The AP lordotic chest radiograph (or AP axial chest radiograph) demonstrates areas of the lung apices that appear obscured on the PA/AP chest radiographic views. It is often used to evaluate suspicious areas within the lung apices that appeared obscured by overlying soft tissue, upper ribs or the clavicles on previous chest views (e.g. in cases of tuberculosis).
- the patient is standing with feet approximately 30cm away from the image receptor, with back arched until upper back, shoulders and head are against the image receptor
- the shoulders and elbows are rolled anteriorly
- the angle formed between the midcoronal body plane and image receptor should be approximately 45 degrees
- anteroposterior projection
- suspended inspiration
- centring point
- superiorly 5 cm above the shoulder joint to allow proper visualisation of the upper airways
- inferior to the inferior border of the 12th rib
- lateral to the level of the acromioclavicular joints
- portrait or landscape
- 35 cm x 43 cm or 43 cm x 35 cm
- 100-110 kVp
- 4-8 mAs
- 180 cm
- yes (this may be departmentally dependent)
Image technical evaluation
- superior lung fields should be in the middle of the image with the clavicles, lung apices and two thirds of the lungs within the collimation field.
- sternoclavicular ends of the clavicles should be projected above the lung apices, and the first to fourth ribs should appear horizontal and near superimposed, demonstrating a correct lordotic position and/or angle.
- lateral borders of the scapulae demonstrated away from the lung fields, demonstrating sufficient anterior rotation of the patient’s shoulders and elbows.
- there should be equal distances from the vertebral column to the sternal clavicular ends, demonstrating no rotation.
- the clavicles should appear in the same horizontal plane.
There are several ways to accomplish this view, should the patient be unable to achieve the aforementioned positioning. The patient can remain completely upright with upper back and shoulders against the image receptor and a 45-degree cephalic central ray angulation used to project the clavicles above the apices. This positioning option can be used to achieve this radiographic view with a supine patient.
A combination of positions can also be utilised, with the patient’s back arched as much as possible and the central ray angled cephalically the amount necessary to equal a 45-degree angle.
Side marker placement is imperative; patients can have congenital conditions that mimic a mirrored image 2.
Remember to explain to your patient what you are about to do; that is ask them to take a breath in and hold it. Many times this gives the patient time to prepare and results in a better breath hold and therefore a higher quality radiograph.
Always remember to tell your patient to breathe again!
- 1. McQuillen-Martensen Kathy. Radiographic image analysis. 1st ed. St. Louis, Mo.: Saunders/Elsevier, 2011.
- 2. Keats TE, Anderson MW. Atlas of Normal Roentgen Variants That May Simulate Disease. Saunders. (2012) ISBN:0323073557. Read it at Google Books - Find it at Amazon
- radiographic positioning and terminology
- systematic radiographic technical evaluation
- chest radiography
- abdominal radiography
upper limb radiography
shoulder girdle radiography
- scapula series
- shoulder AP view
- shoulder internal rotation view
- shoulder external rotation view
- shoulder axial view
- shoulder modified trauma axial
- shoulder supine lateral
- shoulder modified supine lateral
- shoulder Y lateral view
- shoulder AP glenoid view
- shoulder apical oblique view (Garth view)
- humerus (neck) AP view
- humerus axial (bicipital groove) view (Fisk view)
- shoulder outlet view (Neer view)
- Stryker notch view
- acromioclavicular joint series
- clavicle series
- sternoclavicular joint series
- arm and forearm radiography
- wrist and hand radiography
- wrist series
- scaphoid series
- hand series
- thumb series
- fingers series
- rheumatology hands series
- bone age series
- shoulder girdle radiography
lower limb radiography
- pelvic girdle radiography
- pelvis series
- hip series
- sacroiliac joint series
- thigh and leg radiography
- femur series
- knee series
- tibia/fibula series
- ankle and foot radiography
- ankle series
- foot series
- calcaneus series
- toes series
- pelvic girdle radiography
- skull radiography
sinus and facial bone radiography
- facial bones
- Caldwell view (angled skull PA view)
- nasal bones
- zygomatic arches
- paranasal sinuses
- temporal bones
- dental radiography
- cervical spine radiography
- thoracic spine radiography
- lumbar spine series
- sacrococcygeal radiography
- scoliosis radiography