Lecture (21)

Indications for chest Radiography Clinical Problem Chest pain Acute aortic dissection Pulmonary embolus Pericardial effusion Pleural effusion Vascular disease Chest trauma Pneumonia follow up Haemoptysis Non specific chest pain Chest trauma Upper respiratory tract infection Chronic obstructive lung disease Chest masses Chest infection ( consolidation ) Pneumothorax Hydropneumothorax Hydrohaemopneumothorax Haemothorax

Chest Projections Basic views PA/ AP Upright Lateral RAO / LAO RPO/LPO PA chest Exposure factors KvmAsFFD (cm)GridFocusCassette nonbroad35x43 Patient Position  Patient erect, feet spread slightly, weight Distributed on both feet  Chin raised resting against cassette  Hands on lower hips, palms out and elbows flexed

Part position Align Medial sagittal plane to midline of cassette Ensure no rotation of thorax Rotate shoulders forward to allow scapula to move laterally away from lung fields Depress shoulders to downward to move clavicles below the lung apices Make exposure at end of second full inspiration Central Ray Perpendicular to medial sagittal plane Center Point At level of T7 (Inferior angle of scapula )

Structure shown Both lungs from apices to costophrenic angles The air filled trachea from T1 down Hilum region markings Heart &great vessels Bony Thorax

AP Chest (For Stretcher or bed patients Patient Position  Patient is supine in cart  If possible raised the headedcart or bed into a semi erect position  Role patient shoulders forward by rotating armmedially or internally Part Position  Align Medial sagittal plane to midline of cassette  Ensure no rotation of thorax  Top of film 4-5 cm above shoulders  Place caste crosswise to avoid lateral cutoff  Make exposure at end of second full inspiration Central Ray  Angled caudad to be perpendicular to long axis of the sternum Center Point At level of T7 (3-4 inches below jugular noch

AP Chest (For Stretcher or bed patients Patient Position  Patient is supine in cart  If possible raised the headedcart or bed into a semi erect position  Role patient shoulders forward by rotating armmedially or internally Part Position  Align Medial sagittal plane to midline of cassette  Ensure no rotation of thorax  Top of film 4-5 cm above shoulders  Place caste crosswise to avoid lateral cutoff  Make exposure at end of second full inspiration Central Ray  Angled caudad to be perpendicular to long axis of the sternum Center Point At level of T7 (3-4 inches below jugular noch

Structure shown Both lungs from apices to costophrenic angles The air filled trachea from T1 down Hilum region markings Heart will appear enlarged due to magnification from short FFD Bony Thorax Notes: Crosswise alignment of cassette need accurate perpendicular alignment of central ray to cassette to avoid grid cutoff If pleural effusion is suspected decubitus position is recommended to demonstrate air-fluid level