BONY THORAX PP: upright, adjust pt.

in true lateral position; broad

surface of sternum ┴ to IR; suspended deep
PA OBLIQUE PROJECTION inspiration, lock hands behind the back.
PP: Prone or upright (trauma patient); RAO; body
RP: Lateral border of midsternum
rotated 15-20o (prevents superimposition of sternum
CR: ┴ to the center of IR and entering the lateral
& vertebrae); Have the pt support the body on the
forearm and flexed knee. border of the midsternum.
RP: T7 of elevated side of posterior thorax & 1 in. SS: A lateral image of entire length of sternum
lateral to MSP shows the superimposed sternoclavicular joints
CR: ┴ to IR, and medial ends of the clavicles.
SS: Entire sternum from jugular notch to tip of the
xiphoid process
• Sternum free of superimposition from
vertebral column
• Sternum projected over the heart
CI: Fractures, Osteomyelitis, Osteoporosis

LATERAL PROJECTION R OR L POSITION

(RECUMBENT)
PP: Lateral recumbent, Flex the pt. hips and knees
to a comfortable position. Pt. arm over the head and
adjust the rotation of the pt body so that the broad
surface of the sternum is perpendicular to the plane
of IR. Center the sternum to the midline of the grid .
MOORE METHOD RP: level of T7 & 2 in. to the right of spine
PA OBLIQUE PROJECTION CR: ┴ to the center of the IR and entering the
PP: Modified prone position; tube positioned over lateral border of the midsternum
the patient’s right side; patient stand at the side of SS:Lateral aspect of entire length of the sternum,
table; bend at the waist; arms above shoulders; palms sternum free from superimposition by the ribs and
down on table. soft tissues of the shoulders and arms.
RP: level of T7 & 2 in. to the right of spine CI: Fractures, Osteomyelitis, Osteoporosis
CR: 25o toward MSP; large patient (less angulation);
small patient (more angulation)
SS: Sternum free of superimposition from vertebral
column
• Entire sternum from jugular notch to tip of
the xiphoid process
Sternum projected over the heart
CI: Fractures, Osteomyelitis, Osteoporosis
B).STERNOCLAVICULAR ARTICULATIONS

