LATERAL DECUBITUS CHEST

Tuesday, December 6, 2011

AP or PA Projection
Right or Left Decubitus Position


Pathology Demonstrated:
lateral decubitus
Right Lateral Decubitus Position


Small plueral effusion are demonstrated by ari-fluid levels in plueral space, or small amounts of air in plueral cavity mat demonstrate a possible pneumothorax (see notes).

Technical Factors:

IR size - 35 x 43 cm (14 x 17 inches), crosswise (crosswise with respect to patient)
Moving or stationary grid
110 to 125 kV range
Use decub marker (or arrow)

Shielding:

Place lead shield to shield gonads.

Patient Position:

Cardiac board on the cart or radiolucent pad under patient.
Patient lying on right side for right lateral decubitus and on left side for left lateral decubitus (see notes below)
Patient's chin extended and both arms raised above head to clear lungs field; back of patient firmly against IR; cart secured to prevent patient from moving forward and possibly falling; pillow under patient's head
Knee's flex slightly and coronal plane parallel to IR with no body rotation.

Central Ray:

CR horizontal, directed to center of IR, to level of T7, 3 to 4 inches (8 to 10 cm) inferior to level of jugular notch. A horizontal beam must be used to show air-fluid level or pneumothorax.
SID of 72 inches (180cm).

Collimation:

Collimate to area of lung fields (see note)

Respiration:

Make exposure at end of second full inspiration.

Alternative Positioning:

lateral decubitus
Right Lateral Decubitus X ray Image
Some prefer that the head be 10degree lower than the hip to reduce the apical lift caused by the shoulder, thereby allowing the entire chest to remain horizontal (requires support under hips).

Note:
  • Place appropriate "decubitus" marker and R or L indicate which side of chest is shown.
  • Radiograph may be taken as a right or left lateral decubitus.
  • To produce the most diagnostic images, both lungs should be included on the image. For possible fluid in the pleural cavity (pleural effusion), the suspected should be down.
  • Do not cut off that side of the chest.The anatomic side marker must correspond with the patient's left or right side of the body.
  • The market must placed on the IR prior to exposure.
  • It is not acceptable practice to indicate the of the body either digitally or with a marking pen following the exposure.
  • For possible small amounts of air in the pleural cavity (pneumothorax), the affected side should be up, and care must be taken not to cut off this side of the chest.

Radiographic Image: 
On arrows pleural effusion or fluid level is seen, and the standard technique factor should be increase to demonstrate clearly the air fluid levels on radiograph. As the free-air the standard technique factor needs to be decrease to clearly demonstrate on radiograph.

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