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Radiographic Positioning


Adult
Other related pages of interest

Name of projection Ribs - PA Chest. (See "Special Notes" below).
Area Covered This view best shows the anterior ribs. It also shows the lung fields, mediastinal structures and diaphragm.
Pathology shown Pathologies of the ribs, particularly, fractures of the anterior ribs.
This view may also show related pathologies, such as a pneumothorax resulting from trauma to the ribs
Radiographic Anatomy Chest Radiographic Anatomy
IR Size & Orientation 35 x 43 cm
Landscape usually, but may be portrait depending on body habitus
D.R. may cover 43 x 43 cm
Film / Screen Combination Regular
(CR and DR as recommended by manufacturer)
Bucky / Grid Moving or Stationary Grid
Filter Decubitus filter for women with large breasts, particularly for non-digital imaging
Exposure 100 kVp
4mAs
FFD / SID 180cm
Central Ray Directed to the midsaggital plane at the level of T7
Perpendicular to the IR
Collimation Centre: T7, or the inferior border of the scapula
Shutter A: Open to approximately 5cm above the shoulder to include upper airway
Shutter B: Open to the level of the acromioclavicular joints (AC joints) laterally. This will include the lung fields and ribs laterally.
Markers Superior and Lateral
Marker orientation PA
Shielding Gonadal (check your department's policy guidelines)
Respiration On suspended inspirationdeep inspiration
This ensures the diapragm is as low as possible, allowing as many ribs as possible to be seen
Positioning
  • If the patient's condition allows, perform the views with the patient erect, standing or seated, facing the bucky
  • Centre the midsaggital plane of the patient to the midline of the IR
  • Bring the patient's chest so that it is touching the bucky
  • Have the patient relax their shoulders and rolled forward to touch the bucky
  • Adjust the height of the bucky so that the upper border of the IR is 5cm above the shoulders
  • Raise the chin and rest on or above the bucky
  • Clear the scapulae off the lung fields and ribs by getting the patient to either
A. "Hug" the bucky by bringing the forearms behind the bucky (some buckys have purpose built handles for the patients to hold)
OR
B. Place the back of their hands against their lower hips
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 10th anterior ribs will be visualised above the diaphragm on full inspiration. Note that fewer than the first 10 ribs will be seen if the patient is experiencing much pain and so therefore is less likely to take a deep breath. Less than 10 ribs are also seen when the patient is supine.
    Area Covered

    • Anterior ribs, lungs fields, apices, costophrenic angles, heart
    Collimation

    • Centre: T7 Thoracic vertebra
    • Shutter A: Open to show the first rib superiorly and the diaphragm inferiorly
    • Shutter B: Open to show the lung fields and ribs laterally
    Exposure

    • There should be adequate exposure so that the ribs and thoracic vertebrae are seen faintly through the heart
    • There is minimal patient motion demonstrated by sharp, clear cortical margins and bony trabucular markings of the ribs being demonstrated.
    Special Notes PA vs AP Rib views
    There are several factors that will determine whether a PA or an AP rib view is indicated for the X-ray examination. The following information should be considered
    - the patient's clinical history
    - the mechanism of injury
    - the region of the rib cage which is painful
    The cortical margins and bony trabeculation of the ribs closest to the IR/bucky will be sharper and clearer. Therefore,
    Anterior ribs are best shown on a PA view
    &Posterior ribs are best shown on an AP view.