance of rotating the body 10-20 degrees during a PA oblique projection?
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In which scenario is the PA oblique projection especially beneficial?
In which scenario is the PA oblique projection especially beneficial?
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What sagittal plane position is recommended for demonstrating small pleural effusions?
What sagittal plane position is recommended for demonstrating small pleural effusions?
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In a lateral projection, which condition can be best assessed using the ventral or dorsal decubitus position?
In a lateral projection, which condition can be best assessed using the ventral or dorsal decubitus position?
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What is the correct central ray (CR) angle for large patients during a lateral projection?
What is the correct central ray (CR) angle for large patients during a lateral projection?
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What is the primary purpose of the AP Oblique projection in trauma cases?
What is the primary purpose of the AP Oblique projection in trauma cases?
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Which anatomical area is the primary focus of the lateral projection in patients experiencing acute pain?
Which anatomical area is the primary focus of the lateral projection in patients experiencing acute pain?
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What is the body rotation angle for a PA oblique projection when the affected side is placed down?
What is the body rotation angle for a PA oblique projection when the affected side is placed down?
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In the upright position for imaging ribs above the diaphragm, what should the patient do during the procedure?
In the upright position for imaging ribs above the diaphragm, what should the patient do during the procedure?
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For a supine AP axial projection, where should the patient's head be positioned?
For a supine AP axial projection, where should the patient's head be positioned?
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During a PA projection, what respiratory phase is primarily used?
During a PA projection, what respiratory phase is primarily used?
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What is the recommended rotation for a patient in a left anterior oblique (LAO) position for imaging?
What is the recommended rotation for a patient in a left anterior oblique (LAO) position for imaging?
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What is the correct central ray (CR) orientation for imaging the sternoclavicular joints?
What is the correct central ray (CR) orientation for imaging the sternoclavicular joints?
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When positioning the patient supine to image ribs below the diaphragm, where should the knees of the elevated side be?
When positioning the patient supine to image ribs below the diaphragm, where should the knees of the elevated side be?
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What is the purpose of keeping the arm of the affected side abducted during the AP oblique projection?
What is the purpose of keeping the arm of the affected side abducted during the AP oblique projection?
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What is the recommended central ray angle for the Resnick method when demonstrating retrosternal extensions of the thyroid gland?
What is the recommended central ray angle for the Resnick method when demonstrating retrosternal extensions of the thyroid gland?
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In the PA axial projection, which anatomy is best visualized?
In the PA axial projection, which anatomy is best visualized?
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What issue can arise when conducting a lateral projection of the thorax?
What issue can arise when conducting a lateral projection of the thorax?
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Which respiratory phase is critical during a lateral thoracic projection?
Which respiratory phase is critical during a lateral thoracic projection?
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For a patient requiring the AP oblique projection in the LPO position, where should the central ray be directed?
For a patient requiring the AP oblique projection in the LPO position, where should the central ray be directed?
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What position is recommended for a patient during the Lindblom method?
What position is recommended for a patient during the Lindblom method?
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In the right anterior oblique (RAO) position, which anatomical features are primarily visualized?
In the right anterior oblique (RAO) position, which anatomical features are primarily visualized?
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During a PA projection, how should the chin be positioned for best results?
During a PA projection, how should the chin be positioned for best results?
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What is the specific positioning of the patient’s arms during a lateral projection?
What is the specific positioning of the patient’s arms during a lateral projection?
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Where is the RP typically positioned for a lateral thoracic projection?
Where is the RP typically positioned for a lateral thoracic projection?
