BONY THORAX

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Questions and Answers

What is the primary purpose of the PA oblique projection conducted in a left anterior oblique (LAO) position?

To demonstrate the interlobar fissures of the lungs

To localize pulmonary lesions on the left side (correct)

To obtain images of the heart and great vessels during breathing

To visualize the maximum area of the right lung

When the patient is in a recumbent position for a contrast study, which projection technique is employed?

Supine RAO for maximum lung visualization

AP projection at a 20-degree angle

Lateral decubitus with the patient on the affected side (correct)

Upright PA oblique with maximum shoulder elevation

For a cardiac series, what body rotation angle is typically utilized?

20 degrees towards the unaffected side

45 degrees toward the unaffected side

55 to 60 degrees towards the affected side (correct)

10 to 20 degrees towards the affected side

Which of the following is a correct statement regarding the right lateral projection?

It demonstrates the maximum area of the right lung. Signup and view all the answers

What is the correct central ray positioning for a lateral projection of the sternum?

Horizontal Signup and view all the answers

What anatomical landmarks are essential to position the radiograph beam for the PA oblique projections?

T7 as the radiographic point of interest Signup and view all the answers

In PA oblique projection of the sternum, what is the recommended rotation of the body?

15-20 degrees Signup and view all the answers

What position should a patient be in for the lateral recumbent projection if they have a severe injury?

True lateral position Signup and view all the answers

What is the purpose of the lateral projection of the sternum?

To demonstrate the change in fluid position Signup and view all the answers

Where should the radiographic beam be directed in a PA projection of the sternoclavicular joints?

At T7 of the elevated side of the posterior thorax Signup and view all the answers

What anatomical structures are primarily demonstrated using the AP projection at the level of the jugular notch or T7?

Heart and aortic arch Signup and view all the answers

In which position should a patient be placed for the modified prone projection using the Moore method?

Modified prone with arms above shoulders Signup and view all the answers

What is the purpose of conducting a lateral projection in the right or left position?

To visualize pleural effusions and pneumothorax Signup and view all the answers

When performing an AP oblique projection in the left posterior oblique (LPO) position for trauma patients, what is the primary goal?

To provide comfort and demonstrate pulmonary areas Signup and view all the answers

What is the necessary adjustment to make when angulating the tube for larger patients during the lateral projection?

Modify the angulation based on body size Signup and view all the answers

What is the recommended CR angle for the Resnick method to demonstrate retrosternal extensions of the thyroid gland?

30 degrees caudad Signup and view all the answers

In the PA projection, what is the primary purpose of extending the chin upward?

To enhance lung apices visibility Signup and view all the answers

During the RAO position, which structure is best imaged due to this positioning?

Left atrium Signup and view all the answers

What does the lateral projection mainly help to visualize?

Both left and right lung fields Signup and view all the answers

What is the recommended position for performing the Lindblom method?

Upright, leaning backward in extreme lordosis Signup and view all the answers

For the lateral projection, what is critical about the patient's arm positioning?

Arms extended upward Signup and view all the answers

What do ribs assume in a lateral projection when positioning is correct?

Horizontal orientation Signup and view all the answers

What condition can the PA projection be used to assess effectively?

Lung consolidation Signup and view all the answers

What is the correct RP for an AP axial projection?

Midsternum Signup and view all the answers

Which projection has the CR angled 10-15 degrees cephalad?

PA axial projection Signup and view all the answers

What is the positioning of the arms for a trauma patient during a sternum examination?

Arms along lateral to MSP with palms facing upward Signup and view all the answers

For the best projection to demonstrate the sternoclavicular joints, which direction should the CR be angled?

15 degrees caudad Signup and view all the answers

In the Kurzabauer method, how is the arm of the affected side positioned?

Grasping the end of the table Signup and view all the answers

When performing an AP projection for ribs above the diaphragm, how should the patient be positioned?

Upright, with IR top board 2 inches above the shoulder Signup and view all the answers

In a PA oblique projection, what is the body rotation angle toward the affected side?

10-15 degrees Signup and view all the answers

Which of the following accurately describes the required respiratory phase when performing a rib projection in supine for ribs below the diaphragm?

Suspend at full expiration Signup and view all the answers

What is the correct RP for imaging the lower ribs using the AP projection?

Level of T10 Signup and view all the answers

Which ribs are best demonstrated in an AP projection while the patient is supine?

