Copyright © 2009 [Gerald R. Aben, MD MSU Department of Radiology]. All rights reserved.
Revised: April 08, 2009
Chest Radiograph Consultation

 

In most patient encounters, requesting the optimal Chest Radiograph is simple.  For most chest pathologies the upright posterior- anterior (PA) and lateral views most accurately visualize the underlying structure.  This is the preferred view.  

In requesting any radiographic consultation including the Chest Radiograph, include the study desired, e.g. Chest Radiograph PA & Lateral and the indication.  For example "Please obtain PA & lateral Chest Radiographs in the morning; Indication: productive cough".  It is essential that the indication given reflects accurately the symptoms and signs that the patient is presenting with.  Not only does accurate information assist the radiologist in interpretation, in today's health care climate, this is essential information for accurate billing of a procedure.  

In some acutely ill patients it is not practical (or safe) to take the patient to the radiology department. Some patients are not able to tolerate positioning for a PA view.  In these instances the anterior-posterior (AP) portable view is usually acceptable.  In this situation, the technologist will bring the x-ray machine to the patient's bedside.  In all but the most unstable patients, an upright radiograph should be the goal.   PA- lateral and AP films account for more than 95% of Chest Radiographs ordered in typical clinical settings.  

There are three additional techniques that are sometimes utilized. The following table summarizes the Chest Radiographic techniques that you will need to be familiar with.

Indication

Preferred Radiograph Technique

Ambulatory persons

PA - lateral

Critically ill persons

AP (portable)

Possible apical disease

Lordotic

Possible pneumothorax

Expiration view

Possible pleural effusion

Lateral decubitus

The lordotic film is obtained in such a fashion that the upper lung fields are no longer obscured behind the clavicles and ribs.  The expiration film will accentuate a pneumothorax, as the amount of air in the pleural space will not decrease while the lungs themselves are reduced in volume.  Finally, in the decubitus film, by turning the patient on their side, free flowing pleural fluid will flow to the most dependent aspect of the pleural space.