CHEST RADIOGRAPHY
Chest Radiography
Anatomy
• Body Habitus
Anatomy
• Thoracic Cavity
The thoracic cavity is bounded by the
walls of the thorax and extends from
the
superior thoracic aperture, where
structures enter the thorax, to the
inferior thoracic aperture.
The diaphragm separates the thoracic
cavity from the abdominal cavity. The
anatomic structures that pass from the
thorax to the abdomen go through
Anatomy
Anatomy
Anatomy
• Respiratory System : TRACHEA
• fibrous, muscular tube with 16 to 20 C-
shaped cartilaginous rings
• It measures approximately 1/2
inch(1.3cm) in diameter and 4 ½inches
( 11 cm) in length
• posterior aspect is flat.
• The cartilaginous rings are incomplete
posteriorly and extend around the
anterior two third of the tube.
• lies in the midline of the body, anterior
Anatomy
However, in the thorax the trachea is shifted slightly
to the right of the midline as a result of the arching of
the aorta.
The trachea follows the curve of the vertebral column
at the level of the sixth cervical vertebra inferiorly
through the mediastinum to about the level of the
space between the fourth and fifth thoracic
vertebrae.
The last tracheal cartilage is elongated and has a
hooklike process , the carina, which extends
posteriorly on it inferior surface. At the carina the
trachea divides, or bifurcates, into two lesser tubes.
Anatomy
•Respiratory System : Primary
bronchi
The primary bronchi slant obliquely inferiorly
to their entrance into the lungs, where they
branch out to form the right and left bronchial
branches.
The right primary bronchus is shorter, wider,
and more vertical than the left primary
bronchus.
Foreign bodies entering the trachea are more
likely to pass into the right bronchus than the
left bronchus.
Anatomy
• Respiratory System : Secondary bronchi
• each primary bronchus divides, sending
branches to each lobe of the lungs : three to
the right lung and two to the left lung.
• These secondary bronchi further divide and
decrease in caliber. The bronchi continue
dividing into tertiary bronchi, then to smaller
bronchioles, and end in minute tube called
the terminal bronchioles.
Anatomy
•Respiratory System : alveoli
The terminal bronchiole communicate with
alveolar ducts.
Each duct ends in several alveolar sacs. The
walls of the alveolar sacs are lined with
alveoli.
Each lung contain million of alveoli. Oxygen
and carbon dioxide are exchanged by
diffusion within the walls of the alveoli.
Anatomy
•Lungs
Anatomy
•Lungs
Anatomy
•Lungs
Anatomy
•Lungs
Anatomy
•Lungs
• Organ(s) of respiration
• introduces oxygen into the blood and
removing carbon dioxide from the
blood.
• Composed of a light, spongy, highly
elastic substance, the parenchyma,
and they are covered by a layer of
serous membrane.
Anatomy
•Lungs
• The right lung is about 1 inch (2.5 cm)
shorter and is broader than the left
lung
• The inferior surface of the lung is
concave
• During respiration the lungs move
inferiorly for inspiration and
Anatomy
•Mediastinum
Anatomy
• Mediastinum
The mediastinum is the area of the
thorax bounded by the sternum
anteriorly , the spine posteriorly, and
the lung laterally . The structure
associated with the mediastinum are
as follow :
• Heart
• Great vessel
• Trachea
Pathology
Aspiration Inspiration of a foreign material into the airway
Atelectasis A collapse of all or part of the lung
Bronchiectasis Chronic dilatation of the bronchi and
bronchioles associated with secondary infection
Bronchitis Inflammation of the bronchi
Chronic Obstructive Chronic condition of persistent obstruction of
Pulmonary Disease bronchial airflow
Cystic Fibrosis Disorder associated with widespread
dysfunction of the exocrine glands. Abnormal
secretion of sweat and saliva. and accumulation
of thick mucus in the lungs.
