THORACIC VISCERA
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Questions and Answers

What is the angle for the PA oblique projection when performing an LAO for the right lung?

  • 90°
  • 60°
  • 45° (correct)
  • 30°

    • What is one of the evaluation criteria for oblique images of 45 degrees?

  • Increased lung field magnification
  • Visible identification markers (correct)
  • Ribs appearing vertical
  • Clavicle positioned lower

    • What is the primary evaluation criterion for a CXR PA projection?

  • The trachea should be visible in the midline. (correct)
  • Only the lower lung fields need to be evaluated.
  • The diaphragm must be evident at the same level during inspiration and expiration.
  • Only the right lung must be visible.

    • When performing an AP oblique projection in the LPO position, which lung is primarily displayed?

    <p>Left Lung</p> Signup and view all the answers

    In a lateral projection, which of the following statements is accurate regarding patient positioning?

    <p>The medial sagittal plane (MSP) must be perpendicular to the image receptor (IR).</p> Signup and view all the answers

    What is a respiratory consideration that should be made during imaging?

    <p>Patient should hold breath while imaging</p> Signup and view all the answers

    Which of the following characteristics is indicative of a correct oblique angle in chest imaging?

    <p>Sharp outlines of the heart and diaphragm must be observed.</p> Signup and view all the answers

    Which of the following techniques is specifically recommended by Resnick for examining lower lobe diseases?

    <p>AP Projection with a 30° caudal angle</p> Signup and view all the answers

    What is the purpose of using contrast like barium suspension in chest radiography?

    <p>To enhance visualization of the esophagus.</p> Signup and view all the answers

    During a lateral projection, what aspect is crucial for demonstrating interlobar fissures?

    <p>Appropriate angling of the x-ray beam</p> Signup and view all the answers

    What position should the patient's shoulders be in during the PA Axial Projection for optimal evaluation?

    <p>Depressed and rotated forward</p> Signup and view all the answers

    In which projection is the clavicle expected to lie superior to the apices?

    <p>AP Axial Projection</p> Signup and view all the answers

    What is the recommended lordotic position for the AP Axial Oblique Projection?

    <p>Oblique lordotic position with RPO or LPO 30°</p> Signup and view all the answers

    Which finding indicates correct positioning during a lateral projection?

    <p>Visible identification markers</p> Signup and view all the answers

    For patients with pleural effusion, which position should be utilized to visualize fluid effectively?

    <p>Lateral Decubitus Position</p> Signup and view all the answers

    What angle should the x-ray beam be directed for the PA Axial Projection at inspiration?

    <p>10-15° cephalad</p> Signup and view all the answers

    Which of the following indicates that the apices are below the clavicles in an AP Axial Projection?

    <p>Clavicles lying horizontally with their medial ends overlapping the first rib</p> Signup and view all the answers

    What is a key consideration for imaging patients suspected of having pneumothorax?

    <p>Use a lateral decubitus position with the unaffected side up</p> Signup and view all the answers

    During the exposure for a lateral projection, what is the recommended position for the arms?

    <p>Arms above the head</p> Signup and view all the answers

    Which position is indicated for evaluating interlobar effusions effectively?

    <p>Lateral Decubitus Position</p> Signup and view all the answers

    What is the recommended patient position for an Axiolateral projection using the Twining Method?

    <p>Upright with hands clasped behind</p> Signup and view all the answers

    In the lateral projection of the trachea, where should the mid-sagittal plane (MSP) be aligned?

    <p>Parallel to the image receptor</p> Signup and view all the answers

    Which respiration technique is recommended for obtaining an image of the air-filled trachea during imaging?

    <p>Slow deep inspiration</p> Signup and view all the answers

    What anatomical structures are primarily focused on during a PA projection of the chest?

    <p>Lungs and aortic knob</p> Signup and view all the answers

    What is the significance of the shoulder placement in a lateral projection for trachea imaging?

    <p>Shoulders should be depressed and rotated forward</p> Signup and view all the answers

    What structures are visible in the field of view when performing a LAO projection for the right lung?

    <p>Descending aorta and heart</p> Signup and view all the answers

    During an AP oblique projection, which lung structure is highlighted when positioned in LPO?

    <p>Left atrium</p> Signup and view all the answers

    What angle is typically utilized for the elevation of the lung fields in a PA oblique projection?

    <p>45°</p> Signup and view all the answers

    When performing an RAO projection, which area is maximized for better visualization?

    <p>Right lung maximum area</p> Signup and view all the answers

    Which of the following is NOT a part of the evaluation criteria for oblique chest images?

    <p>Carina and heart in the field</p> Signup and view all the answers

    What is one of the characteristics that indicate proper evaluation of a CXR PA projection?

    <p>Ten posterior ribs should be visible above the diaphragm.</p> Signup and view all the answers

    What is the significance of demonstrating sharp outlines of the heart and diaphragm in a chest X-ray?

    <p>It shows that the image was captured at the correct exposure level.</p> Signup and view all the answers

    In a lateral projection, which aspect is important for demonstrating the heart and aorta effectively?

    <p>The patient's left side should be placed against the receptor.</p> Signup and view all the answers

    How is the diaphragm expected to appear on expiration images during chest X-ray?

    <p>It will be at a higher level than on inspiration images.</p> Signup and view all the answers

    What is the purpose of using a barium suspension contrast in imaging the esophagus?

    <p>To create a clear outline of the esophagus.</p> Signup and view all the answers

    What is the appropriate position for the patient during an AP Axial Projection?

    <p>Upright with elbows flexed</p> Signup and view all the answers

    Which of the following correctly describes the expected appearance of clavicles during an AP Axial Projection?

    <p>Clavicles lying superior to the apices</p> Signup and view all the answers

    What is one of the evaluation criteria for an AP Axial Oblique Projection?

    <p>Sternal ends of clavicles equal distance from the vertebral column</p> Signup and view all the answers

    In what projection should the trachea be visible in the midline?

    <p>Lateral Projection</p> Signup and view all the answers

    What is the primary purpose of the lordotic position during chest imaging?

    <p>To provide a clearer view of the pulmonary apices</p> Signup and view all the answers

    During a lateral decubitus position for fluid assessment, which side should the patient lie on for pleural effusion?

    <p>Affected side down</p> Signup and view all the answers

    What is the required distance for the CR in the lateral projection for a standard chest x-ray?

    <p>3-4 inches below the jugular notch</p> Signup and view all the answers

    During an upright PA projection, what should be noted for fluid levels in pulmonary cavities?

    <p>Fluid levels well defined</p> Signup and view all the answers

    For which patient condition should the patient lean laterally at a 45° angle during imaging?

    <p>Pleural effusion</p> Signup and view all the answers

    Which factor helps identify the lung regions effectively in the lordotic position?

    <p>Clavicles lying horizontally</p> Signup and view all the answers

    What is the recommended patient position for lateral projection of the trachea?

    <p>Seated or standing with hands clasped behind</p> Signup and view all the answers

    During an AP projection of the trachea, what body position assists in visualizing the air-filled trachea?

    <p>Patient either supine or upright with neck slightly extended</p> Signup and view all the answers

    What technique is employed for demonstrating the trachea in an axiolateral projection using the Twining Method?

    <p>15° cephalad angulation at the supraclavicular area</p> Signup and view all the answers

    Which anatomical structure is primarily seen in the lateral projection of the trachea?

    <p>Air-filled trachea and superior mediastinum</p> Signup and view all the answers

    What is the correct respiration technique when obtaining an image of the lungs in a PA projection?

    <p>At the end of the first full inspiration</p> Signup and view all the answers

    What anatomical structures are prominently displayed during the RAO position for the left lung in an oblique projection?

    <p>Left atrium and apex of left ventricle</p> Signup and view all the answers

    What criteria must be met for a chest X-ray to demonstrate the entire lung fields appropriately?

    <p>At least ten posterior ribs should be visible above the diaphragm</p> Signup and view all the answers

    Which evaluation criterion ensures maximum visualization of the right lung in a PA oblique projection?

    <p>Maximum area of the right lung on the LAO</p> Signup and view all the answers

    During a lateral projection, how should the mid-sagittal plane (MSP) be positioned in relation to the image receptor (IR)?

    <p>MSP must be perpendicular to the IR</p> Signup and view all the answers

    In an upright AP oblique projection, what is the primary purpose of positioning the patient in LPO for the left lung?

    <p>To maximize exposure of the left lung</p> Signup and view all the answers

    What is a key technique for demonstrating interlobar fissures in chest imaging?

    <p>Utilizing a lateral projection with arms extended laterally</p> Signup and view all the answers

    What is a common evaluation criterion for chest radiographs performed at a 45-degree angle in oblique positions?

    <p>Both lungs should be displayed</p> Signup and view all the answers

    What specific aspect is targeted for imaging when utilizing the RAO position with a 10° to 20° angle for pulmonary diseases?

    <p>Medial part of the right middle lobe</p> Signup and view all the answers

    Which factor is vital for evaluating the sharp outlines of the heart and diaphragm in chest X-ray imaging?

    <p>Adequate inspiration during the exposure</p> Signup and view all the answers

    What technique is recommended for differentiating lobes in a chest X-ray?

    <p>Lateral projection with the patient seated upright</p> Signup and view all the answers

    What is the position of the clavicles in a correctly performed AP Axial Projection?

    <p>Superior to the apices with medial ends overlapping only the first or second ribs</p> Signup and view all the answers

    During which projection is the patient's mid-sagittal plane aligned parallel to the image receptor?

    <p>PA Axial Projection</p> Signup and view all the answers

    What happens to the clavicles during expiration in a PA Axial Projection?

    <p>Clavicles remain elevated above the apices</p> Signup and view all the answers

    Which of the following is an aspect of proper evaluation criteria when performing an upright PA projection?

    <p>Faint image of the ribs visible through heart shadow</p> Signup and view all the answers

    In the lateral decubitus position for assessing pleural effusion, which side should the patient lie on?

    <p>Affected side</p> Signup and view all the answers

    What should be carefully positioned in relation to the image receptor during the lateral projection?

    <p>Arm of the affected side above the head</p> Signup and view all the answers

    What identification marker is crucial for a complete lateral projection?

    <p>Visible identification markers for both lungs</p> Signup and view all the answers

    What alignment is required for the MSP during the AP Axial Projection?

    <p>MSP aligned parallel to the IR</p> Signup and view all the answers

    What is the appearance of pleural markings on a properly executed lung projection?

    <p>Visible from hilar regions to the lung periphery</p> Signup and view all the answers

    What is one of the key positions for the AP Axial Oblique Projection?

    <p>Oblique lordotic position at 30°</p> Signup and view all the answers

    What is the required neck position during the AP projection of the trachea?

    <p>Neck slightly extended</p> Signup and view all the answers

    Which direction should the x-ray beam be oriented for the Axiolateral projection using the Twining Method?

    <p>15° caudad</p> Signup and view all the answers

    What is the appropriate positioning of the arms during the lateral projection of the trachea?

    <p>Arms clasped behind the back</p> Signup and view all the answers

    Which respiration technique is recommended when imaging the air-filled trachea?

    <p>Slowly inspiration</p> Signup and view all the answers

    In which positioning should the patient be during the lateral projection of the trachea?

    <p>Sitting upright</p> Signup and view all the answers

    What is a key requirement for ensuring optimal evaluation of a CXR PA projection?

    <p>Entire lung fields must be visible from the costophrenic angles to the apices.</p> Signup and view all the answers

    Which imaging technique is critical for demonstrating interlobar fissures during a lateral projection?

    <p>Maintaining true lateral alignment.</p> Signup and view all the answers

    When performing a lateral projection, how should the arm positioning be adjusted?

    <p>Arms should be extended upward.</p> Signup and view all the answers

    What visibility is expected regarding the ribs during an ideal CXR PA projection?

    <p>Ten posterior ribs should be seen above the diaphragm.</p> Signup and view all the answers

    What anatomical features are crucial for evaluation in the left lateral projection of the chest?

    <p>Heart and left pulmonary lesions.</p> Signup and view all the answers

    What anatomical structures are primarily evaluated in the RAO position for the left lung?

    <p>Trachea and left atrium</p> Signup and view all the answers

    In a PA oblique projection with the LAO position for the right lung, which structure is maximized for better visualization?

    <p>Maximum area of the right lung</p> Signup and view all the answers

    Which evaluation criterion is crucial for assessing an AP oblique projection?

    <p>Trachea filled with air</p> Signup and view all the answers

    What should be displayed in the thoracic viscera for optimal imaging of the heart and great vessels?

    <p>Engorged heart and great vessels</p> Signup and view all the answers

    In what scenario is a 30° caudal angle recommended during imaging?

    <p>For assessing middle lobe and lingular processes</p> Signup and view all the answers

    What is the primary characteristic of the clavicles in an AP Axial Projection?

    <p>Clavicles lying superior to the apices</p> Signup and view all the answers

    Which technique is recommended for demonstrating fluid levels in the chest?

    <p>Decubitus position with affected side down</p> Signup and view all the answers

    During an AP Axial Oblique Projection, how should the patient be positioned?

    <p>Oblique lordotic position at 30°</p> Signup and view all the answers

    What positioning technique aids in demonstrating upper lung regions in hypersthenic patients?

    <p>Separating apical and clavicular shadows</p> Signup and view all the answers

    What should be avoided to achieve clear imaging of the trachea during lateral projection?

    <p>Excessive rotation of the shoulders</p> Signup and view all the answers

    Which evaluation criterion indicates that the lungs are properly imaged during a lateral projection?

    <p>Both lungs visible in their entirety</p> Signup and view all the answers

    In a lateral decubitus position for identifying pneumothorax, the patient should lie which way?

    <p>On the unaffected side</p> Signup and view all the answers

    Which projection should demonstrate both the apices of the lungs and the mediastinal structures clearly?

    <p>PA Axial Projection</p> Signup and view all the answers

    During an upright AP Axial Projection, which anatomical landmark is positioned below the shadow of the clavicle?

    <p>The apices</p> Signup and view all the answers

    In which projection should pleural markings be visible throughout the entire lung field?