8th-12th ribs Signup and view all the answers

What is the purpose of the lateral decubitus position in radiographic imaging?

To visualize pleural effusion or pneumothorax Signup and view all the answers

What is the recommended patient position for performing a lateral projection of the sternum?

Lateral recumbent or upright position Signup and view all the answers

In a right lateral projection, which anatomical structures are most likely visualized?

Entire right branch of bronchial tree Signup and view all the answers

What is the recommended patient positioning for a left anterior oblique (LAO) projection during imaging?

Upright with the left side elevated Signup and view all the answers

During the PA oblique projection, how much should the body be rotated to avoid superimposition of the sternum and vertebrae?

15-20 degrees Signup and view all the answers

When is the recumbent position typically employed in imaging?

When the patient is too ill to be turned Signup and view all the answers

What should be the breathing technique during the lateral projection of the sternum?

Slow, shallow breaths during exposure Signup and view all the answers

What is the primary benefit of body rotation in PA oblique projections?

Allows differential imaging of lung lobes Signup and view all the answers

What anatomical area does the lateral projection of the sternum primarily reveal?

Pulmonary areas obscured by fluid Signup and view all the answers

Where should the central ray (CR) be directed in a lateral projection of the sternum?

Lateral border of midsternum Signup and view all the answers

What condition is characterized by the accumulation of fluid in the pleural cavity?

Pleural Effusion Signup and view all the answers

Which lung disease is specifically caused by the inhalation of coal dust?

Anthracosis Signup and view all the answers

What is the main characteristic of emphysema?

Enlargement of alveolar walls Signup and view all the answers

Which type of pneumonia involves the alveoli of an entire lobe?

Lobar/Bacterial Signup and view all the answers

What condition is a result of a lack of surfactant in the lungs?

Hyaline Membrane Disease Signup and view all the answers

What is Pneumothorax associated with?

Accumulation of air in the pleural cavity Signup and view all the answers

Which condition is characterized by inflammation caused by the inhalation of silicon dioxide?

Silicosis Signup and view all the answers

What describes atelectasis?

Collapse of all or part of the lung Signup and view all the answers

Which lung condition results specifically from inflammation due to the inhalation of asbestos?

Asbestosis Signup and view all the answers

What condition results from a chronic infection of the lungs due to the tubercle bacillus?

Tuberculosis Signup and view all the answers

What is the preferred patient positioning for an AP oblique projection to image the sternoclavicular joints?

Rotated 45 degrees with the affected side down Signup and view all the answers

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?

Abducted and on the hip Signup and view all the answers

For an AP axial projection, how far should the radiographic beam be directed above the level of the jugular notch?

2 inches Signup and view all the answers

In the PA projection of ribs below the diaphragm, what is the correct respiratory phase?

Suspend at full expiration Signup and view all the answers

When performing a PA oblique projection in the RAO position, which ribs are primarily visualized?

Axiillary ribs closest to the sensor Signup and view all the answers

What is the appropriate central ray angulation for the PA oblique projection of the sternoclavicular joints?

15 degrees toward the MSP Signup and view all the answers

In a supine position for imaging ribs below the diaphragm, how should the patient's knee be positioned?

Flexed on the elevated side Signup and view all the answers

What adjustment should be made to the patient's arms when performing an upright PA projection of the ribs?

Arms should be relaxed at sides Signup and view all the answers

What is primarily visualized in the Lindblom method?

Thyroid gland extensions Signup and view all the answers

During a PA projection, which anatomical structure is expected to be imaged inferior to the shadow of the clavicles?

Lung apices Signup and view all the answers

In a lateral projection, how should the patient’s arms be positioned?

Extended directly upward Signup and view all the answers

What adjustment is recommended for imaging hyperstenic patients during the PA axial projection?

Leaning the patient backward at 15-20 degrees Signup and view all the answers

In the AP oblique projection, where should the patient's shoulder of the affected side be positioned?

Against the IR Signup and view all the answers

What significant characteristic is noted in the chest radiograph with the inferior positioned arm?

Magnification of heart and great vessels Signup and view all the answers

What is the central ray direction for the RAO position to maximize visualization of lung areas?

10-15 degrees cephalad Signup and view all the answers

In which patient position is the thymic enlargement best visualized?

Recumbent position Signup and view all the answers

What does the patient need to do during a lateral projection for optimal imaging?

Hold their breath at exhalation Signup and view all the answers

What anatomical landmarks should be positioned at T7 for an appropriate PA projection?

