Lungs AP Axial Lordotic is a radiography positioning projection of the Thorax. AP lordotic for pulmonary apices. Patient leans back ~30°. SID 72". The centering point is located mid-sternum (manubrium level). patient leaned back ~30 degrees so the lordotic position projects clavicles above the lung apices.. The central ray is lordotic: patient leaned back ~30 degrees; cr horizontal and perpendicular to the ir, to the mid-sternum. (alternative ap axial: cr 15-20 degrees cephalad if the patient cannot lean back.). Image-quality criteria include pulmonary apices clearly visualized above the clavicles without superimposition., both apices and upper lung zones visible in their entirety.. Standard exposure ranges from 110 to 125 kVp, 2 to 5 mAs, at an SID of 72 inches (180 cm).
Anatomy demonstrated
- Bilateral pulmonary apices.
- Upper lung zones free from clavicular superimposition.
- Clavicles and scapulae projected below the apices.
- Thoracic trachea and proximal main bronchi.
- Ribs 1-5 in their entirety.
Patient preparation
- Verify patient identity using two identifiers.
- Remove all radiopaque objects from the chest area.
- Explain breathing instructions: inspiration on the second breath in, hold.
- Position patient erect, then have patient lean backward into lordotic position.
- Ensure patient is stable; use support if needed to maintain the position.
Position & centering point
Mid-sternum (manubrium level). Patient leaned back ~30 degrees so the lordotic position projects clavicles above the lung apices.
Central ray
Lordotic: patient leaned back ~30 degrees; CR horizontal and perpendicular to the IR, to the mid-sternum. (Alternative AP axial: CR 15-20 degrees cephalad if the patient cannot lean back.)
Exposure / technique
- kVp
- 110–125
- mAs
- 2–5
- SID
- 72" (180 cm)
- Notes
- CR angled 15-20 degrees cephalad. Exaggerated lordotic position required.
Image-quality criteria
- Pulmonary apices clearly visualized above the clavicles without superimposition.
- Both apices and upper lung zones visible in their entirety.
- Minimal superimposition of the shoulders over the apices.
- Clavicles and scapulae positioned below the apices.
- Full inspiration noted with a minimum of 10 ribs visible above the diaphragm.
- No rotation evident from the position of the sternoclavicular joints.
Common errors / ARRT traps
- 1 Inadequate lordotic position fails to project apices clear of clavicles.
- 2 Rotation tilts the apices laterally and obscures the midline structures.
- 3 Inadequate tube angulation (less than 15 degrees) does not fully separate clavicles.
- 4 CR aimed too high or low misses the apical region.
- 5 Patient unable to maintain lordotic position causes loss of the effect.
Clinical indications
- Evaluation of tuberculosis or other apical pathology.
- Assessment of pulmonary apical regions not clearly visible on standard projections.
- Detection of cavitary lesions or infiltrates in the apices.
- Follow-up studies of known apical pathology.
Aligned to the 2025 ARRT Content Specifications.