UG3 RDG304, 1st SEM. CHEST PROCEDURE.pptx

RADIOGRAPHIC PROCEDURE
FOR
THE CHEST
6/7/2023 1

INTRODUCTION TO CHEST-
RADIOGRAPHY
• Chest radiography is the most common
radiographic procedure performed in medical
imaging departments, and one of the most
often repeated exams.
• Chest radiography is performed to evaluate the
lungs, heart and thoracic viscera.
• Also disease processes such as pneumonia,
heart failure, pleurisy and lung cancer are
common indications.
6/7/2023 2

INTRODUCTION TO CHEST-XRAY
• Chest radiographs are also indicated for
critically ill patients.
• This includes patients on ventilators, as well as
those with acute cardiopulmonary problems
• Chest Radiography can be perform on both
Pediatric and Adult Chest
• There are several indications for a chest
radiograph
6/7/2023 3

INDICATIONS FOR CHEST-
RADIOGRAPHY
• Some of the indications include:
1. Evaluation of signs and symptoms related to the
respiratory, cardiovascular and upper
gastrointestinal systems, as well as the
musculoskeletal system of the thorax.
2. Evaluation of thoracic disease processes,
including systemic and extra-thoracic diseases
that can secondarily affect the chest. Because
the lungs are a frequent site of metastases.
6/7/2023 4

RADIOGRAPHY
3. Chest radiography can be useful in staging
extrathoracic, as well as thoracic neoplasms.
4. Follow-up of known thoracic disease processes
to assess improvement, resolution or
progression
5. Monitoring of patients with life-support devices
and patients who have undergone cardiac or
thoracic surgery or other interventional
procedures.
6/7/2023 5

RADIOGRAPHY
6. Chest x-ray Medical checkup for active
tuberculosis or occupational lung disease or
exposures.
7. Preoperative radiographic evaluation when
cardiac or respiratory symptoms are present
or when there is significant potential for
thoracic pathology that could compromise the
surgical result.
6/7/2023 6

RADIOGRAPHY
8. To exclude radiographically demonstrable
disease, such as tuberculosis
9. To demonstrate and monitor the progress of
lesion such as pleural or pulmonary pathology
10. To demonstrate cadiac diseases
11. To investigate the mediastinum, diaphragm and
chest wall.
12. To show the size and shape of the heart or
cadiac status.
6/7/2023 7

BRIEF ANATOMY OF NORMAL CHEST
The bony thorax
• The bony thorax of the chest is composed of
the sternum anteriorly and 12 pairs of ribs that
surround the lungs. Each pair of ribs connects to
a corresponding thoracic vertebra posteriorly.
• The anterior portion of each rib connects by
way of costocartilage to the sternum. The
costocartilage usually does not show up on a
radiograph unless it is calcified.
6/7/2023 8

• The true ribs, numbers 1 to 7, connect
anteriorly to the sternum by way of this
costocartilage.
• The false ribs are numbers 8 through 12. Ribs 8
through 10 connect to the sternum by way of
the costocartilages of the seventh ribs.
• False ribs 11 and 12 are short and do not wrap
around the body; they also are called floating
ribs. The ribs collectively provide a protective
framework for the lungs.
6/7/2023 10

The Respiratory System
• The respiratory system is composed of the
larynx, trachea, bronchi and lungs.
• The larynx is commonly referred to as the
voice box, is the most superior structure in the
respiratory system and houses the vocal cords.
• In close proximity to the larynx are the thyroid
cartilage, laryngeal prominence or Adam’s
apple, and the cricoid cartilage.
6/7/2023 11

• The epiglottis also is located nearby and acts
as a covering for the trachea when food is
swallowed.
• The trachea descends inferiorly beginning at
about the level of C5 to approximately T5 or
T6, where it bifurcates at the carina into the
right and left primary bronchi.
6/7/2023 12

• The bronchi then subdivide into several
branches. Three secondary branches feed the
right lung and 2 secondary branches feed the
left lung.
• These branches divide into tertiary levels and
smaller segments, eventually ending in the
terminal bronchioles where the alveoli
exchange oxygen and carbon dioxide
6/7/2023 13

The lungs
• The lungs are composed of a spongy material
called the parenchyma.
• The parenchymal tissue contains the fine
structures of the bronchial trees and
pulmonary circulation.
• The exchange of oxygen and carbon dioxide
takes place at the alveolar level within the
parenchyma. There are millions of alveolar
sacs within each lung.
6/7/2023 14