    <p>PA Axial Projection</p> Signup and view all the answers

    Which structure is primarily assessed in a left lateral projection?

    <p>Left lung lesion</p> Signup and view all the answers

    What is the significance of demonstrating sharp outlines of the heart and diaphragm in a chest X-ray?

    <p>Indicates good contrast and exposure</p> Signup and view all the answers

    Which evaluation criterion indicates correct lung field visibility in a CXR PA projection?

    <p>Ten posterior ribs visible above the diaphragm</p> Signup and view all the answers

    During the expiration image for a lateral projection, how is the diaphragm expected to appear?

    <p>At a higher position, limiting rib visibility</p> Signup and view all the answers

    What is the role of barium suspension in chest imaging?

    <p>Aids in assessing esophageal function</p> Signup and view all the answers

    What body position is recommended for obtaining an AP projection of the trachea?

    <p>Supine or upright with neck extended</p> Signup and view all the answers

    During a lateral projection of the trachea, the mid-sagittal plane (MSP) should be aligned with which part of the imaging receptor?

    <p>The center of the imaging receptor</p> Signup and view all the answers

    Which projection technique requires the neck to be extended and the shoulders to be clasped behind during imaging?

    <p>Lateral projection</p> Signup and view all the answers

    What is the recommended respiration technique for imaging the lung apex using the Twining method?

    <p>Full inspiration at the end of exposure</p> Signup and view all the answers

    What is the appropriate alignment of the central ray during the Axiolateral projection of the trachea?

    <p>15° cephalad at the jugular notch</p> Signup and view all the answers

    Which structure is primarily visualized in a right anterior oblique (RAO) position?

    <p>Right retrocardiac space</p> Signup and view all the answers

    In a PA oblique projection, which angle is required for optimal visualization of the lung fields?

    <p>45°</p> Signup and view all the answers

    What is the purpose of positioning a patient in the LPO position for an AP oblique projection?

    <p>To highlight the left lung structures</p> Signup and view all the answers

    Which of the following is NOT an evaluation criterion for oblique chest images?

    <p>Clavicle positioned lower</p> Signup and view all the answers

    What is emphasized in the medial part during RAO/LAO projections for pulmonary diseases?

    <p>Right middle lobe</p> Signup and view all the answers

    What positioning criterion ensures that the clavicles are correctly positioned in the AP Axial Projection?

    <p>Clavicles lying horizontally with medial ends overlapping only the first or second ribs</p> Signup and view all the answers

    Which evaluation criteria signal proper visualization of the apices in the AP Axial Oblique Projection?

    <p>Sternal ends of the clavicles equidistant from the vertebral column</p> Signup and view all the answers

    When positioning the patient for a lateral projection of the lungs, what is crucial for demonstrating interlobar fissures?

    <p>Use of a decub box with arms above the head</p> Signup and view all the answers

    What is the expected appearance of the ribs when viewed in an oblique position during chest imaging?

    <p>Ribs distorted with anterior and posterior portions overlapping</p> Signup and view all the answers

    In the lateral decubitus position, where should the patient be positioned to effectively visualize fluid in the pleural cavity?

    <p>On the unaffected side</p> Signup and view all the answers

    Which condition is best demonstrated by using the AP Axial Projection in the recommended lordotic position?

    <p>Tuberculosis</p> Signup and view all the answers

    What is a common respiratory consideration when imaging during inspiration for the PA Axial Projection?

    <p>Elevation of the clavicles</p> Signup and view all the answers

    How should the CR be directed for an upright PA projection of the chest?

    <p>$10^{ ext{o}}$ cephalad</p> Signup and view all the answers

    What anatomical feature should be primarily visible in a lateral projection of the lungs?

    <p>Heart and mediastinal structures</p> Signup and view all the answers

    Which technique is a common recommendation for demonstrating lung structures in patients with suspected pleural effusion?

    <p>Patient leaning laterally at a 45° angle</p> Signup and view all the answers

    Which positioning technique is recommended for the AP projection of the trachea?

    <p>Supine with neck slightly extended</p> Signup and view all the answers

    What is the correct alignment for the mid-sagittal plane (MSP) during a lateral projection of the trachea?

    <p>MSP aligned with the IR</p> Signup and view all the answers

    Which description accurately reflects the technique for the axiolateral projection using the Twining Method?

    <p>Patient upright with shoulder resting on the IR</p> Signup and view all the answers

    During the lateral projection of the trachea, at what phase of respiration should the exposure be made?

    <p>At slow inspiration</p> Signup and view all the answers

    What is the primary purpose of collimation during trachea imaging?

    <p>To reduce patient exposure to radiation</p> Signup and view all the answers

    What is the correct positioning for the patient's arms during a lateral projection to effectively demonstrate interlobar fissures?

    <p>Arms extended upward with elbows flexed and resting on the IV stand</p> Signup and view all the answers

    Which of the following is NOT an evaluation criterion for a CXR PA projection?

    <p>Ten posterior ribs visible below the diaphragm</p> Signup and view all the answers

    When evaluating a lateral projection of the chest, what should be observed for a proper demonstration of the heart and aorta?

    <p>Heart distinctly visualized with minimal obfuscation</p> Signup and view all the answers

    Which projection would best help in the differentiation of lobes in the lungs?

    <p>Left lateral projection</p> Signup and view all the answers

    What should be noted regarding the diaphragm's position during expiration images in chest X-ray?

    <p>Diaphragm is at a higher level, demonstrating at least one rib less</p> Signup and view all the answers

    What anatomical structure is best visualized in a RAO position for the left lung?

    <p>Apex of the left ventricle</p> Signup and view all the answers

    Which projection shows the thoracic viscera magnified?

    <p>AP Projection</p> Signup and view all the answers

    In a PA oblique projection, what is the angle for elevating the lung field on the side farthest from the IR?

    <p>45°</p> Signup and view all the answers

    What is the primary goal when performing an LAO for the right lung?

    <p>Maximize area of the right lung</p> Signup and view all the answers

    Which criteria must be met for a valid chest X-ray evaluation?

    <p>Both lungs in their entirety with identification markers</p> Signup and view all the answers

    What position is recommended for the patient when performing an AP Axial Projection?

    <p>Standing with the MSP parallel to the IR</p> Signup and view all the answers

    Which evaluation criteria indicates correct positioning in the Lordotic position?

    <p>Medial ends of the clavicles equidistant from the vertebral column</p> Signup and view all the answers

    During the Lateral Decubitus position, where should the patient be positioned to assess for a pneumothorax?

    <p>On the opposite side of the effusion</p> Signup and view all the answers

    What are the signs of proper positioning when viewing the lungs in a lateral projection?

    <p>Trachea filled with air and heart within lung field</p> Signup and view all the answers

    Which of the following conditions is demonstrated using the AP Axial Oblique Projection?

    <p>Tuberculosis</p> Signup and view all the answers

    What angle should be used when directing the x-ray beam during the PA Axial Projection at inspiration?

    <p>10-15° cephalad</p> Signup and view all the answers

    What is the expected appearance of the clavicles during an AP Axial Projection?

    <p>Clavicles lying superior to the apices</p> Signup and view all the answers

    For which condition is the lateral decubitus position particularly useful in chest imaging?

    <p>Pleural effusion</p> Signup and view all the answers

    What is the significance of the shoulder position during an upright PA projection?

    <p>Shoulders should be depressed and rotated forward</p> Signup and view all the answers

    What positioning is key for the evaluation of interlobar effusions?

    <p>Oblique lordotic position</p> Signup and view all the answers

    What is the primary position of the neck during an AP projection of the trachea?

    <p>Neck slightly extended</p> Signup and view all the answers

    What technique is recommended for the Axiolateral projection of the trachea using the Twining Method?

    <p>Patient seated while resting the shoulder on the IR</p> Signup and view all the answers

    For a lateral projection of the trachea, where should the mid-sagittal plane (MSP) be positioned relative to the IR?

    <p>Parallel to the IR</p> Signup and view all the answers

    When performing a lateral projection of the trachea, what is the recommended respiration phase?

    <p>Slowly during full inspiration</p> Signup and view all the answers

    What anatomical structure is primarily visualized in the lateral projection of the superior mediastinum?

    <p>Air-filled trachea</p> Signup and view all the answers

    What structure is primarily assessed in a right lateral projection?

    <p>Right pulmonary lesion</p> Signup and view all the answers

    Which of the following best describes the position of the diaphragm during expiration in a chest X-ray?

    <p>It is at a higher level with fewer ribs visible.</p> Signup and view all the answers

    What is a key evaluation criterion for CXR PA projection regarding the trachea?

    <p>Should be visible in the midline</p> Signup and view all the answers

    Which evaluation criterion ensures proper lung height is shown in chest imaging?

    <p>Entire lung fields from apices to costophrenic angles</p> Signup and view all the answers

    What is the significance of the scapulae during the evaluation of a CXR PA projection?

    <p>They should be projected outside the lung fields.</p> Signup and view all the answers

    What area is maximized during an RAO projection for better visualization of the left lung?

    <p>Apex of the left ventricle</p> Signup and view all the answers

    In the AP oblique projection, what is the primary effect of positioning the patient in RPO?

    <p>Enhances the view of the right lung structures</p> Signup and view all the answers

    Which evaluation criterion is crucial for determining the correctness of lung positioning during an oblique projection?

    <p>Air-filled trachea visibility</p> Signup and view all the answers

    What angle adjustment is recommended by Resnick for better differentiation of lower lobe diseases?

    <p>30° cephalad</p> Signup and view all the answers

    What is the main characteristic that is expected when performing a LAO projection for the right lung?

    <p>Detailed view of the right bronchial tree</p> Signup and view all the answers

    What indicates a correct lordotic position during an AP Axial projection?

    <p>Clavicles lying superior to the apices</p> Signup and view all the answers

    Which evaluation criterion is essential for assessing the AP Axial Oblique Projection?

    <p>Apices and lungs fully demonstrated</p> Signup and view all the answers

    What is a common method for determining the correct positioning of clavicles in an upright PA projection?

    <p>Sternal ends of clavicles equidistant from the vertebral column</p> Signup and view all the answers

    During a lateral projection, which structure should be maximized for better view on the right side?

    <p>Maximum area of the right lung</p> Signup and view all the answers

    In the context of imaging for pleural effusion, which technique should be employed?

    <p>Patient should lie on the unaffected side</p> Signup and view all the answers

    Which angle is essential for the beam direction during the PA Axial projection at inspiration?

    <p>15-20 degrees cephalad</p> Signup and view all the answers

    Which of the following correctly describes the appearance of the ribs during an AP Axial Projection?

    <p>Ribs appear distorted with anterior and posterior portions somewhat superimposed</p> Signup and view all the answers

    What position is critical for demonstrating a pneumothorax effectively during lateral decubitus positioning?

    <p>The patient lies on the opposite side</p> Signup and view all the answers

    What best indicates the visibility of the trachea during imaging?

    <p>Trachea visible in the midline</p> Signup and view all the answers

    In the AP Axial Projection, how should the medial ends of the clavicles appear?

    <p>Equidistant from the vertebral column</p> Signup and view all the answers

    What is the correct body position for the patient during an AP projection of the trachea?

    <p>Supine or upright with neck slightly extended</p> Signup and view all the answers

    During the lateral projection of the trachea, how should the mid-sagittal plane (MSP) be positioned in relation to the image receptor (IR)?

    <p>Parallel to the IR</p> Signup and view all the answers

    What is the primary respiratory technique used for imaging the air-filled trachea during a lateral projection?

    <p>Slowly inspiration</p> Signup and view all the answers

    In the Twining method for the axiolateral projection of the trachea, what is the recommended positioning of the arms?

    <p>Flexed with the forearm behind the head</p> Signup and view all the answers

    What anatomical feature is crucial to visualize when performing the lateral projection of the trachea?

    <p>Air-filled trachea and superior mediastinum</p> Signup and view all the answers

    In which projection does the right lung get maximum area visibility when positioned in LAO?

    <p>PA Oblique Projection</p> Signup and view all the answers

    What structures are primarily visualized during an RAO projection for the left lung?

    <p>Left atrium and right retrocardiac space</p> Signup and view all the answers

    What angle should the x-ray beam be positioned for an AP oblique projection when the patient is in LPO?

    <p>45°</p> Signup and view all the answers

    What is a key characteristic that must be visible in a CXR PA projection evaluation?

    <p>Sharp outlines of heart and diaphragm</p> Signup and view all the answers

    Which anatomical feature must be filled with air to meet evaluation criteria in any chest imaging?

    <p>Trachea</p> Signup and view all the answers

    Which structure is not emphasized in the criteria for performing a PA oblique projection?

    <p>Pulmonary capillaries</p> Signup and view all the answers

    During lateral chest projection, how should the patient’s arms be positioned?

    <p>Extended upward with elbows flexed.</p> Signup and view all the answers

    What effect does breathing have on the appearance of the diaphragm in chest imaging?

    <p>It appears lower on inspiration and higher on expiration.</p> Signup and view all the answers

    Which anatomical structure is especially highlighted during a left lateral projection of the chest?

    <p>Heart and left pulmonary lesions.</p> Signup and view all the answers

    What is the primary purpose of employing barium suspension during chest radiography?

    <p>To differentiate the anatomical structures of the esophagus.</p> Signup and view all the answers

    What is the primary objective of positioning the patient in an upright PA projection for assessing fluid levels in pulmonary cavities?

    <p>To visualize pleural effusion and its extent</p> Signup and view all the answers

    Which aspect is most critical for demonstrating the clavicles in an AP Axial Projection?

    <p>Clavicles must lie horizontally with medial ends overlapping the first rib</p> Signup and view all the answers

    During a lateral projection of the trachea, how should the mid-sagittal plane (MSP) be aligned?

    <p>Parallel to the imaging receptor</p> Signup and view all the answers

    What positioning technique is recommended for patients with suspected pleural effusion when using the lateral decubitus position?

    <p>Patient lies on the unaffected side to allow gravity to demonstrate the fluid</p> Signup and view all the answers

    In the AP Axial Oblique Projection, what is the significance of the extreme lordotic position?

