Chest - PA Erect

Radiographic Positioning

Adult

Other related pages of interest Applied Radiography Radiographic Anatomy Radiographic Protocols

Name of projection	Chest - 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.
Positioning	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) OR B. Place the back of their hands against their lower hips
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 10th posterior ribs will be visualised above the diaphragm on full inspiration Area Covered Lungs fields, apices, costophrenic angles, heart Collimation 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 Exposure There should be adequate exposure so that the ribs and thoracic vertebrae are seen faintly through the heart 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