The Diaphragm
• The diaphragm is a muscular structure located
immediately below the lung bases. Though it
is a single organ, it is divided into 2 sections
called the right and left hemidiaphragms.
• The right hemidiaphragm is higher on a chest
radiograph because of the location of the liver,
which is immediately inferior to it.
6/7/2023 15

The Diaphragm
• The term cardiophrenic angles is sometimes
used to describe the area where the heart’s
border comes in contact with the diaphragm.
• There are both right and left cardiophrenic
angles, which should be visualized on a
normal chest radiograph.
6/7/2023 16

The Pleura
• Each lung is surrounded by a thin walled sac
called the pleura. The pleura completely encases
the lung with an inner layer called the pulmonary
or visceral layer and an outer layer called the
parietal layer.
• The potential space between these 2 layers is
called the pleural space. Radiographically, this
space is important because it can be filled with
air (pneumothorax) or blood (hemothorax),
which can be seen on a chest radiograph. A chest
tube can be placed within the pleural space to
drain accumulated fluid or air.
6/7/2023 17

The Mediastinum
• The mediastium is the space between the
lungs that houses the heart and great vessels,
including the proximal pulmonary arteries and
aortic root.
• Additionally, the proximal bronchial trees,
pulmonary veins, a portion of the esophagus
and lymphatic vessels are important
structures found beneath the mediastinum.
6/7/2023 18

PATIENT PREPARATION FOR THE
CHEST X-RAY EXAM
• Prior to proceeding with the Chest X-ray exam,
all women of child-bearing age should be
asked if there is any possibility of pregnancy.
• Clothing that interferes with the procedure
should be removed. This includes items such
as bras, jewelry, buttons or any metal objects
that could interfere with the study.
6/7/2023 19

PATIENT PREPARATION FOR THE
CHEST X-RAY EXAM
• T-shirts with prominent logos also should be
removed because they can show up on the study
and can interfere with the diagnosis.
• Long hair that is in braids or tightly held together
with rubber bands should be moved from the
upper lung fields
• Body piercings and especially nipple piercings are
common metallic foreign bodies that can
interfere with interpretation and diagnosis. This
can be a delicate and embarrassing subject for
patients.
6/7/2023 20

How do we care for patient sent to
our department for Chest Xray
1. A smiling face is important, especially when
you go to call in your patient. This will give the
patient some level of assurance and
confidence.
2. Welcome the patient to your exposure room,
ask the patient of he/her profile, such as
– Name, Age, Address.
• Make sure it matches the information you have
on your request card.
3. Check/read the clinical information on the card
6/7/2023 21

your department for Chest X-ray
4. Briefly explain the procedure to the patient
and also inform the patient that the
machines they are seeing is to enable you
examine them and that they wont even feel a
thing. (This will reassure your patient)
5. Give your patient changing instructions, and
provide him/her with a fresh gown that is
clean.
6/7/2023 22

your department for Chest X-ray
6. In the presence of your patient, quickly wipe or
clean the bulky/chest stand, change your hand
gloves to a fresh one and then proceed with the
xray examination.
7. Always wait for your patient to leave the
exposure room before calling in another
patient.
6/7/2023 23

What are the basic view, Alternative
view, and the Supplementary view for
a Chest Xray
Basic view
1. Posterio-anterior View (PA) - Erect
Alternative View
1. Anterio-posterior view (AP) - Erect
2. Anterio-posterior view (AP) – Supine
3. Anterio-posterior view (AP) – Semi erect
6/7/2023 24

What are the basic view, Alternative
view, and the Supplementary view for
a Chest Xray
Supplementary view
1. Lateral
2. Posterio-anterior (PA) – Expiration
3. Apical View
4. Lordotic
5. Decubitus
6. Anterior Oblique view.
6/7/2023 25

RULES IN CHEST RADIOGRAPHY
1. Ensure that the patient is in a true AP or PA
position. This can be evaluated from the
distance of the sternoclavicular joints from
the midline (They should be equidistant
when well positioned). If there is rotation the
heart size is not going to be normal.
6/7/2023 26

RULES IN CHEST RADIOGRAPHY
2. The entire thoracic cavity must be shown on
- The radiograph,
- The chest wall,
- Costophrenic angles,
- Diaphragm,
- Lower part of cervical vertebrae and
- Soft tissues of the chest wall.
6/7/2023 27

BASIC VIEW
Posterio-anterior View (PA) - Erect
Equipment required:
• 35x35cm or 14x14 inch (for Female) detail
screen cassette.
• 43x35cm or 17x14 inch (for male) detail
screen cassette.
• Vertical cassette stand.
• Lead protective waist apron
6/7/2023 28

