HERE IT REVIWES ABOUT THE X RAY OF CHEST IN DIFFERENT VIEWS OTHER THAN THE SPECIAL VIEWS OF CHEST.IT SHOWS THE ANATOMY OF CHEST IMPORTANCE OF PA CHEST X RAY OVER AP.DIFFERNEC BETTWEEN X RAY PA AND AP VIEW

1. GENERAL VIEWS
OF THORAX WITH
GENERAL ANATOMY
PRESENTOR: VANI PUSHPA M
210513027

2. INCLUDES:
• ANATOMY OF CHEST
• INDICATIONS
• CONTRAINDICATIONS
• PATIENT PREPATATION
• GENERAL VIEWS OF THORAX

3. ANATOMY
• SOFT TISSUE:
• Soft tissues cast shadow on plain
radiographs which have less dense radio-
opacity.
• Breast shadow result in increased opacity
over the lower thorax bilaterally.
• Nipple shadow may appear as round
opacities in the 4th or lower ant.
Intercostal space.
• Breast and nipple shadow are usually
bilateral and symmetrical.
• Linear shadow may result from loose skin
fold

4. MEDIASTINUM
• This is the space between the right and
left pleurae in and near the median
sagittal plane of the chest. It is bounded
by anterior surface of the sternum and
the posterior surface of the thoracic
vertebrae.
• The hila are made up of the main
pulmonary arteries and major Bronchi -
The left hilum is higher than the right
• HEART : Size, Shape, Diameter
• Remember: AP views make heart appear
larger than it actually is

5. OTHER FINDINGS
• The trachea appears as an air-shadow
coursing down (c6) the midline of the chest
and terminating at the carina (T5)
• Thymus is usually visible in infants and
occupies the superior part of ant.
Mediastinum (causes widening of the
mediastinum when present)
• When there is enough air in the oesophagus a
tracheo - oesophageal stripe may be seen,
however oesophagus may be outlined by
barium meal to clearly define it’s relation to
other mediastinal structures & detection of
abnormality .

6. Bony thorax
• Chest x-ray outline the shoulder girdle ribs,
cervical ,thoracic vertebrae and Sternum.
• Angulations of the ribs varies with body
types.
• The ribs and the interspaces are
designated into 2 groups : anterior and
posterior.
• Diaphragm in a normal adult is slightly
higher on right compared to the Left.

8. GENERAL VIEWS OF THORAX
• PA VIEW OF CHEST
• AP VIEW OF CHEST(ERECT)
• AP VIEW OF CHEST(SUPINE)
• LATERAL VIEW OF CHEST

9. Indications
 Chest pain
 Fever
 Chronic cough
 Trauma
 Respiratory disease
 Cardiac disease
 hemoptysis
 Occupational disorders
 suspected pulmonary embolism
 investigation of tuberculosis
 pneumonia
 Pneumothorax
 Suspected metastasis
 follow up of known disease to assess
progress
 thoracic disease processes
 monitoring of patients in intensive care
units
 post-operative imaging
 pre-employment medical fitness
 immigration screening
 check position of nasogastric tubes,
endotracheal tubes, pacemakers etc.
 exclude radiopaque foreign bodies
(accidental aspiration, pre surgery)

10. Contraindication
• Patients who are pregnant or suspected of being pregnant unless they get
potential benefits.
Patient preparation:
• Patients will be asked to remove any clothing, jewelry.
• Appropriate clothing is given: Patients will be provided by an X-ray gown to
wear.
• Assess the patient’s ability to hold his or her breath.
• Collect history from patient.
• Instruct patient to cooperate during the procedure.

11. Difference between P.A & A.P VIEW
In PA view
• Heart wont be magnified over the mediastinum therefore preventing
the appearance of cardiomegaly
• Scapula are away from the lung fields
• Ribs are obliquely oriented in PA view
• Spine and posterior ends of ribs are clearly seen
• To prevent the clavicles from obscuring the apices on an AP
projection of the chest.

12. Why is PA preferred over AP
• Reduces magnification of heart therefore preventing appearance of
cardiomegaly
• Reduces radiation dose to radiation sensitive organs such as thyroid, eyes ,
breasts
• Visualized maximum areas of lung fields.
• Moves scapula away from the lung fields
• More stable positioning for the patient as they can hold onto the unit – this
reduces patient movement.
• Compression of breast tissue against the film cassette reduces the density
of tissue around the CP bases therefore visualizing them more clearly

13. Significance of different views
Anteroposterior view
• It is useful in differentiating free and loculated pleural fluid
Lateral view
• The only view that provides information of localization of different
lobes and segments
• Observation on lateral view include- clear spaces, vertebral
translucency , and outline of diaphragms.

14. Posterioanterior view of chest (pa view)
Positioning:
• Patient stands erect in front of chest stand facing it.
• Neck is extended, slightly and chin is placed on the
chin rest, or on upper border of cassette holder.
• Back of his hands are placed oh his hips.
• Shoulders are pressed forwards against cassette. It
ensured that trunk is not rotated .
• Patent is asked to remain motionless. side is marked
and xray beam is collimated.
• It is performed standing and in full inspiration.
• Centering : done at a midway between inferior
angles of scapulae.
Positioning for postero-anterior chest

15. Expiration
NOTE - CHANGE IN HEART SIZE AND
VASCULARITY DUE TO EXPIRATION
Inspiration

16. Anteroposterior view(Erect)
Positioning:
• Patient is upright as possible with their
back against the image receptor
• The chin is raised as to be out of the image
field
• If possible, the hands are placed by the
patient's side
• shoulders are depressed to move the
clavicles below the lung apices
• Centering: The level of the 7th thoracic
vertebra, approximately 7 cm below the
jugular notch of the sternum

17. Anteroposterior view(SUPINE)
• patient is supine
• an image receptor is placed under the patient's
chest via a tray, sliding sheet, cassette holder
• The chin is raised (if possible) as to be out of the
image field
• If possible, the hands are placed by the patient's
side
• Any leads or lines that can be moved should be
transferred out of the image area to improve
image quality.
• Centering: The level of the 7th thoracic vertebra,
approximately 7 cm below the jugular notch of
the sternum

18. Technique:
• kVp:60-65,
• mAs:16-20,
• SID:180cm,
• Grid: With or without
• Cassette size: 12x10, 17x14
• Caution: BREATH HOLD

19. Lateral view of chest
• Patient stands erect in true lateral postion , infront of
the chest.
• The median sagittal plane is adjusted parallel to the
image receptor.
• The arms are folded over the head or raised above the
head.
• The mid-axillary line is coincident with the middle of
the image receptor, which is then is adjusted to
include the apices and the lower lobes to the level of
the first lumbar vertebra.
• Centering: Done over mid-axillary line to the center of
cassette.
• Techniques : kVp :70-75, mAs :30-40, SID:150cm,
GRID: no grid

20. References:
• CLARK’s position of RADiographers
• Handbook of medical radiography C Ramamohan

21. Thank you for your attention