Lungs AP Axial Lordotic

• Bilateral pulmonary apices.
• Upper lung zones free from clavicular superimposition.
• Clavicles projected above the lung apices.

• Verify patient identity using two identifiers.
• Remove all radiopaque objects from the chest area.
• Explain breathing instructions: exposure at the end of the second full inspiration.
• Stand the patient about 1 foot (30 cm) in front of the IR, then lean back until the shoulders, neck and back of the head rest on it.
• Both hands on the hips, palms out; roll the shoulders forward.
• Ensure patient is stable; use support if needed to maintain the position.
• Center the midsagittal plane to the CR and the centerline of the IR; top of the IR about 3 inches (7 to 8 cm) above the shoulders.

Midsternum, 3 to 4 inches (9 cm) below the jugular notch, at the midsagittal plane. Leaning back projects the clavicles above the lung apices.

Lordotic: patient leans back so the shoulders rest on the IR; CR perpendicular to the IR, centered to the midsternum. (Alternative if the patient is weak or unstable: AP semiaxial supine, CR 15 to 20 degrees cephalad to the midsternum.)

kVp

120

mAs

DR 2 / CR 4

SID

72" (183 cm)

Notes

Lean-back lordotic with a horizontal CR. If the patient is weak or unstable, take an AP semiaxial supine with the CR 15-20 degrees cephalad to the mid-sternum. Sample technique: DR 2 / CR 4 mAs at 120 kVp, 72 in SID, for a 23 cm part (Merrill's sample chart). Adjust for your equipment.

kVp and mAs are sample values. Use caution when applying them in your department.

• Entire lung fields and clavicles included.
• Pulmonary apices clearly visualized free of the clavicles, which project above them.
• Both apices and upper lung zones visible in their entirety.
• Clavicles nearly horizontal, medial ends superimposed by the first ribs.
• Ribs distorted: posterior ribs nearly horizontal, superimposing the anterior ribs.
• No rotation: sternal ends of the clavicles the same distance from the vertebral column, and lateral rib borders at nearly equal distances from it.
• Center of the collimation field (CR) at the midsternum, with collimation visible at the top and bottom.

1. 1 Inadequate lordotic position fails to project apices clear of clavicles.
2. 2 Rotation tilts the apices laterally and obscures the midline structures.
3. 3 In the supine alternative, less than 15 degrees cephalad fails to clear the clavicles.
4. 4 CR aimed too high or low misses the apical region.
5. 5 Patient unable to maintain lordotic position causes loss of the effect.
6. 6 Rotation: sternal ends of the clavicles at unequal distances from the vertebral column.
7. 7 CR not centered to the mid-sternum, 3-4 inches below the jugular notch.

• Rule out calcifications and masses beneath the clavicles.
• Assessment of pulmonary apical regions not clearly visible on standard projections.