X-Ray Procedures PDF

# UPPER RESPIRATORY AIR WAY ## X-RAY OF THE PHARYNX (fig.1) ### Common Indication of the examination: - Adenoid (in the nasopharynx). ### Basic View: - Lateral view (true lateral or dead lateral) **Fig. 1:** Lateral View Nasopharynx and Larynx. ### Patient Position: - Patient stands in the l...

# UPPER RESPIRATORY AIR WAY ## X-RAY OF THE PHARYNX (fig.1) ### Common Indication of the examination: - Adenoid (in the nasopharynx). ### Basic View: - Lateral view (true lateral or dead lateral) **Fig. 1:** Lateral View Nasopharynx and Larynx. ### Patient Position: - Patient stands in the lateral view with the shoulder in contact with the standing bucky (containing the cassette inside). - Patient can sit down if he could not stand. - Both hands at both sides of the body. - Neck extended. - Sagittal plane parallel to the cassette tray (or standing bucky). - Ear rings (in females) should be removed. ## CENTRAL RAY: - Perpendicular to the angle of the mandible (horizontal beam). ## EXPOSURE FACTORS: - KV: 65 kv. - MAS: 15 - FFD: 150 CM (to compensate for the distance between the pharynx and the film). - Bucky: used. - Film size: 8 x 10 inch or 24x30 cm. - A soft film is done to show the soft tissue ## COLLIMATION: - Use the diaphragm to collimate the beam From the skull base to the lower neck, and from the nose to behind the cervical spine. ## GOOD RADIOGRAPH ASSESSMENT CRITERIA: - The radiograph should be in the true lateral view. - The following structures should be overlapped: Both mandibles both Ears and the skull base bone ## OTHER ADDITIONAL VIEWS OF THE PHARYNX: - Lateral view with barium swallow. - A.P view. ## X-RAY OF THE LARYNX (fig.1) ### Basic View: - Lateral view ### Position: - Patient stands in the lateral view with the shoulder in contact with the stand bucky (containing the cassette inside). - Patient can sit down if he could not stand. - Both hands at both sides of the body. - Neck extended. - Sagittal plane parallel to the cassette tray (or stand bucky). ## CENTRAL RAY: - The central ray is perpendicular to the laryngeal cartilage (horizontal beam). ## EXPOSURE FACTORS - KV: 80 kv. - MAS: 30 - FFD: 150 CM (to compensate for the distance between the larynx and the film). - Bucky: used. - Film size: 8 x 10 inch or 24x30 cm. ## COLLIMATION: - Use the diaphragm to collimate the beam From the nose to the thoracic inlet and from the skin anterior to the larynx to behind the cervical spine. ## OTHER ADDITIONAL VIEWS: - Lateral view with barium swallow. - A.P view. # X-RAY CHEST ## Indication: - Lung diseases: e.g inflammation, abscess, effusion, tumors - Pre operative and medical check up - Heart disease. ## Basic Views: - Chest Postro anterior view (PA view). - Chest lateral view. ## Additional Views: 1. A.P view (antero posterior view). 2. Lordotic view; 3. Apical view. 4. Oblique Views: - Anterior oblique (right or left .i.e right anterior oblique, left anterior oblique). - Posterior oblique (right or left i.e right posterior oblique, left posterior oblique). 5. Lateral Decubitus view. 6. Chest x-ray in Infant, and paediatric age 7. Chest x - ray for Old patients. 8. Chest x - ray for intensive care patients. ## General Outlines and Precautions - Remove metallic or plastic objects. Remove clothes only pure cotton underwear is allowed. - The female hair should be moved away from the x ray beam pathway. - Put short apron (lead sheet) from the patient waist down to the upper thigh) to protect the gonads. ## Respiration: - All views are done with arrested respiration (i.e stop breathing after deep inspiration, to ensure full expansion of the chest). - In severely ill or uncooperative patient, X-ray exposure could be done after arrested respiration, decrease exposure time (yet maintaining the MAS:miliampere seconds). - Avoid doing chest x ray after expiration (in expiration the lungs are not expanded). - Collimate the x ray beam to the chest; for better contrast of the examined area and to avoid unnecessary exposure of other adjacent parts. - FFD: 150-180 cm to avoid cardiac magnification. - Select KV to avoid deep penetration, in proper chest X-ray the intervertebral discs should be visible while dorsal vertebra should be fairly visualized. # CHEST X-RAY (POSTERO ANTERIOR VIEW) (P.A.) (Fig. 2) ## Patient Position: - Patient stands against the stand bucky in the postero anterior view (with the front in contact with the stand bucky and the back to the x-ray tube side). - Both arms and hands over the lower back, and buttocks. - Both shoulders pushed anteriorly to touch the stand bucky (for the scapula