Is the image diagnostic? (10 point plan)

4. Correct projection for a mobile chest X-ray

If the patients condition allow better quality images will be achieved if the patient is positioned in the standard radiographic procedure, PA erect with a FRD of 180 cms or further.

Patients with Covid-19 can be managed prone to improve oxygenation. Radiographers/radiological technologists may be required to obtain PA prone radiographs, a practice that rarely occurred previously.The patient must be positioned parallel to the detector to reduce distortion and with as little rotation as possible.

Images should be performed on full inspiration and have symmetrical reproduction of the thorax.

For AP erect images the arms should be bent at the elbows, the hands rested on the pelvis and arm elevated if possible to minimize scapula over the lungfields. The whole bony thorax (ribs, spine and clavicles) needs to be demonstrated. Some spine detail is visualised through the heart and mediastinum. Symmetry is checked by having the medial ends of the clavicle equidistant from the spinous process

The commonest technique errors on mobile chest X-rays are:

  • Patient rotation around the coronal plane
  • Patient leaning backward (lordotic)
  • Poor inspiration.
    • This is always a challenge for ill patients and patients with Acute respiratory distress syndrome (ARDS) so practicing the technique with the conscious patients may help
    • the 6th anterior / 10th posterior ribs should cross the hemidiaphragm on the right side
  • Underexposure of the detector
  • Missing anatomy