BASIC VIEW
Patient position:
• Stand the patient erect facing the cassette
stand with her feet apart.
• Extern the neck slightly and rest it on the
upper boarder of the cassette.
• Place the back of the hands on the hips.
• Press the shoulders and upper arm forward
against the cassette,
6/7/2023 29

BASIC VIEW
Patient position:
• This is to throw away the scapula off the lungs
field.
• Ensure that the trunk is not rotated.
• Immobilize the patient, place anatomical
marker, Collimate beam to the area of interest
and select adequate exposure factors.
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BASIC VIEW
6/7/2023 31

BASIC VIEW
• DCR: Horizontal central ray, 90 degrees to the cassette.
• FFD: 150 – 180
• Respiratory manoeuvre: Expose at the end of deep
inspiration.
• Exposure factors:
58 – 60kVp (If no grid was use)
8 – 10mAs
OR
70 – 75kVp (if grid is used/BULKY)
14 – 16mAs
6/7/2023 32

CHEST X-RAY
RADIOGRAPHIC IMAGE APPEARANCE
NOTE:
Different tissues in our body absorb X-rays at
different extents:
•Bone- high absorption (white)
•Tissue- somewhere in the middle absorption
(grey)
•Air- low absorption (black)
6/7/2023 34

Why do you place the patients hands
behind the back?
• This is to enable you through off the spine of the
scapula off the lungs field and allows for better
visualization of parenchymal anatomy.
What is the importance of arrested full
Inspiration during Chest X-ray examination
1. This is to ensure the demonstration of the
maximum number of ribs above the diaphram (Up
to 10 posterior ribs and 6 anterior ribs) .
6/7/2023 35

What is the importance of arrested full
Inspiration during Chest X-ray examination
2. To avoid blurring usually caused by respiratory
movement.
3. The lungs are more translucent
radiographically when aerated.
4. On inspiration the diaphragm moves down
showing more of the lungs.
6/7/2023 37

Why is 150cm - 180cm FFD use for
Chest X-ray?
1. To reduce the geometric magnification and
distortion of structures within the chest x-ray,
such as the heart and thoracic viscera.
2. The object image receptor alignment is
important in controlling distortion of an image,
'the greater the distance between the object
and the film, the greater the magnification.
3. Increase FFD implies reduced skin dose to the
patient (inverse square law)
6/7/2023 40

Why is PA Chest X-ray preferred to AP
chest X-ray
1. The arms are easily adjusted and the
projection of the scapular away from the
lungs field
2. In AP projection the heart tends to be
magnified because the Object Film Distance
(OFD) is increased in the AP position and if
the patient is supine it is not easy to have a
long Film to Focus Distance (FFD) such as a
150cm.
6/7/2023 41

CHEST XRAY
Technical Evaluation Of a Chest Radiograph
• Once the film has been exposed and
processed, the responsibility of reviewing it
does not rest solely with the radiologist.
• The film first should be evaluated by the
radiographer.
• A radiograph cannot be interpreted
adequately by the radiologist unless it is
technically adequate.
6/7/2023 42

CHEST XRAY
Technical Evaluation Of a Chest Radiograph
• The Radiographer should evaluated the
following before submitting the radiograph for
review:
1. Correct demographic information.
2. Correct marker placement.
3. Correct exposure / use of appropriate
exposure factors.
4. Adequate position.
5. Sufficient inspiration.
6. Pertinent anatomy demonstrated.
6/7/2023 43

CHEST XRAY
• Technical Evaluation Of a Chest Radiograph
1. Correct Demographic Information:-
This information should include the patient’s name
and any other identifying information deemed
necessary by the Hospital.
This should include (the patient’s name, the x-ray
number or some other identifying number, the date and
time the exam was performed and the patient’s date of
birth)
6/7/2023 44

CHEST XRAY
• Technical Evaluation Of a Chest Radiograph
2. Correct Marker Placement
• The correct anatomical side marker, right or left,
should be visible on the final radiograph.
• Care should be exercised by the radiographer to
ensure that the marker will not interfere with
interpretation by covering pertinent anatomy.
6/7/2023 45

CHEST XRAY
• Additional care should be exercised to make
sure that the marker is placed on the correct
side.
• Conditions such as situs inversus show the
importance of correct marker placement.
NB: Situs inversus is defined as the reversal of
anatomical structures.
6/7/2023 46

