Chest Radiography: Indications & Views

Chest Radiography

Clinical Indications

• Shortness of breath (SOB) or shortness of breath on examination (SOBOE) may warrant a chest X-ray
• Haemoptysis is the coughing up of blood
• Weight loss and anemia can sometimes be investigated with a chest X-ray
• Pleural effusion refers to fluid accumulation around the lungs
• Pneumothorax is a collapsed lung
• Ongoing cough, lung nodules, COPD, lower respiratory tract infections (LRTI), and upper respiratory tract infections (URTI) can be evaluated

Area of Interest (AOI)

• PA & AP View shows lung apices superiorly, costophrenic angles inferiorly, and the lateral chest wall laterally

Lateral View

• Lateral View shows lung apices superiorly, costophrenic angles inferiorly, and the chest wall anteriorly and posteriorly

Centring Point

• PA View requires centring at the midline at the level of T6/7, which is the inferior border of the scapulae
• AP View requires centring at the midline at T6, about 2.5 cm inferior to the sternum angle
• Lateral View requires centring at the midline at T6, inferior border of the scapula

Collimation

• Collimation should include the entire lung fields, from the apices to the costophrenic angles and the lateral chest walls

Exposure Parameters

• Source to Image Distance (SID) should be 180 cm
• A broad focus should be used
• A grid
• 125 kVp (Kilovoltage Peak) is to be used
• The mAs (Milliampere-seconds) range is 1.25–2

Inspiration

• 6-7 anterior ribs and 8-9 posterior ribs should be clearly outlined

Positioning Critique

• Rotation can be assessed by checking the distance from the spinous process to the pedicles of the thoracic vertebrae
• Rotation can be assessed by checking the distance from each medial end of the clavicle to the spinous process
• Tilt is assessed by looking at the clavicles
• Clavicles should be 2.5 cm below the apices at thoracic vertebrae level 2/3
• If clavicles are higher, the patient is likely lordotic
• If they are lower, the patient is likely kyphotic
• Scapulae should be rotated out of the lung fields, achieved by rotating the hands outwards and downwards

Abdomen

• Use a grid

Clinical Indications

• Use when distension, palpable mass, renal colic, foreign body, trauma, acute pain, or for control images.

Supine (AP) View

• Diaphragm is seen superiorly to kidneys
• Superior aspect of the symphysis pubis is seen inferiorly
• Lateral flank lines and the colon are seen Laterally

Centring Point

• Midline at the level of the iliac crests (L4) for centring

Collimation

• Perform Collimation from diaphragm to symphysis pubis, ensuring lateral margins of the colon are visible

Exposure Parameters

• SID: 115 cm
• FSS: Broad Focus
• 75kVp is the kVp to use
• mAs is 15-20

Left Lateral Decubitus View

• The AOI is the same as supine abdomen

Centring Point

• Midline at the level of the iliac crests (L4)

Collimation

• Include diaphragm and anterior abdominal wall

Exposure Parameters

• SID: 115 cm
• FSS: Broad focus
• 75kVp is the kVp to use
• mAs is 15-20

Grid

• 115 grid

AEC

• Uses 3 chambers

Positioning Critique

• Positioning should be not rotated, check spine and pelvis
• Ensure inclusion of the diaphragm to symphysis pubis including the margins of the colon
• Exposure should demonstrate differences in tissue densities
• Images should be sharp and unaffected by artefacts
• The maximum calibre of the colon should be 5.5cm
• The maximum calibre of the proximal jejunum should be 3.5cms
• The maximum calibre of the mid small bowel should be 3cm
• The maximum calibre of the ileum should be 2.5cm
• The right kidney should be lower than the left

Cervical Spine Radiography

Clinical Indications

• Traumatic Conditions like fractures, dislocations, and subluxations can be assessed
• Signs: Numbness/paraplegia, tingling, and limited movement can prompt imaging