    <p>It allows the clavicles to lie higher than the apices</p> Signup and view all the answers

    What is the expected appearance of the ribs in an AP Axial Projection?

    <p>Ribs are distorted with anterior and posterior portions superimposed</p> Signup and view all the answers

    What is the correct positioning recommendation for a patient during an AP Axial Projection?

    <p>Patient should be upright with elbows flexed and pronated hands</p> Signup and view all the answers

    Which evaluation criterion ensures that the entire lung fields are captured in an imaging procedure?

    <p>Entire lung fields from apices to costophrenic angles visualized</p> Signup and view all the answers

    How should the x-ray beam be directed during the PA Axial Projection for optimal results?

    <p>10-15° cephalad</p> Signup and view all the answers

    What indication confirms proper positioning during a lateral projection when viewing the heart and mediastinal structures?

    <p>Heart and mediastinal structures within the lung field of the elevated side</p> Signup and view all the answers

    What should be demonstrated in a lateral projection to identify interlobar fissures?

    <p>Distinct separation of lung lobes</p> Signup and view all the answers

    Which evaluation criterion for a CXR PA projection ensures there is no rotation?

    <p>Trachea visible in the midline</p> Signup and view all the answers

    How is the diaphragm typically visualized on expiration images?

    <p>At a higher level than inspiration</p> Signup and view all the answers

    What position should the patient's neck be in for an AP projection of the trachea?

    <p>Neck slightly extended</p> Signup and view all the answers

    What is a necessary positioning requirement in a true lateral projection?

    <p>Mid-sagittal plane must align with the image receptor</p> Signup and view all the answers

    In the lateral projection of the trachea, where is the mid-sagittal plane (MSP) positioned in relation to the image receptor (IR)?

    <p>MSP parallel to IR</p> Signup and view all the answers

    What can be inferred if the scapulae are projected inside the lung fields during a CXR?

    <p>There is excessive rotation</p> Signup and view all the answers

    During the Axiolateral projection using the Twining Method, what is the recommended angle for the x-ray beam?

    <p>15° caudad</p> Signup and view all the answers

    What is the recommended respiration technique when performing a lateral projection of the trachea?

    <p>Slowly inspiration</p> Signup and view all the answers

    Which anatomical area is primarily visualized in the lateral projection of the trachea?

    <p>Air-filled trachea and superior mediastinum</p> Signup and view all the answers

    Which anatomical structures are primarily displayed in the RAO position for the left lung?

    <p>Left atrium and apex of the left ventricle</p> Signup and view all the answers

    In a PA oblique projection for the right lung, which position maximizes the visualization of the thoracic structures?

    <p>LAO</p> Signup and view all the answers

    What is the purpose of a 30° caudal angle in the recommended imaging technique for chest X-rays?

    <p>To ensure lower lobe diseases are differentiated</p> Signup and view all the answers

    Which evaluation criteria confirm proper positioning and exposure in a PA projection?

    <p>Trachea must be filled with air</p> Signup and view all the answers

    During an AP oblique projection, what is the primary lung structure that should be visualized in the LPO position?

    <p>Left lung</p> Signup and view all the answers

    What is a key evaluation criterion for the AP Axial Projection?

    <p>Sternal ends of the clavicles equidistant from the vertebral column</p> Signup and view all the answers

    In which projection would you expect to see pleural markings from the hilar regions to the lungs' periphery?

    <p>Upright PA Projection</p> Signup and view all the answers

    During an AP Axial Oblique Projection, where should the affected side be positioned in relation to the IR?

    <p>At the center of the IR</p> Signup and view all the answers

    What is the primary purpose of using a lordotic position during chest imaging?

    <p>To project the apices above the clavicles</p> Signup and view all the answers

    Which statement best describes the expected positioning of the clavicles during a PA Axial Projection?

    <p>Clavicles lying horizontally with the medial ends overlapping the first rib</p> Signup and view all the answers

    When assessing for pleural effusion using a lateral decubitus position, which side should the patient be positioned on?

    <p>The unaffected side</p> Signup and view all the answers

    Which of the following describes a characteristic finding expected in a lateral projection of the chest?

    <p>Both lungs visible in their entirety</p> Signup and view all the answers

    What is the expected appearance of the ribs in an AP Axial projection for hypersthenic patients?

    <p>Ribs are distorted with anterior and posterior portions superimposed</p> Signup and view all the answers

    Which projection requires a 10-15° cephalad angle during inspiration to visualize the heart accurately?

    <p>PA Axial Projection</p> Signup and view all the answers

    In the lateral view of the trachea, what alignment is crucial for achieving accurate imaging?

    <p>MSP aligned frontally with the IR</p> Signup and view all the answers

    What is the proper patient position for an AP projection of the trachea?

    <p>Supine or upright with neck slightly extended</p> Signup and view all the answers

    During a lateral projection of the trachea, which positioning factor is essential for optimal imaging?

    <p>Shoulders are positioned posteriorly with the hands clasped behind</p> Signup and view all the answers

    Which respiration phase is required for obtaining optimal images of the trachea during axiolateral projection?

    <p>End of full inspiration</p> Signup and view all the answers

    What is the recommended technique for demonstrating the trachea in an axiolateral projection using the Twining Method?

    <p>Direct the beam 15° caudad at supraclavicular level</p> Signup and view all the answers

    In a lateral projection of the chest, where should the mid-sagittal plane (MSP) be aligned for optimal visualization?

    <p>Parallel to the image receptor</p> Signup and view all the answers

    Which evaluation criterion ensures the visibility of lung markings from the hilum to the periphery of the lung?

    <p>Lung markings visible from the hilum to the periphery of the lung</p> Signup and view all the answers

    What position is recommended for demonstrating the heart and aorta effectively during a lateral projection?

    <p>Left lateral position</p> Signup and view all the answers

    During a lateral projection, what is the appropriate placement for the arms?

    <p>Arms extended upward and elbows flexed</p> Signup and view all the answers

    What anatomical structures are best evaluated in a left lateral projection for chest imaging?

    <p>Left lung and aorta</p> Signup and view all the answers

    What observation signifies correct positioning during a CXR PA projection?

    <p>Trachea visible in the midline</p> Signup and view all the answers

    What anatomical structure is primarily visible when performing an RAO projection for the left lung?

    <p>Bronchial tree (L)</p> Signup and view all the answers

    In which projection should the maximum area of the right lung be visualized when the patient is in the LAO position?

    <p>PA Oblique</p> Signup and view all the answers

    Which evaluation criterion is NOT associated with performing an AP oblique projection?

    <p>Trachea filled with fluid</p> Signup and view all the answers

    What is the significance of the 30° caudal angle recommended by Resnick for chest imaging?

    <p>It assists in differentiating middle lobe diseases.</p> Signup and view all the answers

    Which lung field is maximized during an LPO position in an AP oblique projection?

    <p>Left lung</p> Signup and view all the answers

    Which positioning technique is essential for demonstrating the apices in an AP Axial Projection?

    <p>Patient standing 1 foot in front of the IR</p> Signup and view all the answers

    What is the primary evaluation criterion ensuring the position of the clavicles during an AP Axial Projection?

    <p>Clavicles lying horizontally overlapping the first or second ribs</p> Signup and view all the answers

    In the lateral projection, which structure should be clearly visible to ensure adequate imaging?

    <p>Trachea filled with air</p> Signup and view all the answers

    Which breathing technique is recommended to optimize clarity when performing an AP projection?

    <p>Forced deep inhale and hold</p> Signup and view all the answers

    What specific patient position is utilized to visualize interlobar effusions in the context of pleural effusion assessment?

    <p>Lateral decubitus on the affected side</p> Signup and view all the answers

    During an upright PA projection, how should the shoulders be positioned for optimal imaging?

    <p>Depressed and rolled forward</p> Signup and view all the answers

    Which factor is NOT considered an evaluation criterion for the AP Axial Oblique Projection?

    <p>Clavicles overlapping the third rib</p> Signup and view all the answers

    What is the expected arrangement of the ribs during an PA Axial projection to ensure proper visualization?

    <p>Ribs should be somewhat superimposed with distortion</p> Signup and view all the answers

    In a lateral decubitus projection for pneumothorax, where should fluid accumulate in relation to patient positioning?

    <p>Fluid gathers in the unaffected side's cavity</p> Signup and view all the answers

    For evaluating the lung fields in an AP projection, which anatomical feature should be visible?

    <p>Heart shadow clearly defined</p> Signup and view all the answers

    Study Notes

    Technology's Impact on Society

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    Lateral Projection

    • True Lateral: MSP || IR, MCP || IR, Arm extended upward, elbow flexed, forearm rests on elbows, use an IV stand
    • Left Lateral:
      • Demonstrates the heart, aorta, and left pulmonary lesions
    • Right Lateral:
      • Demonstrates right pulmonary lesions
    • Evaluation Criteria:
      • Medial portion of clavicles equidistant from the vertebral column, trachea visible in the midline
      • Clavicles lying more horizontally and obscuring more of the apices than in the PA projection
      • Equal distance from the vertebral column to the lateral border of the ribs on each side
      • Faint image of the ribs and thoracic vertebrae visible through the heart shadow
      • Entire lung fields, from the apices to the costophrenic angles
      • Pleural markings visible from the hilar regions to the periphery of the lungs

    Pulmonary Apices

    • AP Axial Projection:
      • Upright, stand 1 foot in front of IR, lordotic position, MSP || IR
    • AP Axial Oblique Projection:
      • Oblique lordotic position, RPO/LPO 30°, affected side centered to the IR, extreme lordosis
    • Evaluation Criteria:
      • Lordotic position
      • Clavicles lying superior to the apices
      • Sternal ends of the clavicles equidistant from the vertebral column
      • Apices and lungs in their entirety
      • Clavicles lying horizontally with their medial ends overlapping only the first or second ribs
      • Ribs distorted with their anterior and posterior portions somewhat superimposed
      • Oblique lordotic position
      • The dependent apex and lung of the affected side in its entirety

    PA Axial Projection

    • Seated/Upright:
      • MSP || IR, depress shoulders, rotate forward, 10-15° cephalad during inspiration
    • T3: Apices above the shadow of the clavicle
    • Inspiration: ↑ clavicles
    • Expiration: ↓ clavicles

    AP Axial Projection

    • Upright/supine:
      • Elbow flexed, hand pronated on hip, 15 to 20° cephalad, manubrium, apices below clavicles
    • For hypersthenic patients:
      • Separate apical & clavicular shadow
    • Evaluation Criteria:
      • Clavicles lying superior to the apices
      • Sternal ends of the clavicles equidistant from the vertebral column
      • Apices in their entirety
      • Superior lung region adjacent to the apices
      • Clavicles lying horizontally with their medial ends overlapping only the first or second ribs
      • Ribs distorted, with their anterior and posterior portions somewhat superimposed

    Lungs & Pleurae

    • AP or PA projection:
      • R or L lateral, decubitus position
    • Lateral decubitus:
      • Pleural effusion: Fluid in the pleural cavity on the affected side
      • Pneumothorax: Free air in the pleural cavity on the unaffected side
    • Horizontal:
      • 17, 3 inches below jugular notch
      • Pneumothorax, pleural effusion
    • Air: Air tends to go up
    • Fluid: Fluid tends to go down due to gravity
    • Position: Remain in position for 5 minutes before exposure

    Upright PA Projection

    • Fluid levels in pulmonary cavities (pleural effusion)
    • Ekimsky recommended:
      • Patient lean laterally 45° for small pleural effusion

    Lateral Projection

    • Prone/supine
    • Use decub box
    • Arms above head
    • Affected side towards the IR
    • Horizontal, 17
    • Dorsal (3-4 inches below jugular notch):
      • Pulmonary areas obscured by fluid
    • Ventral
    • Evaluation Criteria:
      • Both lungs in their entirety
      • Trachea filled with air
      • Visible identification markers
      • Heart and mediastinal structures within the lung field of the elevated side in oblique images of 45 degrees
      • Maximum area of the right lung on the LAO
      • Maximum area of the left lung on the RAO

    PA Oblique Projection

    • Upright:
      • RAD or LAD, 45°
    • Position: Side farthest in
      • LAO: Right lung
      • RAO: Left Lung
    • LAO:
      • Thoracic viscera
      • Trachea & carina
      • Bronchial tree (right)
      • Heart
      • Descending aorta
      • Arch of aorta
    • RAO:
      • Thoracic viscera
      • Trachea
      • Bronchial tree (left)
      • Left atrium
      • Apex left ventricle (anterior)
      • Right retrocardiac space
    • Evaluation Criteria:
      • Both lungs in their entirety
      • Trachea filled with air
      • Visible identification markers
      • Heart and mediastinal structures within the lung field of the elevated side in oblique images of 45 degrees
      • Maximum area of the right lung on the LAO
      • Maximum area of the left lung on the RAO
    • For pulmonary diseases - RAO/LAO 10° to 20°:
      • Display medial part, right middle lobe, lingula of upper lobe

    AP Oblique Projection

    • Upright/supine:
      • RPO/LPO 45°
    • Position: Side closest to the IR (used if patient can't prone)
      • LPO: Left Lung
      • RPO: Right Lung
    • Evaluation criteria:
      • Both lungs in their entirety
      • Trachea filled with air
      • Visible identification markers
      • Heart and mediastinal structures within the lung field of the elevated side in oblique images of 45 degrees
      • Maximum area of the right lung on the LAO
      • Maximum area of the left lung on the RAO

    Chest: Thoracic Viscera

    • AP Projection:
      • Supine/Upright, 17
      • Thoracic viscera magnified: Heart & great vessels (engorged), lung fields shorter, clavicle higher, ribs horizontal
    • Resnick Recommended:
      • 30° caudal
      • Basal lung fields free of imposition
      • Differentiates middle lobe, lingular processes, and lower lobe diseases

    Trachea

    • AP projection positions the patient supine or upright with the MSP parallel to the IR, neck slightly extended, and respiration slowly inspired.
    • Lateral projection positions the patient seated or standing with the MSP parallel to the IR, shoulders posteriorly, neck extended, and respiration slowly inspired.
    • The Lateral projection of Trachea & Superior Mediastinum utilizes a horizontal beam, showcasing the air-filled trachea and superior mediastinum.