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Study Notes
Chest Projections
-
PA Projection
- Patient position: Upright or seated-upright
- Chin extended upward
- Dorsal aspect of hands against the hips
- Shoulders depressed and scapulae rotated laterally
- Exposure done after second full inspiration
- Central ray (CR): Perpendicular
- Rotation Point (RP): T7
- This projection shows the entire lung field
- Useful for detecting pneumothorax and foreign bodies
-
PA Axial Projection
- Patient position: Upright
- Chin resting against the image receptor (IR)
- Elbows flexed
- Pronate hands on hips
- Depress shoulders and rotate forward
- Exposure at the end of full inspiration
- CR: 10-15 degrees cephalad
- RP: T3
- This projection demonstrates lung apices superior to the clavicles
-
Lateral Projection
- Patient position: Upright or seated-upright
- Left side against the IR for heart and left lung or right side against the IR for the right lung
- Median Sagittal Plane (MSP) parallel to IR
- McBurney's Point perpendicular to IR
- Arms extended directly upward
- Elbows flexed
- Forearms resting on elbows
- CR: Perpendicular
- RP: T7
- This projection shows the heart, aorta, and left-sided pulmonary lesions (left lateral) and right-sided pulmonary lesions (right lateral)
-
PA Oblique Projection
- Patient position: Upright or seated-upright
- Body rotated 45 degrees toward the unaffected side
- Shoulder of the unaffected side against the IR
- CR: Perpendicular
- RP: T7
- This projection shows the right lung and tracheal bifurcation (LAO) and the left lung (RAO)
- Good for demonstrating the interlobar fissures and localizing lung lesions
Other Chest Projections
-
Lindblom Method (AP Axial Projection)
- Patient Position: Upright
- Step one foot forward, lean backward into extreme lordosis
- Elbows flexed
- Pronate hands beside hips
- Shoulder against IR
- RP: Midsternum
- CR: Perpendicular
- This projection is similar to the PA Axial Projection, but magnifies the heart and great vessels
-
Resnick Recommendation
- CR: 30 degrees caudad to the midsternal region
- Rationale: To free the basal portions of the lung fields from superimposition by anterior diaphragmatic, abdominal, and cardiac structures
-
Lateral Decubitus Projection
- Patient position: Lateral decubitus
- Body elevated 2-3 inches
- Remain in position for 5 minutes before exposure
- Arms extended well above the head
- Affected side against the IR for pleural effusion or unaffected side against the IR for pneumothorax.
- CR: Horizontal
- RP: 3 inches inferior to the jugular notch (AP) or T7 (PA)
- This projection demonstrates the change in fluid position (pleural effusion) and reveals previously obscured pulmonary areas
Bony Thorax
-
Sternum
-
PA Oblique Projection
- Patient position: Prone or upright (for trauma patients), Right Anterior Oblique (RAO), body rotated 15-20 degrees
- Long exposure time: Slow, shallow breaths during exposure
- Short exposure time: Suspend breathing at the end of expiration
- RP: T7 of the elevated side of the posterior thorax and 1 inch lateral to the MSP
- CR: Perpendicular
- This projection best demonstrates the sternum without superimposition by the vertebrae.
-
Moore Method (PA Oblique)
- Patient position: Modified prone position
- Tube over the patient's right side
- Patient stands at the side of the table
- Bend at the waist
- Arms above shoulders
- Palms down on the table
- RP: Level of T7 and 2 inches to the right of the spine
- CR: 25 degrees toward the MSP; less angulation for larger patients and more angulation for smaller patients
- This projection shows the sternum free of superimposition from the vertebral column
-
Lateral Projection
- Patient position: Lateral recumbent or upright or dorsal decubitus (for patients with severe injury)
- True lateral position
- Broad surface of the sternum perpendicular to the IR
- Suspended deep inspiration
- RP: Lateral border of the midsternum
- CR: Perpendicular
- This projection best demonstrates the entire length of the sternum and the surrounding tissue
-
PA Oblique Projection
-
Sternoclavicular Joints
-
PA Projection
- Patient position: Prone or upright (for trauma patients)
- Arms along the sides
- Palms facing upward
- Head turned facing the affected side for a unilateral examination
- Head resting on the chin for bilateral examination
- RP: T3
- CR: Perpendicular
- This projection shows the sternoclavicular joints.
-
Kurzbauer Method (Lateral)
- Patient position: Lateral recumbent, affected side against the IR
- Hips and knees flexed
- Arm of the affected side grasps the end of the table for support
- Arm of the unaffected side grasps the dorsal surface of the hip (depressed shoulder)
- Anterior surface of the manubrium perpendicular to the IR
- RP: Lowermost sternoclavicular articulation
- CR: 15 degrees caudad
- This projection shows an unobstructed sternoclavicular joint.
-
PA Oblique Projection
- Patient position: Prone or seated-upright, RAO/LAO, body rotated 10-15 degrees toward the affected side
- RP: Level of T2-T3 (3 inches distal to vertebral prominens) and 1-2 in.
