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Chest X-ray positioning
outline
• Plain films different views
• Positioning
• Interpretation of the plain film
Different views of Xray chest
• PA
• Lateral
• AP,decubitis,supine,oblique
• Inspiratory-expiratory
• Lordotic,apical
PA view
• Most frequently requested
• Visualization of the lungs excellent
PA view positioning
• The patient faces
towards the cassette
and the tube is 6 feet
away from the patient.
Technical aspect
• Inspiration
• On full inspiration the
diaphragm should lie
at the level of 8-10th
posterior rib or 5-6t...
Technical aspect
Inspiratory film
Technical aspects
• Penetration
Over penetrated Under penetrated
rotation
Rotated x ray
Interpretation of the PA films
1.request form:
name,age,sex,date and
clinical presentation
2.trachea
3.Heart and
mediastin...
6.Pleural spaces
7.Lungs
8.Hidden areas
9.Hila
10.Below diaphragm
11.Soft tissues
12.Bones
Trachea
Examined for
• Position
• outline
• Caliber coronal diameter is
25mm for males and 21mm for
females
• Para tracheal stripe<5mm
• Azygos vein<10mm
• Carina a...
Heart
• Size
• Shape
Transverse cardiac
diameter:<14.5cm in females
and <15.5cm in males. An
increase of 1.5 cm is signifi...
mediastinum
• Right superior mediastinal
shadow formed by SVC and
innominate vessels.
• Left superior mediastinal
shadow f...
Ant and post junction lines
• Ant junction line
• Parietal and visceral pleurae
meeting
anteromedially.oblique course
• Po...
thymus
• Triangular sail-shaped
structure, well defined borders
projecting from one or both
side of the mediastinum.
Para spinal lines
Diaphragm
• Outline
• shape
• relative position
Pleural spaces
• Costophrenic angles
• Cardiophrenic angles
lungs
• Local,generalised abnormality
• Comparison of the
translucency
• Vascular markings of the lungs
Zones
Hidden areas
• The apices
• Mediastinum and hila
• Diaphragm
• bones
Hila
• Contain the following structures
• The inferior pulmonary ligament
• The pulmonary vessels
• The bronchial vessels
...
Right hilum
Left hilum
Below diaphragms
• Gas shadows
• Calcifications
Soft tissues
• Breast shadows and nipple
shadows
• Skin folds
• Muscles
• Companion shadows
Nipple markers
Skin fold
Muscles and companion shadows
bones
• Sternum
• Clavicles
• Scapulae
• ribs
• spine
Lateral film
• positioning
Interpretation of lateral film
• The clear spaces
• Retrosternal space
• Retrotracheal space
• Vertebral translucency
• Di...
Retrosternal space
Vertebral translucency
Diaphragm outline
• Right diaphragm continues
anteriorly
• Left is silhouetted posteriorly
by heart shadow
The fissures
AP view
• the patient back is towards the
cassette and tube is 40 inches
away from the patient.
• for patients unable to s...
Decubitus position
• The patient faces towards the
cassette while lying in
decubitus position and tube Is
towards the back
Decubitus position
• To asses the volume of
pleural fluid.
• Loculated pleural effusion or
mobile
Apical view
Oblique view
• positioning
Oblique view
• To visualize retro cardiac area,
the posterior costophrenic
angles, the chest wall and the
pleural plaques.
• Lordotic PA view
Paired inspiratory and expiratory
• Demonstrate air trapping and diaphragm
movements.
• Very important in diagnosis of inh...
Paired inspiratory and expiratory view
Thank you
Chest x ray  positioning
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Chest x ray positioning

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Plain films different views
Positioning