    Trachea & Pulmonary Apex

    • Axiolateral projection (Twining Method) positions the patient upright with the arm elevated, forearm behind the head, and the opposite shoulder depressed.
    • Respiration technique for the trachea is slow inspiration, while for the lungs, it's end of full inspiration.

    Chest: Lungs & Heart

    • PA projection positions the patient upright, arms on the side, MSP parallel to the IR, chin upward, and shoulders depressed.
    • Respiration for the PA projection is the end of the second full inspiration.
    • Lateral projection demonstrates enlarged thyroid/thymic glands and bronchial tree.
    • Contrast for the esophagus is a barium suspension.

    CXR PA Projection Evaluation

    • The evaluation criteria include visualizing entire lung fields, no rotation, trachea in the midline, scapulae outside the lung fields, ten posterior ribs visible above the diaphragm, and sharp outlines of the heart and diaphragm.

    Lateral Projection

    • Upright positioning requires true lateral positioning with the MSP and MCP parallel to the IR.
    • Left Lateral projection showcases the heart, aorta, and left pulmonary lesion.
    • Right Lateral projection showcases the right pulmonary lesion.
    • Evaluation points include demonstrating interlobar fissures and differentiating lobes to localize pulmonary lesions.

    PA Oblique Projection

    • Upright positioning involves a 45° RAD or LAD with the side farthest in, using LAO for the right lung and RAO for the left lung.
    • Evaluation criteria include visualizing both lungs in their entirety, the trachea filled with air, visible identification markers, and maximum area of the right lung on LAO and left lung on RAO.

    AP Oblique Projection

    • Upright or supine positioning uses a 45° RPO or LPO with the side closest to the IR, utilizing LPO for the left lung and RPD for the right lung.
    • Evaluation criteria include visualizing both lungs in their entirety, the trachea filled with air, visible identification markers, and maximum area of the right lung on LAO and left lung on RAO.

    Chest: Thoracic Viscera

    • AP projection positions the patient supine or upright, showcasing magnified thoracic viscera, including the heart and great vessels, shorter lung fields, higher clavicle, and horizontal ribs.
    • Resnick Recommended 30° caudal angulation to visualize basal lung fields without imposition, differentiating the middle lobe, lingular processes, and lower lobe diseases.
    • Evaluation criteria include visualizing the medial portion of the clavicles equidistant from the vertebral column, the trachea in the midline, equal distance from the vertebral column to the lateral border of the ribs on each side, faint image of the ribs and thoracic vertebrae visible through the heart shadow, and entire lung fields from the apices to the costophrenic angles.

    Pulmonary Apices

    • AP Axial Projection positions the patient upright, standing 1 foot in front of the IR in a lordotic position with the MSP parallel to the IR.
    • AP Axial Oblique Projection uses an oblique lordotic position with the affected side centered on the IR, employing a 30° RPO or LPO, with extreme lordosis.
    • Evaluation criteria for both include Lordotic position, clavicles lying superior to the apices, sternal ends of the clavicles equidistant from the vertebral column, and apices and lungs in their entirety.
    • PA Axial Projection positions the patient seated or upright with the MSP parallel to the IR, shoulders depressed, and rotated forward.
    • Inspiration results in higher clavicles, while Expiration results in lower clavicles.

    AP Axial Projection

    • Upright or supine positioning involves flexed elbows, hands pronated on the hip, a 15-20° cephalad angulation focusing on the manubrium with apices below the clavicles.
    • Evaluation criteria include clavicles lying superior to the apices, sternal ends of the clavicles equidistant from the vertebral column, and apices in their entirety.

    Lungs & Pleurae

    • AP or PA projection uses a right or left lateral decubitus position to visualize fluid in the pleural cavity on the affected side for pleural effusion, and free air on the unaffected side for pneumothorax.
    • Horizontal positioning uses a 17" beam, 3 inches below the jugular notch, demonstrating pneumothorax and pleural effusion.
    • Air tends to go up, while fluid goes down due to gravity.
    • The patient remains in position for 5 minutes before exposure.

    Upright PA Projection

    • Visualizes fluid levels in pulmonary cavities (pleural effusion).
    • Ekimsky recommended 45° lateral lean to visualize small pleural effusion.

    Lateral Projection

    • Prone or supine with arms above head, the affected side on the IR, utilizing a horizontal 17" beam, demonstrating pulmonary areas obscured by fluid.
    • Evaluation criteria include both lungs in their entirety, the trachea filled with air, visible identification markers, and maximum area of each lung on respective oblique images.

    Trachea

    • GRID and Collimation are necessary techniques for imaging the trachea.
    • AP projection:
      • Performed with the patient supine or upright.
      • The manubrium should be included.
      • The trachea must be air-filled.
      • The neck should be slightly extended.
      • The MSP should be parallel to the IR.
      • Respiration should be slow inspiration.
    • Lateral projection:
      • Performed with the patient seated or standing.
      • Patient clasps their hands behind.
      • Shoulder should be positioned posteriorly.
      • Neck should be extended.
      • MSP should be parallel to the IR.
      • Respiration should be slow inspiration.

    Trachea & Superior Mediastinum

    • Lateral projection:
      • The IR should be centered horizontally, midway from the jugular notch to the MCP.
      • The trachea should be air-filled.
      • The superior mediastinum should be visible.
      • The distance between the jugular notch and MCP is 4-10.5cm in the lower portion of the mediastinum.

    Trachea & Pulmonary Apex

    • Axiolateral Projection (Twining Method):
      • Performed with the patient upright.
      • Rest the shoulder on the IR.
      • Angle the CR 15 degrees caudad at the supraclavicular notch.
      • The trachea should be air-filled, and the apex of the lungs should be near the IR.
      • Elevate the arm, flex the elbow, and place the forearm behind the head.
      • Depress the opposite shoulder.
      • MSP is parallel to the IR.
      • The body should be in a true lateral position.
      • Respiration for the trachea: slow inspiration.
      • Respiration for the lung apex: End of full inspiration.

    Chest: Lungs & Heart

    • PA projection:
      • Performed with the patient upright.
      • Arms are at the patient's side.
      • MSP is parallel to the IR.
      • Chin upward.
      • Arms should be flexing, resting on the hips, with scapulae lateral.
      • Depress shoulders and rotate forward so the scapula is below the apices.
      • SID: 72 inches/183 cm (6 feet).
    • Respiration:
      • End of the second full inspiration.
      • End of expiration.
    • PA projection should demonstrate:
      • Air-filled trachea.
      • Diaphragmatic domes.
      • Heart.
      • Aortic knob.
    • Lateral projection should demonstrate:
      • Enlarged thyroid or thymic gland.
      • Enlarged bronchial tree.

    Large Female Breasts

    • Pull breasts upward and lateral during chest imaging.

    CXR PA Projection Evaluation

    • Evaluation criteria:
      • Entire lung fields from the apices to the costophrenic angles.
      • No rotation.
      • Trachea visible in the midline.
      • Scapulae projected outside the lung fields.
      • Ten posterior ribs visible above the diaphragm.
      • Sharp outlines of the heart and diaphragm.
      • Faint shadow of the ribs and superior thoracic vertebrae visible through the heart shadow.
      • Lung markings visible from the hilum to the periphery of the lung.
      • Inspiration and expiration chest images demonstrate the diaphragm at a higher level on expiration, showing at least one fewer rib within the lung field.

    Lateral Projection

    • Upright:
      • Perform a true lateral projection.
      • For a left lateral: Heart, aorta, and left pulmonary lesions are most visible.
      • For a right lateral: Right pulmonary lesions are most visible.
      • MSP is parallel to the IR.
      • MCP is parallel to the IR.
      • Arm should be extend up with the elbow flexed, and forearm resting on the elbows (use an IV stand for support).
    • Demonstrates:
      • Interlobar fissures.
      • Differentiation of lung lobes.
      • Localization of pulmonary lesions.

    PA Oblique Projection

    • Upright:
      • RAD or LAD at 45°.
      • Position the patient so that the side farthest from the IR is facing forward.
      • LAO: Right lung is most visible.
      • RAO: Left lung is most visible.
    • LAO demonstrates:
      • Thoracic viscera.
      • Trachea and carina.
      • Bronchial tree (R).
      • Heart.
      • Descending aorta.
      • Arch of aorta.
    • RAO demonstrates:
      • Thoracic viscera.
      • Trachea.
      • Bronchial tree (L).
      • Left atrium.
      • Apex of the left ventricle (anterior).
      • Right retrocardiac space.
    • Evaluation criteria:
      • Both lungs in their entirety.
      • Trachea filled with air.
      • Visible identification markers.
      • Heart and mediastinal structures within the lung field of the elevated side at a 45-degree oblique.
      • Maximum area of the right lung demonstrated in the LAO.
      • Maximum area of the left lung demonstrated in the RAO.
    • For Pulmonary Diseases:
      • Use an RAO or LAO projection between 10° and 20° to display the medial part, right middle lobe, and lingula of the upper lobe.

    AP Oblique Projection

    • Upright or supine:
      • RPO or LPO at 45°.
      • Position the patient so the side closest to the IR is facing forward.
      • LPO: Left lung is most visible.
      • RPO: Right lung is most visible.
    • Evaluation criteria:
      • Both lungs in their entirety.
      • Trachea filled with air.
      • Visible identification markers.
      • Heart and mediastinal structures within the lung field of the elevated side at a 45-degree oblique.
      • Maximum area of the right lung demonstrated in the LAO.
      • Maximum area of the left lung demonstrated in the RAO.

    Chest: Thoracic Viscera

    • AP projection:
      • Performed supine or upright.
      • Magnifies the thoracic viscera, including the heart and great vessels.
      • Lung fields appear shorter.
      • Clavicles appear higher.
      • Ribs appear horizontal.
    • Resnick recommends a 30° caudal angle to:
      • Free the basal lung fields from imposition.
      • Differentiate the middle lobe.
      • Visualize the lingular processes.
      • Visualize lower lobe diseases.
    • Evaluation criteria:
      • Medial portion of the clavicles equidistant from the vertebral column.
      • Trachea visible in the midline.
      • Clavicles lying more horizontally and obscuring more of the apices compared to the PA projection.
      • Equal distance from the vertebral column to the lateral border of the ribs on each side.
      • Faint image of the ribs and thoracic vertebrae visible through the heart shadow.
      • Entire lung fields, from the apices to the costophrenic angles.
      • Pleural markings visible from the hilar regions to the periphery of the lungs.

    Pulmonary Apices

    • AP Axial Projection:
      • Performed with patient upright.
      • Stand 1 foot in front of the IR.
      • Place patient in a lordotic position.
      • MSP is parallel to the IR.
    • AP Axial Oblique Projection:
      • Place patient in an oblique lordotic position.
      • RPO or LPO at 30°.
      • Center the affected side on the IR.
      • Encourage extreme lordosis.
    • Demonstrates:
      • Apices.
      • Interlobar effusions.
      • May be effective for visualizing tuberculosis.
    • Evaluation criteria:
      • Lordotic position.
      • Clavicles lying superior to the apices.
      • Sternal ends of the clavicles equidistant from the vertebral column.
      • Apices and lungs in their entirety.
      • Clavicles lying horizontally with their medial ends overlapping only the first or second ribs.
      • Ribs distorted, with their anterior and posterior portions somewhat superimposed.
      • Oblique lordotic position.
      • Dependent apex and lung of the affected side in its entirety.
    • PA Axial Projection:
      • Performed with a seated or upright patient.
      • MSP is parallel to the IR.
      • Depress the shoulders.
      • Rotate the patient forward.
      • Angle the CR 10-15° cephalad during inspiration.
      • Apices should be above the clavicle shadow on a T3 image.
      • Clavicles are higher with inspiration and lower with expiration.

    AP Axial Projection

    • Performed upright or supine:
      • Flex elbow and place patient's hand pronated on the hip.
      • Angle the CR 15-20° cephalad.
      • Center the CR on the manubrium.
      • Apices should be below the clavicles.
      • Use this projection for hypersthenic patients to separate the apical and clavicular shadow.
    • Evaluation Criteria:
      • Clavicles lying superior to the apices.
      • Sternal ends of the clavicles equidistant from the vertebral column.
      • Apices in their entirety.
      • Superior lung region adjacent to the apices.
      • Clavicles lying horizontally with their medial ends overlapping only the first or second ribs.
      • Ribs distorted, with their anterior and posterior portions somewhat superimposed.

    Lungs & Pleurae

    • AP or PA projection:
      • Performed with patient in the R or L lateral decubitus position.
    • Lateral decubitus:
      • Demonstrates fluid in the pleural cavity (pleural effusion) on the affected side.
      • Demonstrates free air in the pleural cavity (pneumothorax) on the unaffected side.
    • Horizontal:
      • Performed at a 17 degree angle.
      • Center 3 inches below the jugular notch.
      • Can be used to demonstrate pneumothorax or pleural effusion.
    • Air:
      • Tends to rise.
    • Fluid:
      • Tends to fall due to gravity.
    • Remain in position for 5 minutes before exposure.

    Upright PA Projection

    • Demonstrates fluid levels in pulmonary cavities (pleural effusion).
    • Ekimsky recommends the patient lean laterally to 45° for small pleural effusions.

    Lateral Projection

    • Performed prone or supine using a decubitus box.
    • Arms are above head.
    • Position the affected side towards the IR.
    • Center the CR horizontally.
    • Angle the CR 17 degrees.
      • Dorsal: 3-4 inches below the jugular notch.
      • Ventral:
    • Demonstrates the pulmonary areas that are obscured by fluid.
    • Evaluation criteria:
      • Both lungs in their entirety.
      • Trachea filled with air.
      • Visible identification markers.
      • Heart and mediastinal structures within the lung field of the elevated side at a 45-degree oblique.
      • Maximum area of the right lung demonstrated in the LAO.
      • Maximum area of the left lung demonstrated in the RAO.