- CR: Perpendicular
- This projection projects the vertebrae well behind the SC joint.
-
PA Projection
-
Ribs
-
PA Projection
- Patient position: Upright or supine
- Upright: 1.5 inches above shoulder, shoulder rotated forward, full inspiration
- Supine: Shoulder in the same transverse plane, full expiration
- RP: T7 (for upper ribs) or T10 (for lower ribs)
- CR: Perpendicular
- This projection shows the posterior ribs, both above and below the diaphragm.
-
Lateral Projection
- Patient position: Lateral recumbent, affected side against IR
- Hips and knees flexed
- Arm of the affected side grasps the end of the table (for support)
- Arm of the unaffected side grasps the dorsal surface of the hip (depresses the shoulder)
- Anterior surface of the manubrium perpendicular to the IR
- RP: Lowermost sternoclavicular articulation
- CR: 15 degrees caudad
- This projection shows an unobstructed sternoclavicular joint.
-
AP Projection
- Patient position: Upright or supine
- Upright: IR top board 1.5 inches above shoulder, shoulder rotated forward, full inspiration
- Supine: Shoulder in the same transverse plane, full expiration
- RP: T7 (for upper ribs) or T10 (for lower ribs)
- CR: Perpendicular
- This projection shows anterior ribs both above and below the diaphragm
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PA Projection
Bony Thorax Pathology
- Aspiration/Foreign Body: Inhalation of foreign material into the airway.
- Atelectasis: Collapse of all or part of a lung.
- Bronchiectasis: Chronic dilation of the bronchi and bronchioles.
- Bronchitis: Inflammation of the bronchi.
- Chronic Obstructive Pulmonary Disease (COPD): Chronic condition of persistent obstruction to bronchial airflow.
- Cystic Fibrosis: Widespread dysfunction of the exocrine glands, abnormal secretion of sweat and saliva, and accumulation of thick mucus in the lungs.
- Emphysema: Enlargement of the alveolar wall caused by alveolar wall destruction and loss of elasticity.
- Epiglottitis: Inflammation of the epiglottis.
- Histoplasmosis: Infection caused by the yeastlike organism Histoplasma capsulatum.
- Sarcoidosis: Condition of unknown origin often associated with pulmonary fibrosis.
- Tuberculosis: Chronic infection of the lungs due to the tubercle bacillus.
- Hyaline Membrane Disease/Respiratory Distress Syndrome: Underaeration of the lungs due to a lack of surfactant.
- Metastases: Transfer of a cancerous lesion from one area to another.
- Pleural Effusion/Hydrothorax: Collection of fluid in the pleural cavity.
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Pneumoconiosis: Lung diseases resulting from inhalation of industrial substances.
- Anthracosis: Coal miner's lung or black lung; inflammation caused by inhalation of coal dust (anthracite).
- Asbestosis: Inflammation caused by inhalation of asbestos.
- Silicosis: Inflammation caused by inhalation of silicon dioxide.
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Pneumonia: Acute infection in the lung parenchyma.
- Aspiration Pneumonia: Pneumonia caused by inhalation of foreign particles.
- Interstitial/Viral/ Pneumonitis: Pneumonia caused by a virus and involving alveolar walls and interstitial structures.
- Lobar/Bacterial: Pneumonia involving the alveoli of an entire lobe without involving the bronchi.
- Lobular/Bronchopneumonia: Pneumonia involving the bronchi and scattered throughout the lung.
- Pneumothorax: Accumulation of air in the pleural cavity resulting in lung collapse.
- Pulmonary Edema: Replacement of air with fluid in the lung interstitium and alveoli.
Trachea
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AP Projection:
- Positioning: Supine or upright with neck slightly extended, MSP perpendicular to IR; exposure during slow inspiration.
- Central Ray: Perpendicular.
- Structure Demonstrated: Air-filled trachea.
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Lateral Projection:
- Positioning: Seated or upright, hands clasped behind the body; shoulder rotated posteriorly; neck extended slightly; exposure during slow inspiration.
- Central Ray: Perpendicular.
- Structure Demonstrated: Air-filled trachea and the superior mediastinum.