Exposure Considerations

• Enough brightness ensures the the spine can be viewed
• Good KvP and good contrast ensures the cortical and trabecular bone shows
• Sufficient mAs eliminates noise in images

1. Antero-Posterior (AP) Projection

Area of Interest:

• Mandible and occiput superimposed
• First thoracic vertebra shown
• Shows the whole length of transverse processes

Centring Point:

• Along the midline right below the thyroid cartilage between C4-C5
• To open the intervertebral joint spaces, angle between 5°-15°

Collimation:

• All collimation lines and soft tissue margins are present

Exposure Factors:

• kVp: 65-75
• mAs: 8–12
• SID: 100 cm

Image Characteristics:

• No rotation –ensure transverse processes are equidistant from the vertebral body
• The spinous processes need to be aligned in the midline
• Intervertebral joint spaces should be clear

2. Lateral Projection

Area of Interest:

• External auditory meatus (EAM)
• Includes the first thoracic vertebra (T1)
• includes the soft tissues (trachea, oesophagus)
• Includes All spinous processes

Centring Point:

• 2.5 cm inferior and posterior to the angle of the mandible

Collimation:

• Includes at least four lines of collimation

Exposure Factors:

• kVp: 65-75
• mAs: 15-25
• SID: 150 cm (some sites use 180 cm)

Image Characteristics:

• The rami of the mandible should be parallel and superimposed and shifted away from the body of C2
• No rotation of vertebrae, articular surface shows

3. Horizontal Beam Lateral (HBL) Projection (Trauma Cases)

• Field of view and centring like the lateral
• needs to show four visible collimation lines

Exposure Factors:

• kVp: 65-75
• mAs: 15-25
• SID: 150-180 cm

4. AP Odontoid Peg (Dens) Projection

• Used to assess C1 and C2 for facts or misalignments

Area of Interest:

Centring Point:

• The centre needs to go through the patients open mouth at the level of the mastoid processes

Collimation:

• The entire odontoid peg (dens), lateral masses of the atlas (C1), and as much of the axis (C2) are included.

Exposure Factors:

• 70-75 kVp and 8-12 mAs

SID:

• Needs to be at 100cm

Image Charactertistics

• The upper incisors should be superimposed with the occipital bone
• Where the upper incisors obscure the peg apply a cranial angle
• For the occiput is Projected over the peg apply a caudal angle
• Atlanto-axial joint space needs to be clearly visualised

Patient consideration

• ensure the area of interest in question is included

5. Lateral Cervical Spine – Flexion & Extension Views

• The images are needed to assess the motion of the joints to observe instability in trauma and athritis cases
• Only used when it is vital to minimise instability

Centring Point:

• Use of a horizontal beam directed 2.5cm inferioir and posterior to the angle of the mandible

Collimation:

• External auditory meatus superiorly
• First thoracic vertebra Inferiorly
• Soft tissues anteriorly
• Spinous processes posteriorly

Exposure Factors

• kVp: 65-75 and mAs15-25

SID

• use 150cm or 180cm to mitigate magnification

Image characteristics and criteria

• rotation is vital to ensure proper articulation of surfaces
• It is important that C1 and C2 aren't mis contorted from the mandible
• separation needs to be well spaced

6. Swimmer’s Lateral Projection (Cervicothoracic Junction)

Purpose:

• Used when C7/T1 cannot be seen because of the superimposition

Positioning :

• Nearest arm needs to be raised the opposite arm needs to depressed as much as possible

Centre point:

• Horizontal Ray just above the shoulder at C7/T1 Levels

Exposure

• 75-85 kVp varies depending on Patients

Colimation:

C7/T1 joints must be seen

• The cervial vertebraes need to be visible

• Thoracic Spine

Clinical indications

• Trauma, Fall, sports injuries the need of sublocations and fractures
• Orthopaedic check ups
• chronic Scoliosis arthritis

1. Antero-Posterior (AP) Projection:

Area of Interest:

