Chest - ApicalThis is a featured page

Radiographic Positioning


Adult
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Name of projectionChest - Lordotic Apical
Area Covered Apices of the lungs, clavicles, the upper two-thirds of the lung fields show foreshortened
Pathology shown Lesions of the lung apices, such as tumour and infection
Radiographic Anatomy Chest Radiographic Anatomy
IR Size & Orientation 24 x 30 cm or 30 x 40cm
Landscape
Film / Screen Combination Regular
(CR and DR as recommended by manufacturer)
Bucky / Grid Yes
Filter No
Exposure 100 kVp
4 mAs
FFD / SID 180 cm
Central Ray Directed to the midsagittal plane, at the level of the manubrium
The angle of the central ray differs depending on the positioning method used
Method 1: central ray is 30° cephalad
Method 2: central ray is perpendicular to the IR
Collimation Centre: Directed to the midsagittal plane, to the manubrium
Shutter A: Open to film size or to include anatomy of interest
Shutter B: Open to the level of the acromioclavicular joints (AC joints) laterally. This will include the lung fields laterally.
Markers Superior and Lateral
Marker orientation AP
Shielding Gonadal (check your department's policy guidelines)
Respiration On suspended deep inspiration



Positioning		 Method 1:
  • Position the patient AP with their back to the bucky
  • Centre the midsaggital plane to the midline of the bucky
  • Adjust the film height so that the clavicles are in the horizontal midline of the IR
  • Angle the central ray 30° cephalad
Method 2:
  • Position the patient either standing or sitting AP with their back to the upright bucky
  • Their back should be 30 cm away from the upright bucky
  • Centre the midsaggital plane to the midline of the bucky
  • Have the patient lean back so that their shoulders, neck and head are resting on the bucky
  • Ask the patient to put the back of their hands against their lower hips (to help clear the lung fields of the scapula)
  • Adjust the IR to 8 cm above the shoulders
  • The central ray is perpendicular to the IR
Critique

 Positioning
  • No rotation as evidenced by
    • the medial ends of the clavicles equidistant from the spine
    • the clavicles are in the same horizontal plane
  • The lungs fields are clear of the scapulae
  • The clavicles are projected above the lung apices
Area Covered
  • The upper two-thirds of the lung fields
Collimation
  • Centre: T4 Thoracic vertebra
    Shutter A: Open to show the lung apices and upper two-thirds of the lung fields superiorly
    Shutter B: Open to show the lung fields laterally.
Exposure
  • There should be adequate exposure so that
    • vascular lungs markings are shown
Special Notes To rectify clavicle superimposition
Method 1: Increase the cephalic central ray angulation
Method 2: Have the patient further away from the bucky, ensuring their torso makes an angle with the bucky of approximately 45°



AndyC
AndyC 		Latest page update: made by AndyC , Jun 19 2011, 2:18 PM EDT (about this update About This Update AndyC Edited by AndyC

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Keyword tags: apical Apical Chest positioning Apical Chest technique apices chest chest apical chest lordotic chest positioning CXR lordotic lung view
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