1. Radiographic Critique of the
Radiographic Critique of the PA Chest
PA Chest

2. of the image that is not correct.
Arm Placement
Full Inspiration
Rotation
Penetration
Upright & PA
Anatomy
2: Question 3 4 5
Click on the area
of the image that is not correct.
6: Question 7 8 9
10: Question 11 12 13 14
15: Question 16 17 18
19: Question
Anatomy
Click on the area of the image that is not correct. 20 21 22
23: Question 24 25
26: Info
27: Summary

3. All the anatomy is not present. The lung angles are cut off.
Arm Placement
Full Inspiration
Rotation
Penetration
Upright & PA
Anatomy
INCORRECT
All the anatomy is not present. The lung angles are cut off.
Incorrect
All the anatomy is not present. The lung angles are cut off.
Click to continue

4. All the anatomy is not present. The lung angles are cut off.
Arm Placement
Full Inspiration
Rotation
Penetration
Upright & PA
Anatomy
CORRECT!
All the anatomy is not present. The lung angles are cut off.
Correct
All the anatomy is not present. The lung angles are cut off.
Click to continue

5. All anatomy must be on the image.
Yellow: Apices
Blue: Lateral lungs
Green: Costophrenic angles
Equal distance from the vertebral column to sternal (medial) ends of the clavicles
Air-filled trachea is aligned with the vertebral column
Small amount of heart shadow is visualized
Anatomy
All anatomy must be on the image. The apices (shown by the yellow lines), the lateral lungs (shown by the blue lines), and costophrenic angles (shown by the green lines) must all be included.
In a true PA, the distance from the vertebral column to sternal (medial) ends of the clavicles are equal. The air-filled trachea is aligned with the vertebral column, and a small amount of heart shadow is visualized on the right side of the patient’s thoracic vertebrae.

6. that indicates this image was taken upright.
Arm Placement
Full Inspiration
Rotation
Penetration
Upright & PA
Anatomy
Click on the area
that indicates this image was taken upright.
Upright & PA
Click on the area that indicates this image was taken upright.

7. The air fluid level is seen here by this flat line.
Arm Placement
Full Inspiration
Rotation
Penetration
Upright & PA
Anatomy
Incorrect
The air fluid level is seen here by this flat line.
INCORRECT
The air fluid level is seen here by this flat line.

8. The air fluid level is seen here by this flat line.
Arm Placement
Full Inspiration
Rotation
Penetration
Upright & PA
Anatomy
Correct
The air fluid level is seen here by this flat line.
CORRECT!
The air fluid level is seen here by this flat line.

9. Upright & PA
To demonstrate precise fluid levels, patient should be upright
A chest x-ray should be done
PA and upright because:
Supine
Upright PA
PA ensures less
magnification of the heart because the heart is closer to the image receptor
Upright
Having the patient upright will demonstrate any fluid that may be in the chest
Upright & PA
Whenever possible, a chest x-ray should be done PA and upright. PA ensures less magnification of the heart because the heart is closer to the image receptor. To demonstrate precise fluid levels, a chest x-ray should be taken with the patient upright and x-ray beam horizontal.
Having the patient upright will demonstrate any fluid that may be in the chest. This image demonstrates fluid levels on a coconut. One image is taken supine and the other upright. You can clearly identify the fluid level in the upright image because of the presence of the fluid line as shown by the red arrow. The supine image is kind of foggy which could be an indication of fluid, but it is not demonstrated as clearly as the upright.

10. Click on the error in this image.
Arm Placement
Full Inspiration
Rotation
Penetration
Upright & PA
Anatomy
Click on the
error in this image.
Penetration
Click on the error in this image.

11. Arm Placement
Full Inspiration
Rotation
Penetration
Upright & PA
Anatomy
INCORRECT
This image is lacking the penetration to see the ribs behind the heart.
Incorrect
This image is lacking the penetration to see the ribs behind the heart.

12. Arm Placement
Full Inspiration
Rotation
Penetration
Upright & PA
Anatomy
CORRECT!
This image is lacking the penetration to see the ribs behind the heart.
Correct
This image is lacking the penetration to see the ribs behind the heart.

13. Beam penetration should be sufficientKV
Penetration
On a chest x-ray, the beam penetration should be sufficient to demonstrate thoracic vertebrae and posterior ribs through the heart and mediastinal [mee-dee-uh-STY-nuhl] structures. A KV of is optimal for achieving this. In these images, you can tell that the one on the left shows optimal penetration because the ribs and spine are faintly visible behind the heart as shown by the red arrow.

