Chest - Apical

Radiographic Positioning

Adult

Other related pages of interest Applied Radiography Radiographic Anatomy Radiographic Protocols

Name of projection	Chest - Lordotic Apical
Area Covered	Apices of the lungs, clavicles, the upper two-thirds of the lung fields show foreshortened
Pathology shown	Lesions of the lung apices, such as tumour and infection
Radiographic Anatomy	Chest Radiographic Anatomy
IR Size & Orientation	24 x 30 cm or 30 x 40cm Landscape
Film / Screen Combination	Regular (CR and DR as recommended by manufacturer)
Bucky / Grid	Yes
Filter	No
Exposure	100 kVp 4 mAs
FFD / SID	180 cm
Central Ray	Directed to the midsagittal plane, at the level of the manubrium The angle of the central ray differs depending on the positioning method used Method 1: central ray is 30° cephalad Method 2: central ray is perpendicular to the IR
Collimation	Centre: Directed to the midsagittal plane, to the manubrium Shutter A: Open to film size or to include anatomy of interest Shutter B: Open to the level of the acromioclavicular joints (AC joints) laterally. This will include the lung fields laterally.
Markers	Superior and Lateral Marker orientation AP
Shielding	Gonadal (check your department's policy guidelines)
Respiration	On suspended deep inspiration
Positioning	Method 1: Position the patient AP with their back to the bucky Centre the midsaggital plane to the midline of the bucky Adjust the film height so that the clavicles are in the horizontal midline of the IR Angle the central ray 30° cephalad Method 2: Position the patient either standing or sitting AP with their back to the upright bucky Their back should be 30 cm away from the upright bucky Centre the midsaggital plane to the midline of the bucky Have the patient lean back so that their shoulders, neck and head are resting on the bucky Ask the patient to put the back of their hands against their lower hips (to help clear the lung fields of the scapula) Adjust the IR to 8 cm above the shoulders The central ray is perpendicular to the IR
Critique PACEMAN	Positioning No rotation as evidenced by the medial ends of the clavicles equidistant from the spine the clavicles are in the same horizontal plane The lungs fields are clear of the scapulae The clavicles are projected above the lung apices Area Covered The upper two-thirds of the lung fields Collimation Centre: T4 Thoracic vertebra Shutter A: Open to show the lung apices and upper two-thirds of the lung fields superiorly Shutter B: Open to show the lung fields laterally. Exposure There should be adequate exposure so that vascular lungs markings are shown
Special Notes	To rectify clavicle superimposition Method 1: Increase the cephalic central ray angulation Method 2: Have the patient further away from the bucky, ensuring their torso makes an angle with the bucky of approximately 45°