XR Chest Portable (AP)

Indications

• Critically ill or non-ambulatory patient
• ICU monitoring
• Line and tube placement verification (ETT, CVC, NG, chest tube, Swan-Ganz)
• Acute respiratory deterioration
• Post-procedure (post-central line, post-intubation)

Patient prep

• Remove or reposition radiopaque external objects, leads, and tubing from field where possible
• Document patient position (supine vs semi-erect) and degree of elevation

Contrast

Technique

• AP projection with detector behind patient's posterior thorax
• Patient upright/semi-erect in bed if condition allows; otherwise supine
• SID as great as achievable, typically 40-72 inches (note SID on image)
• CR perpendicular (or slightly caudal if patient reclined) to T7, ~3 inches below jugular notch
• kVp ~80-90 (lower than upright PA due to portable limits); grid if available
• Suspended deep inspiration if patient able

Series / Sequences

Key points

• Heart appears magnified compared to PA technique
• Air-fluid levels and pneumothorax harder to detect when supine; note positioning
• Mark image with patient position and any rotation
• AP lordotic appearance common if CR not angled correctly

References