CHEST XRAY
• In situs inversus, the morphologic right atrium is
on the left and the morphologic left atrium is on
the right.
• The normal pulmonary anatomy is reversed so
that the left lung has 3 lobes and the right 2
lobes.
• In addition, the liver and gallbladder are located
on the left, while the spleen and stomach are
located on the right. The remaining structures
also are a mirror image of the normal.
6/7/2023 47

CHEST XRAY
• Radiographers should always check prior to
making an exposure to ensure that the correct
marker is placed on the correct side.
• Hand Writing of “R” or “L” on the radiograph
after the exposure is generally not acceptable
because of legal issues associated with mis-
markings.
6/7/2023 48

CHEST XRAY
3. Correct Exposure
• Evaluation of the radiograph for the correct
exposure is vital. An underexposed radiograph
that is too light may simulate pulmonary
opacities that are not really present, leading to
a false positive result.
• Likewise, an overexposed film that is too dark or
overpenetrated can burn out essential anatomy.
An example would be a pulmonary nodule that
was not seen because of overexposure,
resulting in a false negative interpretation.
6/7/2023 49

CHEST XRAY
3. Correct Exposure
• However, Digital technology is solving these
types of concerns. Digital images can be
manipulated after processing by the user.
• Changes to density and contrast can be made
after the exposure by adjusting the window
and level of the image.
• Therefore, anatomy that cannot be
adequately visualized can be manipulated by
the operator to enhance the image.
6/7/2023 50

CHEST XRAY
3. Correct Exposure
 Adequate exposure is evaluated by visualizing
1. The thoracic vertebrae behind the heart. On a
correctly exposed radiograph, the vertebrae and
corresponding posterior ribs should be faintly
visible through the heart.
2. Additionally, the pulmonary blood vessels should
be visualized out to the distal third of the peripheral
lung field.
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CHEST XRAY
4. Adequate positioning
• Prior to submitting a radiograph for
interpretation, the radiographer should
confirm that an adequate position was
obtained.
• This means that the radiograph should not
show signs of rotation.
• If the patient was properly positioned for the
PA projection, the following must be
observed.
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CHEST XRAY
(1) The medial ends of the clavicles will appear
equidistant from the spinous processes of the
thoracic vertebrae.
NB:
• Variation of more than 1 cm could affect the
appearance of the lung. This is important
because rotation can cause differences in
density.
6/7/2023 54

CHEST XRAY
NB:
• Likewise, certain conditions such as
mediastinal widening cannot be evaluated
properly on a rotated chest radiograph.
(2) Additionally, on a well-positioned chest
radiograph the scapulae should not be seen in
the lung field. Scapular densities can prevent
detection of abnormalities in the periphery of
the lung.
6/7/2023 55

CHEST XRAY
(3) Proper positioning on a lateral chest
radiograph should demonstrate
I. Superimposition of the ribs posteriorly.
II. Upper apice of the lungs without
superimposition of the soft tissues of the
arms.
III. The sternum should be visualized as a thin
bony structure on the anterior thorax. (If it
appears widened, this is another indication
of rotation.)
6/7/2023 56

CHEST XRAY
Rotated
6/7/2023 57

CHEST XRAY
5. Sufficient Inspiration
• Sufficient inspiration
is evaluated by
visualizing 10
posterior ribs above
the diaphragm on a
PA projection of the
chest, and 6 anterior
ribs.
6/7/2023 58

• 5. Sufficient Inspiration
Absence of sufficient inspiration on a chest
radiograph will leads to
I. The lung markings become crowded.
II. The heart shadow and borders are not
adequately visualized.
III. The heart will appear larger than it actually
is.
CHEST XRAY
6/7/2023 59

6. Pertinent Anatomy Demonstrated
• The chest radiograph should demonstrate all
of the anatomy of the lungs from the apices to
the lung bases
• This means that both hemidiaphragms should
be seen in their entirety.
• All of the costophrenic angles should be
visualized.
CHEST XRAY
6/7/2023 60

CHEST XRAY
QUALITY OF THE CHEST RADIOGRAPH BEFORE
PASSING IT FOR REPORTING
1. Is the film over
or under penetrated,
if under penetrated
you will not be able
to see the
thoracic vertebrae. And if
Its over penetrated, you
Will see the spine clearly
Over the heart (Spinous)
6/7/2023 61

CHEST XRAY
2. Check for rotation
– Does the thoracic spine
align in the centre of the
sternum and between
the clavicles?
– Are the clavicles level?
(it should be Symmetrical)
6/7/2023 62