Emphysema Destructive and obstructive airway changes
leading to an Increased volume of air In the
lungs.
Pathology
Granulomatous Condition of the lung marked by formation of
Disease granulomas
Sarcoidosis Condition of unknown origin often associated
with pulmonary fibrosis
Tuberculosis Chronic infection of the lung due to the
tubercle bacillus
Hyaline Membrane Underation of the lungs due to a lack of
Disease or surfactant
Respiratory Distress
Syndrome
Pleural Effusion Collection of fluid In the pleural cavity
Pneumoconiosis Lung diseases resulting from inhalation of
industrial substances
Asbestosis Inflammation caused by inhalation of asbestos
Pathology
Anthracosis or Coal Inflammation caused by inhalation of coal dust
Miner's Lung (anthracite).
Silicosis Inflammation caused by inhalation of silicon
dioxide.
Pneumonia Acute infection in the lung parenchyma.
Interstitial or Viral or Pneumonia caused by a virus and Involving the
Pneumonitis alveolar walls and interstitial structures
Lobar or Bacterial Pneumonia involving the alveoli of an entire
lobe without Involving the bronchi.
Lobular or Pneumonia involving the bronchi and scattered
Bronchopneumonia throughout the lung.
Pneumothorax Accumulation of air in the pleural cavity
resulting in collapse of the lung.
Tumor New tissue growth where cell proliferation is
PROJECTIONS : General Positioning
Considerations
• For radiography of the heart and lung
, the patient is placed in an upright
position to demonstrate air and fluid
levels.
• In the recumbent position,
gravitational force causes the
abdominal viscera and diaphragm
to move superiorly.
PROJECTIONS : General Positioning Considerations
PROJECTIONS : General Positioning
Considerations
PA CRITERIA
• Instruct the
patient to sit or
stand upright. If
the standing
position is used,
the weight of the
body must be
equally
distributed on the
feet.
PROJECTIONS : General Positioning
Considerations
LATERAL
CRITERI
A
• Place the side of
interest against
the IR holder.
• Have the patient
PROJECTIONS : General Positioning Considerations
OBLIQUE CRITERIA
• In oblique projections, the patient rotate the hips
with the thorax and points the feet directly forward.
The shoulders should lie in the same transverse
plane on all radiographs.
Breathing Instructions
• During normal inspiration, the costal muscles pull the
anterior ribs superiorly and laterally, the shoulders
rise, and the thorax expands from front to back and
from side to side.
• Deep inspiration causes the diaphragm to move
inferiorly, resulting in elongation of the heart.
Radiograph of the heart should therefore be obtained
at the end of normal inspiration to prevent distortion.
• More air is inhaled during the second breath (and
without strain ) than during the first breath .
Breathing Instructions
• When a pneumothorax (gas or air in the pleural
cavity) is suspected, one exposure is often made at
the end of full inspiration and another at the end
of full expiration.
• Inspiration and expiration radiographs are also
used to demonstrate the movement of the
diaphragm, the occasional presence of a foreign
body, and atelectasis (absence of air).
Technical procedure
• Normally, chest radiography uses a high kilovolt (peak) (kvp)
to penetrate and demonstrate all thoracic anatomy on the
radiograph. The kvp can be lowered if exposures are made
without a grid.
• However, if the selected kvp is too low, the radiographic
contrast may be too high, resulting in few shade of gray.
• If the selected kvp is too high, the contrast may be too low,
which does not allow for demonstration of the finer lung
markings.
• Whenever possible, a minimum source to- image receptor
distance (SID) of 72 inches (183 cm) should be used
• A 120-inch (305-cm) SID is commonly used in radiography of
Technical procedure
• A grid
technique is
recommended
for opaque area
within the lung
fields and to
demonstrate the
lung structure
through
thickened
pleural
membranes.
