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CXR (Chest X-Ray)
-- PA Chest
-- Left Lateral Chest
Notes on PA Chest:
- Erect position
- 14x17 cassette length-wise, lead blocker above shoulders
- SID 72"
- roll 90°
- lock tube longitudinally and transversely
- collimate 14x17 (to match cassette)
- center to T7:
- female: 7" down from Vert. Prominens (hang ten)
- male: 8" down from Vert. Prominens
- center bucky so that IR and CR are in alignment
- marker on top, closest to radiographer
- Chin up, backs of hands on hips, elbows forward, shoulders down
- breathing: expose on 2nd deep inspiration
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CXR (Chest X-Ray)
-- PA Chest
-- Left Lateral Chest
Notes on Left Lateral Chest:
- Erect position
- 14x17 cassette length-wise, lead blocker above shoulders
- SID 72"
- roll 90°
- lock tube longitudinally and transversely
- collimate 14x17
- patient's left side against IR
- marker noting side touching IR (left)
- center to T7:
- female: 7" down from Vert. Prominens (hang ten)
- male: 8" down from Vert. Prominens
- center to mid-thorax (down the armpit)
- patient holds arms up, as high as possible, chin up
- check scapula/sternum for alignment
- breathing: expose on 2nd deep inspiration
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CXR Wheelchair
- 14x17 cassette crosswise (lengthwise in LAB only)
- lead blocker above shoulder
- SID 72" (measuring tape)
- marker on the left (anatomical right)
- CR centered to T7:
- measure 4-5 inches down from manubrial notch (rock fingers)
- adjust collimation manually (IR above shoulder)
- tube angled 90° to IR (raise vertically, angle down)
- chin lifted, backs of hands on hips, elbows forward, shoulders down
- breathing: 2nd deep inspiration
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CXR Stretcher, Supine
- 14x17 cassette crosswise under backboard/patient
- top of cassette lined up with vertebral prominens
- lead blocker on top
- marker on top, noting anatomical side
- check for cassette on both sides of patient
- SID 72"
- CR centered to T7:
- measure 4-5 inches down from manubrial notch (rock fingers)
- chin lifted, backs of hands on hips, elbows forward, shoulders down
- breathing: 2nd deep inspiration
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CXR Stretcher, Semi-erect
- 14x17 cassette crosswise placed behind patient
- lead blocker above shoulder
- marker on left (anatomical right)
- SID: at foot of stretcher
- center to T7:
- measure 4-5 inches down from manubrial notch (rock fingers)
- adjust collimation manually
- tube angled 90° to IR (raise vertically, angle down)
- chin lifted, backs of hands on hips, elbows forward, shoulders down
- breathing: 2nd deep inspiration
- extra: make sure shoulder shadow is on the IR
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Abdominal Series
-- Erect
-- Diaphragm
-- Supine
Notes on Erect:
- everything from waist down removed
- AP projection
- 14x17 cassette lengthwise, lead blocker on bottom
- marker at the top
- 90° roll
- SID 40"
- lock tube transversely and longitudinally
- collimate 14x17
- CR centered to top of ilium (iliac crest)
- mid-sagittal centered to xiphoid process
- hands down by sides
- breathing: 1st expiration
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Abdominal Series:
-- Erect
-- Diaphragm
-- Supine
Notes on Diaphragm:
- AP projection
- 14x17 cassette placed cross-wise
- lead blocker on top
- marker on top
- SID 72 "
- collimate 17x14
- center CR and mid-sagittal to xiphoid process
- arms down by sides
- breathing: 1st inspiration
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Abdominal Series:
-- Erect
-- Diaphragm
-- Supine
Notes on Supine:
- 14x17 cassette placed lengthwise
- lead blocker on bottom
- marker directly on top of lead blocker
- SID 40" (table receptor SID)
- tube locked in transversely
- bucky lined up to CR
- center patient on table
- center CR across iliac crest (by moving table)
- center mid-sag with xiphoid proc. (by moving table)
- hands down by sides
- breathing: 1st expiration
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Decubitus CXR
Additive pathologies are imaged with the affected side down:
- pneumonia
- congestive heart failure
- pleural effusion
- hemothorax
- hydrothorax
- TB
-
Decubitus CXR
Destructive pathologies are imaged with the affected side up:
