MODULE OF SKILL LABORATORIUM PRACTICE

BLOCK : RESPIRATORY SYSTEM

TOPIC

: DEMONSTRATE KNOWLEDGE
INTERPRETING NORMAL PLAIN CHEST
RADIOGRAPH

I. GENERAL OBJECTIVE

After finishing skill practice, the students will be

able to interpret normal plain chest radiograph

II. SPECIFIC OBJECTIVE

At the end of skill practice, the students
will be able to demonstrate knowledge
a. radiopositioning of the chest
b. conditions of a good chest X-ray.
c. radioanatomy of the chest

RADIO-POSITIONING
RADIO-ANATOMY
OF THE CHEST

Dr. Effendi Mansoor, SpRad(K)

RADIO POSITIONING
OF THE CHEST X RAY
Radio positioning

Postero-anterior
projection
Antero-posterior
projection
Lateral projection
Oblique projection
Lateral decubitus
projection
Apical top lordotic
projection
Cross table lateral
projection

Anatomic structure

Heart and lungs

Heart and lungs

Heart and lungs

Heart and lungs
Heart and pleura
Apical and medial lobe
of the lung
Lung and pleura 5

Chest X-ray Indication:

Contact person with open
pulmonary tuberculosis
Cough > 2 weeks after treatment
Recurrent respiratory infection
Hemoptoe
Extra pulmonary TB
Erytema nodosum / conjunctivitis
phlyctenularis
Fissura/fistula anichronicum
DM with cough
Screening

PA Projection in suspended full inspiration:

Place patient between film X ray

source
The patient stands backward to the
X- ray source
Chest close to film with hand on the
hip & with elbow flexed anteriorly
Distance between film and X-Ray

Lung 1.5 m
Heart 2.0 m

Ray concentrated at TH 6-7

7

PA position

Antero posterior (AP) projection

Indication :
Severely ill patient
Children / babies
Obese, pregnancy, ascites, abdominal tumor
Technique :
Place patient lying down on table with elbow
above head
Place film on patients back
Centered ray on Th 6-7

AP Projection

11

Lateral projection
Indication:
To study abnormality that is not
visible on PA film
To study mediastinal disorder
Heart studies
Technique:
Place patient between film and X-ray
source
Place lateral side of chest (left/right)
on film
Hands behind the head
Ray centered on Th 6-7

13

Lateral position

14

Oblique projection:
Indication :
Heart studies, usually with barium
fill in oesophagus
To study abnormality that is not yet
clear on PA/lateral studies
Technique:
Place patient between film and ray
source.
Put ventral left/right side of the
patients thorax on the film making
45 0 angle.
Centered ray on Th 6-7

18

19

Lateral Decubitus projection

Indication :
Fluid in pleural cavity that is around
100-200 cc.
Fluid accumulation that is not yet
determined on PA studies.
Technique:
Have the patient lying down on
left/right side with elbow above the
head.
Centered ray on Th. 6-7 from
anterior /posterior aspect.

21

Normal
22

Pleural effusion

23

Top lordotic projection:

Indication :
To studies disorder located on apex
clavicle turn upward
Technique :
Place patient between film and x-ray
source.
Have the patient face the x-ray source.
Have the patient stand 30 cm in front
with back placed on the film
Set top part of the film 1 inch above
the shoulder.
Centered ray on manubrium sterni.

25

26

PA chest radiograph

27

Condition of good radiograph of the chest

1. The quality of film is good
KV is enough (the thoracic vertebra
is clearly identified until the 3rd
thoracic vertebrae)
MAs is enough (our finger couldnot
be seen indistingly behind the film)
2. The thoracic cage is symetrical :
compare medial ends of the
clavical on each side with the
midline of thoracic spine (proc.
Spinosus)

Condition of good radiograph of the chest (cont)

3. The entire lung are include within

the film, no motion with both
scapulas pull-out
4. Identity (marker/R/L, name,
gender, age) are complete
5. No artifact
6. Maximum inspiration : the right
diaphragm as high as 5th ICS/6
end of the anterior rib

How and what to evaluate

the PA x-ray chest
1. Soft tissue :
- Is there any swelling/foreign
body/calcification/emphysema ?
2. Bony structure : Clavicle, rib, spine
- Is there any fracture, deformity, defect ?

3. Position of the trachea, is there any deviation ?

4. Heart and aorta : position, shape, size ?
5. Costophrenic and cardiophrenic angle : sharp ?
6. Pleural space : thickening/effusion/pneumothorax ?
7. Diaphragm : shape? position?
8. Pulmonal structure : symetrical brightness, pathologic
opafication, nodular, linier, luscency ?

9. Hilar region : shape, enlargment,

deviation, calcification ?
10. Pulmonary vessels : increase, decrease,
crowded ?
11. Mediastinum : shape, size, density ?

PA position

 Heart and great vessels normal in size and

shape.
Lung fields clear, no evidence of lung
tuberculosis or any other lung disease

Sering tidak ada informasi klinis

Mohon thora foto pada pasien dengan

hemoptoe
33

Lung Anatomy-Right
Upper Lobe

Apical Segment (1)

Posterior Segment (2)
Anterior Segment (3)

Middle Lobe Lateral Segment (4)

Medial Segment (5)

Lower Lobe Apical Segment (6)

Medial basal Segment (7)
Anterior basal Segment (8)
Lateral basal Segment (9)
Posterior basal Segment (10)

Lung Anatomy-Left
Upper
Lobe

Apicoposterior Segment (1, 2)

Anterior Segment (3)
Superior Lingula Segment (4)
Inferior Lingula Segment (5)

Lower
Lobe

Apical (6)
Anterior medial basal (7, 8)
Lateral basal (9)
Posterior basal (10)

Pulmonary Segments

36

Pulmonary segments

37

Right lung lateral position

38

Left lung lateral position

39

Lateral position

40

Mediastinum Borders

- Top
- Dorsal
- Ventral
- Inferior
- Lateral

: Apertura thoracis sup.

: Vertebral Column.
: Sternum.
: Diaphragm.
: Mediastinal pleura.

Mediastinal
1.
2.
3.
4.
5.
6.
7.
8.

Anterior superior
Anterior medius
Anterior inferior
Superior medius
Middle
Posterior superior
Posterior medius
Posterior inferior