    Trachea

    • Trachea projections include AP and Lateral.
    • AP projection is done with the patient supine or upright, with the MSP parallel to the IR.
    • Lateral projection is done with the patient seated or standing, with the MSP parallel to the IR.
    • During both AP and Lateral Projections, the respiration should be slow inspiration.
    • Twining method used for the Axiolateral projection; patient should be upright and resting shoulder on IR with 15° caudad angulation at the supraclavicular area.
    • The air-filled trachea and apex of the lungs should be visible in Axiolateral projection.
    • Trachea and Superior Mediastinum projection is a lateral image with the patient in a horizontal position at the midway level.
    • The projection demonstrates air-filled trachea, superior mediastinum, and a 4-10.5 cm distance between the jugular notch and MCP.
    • Demoo projections helpful for retrograde extension of the thyroid gland, thymic enlargement, localization of foreign bodies, and opacified pharynx in infants.

    Chest: Lungs & Heart

    • PA Projection performed with the patient upright, MSP parallel to the IR, arms on side and chin upward.
    • PA Projection uses a 72 inches SID to minimize magnification and increase detail.
    • Lateral Projection demonstrates enlarged thyroid/thymic gland and bronchial tree.
    • Oblique angle used to increase space between structures and improve visualization.
    • Contrast examinations with barium suspension provide detailed visualization of the esophagus.

    PA Projection Evaluation

    • Thoracic Cavity Evaluation criteria include:
      • Entire lung fields from apices to costophrenic angles
      • No rotation
      • Trachea visible in the midline
      • Scapulae projected outside the lung fields
      • Ten posterior ribs visible above the diaphragm
      • Sharp outlines of heart and diaphragm
      • Faint shadow of ribs and superior thoracic vertebrae through the heart shadow
      • Lung markings visible from the hilum to the periphery
      • Diaphragm demonstrated on expiration at a higher level with at least one fewer rib seen within the lung field
    • Large Female Breasts require specific positioning to ensure proper visualization:
      • Pull breasts upward and lateral

    Lateral Projection

    • Upright Lateral projection is performed with the patient in a true lateral position.
    • The MSP and MCP are parallel to the IR, arm extended upward, elbow flexed, and forearm resting on elbows.
    • Left Lateral projection demonstrates the heart, aorta, and left pulmonary lesions.
    • Right Lateral projection demonstrates the right pulmonary lesions.
    • The projection demonstrates interlobar fissures, differentiates lobes, and localizes pulmonary lesions.

    PA Oblique Projection

    • Upright position is used, at 45° RAD or LAD.
    • The side farthest from the IR is used for positioning:
      • LAO - Right lung
      • RAO - Left lung
    • LAO - Right Lung projection demonstrates the thoracic viscera, trachea & carina, bronchial tree (R), heart, descending aorta, and arch of aorta.
    • RAO - Left Lung projection demonstrates the thoracic viscera, trachea, bronchial tree (L), left atrium, apex left ventricle (anterior), and right retrocardiac space.
    • Evaluation criteria:
      • Both lungs in their entirety
      • Trachea filled with air
      • Visible identification markers
      • Heart and mediastinal structures within the lung field of the elevated side in oblique images of 45 degrees
      • Maximum area of the right lung on the LAO
      • Maximum area of the left lung on the RAO
    • RAO / LAO 10° to 20° utilized for pulmonary diseases, displaying the medial part, right middle lobe, and lingula of the upper lobe.

    AP Oblique Projection

    • Upright/supine position used with RPO/LPO 45°
    • Position: Side closest to the IR used for positioning:
      • LPO - Left lung
      • RPD - Right lung
    • Evaluation criteria:
      • Both lungs in their entirety
      • Trachea filled with air
      • Visible identification markers
      • Heart and mediastinal structures within the lung field of the elevated side in oblique images of 45 degrees
      • Maximum area of the right lung on the LAO
      • Maximum area of the left lung on the RAO

    Chest: Thoracic Viscera

    • AP projection performed in the supine or upright position, with the patient 17 from the IR.
    • AP projection of the thoracic viscera demonstrates magnification of the heart, great vessels, and lung fields.
    • Resnick Recommendations:
      • 30° caudal angulation
      • Basal lung fields free of imposition
      • Differentiate middle lobe
      • Lingular processes
      • Lower lobe diseases.

    Pulmonary Apices

    • AP axial projection performed with the patient standing 1 foot in front of the IR.
    • AP axial oblique projection performed with the patient in an oblique lordotic position, at 30° RPO/LPO with the affected side centered on the IR.
    • The projection demonstrates apices, interlobar effusions, and tuberculosis.
    • Evaluation criteria:
      • Lordotic posion
      • Clavicles lying superior to the apices
      • Sternal ends of the clavicles equidistant from the vertebral column
      • Apices and lungs in their entirety
      • Clavicles lying horizontally with their medial ends overlapping only the first or second ribs
      • Ribs distorted with their anterior and posterior portions somewhat superimposed
    • PA axial projection performed with the patient seated or upright, MSP parallel to the IR, with shoulders depressed and rotated forward.
      • T3: apices above the shadow of the clavicle
      • Inspiration: ↑ clavicles
      • Expiration: ↓ clavicles
    • AP axial projection performed with the patient upright/supine, elbow flexed, hand pronated on hip, 15 to 20° cephalad angulation.
      • Manubrium: Apices below clavicles
      • For hypersthenic patients: Separate apical & clavicular shadow
    • Evaluation criteria:
      • Clavicles lying superior to the apices
      • Sternal ends of the clavicles equidistant from the vertebral column
      • Apices in their entirety
      • Superior lung region adjacent to the apices
      • Clavicles lying horizontally with their medial ends overlapping only the first or second ribs
      • Ribs distorted, with their anterior and posterior portions somewhat superimposed

    Lungs & Pleurae

    • AP or PA projection performed with the patient in a right or left lateral decubitus position.
    • Lateral decubitus projection demonstrates fluid in the pleural cavity (pleural effusion) on the affected side, and free air in the pleural cavity (pneumothorax) on the unaffected side.
    • Horizontal projection is performed patient 17 from the IR, 3 inches below the jugular notch, for pneumothorax and pleural effusion visualization
    • Air tends to rise and fluid tends to fall due to gravity.
    • Maintain the position for 5 minutes before exposure.

    Upright PA Projection

    • Demonstrates fluid levels in pulmonary cavities (pleural effusion).
    • Ekimsky recommended: Patient lean laterally 45° for small pleural effusion detection

    Lateral Projection

    • Performed in prone or supine positions, using a decub box, arms above head, affected side on the IR, horizontal, 17 from the IR.
    • Dorsal: 3-4 inches below jugular notch
    • Ventral
    • Demonstrates pulmonary areas obscured by fluid.
    • Evaluation criteria:
      • Both lungs in their entirety
      • Trachea filled with air
      • Visible identification markers
      • Heart and mediastinal structures within the lung field of the elevated side in oblique images of 45 degrees
      • Maximum area of the right lung on the LAO
      • Maximum area of the left lung on the RAO

    Trachea

    • Grid and collimation are used to minimize scatter radiation.
    • AP and Lateral projections are commonly used to visualize the trachea.

    AP Trachea Projection

    • Supine or Upright positions can be used.
    • Focus should be on the manubrium.
    • Air-filled trachea is essential for visualization.
    • Neck should be slightly extended.
    • MSP should be parallel to the image receptor (IR).
    • Slow inspiration is required during exposure.

    Lateral Trachea Projection

    • Seated or standing positions can be used.
    • Arms should be clasped behind the patient.
    • Shoulder should be positioned posteriorly.
    • Neck should be extended.
    • MSP should be parallel to the IR.
    • Slow inspiration is required during exposure.

    Trachea & Superior Mediastinum

    • Lateral projection provides a clear view of the superior mediastinum and air-filled trachea.
    • Focus should be on the area between the jugular notch and the medial clavicular point (MCP).
    • The trachea is 4-10.5 cm in length from the jugular notch to the MCP.

    Demoo (Uses)

    • Visualizes retrosternal extension of the thyroid gland.
    • Identifies thymic enlargement.
    • In infants (recumbent position), helps visualize opacified pharynx, upper esophagus, and outline of trachea and bronchi.
    • Localizes foreign bodies in the airway.

    Trachea & Pulmonary Apex

    • Axiolateral projection (Twining Method) is used to visualize the pulmonary apices.
    • Upright position, with the shoulder resting on the IR.
    • 15° caudad angulation at the supraclavicular area.
    • Elevate the arm and flex the elbow; place the forearm behind the head.
    • Depress the opposite shoulder to ensure true lateral body position and MSP parallel to the IR.
    • Slow inspiration for visualizing the trachea, followed by full inspiration at the end to accurately visualize the lung apices.

    Chest: Lungs & Heart

    • PA projection is used to visualize the lungs and heart.
    • Upright position with arms on the side and MSP parallel to the IR.
    • ** Chin upward** and arms flexed resting on the hips to ensure scapulae are positioned laterally.
    • Depress shoulders and rotate them forward to optimize lung apex visualization.
    • SID of 72 inches (183 cm) for decreased magnification and increased recorded detail.
    • End of second full inspiration for visualization of the lungs and end of expiration for heart visualization.

    PA Projection Evaluation

    • Entire lung fields visualized from apices to costophrenic angles.
    • No rotation, with trachea visible in the midline.
    • Scapulae should be positioned outside the lung fields.
    • Ten posterior ribs should be visible above the diaphragm.
    • Sharp outlines of the heart and diaphragm.
    • Faint shadow of ribs and superior thoracic vertebrae visible through the heart shadow.
    • Lung markings visible from the hilum to the periphery.
    • Inspiration and expiration images with the diaphragm at a higher level during expiration (one fewer rib in the lung field).

    Lateral Projection

    • Upright (True Lateral) position for optimal visualization.
    • Left Lateral position for viewing the heart, aorta, and left pulmonary lesions.
    • Right Lateral position for viewing right pulmonary lesions.
    • Arms extended upward with flexed elbows, resting on elbows.
    • IV stand can be used for support.

    Lateral Projection Demonstration

    • Demonstrates the interlobar fissures.
    • Differentiates the lobes of the lungs.
    • Localizes pulmonary lesions.

    PA Oblique Projection

    • Upright position with a 45° rotation (RAD or LAD).
    • LAO (Left Anterior Oblique) - Right lung is the side farthest in.
    • RAO (Right Anterior Oblique) - Left lung is the side farthest in.

    LAO Evaluation

    • Thoracic viscera, trachea, carina, right bronchial tree, heart, descending aorta, and arch of aorta are visualized.

    RAO Evaluation

    • Thoracic viscera, trachea, left bronchial tree, left atrium, apex of the left ventricle (anterior), and right retrocardiac space are visualized.

    PA Oblique Evaluation

    • Both lungs in their entirety visualized.
    • Trachea filled with air.
    • Visible identification markers.
    • Heart and mediastinal structures within the lung field of the elevated side for angles of 45 degrees.
    • Maximum area of the right lung visualized in LAO.
    • Maximum area of the left lung visualized in RAO.
    • 10° to 20° obliquity for pulmonary diseases to visualize the medial part, right middle lobe, and lingula of the upper lobe.

    AP Oblique Projection

    • Upright or supine position with a 45° rotation (RPO or LPO).
    • LPO (Left Posterior Oblique) - Left lung is the closest side to the image receptor.
    • RPO (Right Posterior Oblique) - Right lung is the closest side to the image receptor.

    AP Oblique Evaluation

    • Both lungs in their entirety.
    • Trachea filled with air.
    • Visible identification markers.
    • Heart and mediastinal structures within the lung field of the elevated side for angles of 45 degrees.
    • Maximum area of the right lung visualized in LAO.
    • Maximum area of the left lung visualized in RAO.

    Chest: Thoracic Viscera

    • AP projection is used to visualize the thoracic viscera.
    • Supine or Upright position with a 17° angle.
    • Thoracic viscera is magnified, including heart and great vessels, while the lung fields appear shorter.
    • Clavicles appear higher and ribs appear more horizontal.
    • A 30° caudal angle is recommended to separate the basal lung fields from imposition.
    • This technique helps differentiate the middle lobe and lingula processes, making it useful for visualizing diseases affecting the lower lobes.

    AP Evaluation Criteria

    • Medial portion of clavicles should be equidistant from the vertebral column.
    • Trachea should be visible in the midline.
    • Clavicles should lie more horizontally, obscuring more of the apices compared to the PA projection.
    • Equal distance between the vertebral column and the lateral border of the ribs on each side.
    • Faint image of ribs and thoracic vertebrae visible through the heart shadow.
    • Entire lung fields visualized from the apices to the costophrenic angles.
    • Pleural markings visible from the hilum to the periphery of the lungs.

    Pulmonary Apices

    • AP Axial Projection is used to visualize the pulmonary apices.

    • Upright position, with the patient standing one foot in front of the IR.

    • Lordotic position for optimal visualization.

    • MSP should be parallel to the IR.

    • AP Axial Oblique Projection is used to further visualize the apices.

    • Oblique lordotic position with a 30° angle (RPO or LPO), ensuring the affected side is centered on the IR.

    • Extreme lordosis is necessary for optimal visualization.

    Pulmonary Apices Demonstration

    • This projection helps visualize apices, interlobar effusions, and tuberculosis-related lesions.

    AP Axial Evaluation Criteria

    • Lordotic position with clavicles lying superior to the apices.
    • Sternal ends of the clavicles should be equidistant from the vertebral column.
    • Apices and lungs in their entirety.
    • Clavicles lying horizontally with their medial ends overlapping only the first or second ribs.
    • Rib distortion with anterior and posterior portions superimposed.
    • Oblique lordotic position with the dependent apex and lung of the affected side in its entirety.

    PA Axial Projection

    • Seated/Upright position with MSP parallel to IR.
    • Depress shoulders and rotate them forward.
    • 10-15° cephalad angulation required during inspiration.
    • T3 should be positioned above the clavicle shadow.
    • Increased clavicle height indicates inspiration while decreased clavicle height indicates expiration.