to be away from the lung fields). - The chin above the stand bucky. - The cassette should be 2 cm above the shoulder. **Fig. 2:** Chest X-Ray (PA View). ## Central Ray: - Over the fifth dorsal vertebrae. - OR first put the central ray in the center of the stand bucky before positioning the patient, and the patient stands with mid sagittal plane corresponds to the midplane of the stand bucky. ## EXPOSURE FACTORS: - KV: 65-70 - FFD: 150-180 CM - MAS: 20-25 - BUCKY: USED - FILM SIZE: according to the patient size. - For adult patient; 14 x 17 inch, or 14 x 14 inch. - For young patient or infant: Smaller sizes 24x 30 cm & 8x 10 inch can be used. ## Collimation: - Use the diaphragm to collimate the X-ray beam, to include from the lower neck to the upper abdomen and both sides of the chest wall. ## Respiration - During X-ray exposure; arrested breath after deep inspiration (to allow better expansion of the chest). ## Good radiograph assessment criteria: - A good chest X-ray radiograph should have the following criteria: 1. The chest x-ray film should include from above the lung apex to the below the diaphragm. 2. The dorsal vertebrae are poorly visualized, and the disc spaces visible. 3. Both lateral costophrenic angles are well visualized. 4. Scapula away from both lung fields 5. Posterior ribs are seen down to 10-11 ribs 6. The chest x ray film should be well centralized fulfilling the following: - A. Trachea is centralized. - B. Both medial ends of the clavicles should be equidistance from the spinous process or midline. # CHEST X-RAY (LATERAL VIEW) (figure 3, 4) ## Patient Position: - Patient stands against the stand bucky in the lateral view (the lateral chest wall in contact with the stand bucky). - Both arms and hands over the head. - The cassette shoulder be 2 cm above the shoulder. ### Left Lateral View: - The left side of the chest in contact with cassette; this is done if there is left lung disease or heart disease or both lungs diseases. ### Right Lateral view: - The right side of the chest in contact with cassette, this is done in right lung disease. **Fig. 3:** Right Lateral View Of The Chest **Fig. 4:** Lateral View Chest. ## Central Ray: - In the mid axilla. - OR first put the central ray over the center of the stand bucky before patient positioning and the patient stands with the mid axillary plane corresponds to the midline of the bucky stand. ## Exposure Factors: - KV: 75-80 - FFD: 150 CM - MAS: 30-35 - BUCKY: USED. - FILM SIZE: according to the patient size. - For adult patient; 14 x 17 inch, or 14 x 14 inch. - For young patient or infant: Smaller sizes 24x 30 cm & 8x 10 inch can be used. ## Collimation: - Use the diaphragm to collimate the beam to the chest, to include from above the apex, to the upper abdomen. ## Respiration: - X-ray exposure; stop breathing after deep inspiration. ## Good radiograph assessment criteria: - A good x ray radiograph should have the following criteria: - The chest x-ray film should include from above the lung apex to the below the diaphragm and from the sternum to the dorsal spine, also, it sould be in the true lateral position. # CHEST X-RAY (ANTERO POSTERIOR VIEW) (A.P VIEW) ## Patient Position: - Patient stands against the stand bucky in the antero postero view (with the front of the chest facing the X – ray tube and the back in contact with the stand bucky - Both arms and hands in the waist. - Both shoulders are pushed anteriorly, (to put the scapula away from both lung fields) - The cassette should be 2 cm above the shoulder. ## Central Ray: - Over angle of the sternum (corresponds to D4-5 disc space). - OR first put the central ray over the center of the stand bucky before patient positioning and the patient stands with mid sagittal plane over the midplane of the stand bucky. ## Exposure Factors: - KV: 65-70 - MAS; 20-30 - BUCKY: USED - FFD: 150 CM - FILM SIZE; according to the patient size. - For adult patient; 14 x 17 inch, or 14 x 14 inch. - For young patient or infant : Smaller sizes 24x 30 cm & 8x 10 inch can be used. ## Collimation: - Use the diaphragm to collimate the X-ray beam to the chest, to include from above the lung apex, to the upper abdomen (including the diaphragm, the lung apex and lower neck and both the sternum and the dorsal spine. ## Respiration: - X-ray exposure; stop breathing after deep inspiration. ## Good radiograph assessment criteria: - A good X-ray film should include from above the lung apex to below the diaphragm, As well as the sternum and the dorsal spine. # APICAL VIEW ## Purpose: - To show apical lesions obscured by the clavicle