Chest X-ray Positioning

[@ameerkasana7319]

I’m in rad tech program right now and I can honestly say that I am going to be one of the best students because of my confidence and the fact I am focused and just fully engaged. We are working on upper extremity right now we will start getting into chest and abdomen I think that’s the last chapter. Mid one is lower

[@calivali2876]

Good luck, remember not to confuse confidence for arrogance, make sure you get help when you need kt

[@xrayimaginglady2586]

I wish you the best of luck!

[@markc15057]

Thanks for posting all these videos! I am an xray/mri tech, but needed to "retire" to be caregiver for parents. I will need to return to work sometime in the future and most likely will return to xray rather than mri (due to my inability to keep up with the ever evolving implant safety in mri). So glad I will be able to make sure I keep up my xray skills by watching videos like yours!

[@dennishdz]

Your videos help out a lot during competencies. Thank you!

[@xrayimaginglady2586]

I’m glad you find them helpful, Thank you!

[@MarionGelan]

I second this ! It’s so refreshing to have clear and concise videos

[@user-bk7bc2yb2h]

Thanks for posting all these videos

[@zahraasadzadeh-p1n]

This post was great,thank you

[@dliv1687]

I did this exact xray today, and they told me I didn't need a lead apron.

[@xrayimaginglady2586]

They are moving away from shielding. Physicists are stating that shielding is unnecessary in most cases and can cause a higher radiation dose.

[@elitestar]

Why did you move the marker to the anterior side? Also how do you find T7?

[@liizzx2]

They move the marker so is not in the way of anatomy, less repeat , t7 = inferior angle of scapula

[@Nanthini-u5r]

Ladies x ray centerla work pannalama

[@user-bk7bc2yb2h]

TR-300A KV-mA- SEC- TIME USE HELP PLEASE

[@MarCo-gv8pt]

Good 👍☢️☢️

[@salmahossam1447]

why is chest x rays most of the time done in a posteroanterior view why not the opposite direction ?

[@xrayimaginglady2586]

The main reason we do a PA as standard is because the heart is magnified on an AP view

[@salmahossam1447]

@@xrayimaginglady2586 thanks a lott

[@FokrulAlam-w6r]

❤

[@IrisFields-e7o]

Jones Melissa Anderson Ruth Jones Betty

[@Banblbe]

Deep breath from the nose or the mouth

[@vorovskoivorovskoi386]

The image is too offensive

[@phuctranviet9198]

the sound is not good I am quite disappointed

[@xrayimaginglady2586]

I’m very sorry, It’s hard with masks on and just a cell phone. I wish I had better tech skills!

[@xrayimaginglady2586]

I am sorry you are disappointed. I do my best with the equipment and technology I have. Plus I think it is harder to hear with masks on.

[@troythexrayboy]

Nice video! I like how you had the patient take in that second breath for maximum inspiration 😁👍

[@xrayimaginglady2586]

Thank you!

[@tranhuong552]

the sound is not good I am quite disappointed

[@xrayimaginglady2586]

I am sorry you are disappointed. I do my best with the equipment and technology I have. Plus I think it is harder to hear with masks on.

[@kyo8905]

She was loud and clear to me… anyways

[@kyo8905]

She was loud and clear to me… anyways

[@yourboysteve5019]

I want to work with you

[@TejRecordz]

Need more of these, im applying for the radiology program in spring CANT WAIT!!!!!!!!!!!!! 😎

[@xrayimaginglady2586]

Best of luck!!

[@yadiraurquiza]

Omg thank you for posting these videos I start school in July and I’m glad I found your channel!

[@xrayimaginglady2586]

Thank you! Good Luck to you!

[@xrayimaginglady2586]

I'm glad you find them helpful! Hope school is going well!

[@yadiraurquiza]

@@xrayimaginglady2586 yes it is! We started chest X-rays this week and this video was very helpful !

[@xrayimaginglady2586]

I appreciate your feedback! Good luck in your program!