PA PROJECTION
PP: Prone or upright (trauma patient); arms along the
sides; palms facing upward; head turned facing the
affected side for unilateral examination (rotates the
spine slightly away from side of interest); head rested
on chin for bilateral examination
LATERAL PROJECTION • Center MSP of the pt.body to the midline of
R or L Position Upright grid. Center IR at the level of spinous process
RP: T3
CR: ┴ to the center of the IR radiograph, with the manubrium and medial end of
SS: Sternoclavicular joints and medial portions of the clavicle inc.
the clavicles. KURZBAUER METHOD
CI: Trauma, Infection, Congenital abnormalities AXIOLATERAL PROJECTION
PP: Lateral recumbent; affected side against IR; hips
& knee flexed; arm of affected grasp the end of table
(for support); arm of unaffected side grasp the dorsal
surface of hip (depressed shoulder); anterior surface
of manubrium ┴ to IR
RP: Lowermost sternoclavicular articulation
PA OBLIQUE PROJECTION CR: 15o caudad
Body Rotation Method SS: Unobstructed sternoclavicular joint; sc joint on
PP: Prone or seated-upright (trauma patient); affected side; sc joint articulation, free from
RAO/LAO; body rotated 10-15o toward affected side superimposition by the shoulders.
(projects vertebrae well behind the SC joint); adjust CI; Trauma, Infection, Congenital abnormalities
the pt. position to center the joint to the midline of
the grid
RP: Level of T2-T3 (3 in. distal to vertebral
prominens) & 1-2 in. lateral from MSP
CR: ┴ to the sternoclavicular joint closest to the IR.
CR enters at the level of T2-T3.
SS: Slightly oblique image of Sternoclavicular joint
is demonstrated; SC joint of interest in the center of C).RIBS
the radiograph, with the manubrium and medial end PA PROJECTION
of the clavicle inc. PP: Upright/prone; center MSP of the pt body to the
CI: Trauma, Infection, Congenital abnormalities midline of the grid; hands rested against hips; palms
turned outward; chin rested on chin; suspend at full
inspiration (depresses diaphragm)
RP: T7
CR: ┴ or 10-15o caudad (to demonstrate 7th-9th ribs)
SS: Anterior ribs (1st-9th ) above the diaphragm
CI: Fractures and neoplastic processes
PA OBLIQUE PROJECTION
Central Ray Angulation Method
PP: Prone pos on a grid IR directly under the upper
chest; chin rested on table or rotated toward the side
of interest; Center grid to the level of SC joints;hands
along the sides palms facing upward; Chin at the side
RP: Level of T2-T3 (3 in. distal to vertebral
prominens) & 1-2 in. lateral from MSP AP PROJECTION
CR: 15o toward MSP PP: CenterMSP to the midline of the grid; palms
SS: Open SC joint space, slightly oblique image of outward, against the hips; adjust pt shoulders to lie in
SC joint; SC joint of interest in the center of the the same transverse plane, and rotate the forward to
draw scapula away from ribcage
 • Upright: to image ribs above diaphragm; IR PP: RAO/LAO; body rotated 45o (affected side up)
top board 1.5 in. above shoulder; shoulder • Upright: to image ribs above diaphragm;
rotated forward; suspend at full inspiration forearm of affected side rested on grid
(to depress diaphragm) device; suspend at full inspiration (to depress
• Supine: to image ribs below diaphragm; diaphragm)
shoulder in the same transverse plane; • Supine: to image ribs below diaphragm;
suspend at full expiration (to elevate patient rested on forearm; knee of elevated
diaphragm) side flexed; suspend at full expiration (to
RP: T7 (upper ribs) or T10 (lower ribs) elevate diaphragm)
CR: ┴ to the center of IR RP: T7 (upper ribs) or T10 (lower ribs)
SS: Posterior ribs above the diaphragm (1st-10th ) & CR: ┴ to the center of IR
below the diaphragm (8th -12th ) SS: Axilliary portion of the ribs free of bony
superimposition; (1st-10th ) ribs visible above
diaprahgm & below the diaphragm (8th -12th )

AP OBLIQUE PROJECTION
PP: RPO/LPO; body rotated 45o (affected side Costal Joints AP AXIAL PROJECTION
down); arm of affected side abducted; opposite hand PP: Supine; head rest directly on the table; center
on hip; Abduct arm of the affected side, and elevate MSP to midline of grid; adjust pt shoulders to lie in
it to carry the scapula away from ribcage same transverse plane
RP:
• Upright: to image ribs above diaphragm;
CR: Directed 20 deg cephalad entering the midline
hand rested on head; suspend at full about 2 inch above xiphoid process
inspiration (to depress diaphragm) SS: Costovertebal and costotransverse joints are
• Supine: to image ribs below diaphragm; hip demonstrated; open costovertebral costotransverse
elevated; suspend at full expiration (to joints
elevate diaphragm) CI:
RP: T7 (upper ribs) or T10 (lower ribs)
CR: ┴ to the center of IR
SS: Axilliary portion of the ribs projected free of
superimposition; 1st-10th ribs visible above the
diaphragm for upper limbs anbelow the diaphragm
(8th -12th ).
CI: Fractures and neoplastic processes
THORACIC VISCERA
D).TRACHEA