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Chest x ray positioning

  1. 1. Chest X-ray positioning
  2. 2. outline • Plain films different views • Positioning • Interpretation of the plain film
  3. 3. Different views of Xray chest • PA • Lateral • AP,decubitis,supine,oblique • Inspiratory-expiratory • Lordotic,apical
  4. 4. PA view • Most frequently requested • Visualization of the lungs excellent
  5. 5. PA view positioning • The patient faces towards the cassette and the tube is 6 feet away from the patient.
  6. 6. Technical aspect • Inspiration • On full inspiration the diaphragm should lie at the level of 8-10th posterior rib or 5-6th anterior rib.
  7. 7. Technical aspect Inspiratory film
  8. 8. Technical aspects • Penetration
  9. 9. Over penetrated Under penetrated
  10. 10. rotation
  11. 11. Rotated x ray
  12. 12. Interpretation of the PA films 1.request form: name,age,sex,date and clinical presentation 2.trachea 3.Heart and mediastinum 4.Diaphragm
  13. 13. 6.Pleural spaces 7.Lungs 8.Hidden areas 9.Hila 10.Below diaphragm 11.Soft tissues 12.Bones
  14. 14. Trachea Examined for • Position • outline
  15. 15. • Caliber coronal diameter is 25mm for males and 21mm for females • Para tracheal stripe<5mm • Azygos vein<10mm • Carina angle:60-75degree.
  16. 16. Heart • Size • Shape Transverse cardiac diameter:<14.5cm in females and <15.5cm in males. An increase of 1.5 cm is significant Cardiothoracic ratio<50%
  17. 17. mediastinum • Right superior mediastinal shadow formed by SVC and innominate vessels. • Left superior mediastinal shadow formed by the subclavian artery • Ant junction line • Post junction line • Thymus • Paraspinal lines 10 mm on the left and 3mm on the right
  18. 18. Ant and post junction lines • Ant junction line • Parietal and visceral pleurae meeting anteromedially.oblique course • Post juction line.formed by posteromedial surfaces of the pleurae of the upper lobes post to oesophagus
  19. 19. thymus • Triangular sail-shaped structure, well defined borders projecting from one or both side of the mediastinum.
  20. 20. Para spinal lines
  21. 21. Diaphragm • Outline • shape • relative position
  22. 22. Pleural spaces • Costophrenic angles • Cardiophrenic angles
  23. 23. lungs • Local,generalised abnormality • Comparison of the translucency • Vascular markings of the lungs
  24. 24. Zones
  25. 25. Hidden areas • The apices • Mediastinum and hila • Diaphragm • bones
  26. 26. Hila • Contain the following structures • The inferior pulmonary ligament • The pulmonary vessels • The bronchial vessels • the bronchi • The lymphatic system • The lymph nodes
  27. 27. Right hilum
  28. 28. Left hilum
  29. 29. Below diaphragms • Gas shadows • Calcifications
  30. 30. Soft tissues • Breast shadows and nipple shadows • Skin folds • Muscles • Companion shadows
  31. 31. Nipple markers
  32. 32. Skin fold
  33. 33. Muscles and companion shadows
  34. 34. bones • Sternum • Clavicles • Scapulae • ribs • spine
  35. 35. Lateral film • positioning
  36. 36. Interpretation of lateral film • The clear spaces • Retrosternal space • Retrotracheal space • Vertebral translucency • Diaphragm outline • The fissures • The trachea • The sternum
  37. 37. Retrosternal space
  38. 38. Vertebral translucency
  39. 39. Diaphragm outline • Right diaphragm continues anteriorly • Left is silhouetted posteriorly by heart shadow
  40. 40. The fissures
  41. 41. AP view • the patient back is towards the cassette and tube is 40 inches away from the patient. • for patients unable to stand
  42. 42. Decubitus position • The patient faces towards the cassette while lying in decubitus position and tube Is towards the back
  43. 43. Decubitus position • To asses the volume of pleural fluid. • Loculated pleural effusion or mobile
  44. 44. Apical view
  45. 45. Oblique view • positioning
  46. 46. Oblique view • To visualize retro cardiac area, the posterior costophrenic angles, the chest wall and the pleural plaques.
  47. 47. • Lordotic PA view
  48. 48. Paired inspiratory and expiratory • Demonstrate air trapping and diaphragm movements. • Very important in diagnosis of inhaled foreign body in children.
  49. 49. Paired inspiratory and expiratory view
  50. 50. Thank you

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