CHEST
RADIOGRAPH
Y
ROUTINE & SPECIAL
VIEWS OF CHEST

CHEST RADIOGRAPHY
 There are many type of views of chest radiography
which are divided in Routine and Special
radiographs –
 Routine – PA Erect , Lateral
 SPECIAL – Supine AP, Oblique (Ant. & Post.),
Apicogram (AP), AP Lordotic, Lateral Decubitus

CHEST PA
(ERECT)
VIEW

CHEST PA (ROUTINE)
 Position Of the Patient
• Pt. is asked to stand facing an
upright cassette holder.
• Midline of the body should be
in the midline of the cassette.
• Ask the pt. to rotate shoulder
forward, flex the elbows and
put the wrist on hips.
• Upper border of cassette
should be 2-3cm above the
shoulder joint.

CHEST PA (ROUTINE)
 Central Ray
• The central ray is directed
horizontally to the level of
T5 vertebra.
• Stop breathing after deep
inhalation for exposure.

CHEST PA (ROUTINE)
 Figure
• Postero anterior (PA) chest
projection position, pt. against
chest board

CHEST PA (ROUTINE)
Exposure chart
(Film size- 12”*15” or
14”*17”)
• Source to Image
Receptor Distance
(SID) – 180cm or 6ft.
• Grid – No
• mA station – 200
• kV = 55 – 60
• mAs = 16 – 20
• Exposure Timer =
mAs/mA = 20/200 =
0.1sec.

CHEST PA (ROUTINE)

CHEST PA (ROUTINE)

CHEST PA (ROUTINE)
 It is used to evaluate the lungs, heart and chest wall.
 The PA view is frequently used to aid in diagnosing a
range of acute and chronic conditions involving all
organs of the thoracic cavity.
 It may be used for the diagnose of fever, cough, TB,
asthma, chest pain, pleural effusion, Pneumo-thorax
etc.

Pneumothorax

Pneumothorax

Pleural effusion

Pleural effusion

DIFFERENCES BETWEEN ERECT PA & AP

DIFFERENCES BETWEEN ERECT PA & AP

Cardio – Thoracic Ratio (CTR)
 The method of determining the CTR –
 The cardiothoracic ratio is measured on only a PA chest x-ray.
 The CTR is determined on the basis of the ratio of the transverse heart
dimension [A] to the transverse dimension of the chest (internal ribs) [B]
measured on the radiograph in the chest PA projection: CTR = A/B.
 A normal measurement is 0.42-0.50.
 A CTR > 0.5 (or > 50%) is considered abnormal. In radiology reports, terms
like “cardiomegaly” or “increased heart size” are commonly used to describe
an increased CTR.
 A small cardiothoracic ratio (CTR) is defined as <42%/0.42 when assessed on a
PA chest radiograph, and is often called small heart syndrome. A
pathologically-small heart is also known as microcardia. It can be due
to/associated with a number of entities: adrenal insufficiency, e.g. Addison
disease.

Cardio – Thoracic Ratio (CTR)

CHEST
LATERAL
VIEW

CHEST LATERAL (ROUTINE)
 Position Of the Patient
• Pt. is asked to stand in lateral erect
position in front of upright cassette.
• Both the arms are elevated upward
and forearms are resting on the
head.
• Mid axillary line of the body should
be in the center of the cassette.
• Cassette should be placed 2-3cm
above the shoulder joint.

CHEST LATERAL (ROUTINE)
 Central Ray
• The central ray is directed horizontally to the level of T5 vertebra.
• Stop breathing after deep inhalation for exposure

CHEST LATERAL (ROUTINE)
Exposure chart
(Film size- 12”*15” or
14”*17”)
• Source to Image Receptor
Distance (SID) – 180cm or
6ft.
• Grid – yes
• mA station – 200
• kV = 65 – 70
• mAs = 30 – 40
• Exposure Timer = mAs/mA =
45/200 = 0.225sec.

