Radiography With Richie

Chest

Chest radiography is the most frequently performed exam in any medical setting. This section is designed to help imaging teams and clinical practitioners produce high-quality images by focusing on clear landmarks, patient comfort, and precise breathing instructions.

Our goal is to capture the entire thoracic cavity on the first attempt, reducing patient dose and ensuring providers have the information they need for fast clinical decisions.

A well-positioned chest X-ray is a powerful diagnostic tool. It allows clinicians to evaluate the heart, lungs, and bony thorax for conditions such as:

  • Infections: Demonstrating pneumonia or pleural effusion (fluid) in the lungs.
  • Trauma: Anatomical evidence for a pneumothorax (collapsed lung) or rib fractures.
  • Chronic Conditions: Assessing changes in cardiac size or lung parenchyma.

Because these exams are often ordered for patients with shortness of breath or chest pain, speed and accuracy are top priorities.

Key Positioning Principles for Chest Imaging

To ensure your images are diagnostic every time, keep these fundamentals in mind:

  • Upright is Best: Always perform chest X-rays with the patient standing if they are able. This allows the diaphragm to drop and demonstrates air-fluid levels.
  • The “Shoulder Roll”: On a PA view, rolling the shoulders forward is critical to move the scapulae (shoulder blades) out of the lung fields.
  • Deep Inspiration: Success depends on the patient taking a full, deep breath to expand the lungs.
  • Check for Rotation: Ensure the patient’s chest is flat against the board. Even a slight turn can make the heart look enlarged or obscure clinical findings.

Imaging Views Covered in This Section

Select a view below to learn step-by-step positioning and technique:

PA Chest
  • CR: Perpendicular to the IR, centered at the level of T7 (7–8 inches below the vertebra prominens).
  • SID: 72 inches.
  • Position: Patient upright, facing the IR; chin elevated; shoulders rolled forward; hands on lower hips.
  • Collimation: From the apices of the lungs to the costophrenic angles.
  • Richie’s Tip: Rolling the shoulders forward is the secret to moving the scapulae out of the lung fields. Also, always take the exposure on the second full inspiration to ensure maximum lung expansion!
Lateral Chest
  • CR: Perpendicular to the IR, centered at the mid-thorax at the level of T7.
  • SID: 72 inches.
  • Position: Left side against the IR; arms raised above the head; chin elevated; no rotation.
  • Collimation: Include the entire lung field from apices to the posterior costophrenic angles.
  • Richie’s Tip: Ensure the patient is in a true lateral position. If the posterior ribs aren’t superimposed, you’ve got rotation. We put the left side against the board to minimize heart magnification!