    AP Axial Projection

    • Upright or supine position with flexed elbows and pronated hands on the hip.
    • 15 to 20° cephalad angulation targeting the manubrium.
    • Apices should be positioned below the clavicles.

    AP Axial Projection for Hypersthenic Patients

    • Separate apical and clavicular shadows to achieve optimal visualization in hypersthenic patients.

    AP Axial Evaluation Criteria

    • Clavicles lying superior to the apices.
    • Sternal ends of the clavicles should be equidistant from the vertebral column.
    • Apices should be visualized in their entirety.
    • Superior lung region adjacent to the apices.
    • Clavicles lying horizontally with their medial ends overlapping only the first or second ribs.
    • Rib distortion with anterior and posterior portions somewhat superimposed.

    Lungs & Pleurae

    • AP or PA projections can be used in Right or Left lateral decubitus positions to visualize the lungs and pleurae.

    • Lateral decubitus helps differentiate fluid in the pleural effusion (affected side) and free air in pneumothorax (unaffected side).

    • Horizontal beam with a 17° angle, 3 inches below the jugular notch best visualizes pneumothorax and pleural effusion.

    • Air tends to rise due to gravity.

    • Fluid tends to settle due to gravity.

    • Patient must remain in the position for 5 minutes before the exposure.

    Upright PA Projection

    • Upright PA projection is recommended to view fluid levels in pulmonary cavities (pleural effusion).

    Ekimskey Recommendation

    • Patient should lean laterally at a 45° angle for optimal visualization of small pleural effusions.

    Lateral Projection

    • Prone or supine position using a decubitus box with arms above the head and the affected side facing the IR.
    • Horizontal beam with a 17° angle.
    • Dorsal (3-4 inches below the jugular notch) and ventral views to visualize pulmonary areas obscured by fluid.

    Lateral Projection Evaluation Criteria

    • Both lungs in their entirety.
    • Trachea filled with air.
    • Visible identification markers.
    • Heart and mediastinal structures within the lung field of the elevated side for angles of 45 degrees.
    • Maximum area of the right lung visualized in LAO.
    • Maximum area of the left lung visualized in RAO.

    Trachea Technique

    • Grid and collimation are needed for optimal image quality.

    Trachea Projections

    • AP Projection:
      • Patient can be supine or upright.
      • Center image at the manubrium.
      • Ensure trachea is air-filled.
      • Neck should be slightly extended.
      • MSP should be parallel to the IR.
      • Respiration: slow inspiration.
    • Lateral Projection:
      • Patient can be seated or standing.
      • Patient should clasp hands behind their back.
      • Shoulder should be positioned posteriorly.
      • Neck should be extended.
      • MSP should be parallel to the IR.
      • Respiration: slow inspiration.

    Trachea & Superior Mediastinum

    • Lateral Projection:
      • Use a horizontal beam, centered midway.
      • Image an air-filled trachea and superior mediastinum.
      • Center image between the jugular notch and MCP.
      • The trachea and superior mediastinum should measure 4-10.5 cm in the lower portion.

    Trachea & Pulmonary Apex

    • Axiolateral Projection (Twining Method):
      • Patient should be upright.
      • Rest the shoulder against the IR.
      • Angle the CR 15° caudad at the supraclavicular notch.
      • Image the air-filled trachea and apex of the lungs.
      • Elevate the arm and flex the elbow.
      • Position the forearm behind the head.
      • Depress the opposite shoulder.
      • MSP should be parallel to the IR.
      • Ensure the body is in a true lateral position.
      • Respiration: slow inspiration for the trachea, end of full inspiration for the lung apex.

    Respiration Technique

    • Air-filled trachea: Slowly inspiration
    • Lungs: End of full inspiration

    Chest: Lungs & Heart

    • PA Projection:
      • Patient should be upright.
      • Position arms at the sides.
      • MSP should be parallel to the IR.
      • Chin should be raised.
      • Flex arms and rest on hips to lateralize scapulae.
      • Depress shoulders and rotate forward to bring scapulae below lung apices.
      • SID: 72 inches (183 cm) or 6 feet.
      • This reduces magnification and increases recorded detail.
      • Respiration: End of the second full inspiration.
    • Lateral Projection:
      • Enlarged thyroid/thymic gland
      • Bronchial tree
    • Oblique Angle:
      • Not explicitly addressed in this text.
    • Contrast:
      • Esophagus (barium suspension)

    Large Female Breasts

    • Pull breasts upward and lateral to improve image quality.

    CXR PA Projection Evaluation

    • Evaluation Criteria:
      • Entire lung fields from the apices to the costophrenic angles.
      • No rotation.
      • Trachea visible in the midline.
      • Scapulae projected outside the lung fields.
      • Ten posterior ribs visible above the diaphragm.
      • Sharp outlines of the heart and diaphragm.
      • Faint shadow of the ribs and superior thoracic vertebrae visible through the heart shadow.
      • Lung markings visible from the hilum to the periphery of the lung.
      • With inspiration and expiration chest images, the diaphragm demonstrated on expiration at a higher level so that at least one fewer rib is seen within the lung field.

    Lateral Projection

    • Upright:
      • True lateral positioning.
      • Left lateral: Heart and left lung are visible.
      • Right lateral: Only right lung visible.
      • MSP should be parallel to the IR.
      • MCP should be parallel to the IR.
      • Extend arm upward.
      • Flex elbow.
      • Rest forearm on elbows.
      • Use an IV stand for support.
      • Left lateral: Heart, aorta, and left pulmonary lesions are well visualized.
      • Right lateral: Right pulmonary lesions are well visualized.
    • Demonstrate:
      • Interlobar fissures
      • Differentiate lobes
      • Localize pulmonary lesions

    PA Oblique Projection

    • Upright Positioning:

      • RAD or LAD positioning.
      • 45° oblique angle.

    • Position:

      • Side furthest from the IR:
        • LAO: Right lung is visualized.
        • RAO: Left lung is visualized.

    • LAO - Right Lung:

      • Thoracic viscera
      • Trachea and carina
      • Right bronchial tree
      • Heart
      • Descending aorta
      • Arch of aorta

    • RAO - Left Lung:

      • Thoracic viscera
      • Trachea
      • Left bronchial tree
      • Left atrium
      • Apex of the left ventricle (anterior)
      • Right retrocardiac space

    • Evaluation Criteria:

      • Both lungs in their entirety.
      • Trachea filled with air.
      • Visible identification markers.
      • Heart and mediastinal structures within the lung field of the elevated side in oblique images of 45 degrees.
      • Maximum area of the right lung shown on LAO.
      • Maximum area of the left lung shown on RAO.

    • For Pulmonary Diseases - RAO/LAO 10° to 20°:

      • Display the medial part, right middle lobe, and lingula of the upper lobe.

    AP Oblique Projection

    • Upright/Supine Positioning:

      • RPO/LPO 45°

    • Position:

      • Side closest to the IR. If patient cannot prone, use this position instead.
      • LPO: Left lung is visualized.
      • RPO: Right lung is visualized.

    • Evaluation Criteria:

      • Both lungs in their entirety.
      • Trachea filled with air.
      • Visible identification markers.
      • Heart and mediastinal structures within the lung field of the elevated side in oblique images of 45 degrees.
      • Maximum area of the right lung shown on LAO.
      • Maximum area of the left lung shown on RAO.

    Chest: Thoracic Viscera

    • AP Projection:

      • Supine/Upright.
      • 17" SID (17" x 17" IR).
      • Magnifies thoracic viscera, particularly the heart and great vessels.
      • Lung fields are shorter, clavicles are higher, and ribs are horizontal.

    • Resnick Recommended:

      • 30° caudal angle.
      • Basal lung fields free of imposition.
      • Differentiates the middle lobe.
      • Visualizes the lingular process.
      • Useful for visualizing lower lobe diseases.

    • Evaluation Criteria:

      • Medial portion of the clavicles equidistant from the vertebral column.
      • Trachea visible in the midline.
      • Clavicles lying more horizontally and obscuring more of the apices than in the PA projection.
      • Equal distance from the vertebral column to the lateral border of the ribs on each side.
      • Faint image of the ribs and thoracic vertebrae visible through the heart shadow.
      • Entire lung fields, from the apices to the costophrenic angles.
      • Pleural markings visible from the hilar regions to the periphery of the lungs.

    Pulmonary Apices

    • AP Axial Projection:
      • Patient upright.
      • Stand 1 foot in front of the IR.
      • Lordotic position.
      • MSP parallel to the IR.
    • AP Axial Oblique Projection:
      • Oblique lordotic position.
      • RPO/LPO 30°.
      • Affected side centered to the IR.
      • Extreme lordosis.
      • Demonstrate:
        • Apices.
        • Interlobar effusions.
        • Tuberculosis.
    • Evaluation Criteria:
      • Lordotic position.
      • Clavicles lying superior to the apices.
      • Sternal ends of the clavicles equidistant from the vertebral column.
      • Apices and lungs in their entirety.
      • Clavicles lying horizontally with their medial ends overlapping only the first or second ribs.
      • Ribs distorted with their anterior and posterior portions somewhat superimposed.
      • Oblique lordotic position: Dependent apex and lung of the affected side in its entirety.

    PA Axial Projection

    • Seated/Upright:
      • MSP parallel to the IR.
      • Depress shoulders.
      • Rotate forward.
      • 10-15° cephalad angle.
    • T3: Apices above the shadow of the clavicle.
    • Inspiration: Increased clavicle elevation.
    • Expiration: Decreased clavicle elevation.

    AP Axial Projection

    • Upright/Supine:
      • Flex elbow.
      • Pronate hand on hip.
      • 15-20° cephalad angle.
      • Center on the manubrium.
      • Apices below clavicles.
    • For Hypersthenic Patients:
      • Separate apical and clavicular shadows.
    • Evaluation Criteria:
      • Clavicles lying superior to the apices.
      • Sternal ends of the clavicles equidistant from the vertebral column.
      • Apices in their entirety.
      • Superior lung region adjacent to the apices.
      • Clavicles lying horizontally with their medial ends overlapping only the first or second ribs.
      • Ribs distorted, with their anterior and posterior portions somewhat superimposed.

    Lungs & Pleurae

    • AP or PA Projection

      • R or L Lateral decubitus position.

    • Lateral Decubitus:

      • Fluid in the pleural cavity (pleural effusion): Affected side positioned down.
      • Free air in the pleural cavity (pneumothorax): Unaffected side positioned down.

    • Horizontal:

      • 17" SID.
      • Center beam 3 inches below the jugular notch.
      • Demonstrate pneumothorax or pleural effusion.

    • Air: Tends to rise.

    • Fluid: Tends to settle (gravity).

    • Remain in position for 5 minutes before exposure to allow fluid and air to settle.

    Upright PA Projection

    • Use for demonstrating fluid levels in pulmonary cavities (pleural effusion).
    • Ekimsky Recommended:
      • Patient leans laterally 45°.
      • Used for small pleural effusions.

    Lateral Projection

    • Prone or supine.

    • Use a decubitus box for positioning arms.

    • Arms above head.

    • Affected side against the IR.

    • Horizontal beam.

    • 17" SID.

    • Dorsal

      • Center beam 3-4 inches below the jugular notch.

    • Ventral

      • Center beam

    • Demonstrate: Pulmonary areas obscured by fluid.

    • Evaluation Criteria:

      • Both lungs in their entirety.
      • Trachea filled with air.
      • Visible identification markers.
      • Heart and mediastinal structures within the lung field of the elevated side in oblique images of 45 degrees.
      • Maximum area of the right lung shown on LAO.
      • Maximum area of the left lung shown on RAO.

    Trachea

    • GRID & Collimation used for optimal image quality
    • AP projection:
      • Performed supine or upright
      • Centered on manubrium
      • Ensure trachea is air-filled
      • Neck slightly extended
      • MSP parallel to IR
      • Slow inspiration during exposure
    • Lateral projection:
      • Seated or standing
      • Patient clasps hands behind, shoulder posteriorly
      • Neck extended
      • MSP parallel to IR
      • Slow inspiration during exposure

    Trachea & Superior Mediastinum

    • Lateral projection:
      • Horizontal beam
      • Centered midway between the jugular notch and MCP
      • Visualizes air-filled trachea and superior mediastinum
      • Measures 4-10.5 cm in the lower portion

    Trachea & Pulmonary Apex

    • Axiolateral Projection (Twining Method):
      • Performed upright
      • Patient rests shoulder against IR
      • 15° caudad angulation at supraclavicular area
      • Visualizes air-filled trachea and lung apices
      • Patient elevates arm, flexes elbow, and places forearm behind head
      • Depress opposite shoulder
      • MSP parallel to IR
      • Body in true lateral position
      • Slowly inspire during trachea exposure, end of inspiration for lung apices

    Chest: Lungs & Heart

    • PA Projection:
      • Performed upright
      • Arms at sides, chin elevated, flexed arms resting on hips
      • Depress shoulders, rotate forward
      • SID 72 inches (183cm)
      • End of second full inspiration for lung exposure
      • End of expiration for heart exposure
    • PA projection visualizes:
      • Air-filled trachea
      • Diaphragmatic domes
      • Heart
      • Aortic knob
    • Lateral projection visualizes:
      • Enlarged thyroid or thymic gland
      • Bronchial tree
    • Oblique angles can be used
    • Contrast media, such as barium suspension, can be used to visualize the esophagus

    Large Female Breasts

    • Pull breasts upward and lateral to avoid obscuring lung fields

    CXR PA Projection Evaluation Criteria

    • Lung fields from apices to costophrenic angles
    • No rotation
    • Trachea in midline
    • Scapulae outside lung fields
    • Ten posterior ribs above diaphragm
    • Sharp heart and diaphragm outlines
    • Faint rib and vertebral shadows through the heart shadow
    • Lung markings from hilum to periphery
    • With inspiration and expiration images, the diaphragm is higher on expiration, showing one fewer rib within the lung field