• Top of C7
• Bottom of L1
• The side of the transverse processes
• All the Pedicles should be equivalent
• There should be transverse processes should be equal in length

Centre point:

• In the middle of where the sternus and what nots

• collimation:

• C7:L1 needs to be inside the borders

• the Transverse processes need to be clearly visible

• Need to be a marker #####Exposure parameters

• SID: 100CM

• Suspended breathing is used during the exposure

2. Lateral Projection:

Turn the patient supine until the MSP is Parallel to the IR need to lift there arms and fold pads in

• The arms need to be raised
• pads need to be placed on knees

area of interest

• C7 needs to be visilbe
• L1 needs to be shown
• and intervertebral body

Side view

• Side view in the centre of the midline from the inferior border of the scapula,

• and intervertebral body

lateral for PA positioning of thoracic spine

In Pa, radiation needs to hit more anteriorly it's the only differences between AP settings and a pa is patient comfort with lower tolerance

Lumbar spine

• Is used to look for fractures and abnormalities in bone.

positioning

• Trauma /Falls a fracture
• post fractures
• conditions like birth defects

AP Lumbar spine

The main goal is and has always bent to find issues with the spine

Patient positions The patient needs to in the supine the MSP can be parallel ,pads and knees need folded.

• alternative PA erect

centerPoint

• Midline is need and where The xiphoud is
• 4cm above iliac

The collimation needs to include t12

And the Sacrum

And the Joints and entire view of vertrbia

all exposure params for

100cm Sid

And a middle Chamer

The kVp needs to be between 70:85

MAs needs to be between 30:50

breath needs not be in movement and still

• It is important to be equallydistant

lateral parameters

• Make sure you have equal distances .
• All rotation be equal to get clear visbility
• lateral lumbar positions
• Must be laid side down to the casste and make sure is MSP
• arms raised and pads on knees
• shoulers hips ankles must need super
• Put a sponge to support what's necessary .

Vertical needs to be at the lower marigin to show

~ 7.5 to anterior

• and a 3rd of A

• sid 100Cm

Medial must used and in breathing and is still 70;85 Kvm

50 :80 MAs

Image needs to be equal and stable

Skull and facial bones

Clinical indications:

• Used to look for Tumors myeloma
• Cancer
• To observe for Pager Diseases
• Radiograph

Facial bones:

• trauma and if issues persists later after a accidents RTA and if wounds are causing issues

1. Side veiw

Need to the Cranial vault

Where is the centre

Halfbetween the EOP Side is 100CM

What not

• kVp values need to be taken

Images parameters

• Single Line ant and Posterior
• To superimposed the area around the skull

There is much not for chin and it cannot affect the radiograph

2. To locate the Mentatol PA the place the bones in the nasal region to align the area

• Use a horizon
• Sid 100cm Kvm need to be off

3 . To locate to30°

• The point needs to be shown clear

• -30 the chin and midline Need to see the mandible and the oribatal region

• MAs to be 16

Mandible

Clinical

• traumas to the area
• Tumors

Can locate teeth

AREA of intrest is ENTIRLEY MANDIBLE Mid line with jaws And what area needs to be shown Skin needs needs to collimated SIDE is 100

images parameters

Need to visible symmetry and no distortion

Lateral oquliuge

• The manidnbes needs to be clear on each side
• TMj protbance is need

The panoramic also help in assessing the bones and dental images

Must aligned sagittal laser beam in centre

Need to see if teeth focus and gums aligned

###Dental Projections

• Bitwigs
• Can clear carious parts

###Area of in test

• Crows in the upper jaw clear
• and clear centre

Images must show not overlap

And be clear in the side Occlusals.

Indication

• Area to assessment Dentals ARCH

Area to in test must be shown and centred from angled images must be use to clearly see if all teeth are focused ####Preiapicals- Used root Structure One single the must be use

• Align parallel images must be very and focused