Chest
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PA Projection:
- Positioning: Upright or seated-upright, chin extended upward, dorsal aspect of hands against hips, rotate scapulae laterally, depress shoulders, pull breasts upward and laterally (female); exposure after 2nd full inspiration or end of full inspiration and expiration.
- Central Ray: Perpendicular.
- Structure Demonstrated: Entire lung field.
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Lateral Projection:
- Positioning: Upright or seated-upright, left or right side against IR; MSP parallel to IR, MCP perpendicular to IR; arms extended directly upward; exposure during slow inspiration.
- Central Ray: Perpendicular.
- Structure Demonstrated: Heart, aorta, and left-sided pulmonary lesions (left lateral); right-sided lesion (right lateral).
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AP Axial Projection:
- Positioning: Upright, step one foot in front, lean backward in extreme lordosis; elbow flexed; hands pronated beside hips; shoulder against IR.
- Central Ray: Perpendicular or 15-20 degrees cephalad.
- Structure Demonstrated: Lung apices inferior to the shadow of the clavicles, demonstrate interlobar effusions.
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PA Axial Projection:
- Positioning: Upright, chin rested against IR, elbow flexed; pronate hands on hips; depress shoulders and rotate forward; exposure at the end of full inspiration.
- Central Ray: 10-15 degrees cephalad.
- Structure Demonstrated: Lung apices superior to the shadow of the clavicles.
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Oblique Projections:
- RAO/LAO: Used for maximum area of left or right lung, trachea, carina, entire left or right branch of bronchial tree, esophagus (if barium filled).
- RPO/LPO: Used to demonstrate the change in fluid position, reveals pulmonary areas obscured by fluid in standard projections.
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Lateral Decubitus:
- Positioning: Lateral decubitus, patient lies on affected side (pleural effusion) or unaffected side (pneumothorax); body elevated 2-3 inches; arms well above the head and remain in position for 5 minutes before exposure
- Central Ray: Horizontal
- Structure Demonstrated: Changes in fluid location in pleural effusion and collapse in pneumothorax.
Sternum
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PA Oblique Projection (Central Ray Angulation Method):
- Positioning: Prone or seated-upright, chin rested on table or rotated toward the side of interest.
- Central Ray: 15 degrees towards MSP.
- Structure Demonstrated: Sternoclavicular joints.
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PA Oblique Projection (Standard Method):
- Positioning: Prone or upright (trauma patient), RAO; body rotated 15-20 degrees.
- Central Ray: ┴.
- Structure Demonstrated: Sternoclavicular joints.
Sternoclavicular Joints
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PA Projection:
- Positioning: Upright or prone, hands rested against hips, palms turned outward, chin rested on chin; suspend at full inspiration.
- Central Ray: ┴.
- Structure Demonstrated: Sternoclavicular joints.
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AP Oblique Projection:
- Positioning: RPO/LPO; body rotated 45 degrees (affected side down), arm of affected side abducted, opposite hand on hip.
- Central Ray: ┴.
- Structure Demonstrated: Sternoclavicular joints.
Ribs
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PA Projection:
- Positioning: Upright or prone, hands rested against hips; palms turned outward, chin rested on chin; suspend at full inspiration.
- Central Ray: ┴.
- Structure Demonstrated: Entire lung field.
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AP Oblique Projection:
- Positioning: RAO/LAO; body rotated 45 degrees (affected side up).
- Central Ray: ┴.
- Structure Demonstrated: Axillary ribs away from IR.
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AP Axial Projection:
- Positioning: Supine; head rested directly on table; arms along sides of the body.
- Central Ray: Directed 2 in. below the level of the jugular notch.
- Structure Demonstrated: Ribs demonstrated in axial projection.
Chest Projections
- PA Projection: Performed upright or seated-upright. Patient should extend their chin upwards, with the dorsal aspect of their hands against their hips. Rotate the scapulae laterally, depress the shoulder, and pull the breast upward & laterally for females. Exposure should be after a second full inspiration, except when looking for pneumothorax or foreign bodies, where exposure occurs at the end of full inspiration and expiration.
- Midway Between Jugular Notch & Midcoronal Plane: The central ray should be directed to this point for a PA projection.
- 4-5 Inches Lower: This is the location of the central ray for a PA projection of the superior mediastinum.
- AP Axial Projection: This projection is performed with the patient upright, with one foot forward and leaning backward in extreme lordosis. Flex the elbows, pronate the hands beside the hips, and place the shoulder against the image receptor.