Jugular notch and sternal angle Signup and view all the answers

What is the primary purpose of using a lateral projection for the sternum?

To reveal pulmonary areas obscured by fluid. Signup and view all the answers

In the PA oblique projection of the sternum, how much should the body be rotated to prevent superimposition with the vertebrae?

15-20 degrees Signup and view all the answers

Which patient position is optimal for conducting a PA projection of the sternoclavicular joints?

Upright with shoulders relaxed Signup and view all the answers

What is the orientation of the central ray when performing a lateral projection of the sternum?

Perpendicular to the IR Signup and view all the answers

Which technique is essential for achieving optimal imaging of the sternum during the RAO position?

Slow, shallow breaths during exposure Signup and view all the answers

What positioning technique should be employed to demonstrate small pleural effusions?

Lateral leaning position at 45 degrees Signup and view all the answers

In performing the Moore method, what is the correct recommendation for patient positioning?

Modified prone with the right side elevated Signup and view all the answers

During a lateral projection of the sternum, what is the crucial factor regarding the positioning of the arms?

Arms must be extended well above the head Signup and view all the answers

What is the effect of positioning a patient for the ventral/dorsal decubitus lateral projection?

It reveals the presence of free air and fluid levels. Signup and view all the answers

What is the correct central ray (CR) angle for larger patients during the lateral projection of the sternum?

25 degrees toward the mid-sagittal plane Signup and view all the answers

What is the recommended arm position for a patient during the AP oblique projection?

Arm of the affected side is abducted Signup and view all the answers

Which position is utilized for imaging ribs below the diaphragm during a PA projection?

Supine with knee of elevated side flexed Signup and view all the answers

What is the proper central ray entrance for a PA oblique projection performed on the left side?

Left SC joint Signup and view all the answers

During an upright AP axial projection, how should the patient's head be positioned?

Resting directly on the table Signup and view all the answers

In a PA oblique projection of the ribs, what is the recommended body rotation angle?

45 degrees Signup and view all the answers

What is the main goal of suspending respiration at full inspiration during rib imaging above the diaphragm?

To help depress the diaphragm Signup and view all the answers

Where should the central ray be directed when performing the AP oblique projection of the sternoclavicular joints?

15 degrees toward the MSP Signup and view all the answers

In which position should the patient be for the PA projection to image the upper ribs?

Upright or prone with hands on hips Signup and view all the answers

What is the recommended rotation of the body for the PA oblique projection during evaluation of the sternum?

10-15 degrees Signup and view all the answers

For an AP projection conducted when the patient is upright, where should the IR be positioned?

1.5 inches above the shoulders Signup and view all the answers

What is the primary purpose of angling the CR 15 degrees caudad for the sternoclavicular joint projection?

To avoid superimposition of the vertebrae Signup and view all the answers

What positioning is required for a patient being examined in a lateral recumbent position?

Unaffected side down with the hips and knees flexed Signup and view all the answers

Which of the following correctly describes the RP for an AP projection when imaging lower ribs?

At the level of T10 Signup and view all the answers

In the lateral projection of the sternum, how should the patient's arms be positioned?

Along the lateral sides with palms facing upwards Signup and view all the answers

What is the central ray orientation when performing the Limburg method?

15 degrees caudad Signup and view all the answers

What type of projection is typically used to best demonstrate the anterior ribs above the diaphragm?

PA projection Signup and view all the answers

What is a common cause of bronchiectasis?

Recurrent infections Signup and view all the answers

Which lung condition is associated with the accumulation of air in the pleural cavity?

Pneumothorax Signup and view all the answers

Which condition is typically resultant from inhalation of asbestos fibers?

Asbestosis Signup and view all the answers

Which pneumonia type involves both the alveoli and interstitial structures in the lungs?

Interstitial pneumonia Signup and view all the answers

What is the primary issue associated with chronic obstructive pulmonary disease (COPD)?

Permanent obstruction of airflow Signup and view all the answers

What is the main focus of treatment for pulmonary edema?

Removing excess fluid from the lungs Signup and view all the answers

Histoplasmosis is caused by which type of organism?

Fungi Signup and view all the answers

Which lung condition is characterized by a collapse of all or part of the lung?

Atelectasis Signup and view all the answers

Which of the following is an accurate description of silicosis?

Inhalation of silicon dioxide Signup and view all the answers

What condition is typically linked to chronic infections of the lungs?

