Chest Protocol

Technical Parameters

SID: 180cm (72 inches) minimum to reduce heart magnification.

Patient Prep: Remove artifacts (necklaces, bra underwire, ECG leads if safe).

Position: Patient erect, anterior chest against IR. Midsagittal plane aligned to midline. Chin raised. Hands on lower hips, elbows pushed forward to roll scapulae out of lung fields.

Centering Point (CR): Perpendicular to IR, centered to T7 (level of the inferior angle of the scapulae).

Respiration: Arrested on second full inspiration.

Image Evaluation Criteria

• Inclusion: Lung apices to costophrenic angles, and lateral rib margins.
• Rotation: Medial ends of clavicles must be equidistant to the thoracic spinous processes.
• Inspiration: Minimum of 10 posterior ribs visible above the diaphragm.
• Exposure: Faint outline of the upper thoracic vertebrae visible through the heart shadow.

Technical Parameters

Position: Patient erect, left side positioned against the IR (Left Lateral minimizes heart magnification). Arms raised high and folded over head to clear the apices.

Centering Point (CR): Perpendicular to IR, centered to T7 on the mid-coronal plane.

Collimation: Superior to lung apices, inferior to costophrenic angles, anterior to sternum, posterior to posterior ribs.

Image Evaluation Criteria

• Rotation: Posterior ribs should be superimposed (less than 1cm of separation).
• Inclusion: Apices, sternum, and posterior ribs completely included.
• Anatomy: Sharp outlines of the diaphragm and heart shadow. Intervertebral foramina should appear open.

Technical Parameters

SID: 100-150cm depending on child size (shorter SID for smaller children).

Patient Prep: Remove artifacts. Use immobilization devices if needed. Parent/guardian may hold child if cooperative.

Position: Child erect or sitting, anterior chest against IR. Midsagittal plane aligned to midline. Arms raised or supported to clear lung fields.

Centering Point (CR): Perpendicular to IR, centered to T6-T7 level.

Respiration: Full inspiration - count ribs to ensure adequate inspiration (8-9 posterior ribs above diaphragm).

Special Considerations: Fast exposure times to minimize motion blur. Lower kVp for better contrast in soft tissues.

Image Evaluation Criteria

• Inclusion: Lung apices to costophrenic angles, including thymus shadow.
• Rotation: Medial ends of clavicles equidistant to spinous processes.
• Inspiration: 8-9 posterior ribs visible above diaphragm.
• Exposure: Vertebral bodies visible through cardiac shadow. Thymus may be prominent.
• Motion: No motion blur from breathing or movement.

Technical Parameters

Equipment: Portable X-ray unit with appropriate SID (minimum 100cm).

Position: Elevate head of bed as much as patient's condition allows (semi-erect preferred). Roll shoulders forward if possible.

Centering Point: T7 (approximately 8-10cm below the jugular notch).

Tube Angulation: Ensure central ray is perpendicular to sternum to avoid lordotic appearance.

Respiration: Full inspiration if patient can cooperate.

Image Evaluation Criteria

• Inclusion: Lung apices to costophrenic angles, including mediastinum.
• Rotation: Assess for rotation (may be difficult in supine position).
• Inspiration: As much as patient's condition allows.
• Exposure: Adequate penetration despite shorter SID and potential OID increase.
• Artifacts: Note any equipment or patient-related artifacts.