    Lateral Projection

    • Upright:
      • True lateral position
      • Left lateral visualizes heart, aorta, and left pulmonary lesions
      • Right lateral visualizes right pulmonary lesions
      • MSP and MCP parallel to IR
      • Arm extended upward, elbow flexed, forearm resting on elbows
      • IV stand can be used to support the arm
    • Demonstrates:
      • Interlobar fissures
      • Differentiation of lobes
      • Localization of pulmonary lesions

    PA Oblique Projection

    • Upright:
      • RAD or LAD, 45° angulation
      • Side farthest from IR is elevated
      • LAO visualizes right lung
      • RAO visualizes left lung
    • LAO - Right Lung:
      • Visualizes thoracic viscera, trachea, carina, right bronchial tree, heart, descending aorta, and arch of aorta
    • RAO - Left Lung:
      • Visualizes thoracic viscera, trachea, left bronchial tree, left atrium, apex of left ventricle, and right retrocardiac space
    • Evaluation Criteria:
      • Both lungs in their entirety
      • Trachea filled with air
      • Visible identification markers
      • Heart and mediastinal structures within the lung field of the elevated side
      • Maximum area of the right lung on LAO
      • Maximum area of the left lung on RAO
    • 10-20° RAO / LAO for pulmonary diseases:
      • Displays medial part, right middle lobe, and lingula of upper lobe

    AP Oblique Projection

    • Upright or supine:
      • RPO or LPO, 45° angulation
      • Side closest to IR is elevated
      • LPO visualizes left lung
      • RPO visualizes right lung
    • Evaluation Criteria:
      • Both lungs in their entirety
      • Trachea filled with air
      • Visible identification markers
      • Heart and mediastinal structures within the lung field of the elevated side
      • Maximum area of the right lung on LAO
      • Maximum area of the left lung on RAO

    Chest: Thoracic Viscera

    • AP Projection:
      • Supine or upright
      • Magnifies thoracic viscera, including heart and great vessels
      • Lung fields appear shorter
      • Clavicle higher
      • Ribs horizontal
    • Resnick Recommended:
      • 30° caudal angulation
      • Basal lung fields free of imposition
      • Differentiates middle lobe and lingula
      • Visualizes lower lobe diseases
    • Evaluation Criteria:
      • Medial clavicles equidistant from vertebral column
      • Trachea in midline
      • Clavicles horizontal, obscuring more apices than PA
      • Equal distance from vertebral column to rib lateral borders
      • Faint ribs and thoracic vertebrae through heart shadow
      • Entire lung fields, from apices to costophrenic angles
      • Pleural markings visible from hilum to periphery

    Pulmonary Apices

    • AP Axial Projection:
      • Upright
      • Patient stands 1 foot in front of IR
      • Lordotic position
      • MSP parallel to IR
    • AP Axial Oblique Projection:
      • Oblique lordotic position
      • RPO or LPO, 30° angulation
      • Affected side centered to IR
      • Extreme lordosis
    • Demonstrates:
      • Apices
      • Interlobar effusions
      • Tuberculosis (TB)
    • Evaluation Criteria:
      • Lordotic position
      • Clavicles superior to apices
      • Sternal ends of clavicles equidistant from vertebral column
      • Apices and lungs in their entirety
      • Horizontal clavicles overlapping first or second ribs
      • Distorted ribs with superimposed anterior and posterior portions
      • Oblique lordotic position
      • Dependent apex and lung of the affected side in entirety
    • PA Axial Projection:
      • Seated or upright
      • MSP parallel to IR
      • Depress shoulders, rotate forward
      • 10-15° cephalad angulation during inspiration
      • T3 should be above clavicle shadow
      • Inspiration increases clavicle height
      • Expiration decreases clavicle height

    AP Axial Projection

    • Upright or supine:
      • Elbow flexed, hands pronated on hip
      • 15-20° cephalad angulation
      • Centered on manubrium
      • Apices below clavicles
    • For hypersthenic patients:
      • Separate apical and clavicular shadows
    • Evaluation Criteria:
      • Clavicles superior to apices
      • Sternal ends of clavicles equidistant from vertebral column
      • Apices in their entirety
      • Superior lung region adjacent to apices
      • Horizontal clavicles overlapping first or second ribs
      • Distorted ribs, with anterior and posterior portions somewhat superimposed

    Lungs & Pleurae

    • AP or PA projection:
      • Right or left lateral decubitus position
    • Lateral decubitus:
      • Fluid in pleural effusion will pool in the dependent pleural cavity
      • Free air in pneumothorax will rise to the non-dependent pleural cavity
    • Horizontal beam:
      • Centered 3 inches below jugular notch
      • Visualizes pneumothorax and pleural effusion
      • Air rises, fluid falls due to gravity
    • Remain in position for 5 minutes prior to exposure

    Upright PA Projection

    • Visualizes fluid levels in pulmonary cavities (pleural effusion)
    • Ekimsky recommended:
      • Patient leans laterally 45°
      • Useful for small pleural effusions

    Lateral Projection

    • Prone or supine:
      • Use a decubitus box
      • Arms above head
      • Centered on affected side
      • Horizontal beam
      • 17 inches SID
      • Dorsal (3-4 inches below jugular notch) and ventral beams can be used
      • Visualizes pulmonary areas obscured by fluid
    • Evaluation Criteria:
      • Both lungs in their entirety
      • Trachea filled with air
      • Visible identification markers
      • Heart and mediastinal structures within the lung field of the elevated side
      • Maximum area of the right lung on LAO
      • Maximum area of the left lung on RAO

    Trachea

    • Trachea (windpipe) procedures can include GRID and collimation techniques.
    • AP (anteroposterior) is done supine or upright with the neck extended.
    • Lateral is done seated or standing with the neck extended.
    • For both AP and lateral, proper alignment includes MSP || IR (midsagittal plane parallel to image receptor).
    • Inspiration should be slow.

    Trachea & Superior Mediastinum

    • Lateral projection with a horizontal beam is used to visualize the air-filled trachea and superior mediastinum.
    • The superior mediastinum is the space between the jugular notch and manubriosternal joint.
    • The trachea measures 4-10.5 cm in its lower section.

    Demo

    • Trachea & Superior Mediastinum projections can demonstrate retrosternal thyroid extension, thymic enlargement, and foreign body localization.
    • In infants, recumbent positioning helps visualize opacified pharynx, upper esophagus and the outline of the trachea and bronchi.

    Trachea & Pulmonary Apex

    • The Twining method is used for axiolateral projection to visualize the air-filled trachea.
    • The patient is upright with 15° caudad angulation at the supraclavicular notch.
    • This projection helps visualize the apex of the lungs.
    • Inspiration is slow for the trachea and end inspiration for the lung apex.

    Chest: Lungs & Heart

    • PA (posteroanterior) projection is performed upright with arms by the side, chin upward, and shoulders depressed.
    • The SID (source-to-image distance) is 72 inches (183 cm).
    • Respiration is at the end of the second full inspiration, or at the end of expiration.
    • This projection demonstrates the air-filled trachea, lungs including diaphragmatic domes, heart, and aortic knob.
    • Lateral projection can display enlarged thyroid/thymic glands and bronchial tree.
    • Esophagus can be contrasted with barium suspension.

    Large Female Breasts

    • Female patients with large breasts should have their breasts pulled upward and laterally.

    CXR PA Projection Evaluation

    • Proper CXR PA projection evaluation includes:
      • Full visualization of both lung fields from apices to costophrenic angles.
      • No rotation.
      • Trachea visible in the midline.
      • Scapulae projected outside the lung fields.
      • Ten posterior ribs visible above the diaphragm.
      • Sharp outlines of the heart and diaphragm.
      • Faint shadow of the ribs and superior thoracic vertebrae visible through the heart shadow.
      • Lung markings visible from the hilum to the periphery.
      • With inspiration and expiration images, the diaphragm demonstrates a higher level on expiration.
      • One fewer rib is visible in the lung field during expiration.

    Lateral Projection

    • True lateral positioning is achieved by aligning MSP || IR (midsagittal plane parallel to image receptor) and MCP || IR (mediocoronal plane parallel to image receptor).
    • The arm is extended upward with the elbow flexed and the forearm resting on the elbow.
    • An IV stand may be used for support.
    • Left lateral projection displays the heart, aorta, and left pulmonary lesions.
    • Right lateral projection displays the right pulmonary lesions.
    • Lateral projections demonstrate interlobar fissures and differentiate lobes.

    PA Oblique Projection

    • PA Oblique projection is performed upright with 45° RAD or LAD.
    • LAO (left anterior oblique) projects the right lung and right lobe of the lung.
    • RAO (right anterior oblique) projects the left lung.
    • Evaluation criteria include full visualization of both lungs, air-filled trachea, visible identification markers, heart and mediastinal structures within the lung field of the elevated side, and the maximum area of the lung on the elevated side.
    • RAO/LAO 10° to 20° displays the medial part, right middle lobe, and the lingula of the upper lobe.

    AP Oblique Projection

    • AP Oblique projection is done upright or supine at 45° RPO or LPO.
    • LPO (left posterior oblique) projects the left lung.
    • RPO (right posterior oblique) projects the right lung.
    • Evaluation criteria are similar to PA Oblique.

    Chest: Thoracic Viscera

    • Thoracic viscera AP projection is done upright or supine.
    • This projection exaggerates the size of the heart and great vessels, shortens the lung fields, raises the clavicles, and makes the ribs more horizontal.
    • Resnick recommended a 30° caudal angle for better visualization of the basal lung fields, especially with lower lobe diseases.
    • Evaluation criteria include:
      • Medial portions of the clavicles equidistant from the vertebral column.
      • Trachea in the midline
      • Clavicles more horizontal, obscuring the apices.
      • Equal distance from the vertebral column to the lateral border of the ribs.
      • Faint image of the ribs and thoracic vertebrae visible through the heart shadow.
      • Full visualization from the apices to the costophrenic angles.
      • Pleural markings visible from the hilum to the periphery.

    Pulmonary Apices

    • AP Axial projection is performed upright with the patient standing one foot in front of the IR.
    • AP Axial Oblique projection is done with the patient in an oblique lordotic position with 30° RPO/LPO.
    • These projections are used to visualize the apices and locate effusions, especially for tuberculosis.
    • Evaluation criteria include:
      • Lordotic position.
      • Clavicles superior to the apices.
      • Sternal ends of clavicles equidistant from the spine.
      • Full visualization of lung apices.
      • Clavicles lying horizontally.
      • Ribs distorted with anterior and posterior portions somewhat superimposed.

    PA Axial Projection

    • PA Axial projection is performed seated or upright with MSP || IR.
    • Shoulders are depressed and rotated forward.
    • Inspiration with 10 to 15° cephalad angulation makes T3 visible above the clavicle shadow.
    • Inspiration raises the clavicles, and expiration lowers them.

    AP Axial Projection

    • AP Axial is performed upright or supine with 15 to 20° cephalad angulation.
    • Elbow is flexed with the hand pronated on the hip.
    • The manubrium is visualized with apices visualized below the clavicles.
    • This projection separates the apical & clavicular shadows for hypersthenic patients.
    • Evaluation criteria include:
      • Clavicles superior to the apices.
      • Sternal ends of clavicles equidistant from the spine.
      • Full visualization of the apices.
      • Superior lung region visualized adjacent to the apices.
      • Clavicles lying horizontally.
      • Ribs distorted with anterior and posterior portions somewhat superimposed.

    Lungs & Pleurae

    • AP or PA projection with lateral decubitus position highlights fluid in the pleural cavity (pleural effusion) on the affected side.
    • Free air in the pleural cavity (pneumothorax) is seen on the unaffected side.
    • Horizontal beam at 17 with 3 inches below the jugular notch is used for pneumothorax and pleural effusion.
    • Air tends to rise (go upwards), while fluid tends to fall (go downwards) due to gravity.
    • The patient should remain in the decubitus position for at least 5 minutes before taking the image.

    Upright PA Projection

    • Upright PA projection demonstrates fluid levels in pulmonary cavities, especially pleural effusions.
    • Ekimsky recommends leaning the patient laterally by 45° to better visualize small pleural effusions.

    Lateral Projection

    • Prone or supine positioning is used with the affected side towards the IR.
    • A decubitus box may be used.
    • Arms should be above the head.
    • Horizontal beam at 17 should be directed 3-4 inches below the jugular notch (dorsal) or to the ventral area, depending on the positioning.
    • Pulmonary areas are obscured by fluid on the affected side.
    • Evaluation criteria include:
      • Full visualization of both lungs.
      • Air-filled trachea.
      • Visible identification markers.
      • Heart and mediastinal structures projected within the lung field of the elevated side in the oblique images.
      • Maximum area of the right lung on the LAO.
      • Maximum area of the left lung on the RAO.

    Trachea

    • AP projection: Patient supine or upright, neck slightly extended, MSP parallel to IR, respiration during slowly inspiration.
    • Lateral projection: Patient seated or standing, shoulder posteriorly, neck extended, MSP parallel to IR, respiration during slowly inspiration.

    Trachea & Superior Mediastinum

    • Lateral projection: Air-filled trachea and superior mediastinum.
    • Measured distance between the jugular notch and MCP.
    • The distance is between 4 to 10.5 cm in the lower region.

    Trachea & Pulmonary Apex

    • Twining Method: Patient upright, shoulder resting on IR, 15° caudad angulation at supraclavicular area.
    • Positioning: Elevate arm, flex elbow, forearm behind head, depress opposite shoulder, MSP parallel to IR, body in true lateral.
    • Respiration: Slowly inspiration for the trachea, full inspiration for the lung apex.

    Chest: Lungs & Heart

    • PA projection: Patient upright, arms on side, MSP parallel to IR, chin upward, arms flexed, scapulae lateral, depress shoulder, rotate forward.
    • SID: 72 in (183cm) or 6ft.
    • Respiration: End of second full inspiration or end of expiration.

    Evaluation Criteria (PA projection)

    • Entire lung fields from the apices to the costophrenic angles
    • No rotation
    • Trachea visible in the midline
    • Scapulae projected outside the lung fields
    • Ten posterior ribs visible above the diaphragm
    • Sharp outlines of heart and diaphragm
    • Faint shadow of the ribs and superior thoracic vertebrae through the heart shadow
    • Lung markings from the hilum to the periphery of the lung
    • On inspiration and expiration images, diaphragm demonstrated on expiration at a higher level, so that at least one fewer rib is seen within the lung field.