[@sandrapeterson3849]

Lewis David Gonzalez Richard Jones Jennifer

[@BobCarl-b8s]

Anderson Eric Robinson Barbara Lewis Richard

[@crystalingram3993]

I h. Pnmont and I so sad

[@busarial-amid8124]

Radiography 😊

[@boss-ts6gd]

perfect

[@kelsenonyedikachinnaji9412]

Your videos have helped me a lot. Thank you for posting them!

[@xrayimaginglady2586]

I’m so glad to hear it! Thank you!

[@cloverleaf3146]

Can chest x-ray detect any breast issues? Like tumors or something?

[@jax6230]

I am sorry but I'll have to criticise the positioning. If you have a mobile and stable patient like that, you'd want them to laterally extend their arms, place the dorsal aspect of their hand on their hips and roll their elbows anteriorly while the shoulders are relaxed. This moves the scapulae out of the lung fields more effectively than just making them hug the board. Even if they are to hug the board, you can still ask them to turn their hand in a way where the thumbs are pointing towards the floor and the palms are facing outwards away from the bucky.

[@jax6230]

Also, there is no need for the led sheet anymore. Recent research suggests it actually contributes to higher doses as the scattered radiation bounces back and forth in the patient's body as it can't escape as effectively. In the UK we have stopped using them completely.

[@Iwillfightcauseigotnothing]

@@jax6230 with lead aprons thing, it depends on the country, state, hospital, and the department's protocol for each examination. a specific tech can't just stop using them even though the AAPM/NCRP recommends it. the department need to discuss the lead shielding situation first. although i'm assuming the OP is in US, and many don't do shielding anymore there based on recommendations also, for moving the scapula out of the lung field. the way she did it is "famous" in the US and is taught there. but yeah the method you mentioned is more obviously effective. a preference for some techs I guess?

[@xrayimaginglady2586]

You are correct! Many physicists are recommending not to shield, due to the increased dose by trapping scatter. However, that decision is based on the individual facility. My students attend clinicals at many different facilities in our area and some still require shielding. So, until there is a change in requirements from the ASRT they will be required to follow the protocols of their departments. As for the comment on the positioning I completely respect your opinion. In our facilities in my area wrapping the arms around the back of the machine to grab the handles and rolling the shoulders is common and will obtain a good quality image and move the scapula's out of view, but it also increases safety by keeping the patient steady and decreases the chance of motion. I do always tell my students; I am one person, and not everyone does things the way I do. All Radiographer's have slightly different ways of doing things, which is perfectly acceptable as long as you are obtaining a high-quality diagnostic image. They may also go to different facilities and learn different techniques and to follow their policy's. Thank you for your feedback!

[@jax6230]

​@@xrayimaginglady2586 Thank You for your answer! Yes, I do realise your point now, that it`s not exactly always an individual choice to use led sheets or not. I do hope that all organisations will synchronise with the latest research though eventually. To be completely honest about the PA CHX positioning, UK radiographers use the technique showed in the video as well, but mostly with patient who are less stable. I had some conversations with reporting radiographers who report and diagnose images and they can get quite annoyed with us sometimes if we use this technique as it still leaves some of the medial border of the scapula in the Lung field. Of course, sometimes you just have to do what you do based on the patient`s ability.

[@farihahanjum]

@@xrayimaginglady2586 can you tell me where you got the positioning from? if its in some research or book? i have tried to find this positioning in multiple books but i have never seen it

[@Samson-dn4eo]

im a student and always clip the front or back for the lateral. and for the PA i almsot always click the top or bottom for landscape (most patients are big)

[@xrayimaginglady2586]

Hi there! Keep working you will figure it out. When you clip next time ask the tech you are working with for feedback on how to correct it. On the lateral try to make sure you are at the mid coronal plane. Your CR should be just below the posterior area of the arm pit on the lateral. On the PA landscape make sure that you don’t have a lot of light above the shoulders. Try just barely grazing the top of shoulders with light. It’s hard to explain here and without seeing your positioning. Good luck!