CHEST XRAY
• Other things to take note
of are:
- Gastric bubble should
be on the left. This should
Also help you in identifying
The left side of your patient
In the absence of a marker.
6/7/2023 64

CHEST XRAY
- Look at the diaphragm:
for tenting free air abnormal
elevation
- Margins should
be sharp (the right
hemidiaphragm
is usually slightly
higher than the left)
6/7/2023 65

NOTE:-- > The costophrenic angles should be
sharp on both views (sharp enough to pick
your teeth with), except in patients with
severe pulmonary emphysema, resulting in
flattening of the hemidiaphragms.
6/7/2023 66

RESPIRATORY MANOEVRE IN
RADIOGRAPHY
1. INSPIRATION: At a phase of respiratory
mechanism when the cavity increases due to
the upward and downward movement of the
ribs as well as diaphragmatic movement, air
are drawn into the lugs
Inspiration is the most common phase of
respiration used in radiography of the thorax
because the diaphragm is lower, more lungs
area are visible, the lungs are more
radioluscent and less exposure is required.
6/7/2023 67

RADIOGRAPHY
If inspiration is used for radiography of the
abdomen, the abdomen will be under tension
and more exposure will be required.
It may usefully limits considerable movement in
the abdomen or demonstrates relative position
of calculi and foreign bodies when the films are
compared with those taken on expiration.
6/7/2023 68

RADIOGRAPHY
2. EXPIRATION: During the passive process of
diaphragmatic muscle recoiling, when the
internal intercostals muscle contract pushing the
inwards and downward.
The diaphragm assumes a dome shape resulting
in net reduction in the thoracic volume and
increased intra thoracic pressure , air is pushed
out of the lungs.
6/7/2023 69

In Chest X-ray examination, when is Expiration
used
• To demonstrate the following conditions
1. Suspected spontaneous pnemothorax
2. Small Pnemothorax
3. Bronchiole carcinoma
4. Emphysema
5. To distinguish between opacity in the ribs and in the
lungs
6. To show diaphragmatic level and excursions.
7. Thymus in young children
8. Brochiole foreign body
9. Subphrenic abscess
10.Lower ribs and multiple injuries of the rib for
impaired lung motion.
6/7/2023 70

RESPIRATORY MANOEVRE IN RADIOGRAPHY
3. VALSALVA MANOEUVRE: This is a strong
expiratory effort with a closed mouth and nose.
The air passage becomes distended and lungs
more radioluscent.
The thoracic vascular shadows decrease in size
due to increase intra thoracic pressure and
valves in the vein closed. (This is used in
VEINOGRAPHY, e.g in pathological condition
called Varicose vain (dilated vein with
incompetent valves causing the back flow of
blood))
6/7/2023 71

RESPIRATORY MANOEVRE IN RADIOGRAPHY
When VALSALVA MANOEUVRE IS TO BE USED
The main uses of this manoeuvre is in the
radiography of the
1. Upper respiratory passage
2. Veinography
3. During screening for esophageal varises
(dilated tortuous veins)
4. Differentiation of Lymph nodes
6/7/2023 72

RADIOGRAPHY
4. MODIFIED VALSALVA MANOEVRE: This is a
strong expiration effort against a closed glottis.
5. MULLER MANOEUVRE: A strong inspiration
effort against a closed glottis. Its application are
fewer than for valsalva.
During muller manoeuvre the air compress the
lungs making them more radiopague and the
pulmonary vascular shadows increased in size due
to decrease pressure on them. The peripheral and
abdominal vessels decrease in size.
6/7/2023 73

RADIOGRAPHY
6. HYPERVENTILATION APNOEA: This manoeuvre is
often used in radiography of the pregnant abdomen
for the purpose of keeping the fetus still and
assisting patient to hold breath.
The patient is asked to breath in and out deeply
several times and to breath in deeply and hold her
breath. Because there is a temporal increase in
Oxygen, content of the body apnoea occurs. An
alternative to deep respiration is a panting
respiration before the patient is advised to hold her
breath.
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RADIOGRAPHY
7. BREATHING TECHNIQUE: The patient is
allowed to breath gently during a long exposure
time in an attempt to blur out structures not
required in the film. For example, ribs and lungs
markings are blurred out on the lateral thoracic
spine.
8. PHONATION (TALKING): The utterance of
vocal sound is used particularly during
tomography of the larynx when the patient is
asked to say ‘E’ and ‘O’ to demonstrate the vocal
cord in different positions.
6/7/2023 75