and upper ribs ## Patient position: - We do one of the following two positions 1. Patient in the chest AP position; with X-ray beam angled cephalic (30 degree), and the central ray, below the clavicle at each side, or in the midline in the mid sternum to see both sides at the same time. 2. Patient in the chest PA position; with X-ray beam angled caudal (30 degree) and the central ray at the lung apex. # LORDOTIC VIEW (Figure 5) ## Purpose - To show lesion in the right middle lobe, or pleural effusion encysted between the lobes. (in the transverse fissure of the right lung). ## Patient position: - We do one of the following positions: 1. Patient in the AP standing, and the patent stands about 25-30 cm, in front of the bucky stand, then the patient leans his back so that the back of the shoulders touching the bucky. The central ray is horizontal in the mid sternum. 2. Patient in the AP standing, the back in contact with bucky The central ray is horizontal in the mid sternum with cephalic angle 25-30 degree. 3. If the patient could not stand in the above two views, it could be done with the patient sitting on a chair (without back). **Fig. 5:** Lordotic View (Patient Stands In AP View) With Angled (A) or Straight X - Ray Beam (B). # OBLIQUE VIEWS ## AP OBLIQUE (RT. OR LT.) - i.e. right anterior oblique and left anterior oblique). ## PA OBLIQUE (RT. OR LEFT) - i.e, right posterior oblique and left posterior oblique. ## RIGHT ANTERIOR OBLIQUE - (i.e. right postero anterior oblique) (fig.6 A & 6B) : - From the right lateral view the patient is rotated toward the cassette ,so that the anterior aspect of the right shoulder in contact with cassette and the left shoulder away from the cassette, making an angle with cassette about 60 degrees. The X-ray pass from posterior to anterior in the oblique position. ## LEFT ANTERIOR OBLIQUE - (i.e. left postero anterior oblique Fig. 7) - From the left lateral view the patient is rotated so that the front of the left shoulder touching the cassette and the right shoulder away from the cassette making an angle with cassette 60 degrees. **Fig.6 A: RT. ANT. OBLIQUE** **Fig. 6 B: RT. ANT. OBLIQUE** **Fig. 7 :LT. Postero-Anterior Oblique. (Lt. Anterior Oblique).** ## RIGHT POSTERIOR OBLIQUE - (i.e RT. Antero posterior oblique ):- - From the right lateral view the patient is rotated toward the cassette ,so that the posterior aspect of the right shoulder in contact with cassette and he left shoulder away from the cassette, making an angle with cassette 60 degrees. ## LEFT POSTERIOR OBLIQUE - (i.e LT Antero posterior oblique ) :- - From the left lateral view the patient is rotated so that the back of the left shoulder touching the cassette and the right shoulder away from the cassette making an angle with cassette 60 degrees. ## Exposure factors: - KV: 70 - MAS 30 - FFD150 CM - BUCKY: used ## Central ray:- - (for any oblique view):- - In the mid clavicular line of the side away from the film # LATERAL DECUBITUS (figure 8) ## Purpose: - To detect mild effusion, to see obscured diaphragm ## Patient Position: - Patient lie on one side (if the left side is down this is called left lateral decubitus, if the right is down this is called right lateral decubitus) - This could be Postero anterior (PA), OR Antero posterior (AP). - In suspected pleural effusion the affected side is down. - Central ray and exposure factors as in the chest x ray PA view, - The dependent side preferred to be raised above the table by few centimeters (using e.g soft pillow). **Fig. 8 A: Right Lateral Decubitus in AP View.** **Figure; 8B; Right Lateral Decubitus (PA)** **Figure 8 C: Left Lateral Decubitus PA** # CHEST X - RAY FOR INTENSIVE CARE AND OLD PATIENTS - Patient could not stand or sit down. - Chest x- ray can be done in the recumbent position (supine), AP view. - It can be done in the semisitting position, if tolerated by the patient. - Lateral view can be done with the cassette at the side of the patient (right or left). - FFD 120 CM. - As the patient could not hold breath short exposure time is used. ( with the same MAS (milliampere seconds) - The X-ray should be done accurate from the first time to avoid repeat. # CHEST X-RAY FOR INFANTS AND NEWBORN - According to the age of the infant it can be done in the standing PA view, or we can use special support for the infant to be done in the standing PA, OR AP. - AP supine view (with both hands above the head) can be done for young infant or new born. - It should be done accurate from the first time to avoid repeat. - Short exposure time as possible. Maintaining the same MAS.