CHEST LATERAL (ROUTINE)

CHEST LATERAL (ROUTINE)

CHEST LATERAL (ROUTINE)
 The lateral chest view can be particularly useful in
assessing the retrosternal and retrocardiac
airspaces.
 The lateral chest view examines the lungs, bony
thoracic cavity, mediastinum, and great vessels.
 To see the position of pacemaker, side chest pain etc.

Outline Representation

Outline Representation

Special views of Chest
Supine AP
Apicogram (AP)
Lordotic (AP)
Decubitus (LAT)
Oblique

CHEST
SUPINE
AP

CHEST SUPINE AP (SPECIAL)
 If the pt. have difficulty to sit or not able to stand
properly or pt. is in very serious condition and on
ventilator that time we can do the chest supine AP
view.
 Generally AP view is taken to see the fractures of
ribs and effective for the patient of ICUs.

CHEST SUPINE AP (SPECIAL)
Position of the Patient
• Ask the pt. lie down in the
supine position.
• Palm of the both hand should
be pronate and elbow should
be away from the body.
• Midline of the body is in the
midline of the cassette.
• Place the cassette on the
Bucky and 2cm above the
shoulder region.

CHEST SUPINE AP (SPECIAL)
 Central Ray
• The central ray is directed vertically to the level of T5 vertebra.
• Stop breathing after deep inhalation for exposure.

CHEST SUPINE AP (SPECIAL)
 Exposure chart
(Film size- 12”*15” or 14”*17”)
• Source to Image Receptor
Distance (SID) – 100cm
• Grid – yes
• mA station – 200
• kV = 55 – 60
• mAs = 12 – 16
• Exposure Timer = mAs/mA =
12/200 = 0.06sec.

Ribs Fracture

Ribs Fracture

CHEST
APICOGRAM
AP

CHEST APICOGRAM AP
To see the apices of chest.
To see the region under clavicle bone.
To remove superimposition of clavicle over
apex.
For the diagnosis of the Tuberculosis (TB).

CHEST APICOGRAM AP
Position of the patient
Patient stands in AP position before upright
cassette.
Place the cassette 3 – 4 cm above the shoulder.
Patient is asked to lean as much as he can
forward after resting the shoulder on the
cassette (about 1 to 1.5 feet ahead)

CHEST APICOGRAM AP

CHEST APICOGRAM AP
Central Ray
• The central ray is directed horizontally with tube angle
30 degree toward head at the level of mid sternum or
xiphi sternum.
• Stop breathing after deep inhalation for exposure.

CHEST APICOGRAM AP
Exposure Chart
(Film size- 12”*15” or 14”*17”)
• Source to Image Receptor Distance (SID) – 150cm
• Grid – No
• mA station – 200
• kV = 50 – 60
• mAs = 16 – 20
• Exposure Timer = mAs/mA = 20/200 = 0.1sec.

**CHEST APICOGRAM PA

CHEST APICOGRAM AP

CHEST APICOGRAM AP

TUBERCULOSIS XRAY FILM

CHEST
LORDOTIC AP

CHEST LORDOTIC AP
 The view especially useful to demonstrate
spontaneous pneumothorax, emphysema and
collapse due to an inhaled foreign body.
 The view also demonstrates right middle lobe
collapse or interlobar effusion on right side.

FOREIGN BODY
 A foreign body is something that is stuck inside you
but isn't supposed to be there. You may inhale or
swallow a foreign body, or you may get one from an
injury to almost any part of your body.
 Foreign bodies are more common in small children,
who sometimes stick things in their mouths, ears, and
noses.

FOREIGN BODY

EMPHYSEMA
 Emphysema is a lung condition that causes shortness of
breath. In people with emphysema, the air sacs in the
lungs (alveoli) are damaged.

EMPHYSEMA

CHEST LORDOTIC AP
 Position of the patient
 Patient stands in AP position before upright cassette.
 Place the cassette 3 – 4 cm above the shoulder.
 Patient is asked to lean as much as he can forward
after resting the shoulder on the cassette (about 1 to
1.5 feet ahead)

CHEST LORDOTIC AP
 Central Ray
• The central ray is directed horizontally at the level
of mid sternum or xiphi sternum.
• Stop breathing after deep inhalation for exposure.