RADIOGRAPHY
8. COUPHING TECHNIQUE: A sudden noisy
expulsion of air from the lungs is used to induce
vesico-ureteric reflux (i.e valve incompetent)
during cystography. It may also be used to
demonstrate Hiatus hernia during barium meal
examination. Sneezing may be used in place of
coughing.
6/7/2023 76

What are the reason for erect chest xray.
1. It produces the normal state of the lungs and
mediastinum.
2. Air rises to the apical region, making it easy
to recognise a pneumothorax.
3. Fluid runs downward, producing a level at
the base with a curved line (Meniscus)
4. The diaphragms are lower, showing more of
the lungs base and the heart size can be
accurately assessed.
5. Erect chest x-ray are preferred because they
better demonstrate pleural effusions and
pulmonary edema.
6/7/2023 77

Lateral View
• Equipment required:
• 35x35cm or 14x14 inch (for Female) detail
screen cassette.
• 43X35cm or 17x14 inch (for male) detail
screen cassette.
• Vertical cassette stand.
• Lead protective waist apron
6/7/2023 78

Lateral View
Patient position:
• Stand the patient erect in a true lateral
position, with the feet apart.
• Place the affected side against the cassette.
Raise the arms and fold it over the head.
• Immobilize the patient, place anatomical
marker, Collimate beam to the area of interest
and select adequate exposure factors.
6/7/2023 79

Lateral View
• Centring point: Centre to the midline of the film
through the axilla at the level of T6 - T7 corresponding
to the lower boarder of the scapula.
• DCR: Horizontal central ray, 90 degrees to the film.
• FFD: 150 – 180
• Respiratory manoeuvre: Expose at the end of deep
inspiration.
• Exposure factors: 67 – 75kVp (If no grid was use)
8 – 10mAs
Or
80 – 90kVp (if grid is used/BULKY)
18 – 25mAs
6/7/2023 81

When should a lateral view be done?
– To demonstrate foreign bodies
– To localize a lesion seen on a PA chest X-ray film
– To clarify lobar collapse or consolidation
– To explore a retrosternal or retrocardiac shadow
– To confirm the presence of encysted fluid in the
oblique fissure (pseudotumour)
– To demonstrate anterior mediastanal masses not
shown on PA chest x-ray film
6/7/2023 83

NOTE:
• Collapse in the above context refers to
diminished volume of air in the lungs with
associated reduction of lungs volume.
• Consolidation is the diminished volume of air
in the lung associated with normal lung
volume
6/7/2023 84

Example of lobar collapse or consolidation
6/7/2023 85

Apical View/Apical Lordotic
6/7/2023 87

Why is Apical View/Apical Lordotic
done?
– When the anatomy of interest is the lungs apices
– If there suspected or known pathology associated
with the lungs apices e.g tuberculosis.
– To demonstrate the middle lobe of the right lung
and the lingula segment of the left upper lobe
6/7/2023 88

Equipment required:
– 24 x 30 cm detailed screen cassette,
– Vertical Cassete stand.
– Lead protective waist apron.
Patient position: Stand or sit the patient erect facing
the xray tube a short distance in front of the
cassette. Lean back at an angle of 30 degrees and
rest against the cassette. Place the hands on the
hips. Immobilize the patient, place anatomical
marker, collimate beam and apply protection.
6/7/2023 89

Centring point:
Centre to the midline at the level of the middle
of the body of the sternum.
Direction of central ray: Use horizontal central
ray, 90 degrees to the film
6/7/2023 90

Lordotic view
Equipment required
– 35 x 40 cm detailed screen cassette,
– Vertical Cassete stand / Bucky.
– Lead protective waist apron.
Patient position: Stand or sit the patient erect facing
the cassette. Ask the patient to lean back at an
angle of 45 degrees and grip the side of the
vertical cassette stand for support. Immobilize the
patient, place anatomical marker, collimate beam
and apply protection.
6/7/2023 92

Lordotic view
Centring point:
Centre to the midline at the level of the fourth
thoracic vertebra.
Direction of central ray: Use horizontal central
ray at 90 degree to the film
6/7/2023 93

What are demonstrated on Lordotic
view
Lordotic view will demonstrate
– Interlobular pleural effussion or
– Right middle lobe collapse
6/7/2023 94

ASSIGNMENT
• Look up the following abbreviations
Commonly use on chest X-ray request cards
1. CCF
2. PTB
3. CAP
4. HHDX
5. Mets
6. Ca
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UG3 RDG304, 1st SEM. CHEST PROCEDURE.pptx

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