- Midsternum: The central ray should be directed to this point for an AP axial projection.
- Linblom Method: A specialized AP axial projection often performed in patients with a high clavicle position or a hyperstenic build. CR is angled 30 degrees caudad to the midsternal region.
Lateral Projection
- Left Side: The patient is positioned with the left side against the image receptor for the heart and left lung.
- MCP Perpendicular to IR: This ensures proper alignment.
- T7: The central ray should be directed to this point.
- Right Side: The patient is positioned with the right side against the image receptor for the right lung.
- PA Oblique Projection: Performed with the patient upright or seated-upright. The body is rotated 45 degrees toward the unaffected side. For cardiac series, 55-60 degrees of rotation is used. For pulmonary disease studies, 10-20 degrees of rotation is used.
- LPO: Shows the maximum area of the left lung. Similar to RAO.
- RPO: Shows the maximum area of the right lung. Similar to LAO.
- AP/PA Projection, Right or Left Lateral Decubitus: Performed with the patient lying on the affected side for pleural effusion or the unaffected side for pneumothorax. The body should be elevated 2-3 inches, and arms should be positioned well above the head for 5 minutes prior to exposure.
Bony Thorax
- RAO: This position shows the maximum area of the left lung, trachea, the entire left branch of the bronchial tree, the left atrium, the anterior portion of the apex of the left ventricle, the right retrocardiac space, and the esophagus if filled with barium.
- Medial Part of the Right Middle Lobe & Lingula of the Left Upper Lobe: These areas are free from the hilum when using a 10-20-degree caudal angle for a PA oblique projection.
- AP Oblique Projection: Performed with the patient upright or supine. The body is rotated 45 degrees toward the affected side. The shoulder of the affected side rests on the image receptor.
- 3 Inches Inferior to Jugular Notch: This is the location of the central ray for an AP oblique projection.
- Ekimsky Recommendation: This technique is preferred to demonstrate small pleural effusions. The patient leans laterally 45 degrees.
- Lateral Projection, Ventral/Dorsal Decubitus Position: Performed with the patient supine or prone. The thorax is elevated 2-3 inches and the patient remains in position for 5 minutes before exposure. Arms should be extended well above the head, with the affected side against the image receptor.
- Moore Method: Used to image the sternum in an ambulatory patient. The patient stands at the side of the table and bends at the waist with arms above shoulders and palms down on the table.
- Lateral Projection, Right or Left Position: Performed with the patient lateral recumbent/upright or in dorsal decubitus position. The patient is in a true lateral position, with the broad surface of the sternum perpendicular to the image receptor.
- Lateral Border of Midsternum: Here, the central ray should be directed to this point.
Sternoclavicular Joints
- PA Projection: Performed with the patient upright or prone. Arms should be extended well above the head, with the affected side against the image receptor.
- Central Ray Angulation Method: The patient should be prone or seated-upright. The central ray is angled 15 degrees toward the MSP.
- AP Oblique Projection: Done with the patient in RPO/LPO. The body is rotated 45 degrees. The affected side is down. The arm of the affected side is abducted, and the opposite hand is placed on the hip.
Ribs
- PA Projection: The patient should be upright or prone. The hands are rested against their hips, with the palms turned outward. The chin should be rested on the chest. For imaging the ribs above the diaphragm, the patient suspends at full inspiration. For imaging ribs below the diaphragm, the patient suspends at full expiration.
- Upright: When imaging ribs above the diaphragm, the patient rests the forearm on the grid device. When imaging ribs below the diaphragm, the patient rests on the forearm and the knee of the elevated side is flexed.
### Sternum
- PA Oblique Projection: The patient lies prone or upright. They should be in the RAO position. The body is rotated 15-20 degrees. This helps prevent superimposition of the sternum and vertebrae.
- PA Oblique Projection, Central Ray Angulation Method: This method is preferred for trauma patients. The patient should be prone or seated-upright.
- AP Oblique Projection: Preferred for imaging trauma patients, especially if supine.
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Test your knowledge on chest X-ray projections including PA, PA axial, and lateral views. This quiz covers patient positioning, technical factors, and the clinical significance of each projection. Perfect for radiology students and healthcare professionals.