    Lateral Projection

    • Upright: True lateral position.
    • Left lateral: Heart, aorta, and left pulmonary lesion.
    • Right lateral: Right pulmonary lesion
    • Demonstration: Interlobar fissures, differentiate lobes, localize pulmonary lesion.

    PA Oblique Projection

    • Upright: RAD or LAD, 45° angle.
    • LAO: Right lung.
    • RAO: Left lung
    • Evaluation criteria: Both lungs in their entirety, trachea filled with air, visible identification markers, heart and mediastinal structures within the lung field of the elevated side, maximum area of the right lung on LAO, maximum area of the left lung on RAO.
    • Pulmonary diseases: Use RAO/LAO 10° to 20° to display medial part, right middle lobe, and lingula of upper lobe.

    AP Oblique Projection

    • Upright/supine: RPO/LPO 45°
    • LPO: Left lung
    • RPO: Right lung
    • Evaluation criteria: Both lungs in their entirety, trachea filled with air, visible identification markers, heart and mediastinal structures within the lung field of the elevated side in oblique images of 45 degrees, maximum area of the right lung on the LAO, maximum area of the left lung on the RAO

    Chest: Thoracic Viscera

    • AP projection: Supine or upright, 17, thoracic viscera magnified (heart and great vessels engorged), lung fields shorter, clavicle higher, ribs horizontal.
    • Resnick Recommendation: 30° caudal angulation for basal lung fields free of imposition, differentiates middle lobe, lingular processes, and lower lobe diseases.
    • Evaluation criteria: Medial portion of the clavicles equidistant from the vertebral column, trachea visible in the midline, clavicles lying more horizontally and obscuring more of the apices than in the PA projection, equal distance from the vertebral column to the lateral border of the ribs on each side, faint image of the ribs and thoracic vertebrae visible through the heart shadow, entire lung fields from the apices to the costophrenic angles, pleural markings visible from the hilar regions to the periphery of the lungs.

    Pulmonary Apices

    • AP Axial Projection: Upright, stand 1 foot in front of IR, lordotic position, MSP parallel to IR.
    • AP Axial Oblique Projection: Oblique lordotic position (RPO/LPO 30°), affected side center IR, extreme lordosis.
    • Demonstration: Apices, interlobar effusions.
    • Evaluation Criteria: Lordotic position, clavicles lying superior to the apices, sternal ends of the clavicles equidistant from the vertebral column, apices and lungs in their entirety, clavicles lying horizontally with their medial ends overlapping only the first or second ribs, ribs distorted with their anterior and posterior portions somewhat superimposed, oblique lordotic position, dependent apex and lung of the affected side in its entirety
    • PA Axial Projection: Seated or upright, MSP parallel to IR, depress shoulders, rotate forward, inspiration 10-15° cephalad, T3, apices above the shadow of clavicle.
    • Inspiration: Increased clavicle (↑)
    • Expiration: Decreased clavicle (↓)
    • AP Axial Projection: Upright/supine, elbow flexed, hand pronated on hip, 15-20° cephalad, manubrium, apices below clavicles.
    • Hypersthenic patients: Separate apical and clavicular shadow.
    • Evaluation criteria: Clavicles lying superior to the apices, sternal ends of the clavicles equidistant from the vertebral column, apices in their entirety, superior lung region adjacent to the apices, clavicles lying horizontally with their medial ends overlapping only the first or second ribs, ribs distorted, with their anterior and posterior portions somewhat superimposed.

    Lungs & Pleurae

    • AP or PA projection: Upright or supine, R or L lateral, decubitus position.
    • Lateral decubitus: Affected side down for fluid (pleural effusion) and unaffected side down for air (pneumothorax).
    • Horizontal (17): 3 in below jugular notch for pneumothorax and pleural effusion.
    • Fluid: Tends to go down due to gravity.
    • Air: Tends to go up.
    • Remain in position for 5 min before exposure.

    Upright PA Projection

    • Fluid levels in pulmonary cavities (pleural effusion)
    • Ekimsky recommendation: Patient lean laterally 45° for small pleural effusion.

    Lateral Projection

    • Prone/supine, use decub box, arms above head, affected side on IR, horizontal (17)
    • Dorsal: 3-4 in below jugular notch.
    • Ventral: Pulmonary areas obscured by fluid.
    • Evaluation criteria: Both lungs in their entirety, trachea filled with air, visible identification markers, heart and mediastinal structures within the lung field of the elevated side in oblique images of 45 degrees, maximum area of the right lung on the LAO, maximum area of the left lung on the RAO.

    Trachea Projection

    • AP Projection: The patient should be supine or upright, with the manubrium centered to the image receptor. The trachea should be air-filled, and the neck should be slightly extended. The MSP is parallel to the image receptor. During respiration, the patient should slowly inspire.
    • Lateral Projection: The patient should be seated or standing with hands clasped behind, shoulder posteriorly, and neck extended. The MSP is parallel to the image receptor. During respiration, the patient should slowly inspire.

    Trachea & Superior Mediastinum

    • The lateral projection of the trachea and superior mediastinum is created by positioning the patient with the horizontal beam midway.
    • The trachea should be air-filled.
    • The superior mediastinum should be visualized between the jugular notch and MCP.
    • The width should be between 4-10.5 cm at the lower end.

    Demoo

    • This projection demonstrates the retrosternal extension of the thyroid gland, thymic enlargement, and foreign body localization.
    • In infants, the opacified pharynx, the upper esophagus, and the outline of the trachea and bronchi are visible in the recumbent position.

    Trachea & Pulmonary Apex

    • Twining Method: This upright projection is completed with the patient resting their shoulder on the image receptor and 15° caudad angulation at the supraclavicular area. The trachea should be air-filled and the pulmonary apex should be near the image receptor.

    Respiration Technique

    • For visualizing the trachea, the patient should take a slow inspiration.
    • For visualizing the lungs, the patient should take and hold a full inspiration.

    Chest: Lungs & Heart

    • PA Projection: The patient should be positioned upright, arms at their sides, and the MSP parallel to the image receptor. Chin should be elevated, arms flexed and resting on the hips. Ensure scapulae are lateral, shoulders are depressed and rotated forward, below the lung apices. The SID should be 72 inches/183 cm.
    • Respiration: The patient should hold their breath at the end of the second full inspiration.
    • Lateral Projection: This projection may demonstrate an enlarged thyroid or thymic gland, as well as the bronchial tree.

    Large Female Breasts

    • Pull the breasts upward and lateral to ensure the entire lung field is visualized.

    CXR PA Projection Evaluation

    • Evaluation Criteria:
      • Ensure the entire lung fields are visualized from the apices to the costophrenic angles.
      • The trachea should be visible in the midline.
      • The scapulae should be projected outside the lung fields.
      • Ten posterior ribs should be visible above the diaphragm.
      • Sharp outlines of the heart and diaphragm should be visible.
      • A faint shadow of the ribs and superior thoracic vertebrae should be visible through the heart shadow.
      • Lung markings should be visible from the hilum to the periphery of the lung.
      • With inspiration and expiration chest images, the diaphragm should be demonstrated at a higher level on expiration so that at least one fewer rib is seen within the lung field.

    Lateral Projection

    • Upright: The patient should be positioned in a true lateral position. The MSP and MCP are parallel to the image receptor. Extend the arm upward with the elbow flexed and resting on the elbows. An IV stand may be used for stabilization.
      • Left Lateral: Visualizes the heart, aorta, and left pulmonary lesions.
      • Right Lateral: Visualizes right pulmonary lesions.

    Demonstrate:

    • This projection demonstrates interlobar fissures, differentiates lobes, and localizes pulmonary lesions.

    PA Oblique Projection

    • Upright: The patient should be positioned in a 45° RAD or LAD.
    • Position: The side farthest from the image receptor is the side being visualized.
      • LAO: Right lung.
      • RAO: Left lung.

    LAO - Right Lung:

    • Visualizes the thoracic viscera, the trachea and carina, the right bronchial tree, the heart, the descending aorta, and the arch of the aorta.

    RAO - Left Lung:

    • Visualizes the thoracic viscera, the trachea, the left bronchial tree, the left atrium, the apex of the left ventricle (anterior), and the right retrocardiac space.

    Evaluation Criteria:

    • Both lungs in their entirety should be visible.
    • The trachea should be filled with air.
    • Identification markers should be visible.
    • The heart and mediastinal structures should be visible and within the lung field of the elevated side in oblique images of 45 degrees.
    • The maximum area of the right lung should be visible in the LAO.
    • The maximum area of the left lung should be visible in the RAO.

    For pulmonary diseases - PA Oblique 10° to 20°:

    • This projection should display the medial part, the right middle lobe, and the lingula of the upper lobe.

    AP Oblique Projection

    • Upright/Supine: The patient should be RPO/LPO at 45 degrees.
    • Positioning: The side closest to the IR is being visualized.
    • LPO: Left lung.
    • RPD: Right lung.
      • This position can be performed if the patient cannot lay prone.

    Evaluation Criteria

    • Both lungs in their entirety should be visible.
    • The trachea should be filled with air.
    • Identification markers should be visible
    • The heart and mediastinal structures should be visible and within the lung field of the elevated side in oblique images of 45 degrees.
    • The maximum area of the right lung should be visible in the LAO.
    • The maximum area of the left lung should be visible in the RAO.

    Chest: Thoracic Viscera

    • AP Projection: This projection can be done upright or supine. It magnifies the thoracic viscera, including the heart and great vessels. The lung fields appear shorter, the clavicles are higher, and the ribs are horizontal.
    • Resnick Recommendation: 30° caudal projection provides an optimal image to view the basal lung fields free of imposition, differentiate the middle lobe, and view the lingular processes and lower lobe diseases.
    • Evaluation Criteria:
      • Ensure the medial portion of the clavicles are equidistant from the vertebral column.
      • The trachea should be visible in the midline.
      • The clavicles should be lying more horizontal and are obscuring more of the apices than in the PA projection.
      • The distance from the vertebral column to the lateral border of the ribs should be equal on each side.
      • A faint image of the ribs and thoracic vertebrae should be visible through the heart shadow.
      • The entire lung fields from the apices to the costophrenic angles should be visible.
      • Pleural markings should be visible from the hilar regions to the periphery of the lungs.

    Pulmonary Apices

    • AP Axial Projection: The patient should be upright and stand 1 foot in front of the image receptor. The patient should stand in a lordotic position with MSP parallel to the image receptor.
    • AP Axial Oblique Projection: The patient should be in an oblique lordotic position, RPO/LPO 30° with the affected side centered to the image receptor. The patient should exaggerate the lordosis.
    • Demonstrate: This projection demonstrates the apices and interlobar effusions.

    Evaluation Criteria:

    • AP Axial:

      • Ensure the patient is in a lordotic position.
      • The clavicles should be lying superior to the apices.
      • The sternal ends of the clavicles should be equidistant from the vertebral column.
      • The apices and lungs should be in their entirety.
      • The clavicles should be lying horizontally with their medial ends overlapping only the first or second ribs.
      • The ribs should be distorted with their anterior and posterior portions somewhat superimposed

    • AP Axial Oblique:

      • Ensure the patient is in an oblique lordotic position

    • Demonstrate: This projection demonstrates the apices and interlobar effusions.

    PA Axial Projection

    • Seated/ Upright: The patient should be positioned with the MSP parallel to the image receptor, shoulder depressed, and rotated forward. Inspiration should be held at 10-15° cephalad.
    • T3: The apices should be visible above the clavicle.
    • Inspiration: The clavicles should be raised.
    • Expiration: The clavicles should be lowered.

    AP Axial Projection

    • Upright/ Supine: The patient should have their elbow flexed and hand pronated on their hip. The angle should be 15 to 20° cephalad. The manubrium should be centered, and the apices should be visualized below the clavicles.

    For hypersthenic patients:

    • This technique will separate the apical and clavicular shadows

    Evaluation Criteria

    • AP Axial: Ensure the clavicles are lying superior to the apices.
    • The sternal ends of the clavicles should be equidistant from the vertebral column.
    • The apices should be seen in their entirety.
    • The superior lung region adjacent to the apices should be visible.
    • The clavicles should be lying horizontally with their medial ends overlapping only the first or second ribs.
    • The ribs should be distorted, with their anterior and posterior portions somewhat superimposed.

    Lungs & Pleurae

    • AP or PA Projection: The patient should be positioned in R or L lateral decubitus.
    • Lateral Decubitus: This position will visualize fluid in the pleural effusion, which will be present in the pleural cavity on the affected side. It will also visualize free air in the pneumothorax, which will be present in the pleural cavity on the unaffected side.
    • Horizontal: The patient should be placed in a horizontal position, 3 inches below the jugular notch. This is used to visualize pneumothorax and pleural effusion.
    • Air: Air will always rise due to gravity.
    • Fluid: Fluid will always settle due to gravity.
    • Position Maintenance: The patient should remain positioned for 5 minutes before exposure.

    Upright PA Projection:

    • This projection is used to visualize fluid levels in pulmonary cavities.
      • Ekimsky Recommendation: The patient should lean laterally 45° to visualize small pleural effusions.

    Lateral Projection

    • The patient should lay in either prone or supine position. A decubitus box should be used for stability, the arms should be raised above the head, the affected side should be placed on the image receptor, and the patient should be positioned in a horizontal position.
      • Dorsal: The beam should be centered 3-4 inches below the jugular notch.
      • Ventral:
    • This projection will visualize pulmonary areas that are obscured by fluid.

    Evaluation Criteria:

    • Both lungs in their entirety should be visible.
    • The trachea should be filled with air.
    • Identification markers should be visible
    • Heart and mediastinal structures should be visible and within the lung field of the elevated side in oblique images of 45 degrees.
    • The maximum area of the right lung should be visible in the LAO.
    • The maximum area of the left lung should be visible in the RAO.

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