[@Samson-dn4eo]

@@xrayimaginglady2586 thank you! i will try this tomorrow

[@dannypatino3895]

just bring the board down a little bit when doing lateral

[@AfiOye]

Thank you! Just got my chest comp! 🥰

[@xrayimaginglady2586]

Wonderful!

[@jereledwards2291]

I miss my healthcare provider.

[@abhishektyagi4047]

Thanks for the crisp informative video!

[@brownskinbeauty.]

How do we fix the lateral if a patient is over rotated? I did the same steps in the video but the provider I work for keeps saying the positioning is more oblique and obstructs his view

[@xrayimaginglady2586]

The first thing you should do when you put a patient into a lateral position is check that the feet and hips are not rotated at all. One foot shouldn’t be in front or behind the other. Then once the arm are up you can feel on the scapulas. If you put you hand across both scapula at the same time the shouldn’t be rotated. I can’t see how the Cheat would be more of an “oblique” unless it is very rotated.

[@NSS9749]

Should collimation be part of this exam? on the Left lateral it seems that there was too much light in the back and in the front, unnecessary radiation to the patient. Also, on the left lateral, the bucky should be lowered by 1/2 inch to avoid clipping the anatomy, more specifically, the costophrenic angles due to magnification OID (divergence of the beam). OR it all depends on the patient's body habit? It is not a rule?!!! just curious, thanks.

[@xrayimaginglady2586]

Hello! Yes, collimation should always be part of an exam! Unfortunately I made these videos quickly during COVID and they aren’t perfect! Collimation is the best way to limit your patient’s radiation exposure and get a better quality image. In real life I would absolutely collimate in. As far as moving the bucky down on the lateral, that is not a set in stone rule. I will take my PA view and look at my image to access if I need to move my bucky down or not. If I am close the clipping the costophrenic angles then I will lower my bucky down. Your positioning book probably says “it may be necessary due to the reasons you listed” you don’t automatically have to do it unless your instructor or site requires it.

[@NSS9749]

@@xrayimaginglady2586 excellent! it makes sense; If we see a PA chest X-ray with enough space inferiorly, then not messing with the bucky moving down for lateral would be okay, nice! thank you!

[@blastomanto5687]

How would you find where t7 is

[@xrayimaginglady2586]

I teach my students to use a hang 10 method. Put your hang in the hang10 sign and put your pinky finger on the vertebral prominence and let your thumb rest about 7” below that. That is the approximate level of T7. Also T7 is about in-line with the inferior border of the scapula

[@peezy5895]

what can this xray detect ?

[@xrayimaginglady2586]

Hi! A chest Xray can detect many things, heart related issues, lung disease, fluid, CoVID, pneumonia, collapsed lung, Cancer and more.

[@reneyoo6111]

How much msv exposure for chest?

[@AfiOye]

The technique? I would use 100KVP at 2mAs for her. She's small.

[@vermilionwinsor411]

you don't need to take off your shirt? :D

[@xrayimaginglady2586]

Well that depends. This is just an example. In real life you would want to ensure there are no artifacts. So we do change patients into a gown. However many facilities allow a T-shirt to be left on if there isn’t any artifacts.

[@vermilionwinsor411]

@@xrayimaginglady2586 got an x ray done today and yeah, had to strip my top and wear the patient gown. the person in charge was pretty assertive, probably had enough with shy folks like me🤣👍

[@oswaldopadilla3128]

Any tips for when you’re clipping the costophrenic angles? My collimation was good so was my positioning. The patient was a bit big.

[@vinceiodice824]

Usually big patients have smaller lungs, while very high patients have much longer lungs so you can collimate vertically if necessary

[@jazmindominguez9672]

What mAs would you set this to? For the PA and lateral?

[@xrayimaginglady2586]

Sorry for the delayed response. Every machine is different so it’s hard to say a definitive number. On average 1.2 mAs for the PA and 5 mAs for Lateral. Again this would also depend on your equipment and the kVP you use.

[@snehavarak7917]

@@xrayimaginglady2586 I want to work with you ma'am

[@sevaceferova4286]

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