CHEST LORDOTIC AP
 Exposure Chart
 (Film size- 12”*15” or 14”*17”)
• Source to Image Receptor Distance (SID) – 180cm
• Grid – No
• mA station – 200
• kV = 55 – 60
• mAs = 16 – 20
• Exposure Timer = mAs/mA = 20/200 = 0.1sec.

CHEST LORDOTIC AP

**CHEST LORDOTIC PA

CHEST LORDOTIC AP

LATERAL
DECUBITUS
VIEW

LATERAL DECUBITUS
 The projection is called a right lateral decubitus if the
patient is lying on the right side and a left lateral
decubitus if the patient is lying on the left side.
 A lateral decubitus projection can be obtained in
anteroposterior (AP) or posteroanterior (PA) view; however,
the AP view is more commonly used.
 To demonstrate the Pleural effusion.
 To diagnose the Lung cancer
 To demonstrate Fluid or air collection around the lungs.

LATERAL DECUBITUS
 Position of the patient
 The patient is lying either left lateral or right lateral on
trolley (x-ray table).
 Note – when investing pleural effusion the side of interest
should be down.
 The detector is placed landscape, posterior to the patient
running parallel with the long axis of thorax (in the same
position as AP chest).
 Patient hand should be raised to avoid superimposing on
the region of interest; legs may be flexed for balance.
 Let the patient lie in the same position for few minutes (5
min) to allow the fluid trickle down in dependent part of
chest.

LATERAL DECUBITUS
 Central ray
 The central ray is directed horizontally to mid
sagittal plane – xiphi sternum).
 Stop breathing after deep inhalation for exposure.

LATERAL DECUBITUS
 Exposure Chart
 (Film size- 12”*15” or 14”*17”)
• Source to Image Receptor Distance (SID) – 180cm
• Grid – No
• mA station – 200
• kV = 55 – 60
• mAs = 20 – 25
• Exposure Timer = mAs/mA = 20/200 = 0.1sec.

LATERAL DECUBITUS AP

**LATERAL DECUBITUS PA

LATERAL DECUBITUS AP

CHEST
OBLIQUE
VIEW

CHEST OBLIQUE
 Generally, two types of oblique view of chest are obtained
 Anterior Oblique
 Right Anterior Oblique
 Left Anterior Oblique
 Posterior Oblique
 Right Posterior Oblique
 Left Posterior Oblique
 Oblique views are prescribed for any type of chest
pathology which are not clear in PA view.
 To see the ribs fractures
 To see the apical regions (upper ribs)

ANTERIOR OBLIQUE (PA)
 Position of the patient –
 Patient is asked to stand in front of upright cassette
holder in PA position.
 Turn the patient 45-degree oblique (L/R).
 If the left side is near to the cassette raise the right hand
above head or place on the cassette.
 Place the left hand on the left hip.
 Upper border of cassette should be 2 – 3 cm above the
shoulder joint.

ANTERIOR OBLIQUE
 Central ray –
• The central ray is directed horizontally at the level of T5.
• Stop breathing after deep inhalation for exposure.

ANTERIOR OBLIQUE
RAO LAO

ANTERIOR OBLIQUE

POSTERIOR OBLIQUE (AP)
 Patient positioning –
 Patient is asked to stand in front of upright cassette
holder in AP position.
 Patient is made oblique position.
 45-degree angle is made between cassette and
unaffected side is way from the cassette.
 Affect side hand should remain parallel to the body
and unaffected side hand should be over the head.
 No movement in the patient during the exposure.

POSTERIOR OBLIQUE (AP)
 Central ray –
 It is directed horizontal at the xiphoid process.
 Stop breathing after deep inhalation for exposure

POSTERIOR OBLIQUE (AP)
RPO LPO

CHEST OBLIQUE
 Exposure Chart
 (Film size- 12”*15” or 14”*17”)
• Source to Image Receptor Distance (SID) – 180cm (May be
change according to the pt. positioning)
• Grid – No
• mA station – 200
• kV = 60 – 65
• mAs = 20 – 25
• Exposure Timer = mAs/mA = 20/200 = 0.1sec.