- COPD (chronic obstructive pulmonary disease)
- Emphysema
- pneumothorax
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Left/Right Lateral Decubitus CXR
- 14x17 cassette lengthwise to patient = crosswise
- marker notes the elevated side, above the shoulder
- SID 72"
- lock tube transversely and longitudinally
- center bucky to patient
- patient on Left or Right side, according to pathology
- 90° roll
- collimate 17x14
- both arms above head
- line up bucky to the CR
- center CR on T7 (using Vert. Prom. or Man. Notch)
- move entire stretcher to line up, not tube
- top of light lined up with top of cassette
- lift chin
- breathing: 2nd deep inspiration
- extra: bi-lateral decubitus, 2 projections: right and left
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Dorsal Decubitus
- 14x17 cassette lengthwise to patient = crosswise
- marker placed to note the side touching the IR, above the patient (left in our LAB)
- SID 72"
- collimated 17x14
- bucky centered to patient
- patient flat on back, in one plane, arms raised up
- CR centered on mid-thorax (armpit)
- center to T7: 4-5 inches down from manubrial notch
- chin up
- breathing: 2nd deep inspiration
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Decubitus Abdomen
-- to include bladder
-- to include diaphragm
Notes on including bladder:
- 14x17 cassette lengthwise to patient = crosswise
- lead blocker on bottom
- right anatomical marker, to mark the elevated side
- SID 40"
- collimate 17x14
- patient lays on left shoulder, both arms up
- top of light lined up with top of cassette
- CR centered to spine and the top of the iliac crest
- breathing: 1st expiration
-
Decubitus Abdomen
-- to include bladder
-- to include diaphragm
Notes on including diaphragm:
- 14x17 cassette lengthwise to patient = crosswise
- lead blocker on bottom
- right anatomical marker, to mark the elevated side
- SID 40"
- collimate 17x14
- patient lays on left shoulder, both arms up
- top of light lined up with top of cassette
- CR centered to spine and 2 inches above the top of the iliac crest (3 fingers)
- breathing: 1st expiration
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Lordotic CXR
- 14x17 cassette lengthwise, lead blocker at the top
- marker at the top (left marker in big lab room)
- collimate 14x17
- AP projection
- lean patient's shoulders against bucky, walk their feet out about a foot from the bucky
- have patient arch back
- CR centered to mid-sternum:
- halfway between xiphoid process and manubrial notch
- line bucky up to tube; move patient first
- chin up, backs of hands on hips, elbows forward, shoulders down
- breathing: 2nd deep inspiration
- extra: there will probably be 4-5 inches of light above the shoulder
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PA Obliques CXR
-- RAO
-- LAO
- 14x17 lengthwise, lead blocker up
- marker on top next to blocker
- SID 72"
- collimate 14x17
- turn patient 45° (right and left)
- CR centered to T7 using Vert. Prominens
- centered to half-way between the mad-sagittal plane (spine) and the lateral abdominal margin (armpit)
- arms:
- arm closest to IR does standard CXR position
- arm farther from IR rests on top of chest rack
- chin lifted, shoulders relaxed
- breathing: 2nd deep inspiration
-
PA Obliques CXR
Emphasis on heart
-- RAO
-- LAO
- 14x17 lengthwise, lead blocker up
- marker on top next to blocker
- SID 72"
- collimate 14x17
- turn patient 45° for RAO
- turn patient 60° for LAO
- CR centered to T7 using Vert. Prominens
- centered to half-way between the mad-sagittal plane (spine) and the lateral abdominal margin (armpit)
- arms:
- arm closest to IR does standard CXR position
- arm farther from IR rests on top of chest rack
- chin lifted, shoulders relaxed
- breathing: 2nd deep inspiration
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AP Obliques CXR
-- RPO
-- LPO
- 14x17 lengthwise, lead blocker up
- marker on top next to blocker
- SID 72"
- collimate 14x17
- turn patient 45° (right and left)
- CR centered to T7 using manubrial notch
- centered to half-way between the mad-sagittal plane (xiphoid process) and the lateral abdominal margin (armpit)
- arms in normal CXR positions, but angled according to which pblique being done
- chin lifted, shoulders relaxedbreathing: 2nd deep inspiration
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