14. Penetration Chest rays should: Demonstrate: Lung markings Diaphragm
Heart borders
Bony cortical outlines
Show no motion
Be taken at 72” SID
Penetration (continued)
You also want to be able to view the lung markings, diaphragm, heart borders and bony cortical outlines. There should be no motion. All chest xrays should be taken at 72” SID to DECREASE magnification of the heart and lung details. This is sometimes not possible, such as on portable exams when you can not obtain a distance of 72”.

15. Click on the error in this image.
Arm Placement
Full Inspiration
Rotation
Penetration
Upright & PA
Anatomy
Click on the
error in this image.
Rotation
Click on the error in this image.

16. Arm Placement
Full Inspiration
Rotation
Penetration
Upright & PA
Anatomy
INCORRECT
The patient is rotated. Notice the SC joints are not equal distance to the spine.
Incorrect
The patient is rotated. Notice the SC joints are not equal distance to the spine.

17. Arm Placement
Full Inspiration
Rotation
Penetration
Upright & PA
Anatomy
CORRECT!
The patient is rotated. Notice the SC joints are not equal distance to the spine.
Correct
The patient is rotated. Notice the SC joints are not equal distance to the spine.

18. Rotation The SC joint that
demonstrates the lesser amount of vertebral column uperimposition represents the side of the chest that is positioned farther from the film
Equal distance from the vertebral column to sternal (medial) ends of the clavicles
Air-filled trachea is aligned with the vertebral column
Small amount of heart shadow is visualized
Evaluating Rotation
On a true PA, the distance from the vertebral column to the sternal (medial) ends of the clavicles is equal, the air filled trachea (shown in red) is aligned with the vertebral column, and a small amount of heart shadow is visualized on the right side of the patient’s thoracic vertebrae as shown by the green blob.
This is a zoomed in image of the SC joints to show the distance between the spine and clavicles . This demonstrates a slight rotation because the distances are not equal. The SC joint that demonstrates the lesser amount of vertebral column superimposition represents the side of the chest that is positioned farther from the film. The OPPOSITE is true for an AP projection. The side of the chest closer to the film shows the SC joint superimposing the LEAST amount of the vertebral column

19. anatomy that should be moved out of the area of interest.
Arm Placement
Full Inspiration
Rotation
Penetration
Upright & PA
Anatomy
Arm Placement
What patient anatomy should be moved out of the area of interest?
Click on the patient
anatomy that should be moved out of the area of interest.

20. Arm Placement
Full Inspiration
Rotation
Penetration
Upright & PA
Anatomy
INCORRECT
The humeri should be abducted away from the chest and scapulae located outside the lung field.
To do this, have the patient roll their shoulder forward to pull the scapulae away from the lung field.
Incorrect
The humeri should be abducted away from the chest and scapulae located outside the lung field. To do this, have the patient roll their shoulder forward to pull the scapulae away from the lung field.

21. Arm Placement
Full Inspiration
Rotation
Penetration
Upright & PA
Anatomy
CORRECT
The humeri should be abducted away from the chest and scapulae located outside the lung field.
To do this, have the patient roll their shoulder forward to pull the scapulae away from the lung field.
Correct
The humeri should be abducted away from the chest and scapulae located outside the lung field. To do this, have the patient roll their shoulder forward to pull the scapulae away from the lung field.

22. Here is an example of an image where the scapula is in the lung field.
Arm Placement
Here is an example of an image where the scapula is in the lung field.
Arm Placement
Here is an example of an image where the scapula is in the lung field as shown by the yellow line.

23. Click on the error in this image.
Arm Placement
Full Inspiration
Rotation
Penetration
Upright & PA
Anatomy
Click on the
error in this image.
Full Inspiration
Click on the error in this image.

24. This patient did not take a full inspiration.
Arm Placement
Full Inspiration
Rotation
Penetration
Upright & PA
Anatomy
Incorrect
This patient did not take a full inspiration.
INCORRECT
This patient did not take a full inspiration.

25. This patient did not take a full inspiration.
Arm Placement
Full Inspiration
Rotation
Penetration
Upright & PA
Anatomy
Correct
This patient did not take a full inspiration.
CORRECT
This patient did not take a full inspiration.

26. Full Inspiration Do the exposure after a second full inspiration.
On the image shown here, the patient needed to take a deeper breath.
Full inspiration
Ten to 11 posterior ribs are seen above the diaphragm for full lung aeration. It is best to do the exposure after a second full inspiration to make sure you have complete inspiration. If the exposure is done on expiration, as few as 9 posterior ribs may be seen. On the image shown here, the patient needed to take a deeper breath.

27. the highest quality radiographs to physicians
KNOW
how to provide
the highest quality radiographs to physicians
Summary
Chest radiographs are one of the most popular screening tools used in a medical facility. Being able to evaluate and provide the highest quality radiographs to physicians is an essential skill for every radiographer.

28. RESOURCES
Xray2000.co.uk
eorthopod.com