Radiographic Techniques for Lungs

Radiographic Techniques

• Lungs: AP, lateral, and apical views are used to show lung structures, with the subject positioned in a lordotic posture.
• Technician: Ahmed Jasem, Abass, and others performed the procedure.
• Degree: Masters of Science (MSc) in Medical Imaging.

Antero-posterior – Erect

• Alternative: Used as an alternative to PA erect projection when a patient cannot stand or sit.
• Patient Support: Patient is supported sitting upright on a trolley against a Bucky.
• Positioning: Patient stands or sits, back against the image receptor (supported vertically). The median sagittal plane is adjusted perpendicular to the receptor center. Shoulders are lowered and forward, elbows forward, and hands below hips to clear the scapulae from the lung fields.

Antero-posterior – Erect (X-ray Beam)

• Beam Direction: Collimated horizontal beam positioned at a right angle to the sternum and centered midway between sternal notch and xiphisternum.
• Inspiration: Exposure is taken during normal full inspiration.
• Radiological Considerations: Projection moves the heart away from the image receptor plane, increasing magnification and reducing heart size assessment accuracy.

Antero-posterior – Supine

• Patient Position: Patient lies supine, cassette positioned under the chest, with the upper edge above lung apices (C7 prominence).
• Positioning: Median sagittal plane is adjusted at right angles to the receptor center. The patient's pelvis is checked for rotation, and arms are beside the body, chin slightly raised on pillow.

Antero-posterior – Semi-Erect

• Alternative: Used for patients too ill to stand or sit without support.
• Cassette Size: 35 x 43 cm cassette selected.
• Patient Position: Supported in semi-recumbent position, facing the X-ray tube.
• Body Positioning: Image receptor is supported against back, upper edge above lung fields. The median sagittal plane is adjusted perpendicular to the receptor center. Patient rotation is prevented by foam pads. The arms are rotated medially with shoulders forward to clear scapulae.

Antero-posterior – Semi-Erect (X-ray Beam)

• Beam Direction: Collimated horizontal beam first directed at right angles to image receptor, then angled caudally, centered midway between the sternal notch and the xiphisternum.
• Angulation: 5-10° caudal angulation, for lung field visualization, avoiding clavicle obscuring.

Lateral

• Supplementary: Used to localize lesions, particularly mediastinal masses, not visible on PA projections.
• **Procedure:**Erect patient, turned to bring affected side in contact with image receptor. Median sagittal plane is positioned parallel to the image receptor. Position arms folded over head or elevated on a support. The mid-axillary line should be positioned in line with the receptor center.
• Level: The receptor is adjusted to include the apices and the lower lobes to the level of the 1st lumbar vertebra.

Lateral (X-ray Beam)

• Beam Direction: Collimated horizontal beam directed at a right angle to the middle of the image receptor, coincident with the midaxillary line.

Apices

• Opacity Resolution: Used to demonstrate opacities obscured by overlying ribs or clavicles.
• PA Projection: Collimated beam angled 30° caudally for the PA position, centered over the 7th cervical spinous process and sternal angle.
• AP Projection: Collimated beam angled 30° cranially towards the sternal angle for the AP position.

Lordotic

• Application: Used for demonstrating right middle-lobe collapse or interlobar pleural effusion, positioning the middle-lobe fissure horizontally.
• Positioning Steps: Patient placed in a posteroanterior projection position, bends backwards at the waist (30-40 degree dorsiflexion) with the sides of the vertical Bucky clasped.
• X-ray Direction: Horizontal ray directed perpendicular to the cassette and towards the middle of the film.

This quiz covers advanced radiographic techniques used for imaging lung structures, including specific views like AP, lateral, and apical. It is aimed at students pursuing a Master's degree in Medical Imaging, detailing procedures and patient positioning techniques. Test your knowledge on the importance of proper positioning and beam direction in radiography.