AP PROJECTION
PP: Supine/upright; neck slightly extended; MSP ┴
to IR; Adjust pt.shoulders to lie in the same
transverse plane; Center IR at the level of the
PA OBLIQUE PROJECTION manubrium; exposure during slow inspiration;
RP: Manubrium rest shoulder firmly against IR; depress the opposite
CR: ┴ through the manubrium to the center of the IR shoulder as pos. body in true lateral position.
SS: Outline of the Air-filled trachea; Area from the RP:
CR:15 deg caudad directed to the center of IR
midcervical to the midthoracic region.
through the adjacent supraclavicular impression
CI: Aspiration/Foreign body, SS: Air-filled trachea; Shoulders well separated
from each other; area from mid-cervical to
midthoracic region
CI: visualize subluxation and fractures involving
the inferior cervical spine, superior thoracic spine
and adjacent soft tissue

LATERAL PROJECTION
PP: Seated/upright lateral position; hands clasped
behind the body; shoulder rotated posteriorly
(prevents superimposition of arms & superior
mediastinum); neck extended slightly; exposure
during slow inspiration
E). CHEST
RP: Midway b/n jugular notch & midcoronal plane PA PROJECTION
(for trachea); 4-5 in. lower (for superior PP: Upright/seated-upright (always); chin extended
mediastinum) upward; arms hanging at the side and flex arms and
CR: Horizontal though a point of midway bet. The to the rest of the back f the hands low on the hips;
jugular notch and the MCP depress the shoulders and adjust to lie in the same
SS: Air-filled trachea &trachea and superior transverse plane; exposure after second full
mediastinum free from superimposition y the inspiration (general) or end of full inspiration &
shoulders expiration (for presence of pneumothorax & foreign
ER: described by Eiselbeg & Sgalitzer body)
• Used to demonstrate restrosternal extensions RP: T7
of the thyroid gland CR: ┴ CR enters at the level of T7
• Thymic enlargement in infants (recumbent SS: Entire lung field
position) • Sharp outline of heart
• Opacified larynx & upper esophagus • Sharp outline of diaphragm (expiration)
• Outline of trachea & bronchi • Ten posterior ribs above diaphragm
CI: Aspiration/ For foreign body localization Upright Position Rationale:
• Diaphragm at its lowest position
• Air-fluid levels are seen
• Avoid engorgement of the pulmonary
vessels
CI: Pleural effusion, Pneumothorax, Atelectasis