PA Lungs and Heart
• SID: A minimum S I D of 72 inches( 1 83 cm) is
recommended
• If possible, always examine patients in the upright
position, either standing or seated
• Place the patient, with arm hanging at sides, before a
vertical grid device.
• Adjust the height of the IR so that its upper border is about
1 to 1/2 inches above the relaxed shoulder .
• Ask the patient to flex the arm and to rest the backs of the
hands low on the hips, below the level of the costophrenic
angles.
• Depress the shoulders and adjust to lie in the same
transverse plane. Rotate them forward to position them
below the lung apices
• Be careful not to rotate the body when applying the band.
The least amount of rotation will result in considerable
distortion of the heart shadow.
PA Lungs and Heart
• If a female patient'
breasts are large
enough to be
superimposed over
the lower part of the
lung fields, ask the
patient to pull the
breasts upward and
laterally.
• Have the patient
PA Lungs and Heart
Lateral Lungs and Heart
• SID: A minimum S I D of 72 inches
• If possible, always examine the patient in the upright
position, either standing or seated
• Use the right lateral position to best demonstrate the
right lung.
• Have the patient extend the arms directly upward, flex
the elbows, and with the forearms resting on the
elbows, hold the arms in position
• Have the patient extend the arm and grasp the stand as
high as possible for support.
• IR: upper border about 1 ½” to 2 inches above the
shoulder
• Shield gonads.
Lateral Lungs and Heart
• Respiration:
The exposure is
made after the
second full
inspiration to
ensure maximum
expansion of the
lungs.
• Central ray:
Perpendicular to
PA Oblique Lungs and Heart
RAO or LAO
• SID: A minimum S I D
of 72 inches is
recommended
• (standing or seated
upright)
• • Instruct the patient to
let the arms hang free.
• Have the patient turn
PA Oblique Lungs and Heart
RAO or LAO
LAO position
• Rotate the patient 45
degrees to place the
left shoulder in
contact with the grid
device, and center
the thorax to the IR.
• place the left hand
on the hip with the
PA Oblique Lungs and Heart
RAO or LAO
RAO position
• Reverse the
previously described
position, placing the
patient's right shoulder
in contact with the grid
device, the
• right hand on the hip
and the left hand on
the top of the vertical
PA Oblique Lungs and Heart
RAO or LAO
• Structures shown:
LAO position
• The maximum area of the right lung
field (side farther from the IR) is
demonstrated along with the
thoracic viscera. The anterior
portion of the left lung is
superimposed by the spine
• Also shown are the trachea and it
PA Oblique Lungs and Heart
RAO or LAO
AP Oblique Lungs and Heart
RPO or LPO
• RPO and LPO
position are used
when the patient is
too ill to be turned to
the prone position
and sometimes as
supplementary
positions.
• They are also used
with the recumbent
AP Oblique Lungs and Heart
RPO or LPO
• Flex the patient's
elbows and place the
hands on the hip with
the palm facing
outward, or pronate
the hand beside the
hips. The arm closer to
the IR may be raised as
long as the shoulder is
rotated anteriorly.
AP Chest
• The supine position
is used when the
patient is too ill to be
turned to the prone
position.
• It is sometimes used
as a supplementary
projection in the
investigation of
AP Chest
• Central ray:
Perpendicular to
the long axis of
the sternum and
the center of the
IR entering about
3-inches below
the jugular notch.
• Structures
shown:
AP Axial Chest
Lindbolm Method
Lordotic position
• SID: A minimum S I D
of 72 inches is
recommended
• Place the patient in
the upright position,
facing the x-ray tube
and standing
approximately 1 foot
( 30.5 cm) in front of
the vertical grid
AP Axial Chest
Lindbolm Method
Lordotic position
• Oblique lordotic
positions LPO or RPO
• Rotate the patient's
body approximately
30 degree away from
the position used for
the AP projection,
with the affected ide
toward and centered
to the grid
Non- Contrast Radiographic
Examination of the
Abdomen
Anatomy