Chest - PA Erect

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Name of projectionChest - PA Erect
Area Covered Lung fields, apices, costophrenic angles, heart
Pathology shown Pleural effusions, pneumothorax, signs of infection, masses, nodules, atelectasis
Radiographic Anatomy Chest Radiographic Anatomy
IR Size & Orientation 35 x 43 cm
Landscape usually, but may be portrait depending on body habitus
D.R. may cover 43 x 43 cm
Film / Screen Combination Regular
(CR and DR as recommended by manufacturer)
Bucky / Grid Moving or Stationary Grid
Filter Decubitus filter for women with large breasts, particularly for non-digital imaging
Exposure 100 kVp
4 mAs
FFD / SID 180 cm
Central Ray Directed to the midsaggital plane at the level of T7
Perpendicular to the IR
Collimation Centre: T7, or the inferior border of the scapula
Shutter A: Open to approximately 5cm (2 inches) above the shoulder to include upper airway
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 PA
Shielding Gonadal
(check your department's policy guidelines)
Respiration On suspended deep inspiration
Exposure may be taken on suspended full expiration when pneumothorax is suspected.
  • Patient erect, standing or seated, facing the bucky
  • Arms relaxed at the sides
  • Centre the midsaggital plane of the patient to the midline of the IR
  • Have the patient relax their shoulders and rolled forward to touch the bucky
  • Adjust the height of the bucky so that the upper border of the IR is 5cm (2 inches) above the shoulders
  • Raise the chin and rest on or above the bucky
  • Clear the scapulae off the lung fields by getting the patient to either

A. "Hug" the bucky by bringing the forearms behind the bucky (some buckys have purpose built handles for the patients to hold)
B. Place the back of their hands against their lower hips


  • 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 10th posterior ribs will be visualised above the diaphragm on full inspiration
    Area Covered
    • Lungs fields, apices, costophrenic angles, heart
    • Centre: T7 Thoracic vertebra
    • Shutter A: Open to show the lung apices superiorly and the costophrenic angles inferiorly
    • Shutter B: Open to show the lung fields laterally
    • There should be adequate exposure so that

      1. the ribs and thoracic vertebrae are seen faintly through the heart
      2. vascular lungs markings are shown
    Special Notes PA Erect Chest vs AP Supine Chest
    Where possible a PA Erect should be done instead of the AP Supine view. The AP Supine Chest view is taken when the patient is unable to be safely moved into the upright position. Differences or disadvantages of the AP Supine Chest view are;
    • Lung fields are shortened
    • the heart is magnified
    • the ribs may appear more horizontal
    • air-fluid levels are not seen
    • the clavicles are projected higher up
    PA Erect Chest vs AP Erect Chest
    The AP view shows magnification of the heart and widening of the mediastinum because they are anterior structures