AXIOLATERAL PROJECTION (TWINING

METHOD R OR L POSITION)
PP: Seated/Upright; affected side toward the IR;
elevate the arm adjacent to IR in extreme abduction,
flex elbow,place foream across or behind the head;
 AP PROJECTION PA OBLIQUE PROJECTION
PP: Supine/upright; back against IR; place hands on PP: Upright/seated-upright; LAO/RAO (affected
hips; elbow flexed; hand pronated side up); body rotated 45o toward unaffected side;
RP: 3 in. inferior to jugular notch 55-60o (for cardiac series; )10-20o (for study of
CR: ┴ pulmonary diseases); shoulder of unaffected side
SS: Somewhat similar to PA but magnified against IR; weight of pt must be equally distributed
on both feet;
• Magnified heart & great vessels
RP: T7
• Lung fields appear shorter
CR: ┴
• Clavicle projected higher SS: Entire lungs, Trachea filled with air,
• Ribs assume horizontal position • LAO:
Resnick Recommendation: o Maximum area of right lung
• CR 30o caudad to midsternal region o Trachea & carina
• Rationale: to free basal portions of the lung o Entire right branch of bronchial tree
fields from superimposition by anterior o Heart, descending aorta & aortic arch
diaphragmatic, abdominal & cardiac o Esophagus (if barium filled)
structures • RAO:
CI: Pleural effusion, Pneumothorax, Atelectasis o Maximum area of left lung
o Trachea
o Entire left branch of bronchial tree
o Best image of left atrium, anterior
portion of apex of left ventricle &
right retrocardiac space
o Esophagus (if barium filled)
• Medial part of right middle lobe & lingula of
LATERAL PROJECTION the left upper lobe free from hilum (CR 10-
PP: Upright/seated-upright; left side against the IR 20o )
(for heart & left lung) or right side against the IR (for CI: Pleural effusion, Pneumothorax, Atelectasis
right lung); MSP // to IR; MCP ┴ to IR; arms
extended directly upward; elbow flexed; forearm
resting on elbows
RP: T7
CR: ┴ to IR, CR enters on the MCP at the level of
T7
SS: Heart, aorta & left-sided pulmonary lesions (left
lateral) AP OBLIQUE PROJECTION
• Right-sided pulmonary lesions (right lateral) PP: Upright/supine; LPO/RPO (affected side down);
ER: body rotated 45o toward affected side; shoulder of
• Employed to demonstrate the interlobar affected side against IR; flex elbows and place hands
fissures on the hips with palms facing outward or pronate
• To differentiate the lobes hands beside hips; raised hands closer to IR
• To localize pulmonary lesions RP: 3 in. inferior to jugular notch
CR: ┴ to IR at a level 3 inch below jugular notch
SS: Both lungs and its entirety; Trachea filled
with air; Visible identification markers
 • LPO: maximum area of left lung; similar to SS: Lung apices superior to shadow of clavicles;
RAO Apices in their entirety; Clavicles lying below the
• RPO: maximum area of right lung; similar apices
to LAO CI: Pleural effusion, Pneumothorax, Atelectasis
ER:
• Used when patient is too ill to be turned in
prone position
• Supplementary position in investigation of
specific lesions
• Used with recumbent patient in contrast
studies of the heart & great vessels
AP AXIAL PROJECTION
PP: Upright/supine; flex pt elbows and place hands
on hips with the palms out; place shoulders back
against the grid.
RP: Midsternum
; CR:15-20 deg cephalad to the center of IR
SS;Apices lying below the clavicles; Clavicles lying
superior to the apices; Superior lung region adjacent
LINDBLOM METHOD
to the apices.
AP AXIAL PROJECTION CI: : Pleural effusion, Pneumothorax, Atelectasis
PP: Upright; step 1 foot in front; lean backward in
extreme lordosis; elbow flexed; pronate hands beside
the hips; shoulder against IR;
RP: Midsternum
CR: ┴ or 15-20o cephalad (no leaning backward)
SS: Lung apices inferior to shadow of clavicles;
clavicles lying superior to the apices
• Demonstrate interlobar effusions
ER: Used in preference to PA axial projection in AP/PA PROJECTION
hyperstenic patient & whose clavicles occupy a R or L Lateral Decubitus
high position PP: Lateral decubitus; patient lie on affected side
CI: Rule out calcifications and masses beneath the (for pleural effusion) or unaffected side
clavicles (pneumothorax); body elevated 2-3 in.; arms well
above the head; remain in position for 5 minutes
before exposure
RP: 3 in. inferior to jugular notch (AP) or T7 (PA)
CR: Horizontal and ┴ to the center of the IR at a
level of 3 inch
SS: Apices; affected side and its entirety;
PA AXIAL PROJECTION demonstrates the change in fluid position and
PP: Upright; chin rested against the IR; elbow reveals any obscured pulmonary areas
flexed; pronate hands on hips; depress shoulder & Cl: Pleural effusion, Pneumothorax, Atelectasis
rotated forward; exposure at end of full inspiration
RP: T3
CR: 10-15o cephalad (expiration optional) or ┴ to IR
and centered at the level of T7
 LATERAL PROJECTION
R or L Position
Ventral/Dorsal decubitus Position
PP: Supine/prone; thorax elevated 2-3 in.; remain in
position 5 minutes before the exposure; extend arms
well above the head; affected side against the IR
RP: 3 in. inferior to jugular notch (ventral decubitus)
or T7 (dorsal decubitus)
CR: Horizontal
SS: Shows aa change in position of fluid and
reveals pulmonary areas that are obscured by fluid
in standard projection
• Entire lung fields; Upper lung fields not
obscured by the arms; no rotation of thorax
Cl: Pleural effusion, Pneumothorax, Atelectasis