XR Chest (PA and Lateral)

Indications

• Cough, dyspnea, chest pain
• Suspected pneumonia or other infection
• Suspected pneumothorax, pleural effusion, or edema
• Evaluation of cardiac silhouette/mediastinum
• Pre-operative screening
• Line/tube position (non-emergent)
• Follow-up of known thoracic disease

Patient prep

• Remove all radiopaque objects from neck and chest (necklaces, jewelry, bra, snaps, EKG leads if possible)
• Change into gown
• No other specific preparation

Contrast

Technique

• Performed upright/erect whenever possible
• PA: anterior chest against upright detector, chin raised, hands on hips with palms out and shoulders rolled forward to clear scapulae from lung fields
• Lateral: left side against detector (left lateral) to minimize cardiac magnification, arms raised and crossed above head
• SID 72 inches (180 cm)
• Higher kVp technique 110-125 kVp (low-kVp ~75-85 may be used in some departments) with grid
• CR perpendicular to T7 (about 7-8 inches below vertebra prominens / 3-4 inches below jugular notch)
• Exposure on second full inspiration; suspended respiration

Series / Sequences

Key points

• 10 posterior ribs above the diaphragm indicate adequate inspiration
• Right lateral performed if pathology is on the right side or as requested
• Lateral decubitus views (affected side down for effusion, up for pneumothorax) when free fluid/air must be confirmed
• Lordotic (AP axial) view to evaluate apices or right middle lobe
• Expiration PA helps demonstrate small pneumothorax

References