Tuberculosis Signup and view all the answers

What is the primary reason for using a lateral projection during sternum imaging?

To demonstrate the change in fluid position Signup and view all the answers

In the PA oblique projection of the sternum, how is the patient positioned to prevent superimposition with the vertebrae?

Body rotated 15-20 degrees toward the elevated side Signup and view all the answers

Where is the CR aimed for the lateral projection of the sternum?

At the lateral border of the midsternum Signup and view all the answers

Which breathing technique is recommended during the PA oblique projection of the sternum?

Short exposure while suspended at the end of respiration Signup and view all the answers

What is the recommended position for a patient with a severe injury when performing the lateral projection of the sternum?

Lateral recumbent or upright Signup and view all the answers

When performing a right lateral projection, which anatomical aspects are primarily demonstrated?

Maximum area of the right lung Signup and view all the answers

What is the primary purpose of the lateral decubitus position during imaging?

To evaluate pleural effusions or pneumothorax Signup and view all the answers

Which position is employed to achieve maximum visualization of the left lung?

Left posterior oblique (LPO) Signup and view all the answers

What is the significance of rotating the body 10-20 degrees during a PA oblique projection?

To prevent superimposition of the sternum and vertebrae Signup and view all the answers

In which scenario is the PA oblique projection especially beneficial?

When the patient is too ill to be turned prone Signup and view all the answers

What sagittal plane position is recommended for demonstrating small pleural effusions?

Lateral position leaning 45 degrees Signup and view all the answers

In a lateral projection, which condition can be best assessed using the ventral or dorsal decubitus position?

Pneumothorax detection Signup and view all the answers

What is the correct central ray (CR) angle for large patients during a lateral projection?

25 degrees toward MSP Signup and view all the answers

What is the primary purpose of the AP Oblique projection in trauma cases?

To provide comfort and reduce pain Signup and view all the answers

Which anatomical area is the primary focus of the lateral projection in patients experiencing acute pain?

Pulmonary areas previously obscured Signup and view all the answers

What is the body rotation angle for a PA oblique projection when the affected side is placed down?

45 degrees Signup and view all the answers

In the upright position for imaging ribs above the diaphragm, what should the patient do during the procedure?

Rest the forearm of the affected side on the grid device Signup and view all the answers

For a supine AP axial projection, where should the patient's head be positioned?

Rested directly on the table Signup and view all the answers

During a PA projection, what respiratory phase is primarily used?

Full inspiration Signup and view all the answers

What is the recommended rotation for a patient in a left anterior oblique (LAO) position for imaging?

45 degrees Signup and view all the answers

What is the correct central ray (CR) orientation for imaging the sternoclavicular joints?

CR perpendicular Signup and view all the answers

When positioning the patient supine to image ribs below the diaphragm, where should the knees of the elevated side be?

Flexed toward the chest Signup and view all the answers

What is the purpose of keeping the arm of the affected side abducted during the AP oblique projection?

To visualize the structures more clearly Signup and view all the answers

What is the recommended central ray angle for the Resnick method when demonstrating retrosternal extensions of the thyroid gland?

30 degrees caudad Signup and view all the answers

In the PA axial projection, which anatomy is best visualized?

Lung apices Signup and view all the answers

What issue can arise when conducting a lateral projection of the thorax?

Superimposition of the heart Signup and view all the answers

Which respiratory phase is critical during a lateral thoracic projection?

After full inspiration Signup and view all the answers

For a patient requiring the AP oblique projection in the LPO position, where should the central ray be directed?

At the level of T7 Signup and view all the answers

What position is recommended for a patient during the Lindblom method?

Sitting upright with extended arms Signup and view all the answers

In the right anterior oblique (RAO) position, which anatomical features are primarily visualized?

Left lung and trachea Signup and view all the answers

During a PA projection, how should the chin be positioned for best results?

Extended upward Signup and view all the answers

What is the specific positioning of the patient’s arms during a lateral projection?

One arm raised above the head, the other on the hip Signup and view all the answers

Where is the RP typically positioned for a lateral thoracic projection?

Midway between the jugular notch and T7 Signup and view all the answers

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
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.
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

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.
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.
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

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.
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

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.
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).
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.
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.
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.
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

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.
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

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.
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

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.
AP Oblique Projection:
- Positioning: RAO/LAO; body rotated 45 degrees (affected side up).
- Central Ray: ┴.
- Structure Demonstrated: Axillary ribs away from IR.
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.