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Citation, DOI & article dataCitation: Murphy A, Bell D, Er A, et al. Chest (supine view). Reference article, Radiopaedia.org (Accessed on 25 Dec 2022) https://doi.org/10.53347/rID-45309 The supine anteroposterior chest view is the alternative to the PA view and the AP erect view when the patient is generally too unwell to tolerate standing, leaving the bed, or sitting 1. The supine view is of lesser quality than both the AP erect and the PA view for many reasons, yet sometimes it is the only imaging available to the patient. On this page:The supine view examines the lungs, bony thoracic cavity mediastinum and great vessels. This particular chest radiograph is often used to aid diagnosis of acute trauma abnormalities, or chronic conditions in intensive care units and wards. It is important to note that the supine projection will produce a magnified mediastinal shadow due to the increased distance of the heart from the image receptor and beam divergence (see figure 1 AP supine and figure 2 PA projection of the same patient).
The entire lungs should be visible from the apices down to the costophrenic angles:
This projection can be very challenging in emergency situations; clear communication is the key to ensuring your patient gets the best image possible under the situation at hand. The supine view, although a supplementary projection for the PA comes with a wide range of technically-challenging factors and is hence inferior. The phase of respiration has a profound effect on the appearance of several structures on the chest radiograph. A suboptimal inspiration AP radiograph may mimic pathology. Structures that can appear different on expiration include:
Rotation of a patient can mimic common pathology processes and make it hard to produce an appropriate diagnosis. The supine view is used to investigate many conditions and it is the radiographer's responsibility to ensure high-quality diagnostic images are achieved consistently. The sternoclavicular joints are a sound indicator for positional rotation, if one sternoclavicular joint is notably wider than the other, that respected side needs to be rotated away from the image receptor to correct rotation. Patients with a long-standing history of emphysema or COPD will have abnormally long lungs compared to the general population, remember this when collimating superior to inferior. 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! Related articles: Imaging in practicePromoted articles (advertising)Where should the top of the IR be positioned for a supine AP projection of the chest?For an AP chest projection obtained with a mobile x-ray unit, 1) the IR is positioned parallel with the midcoronal plane. 2) the image is obtained without the use of a grid.
How should the CR for an AP supine chest be aligned?The central ray (CR) is set perpendicular to the long axis of the sternum and the center of the cassette. The jugular notch is the recommended landmark for the location of the CR for AP chest radiographs. The notch is used for locating the center of the lung fields at the T7 level (mid-thorax).
How far above the top of the shoulders should the IR be positioned for any decubitus position of the chest?For lateral decubitus chest radiographs, place a 14 x 17-inch (35 x 43-cm) film holder or IR behind the patient, either crosswise or lengthwise depending on their build. Adjust the IR so that it extends approximately 1 ½ - 2 inches (4-5 cm) beyond their shoulders.
What will be observed on a supine AP chest radiograph?The supine view examines the lungs, bony thoracic cavity mediastinum and great vessels. This particular chest radiograph is often used to aid diagnosis of acute trauma abnormalities, or chronic conditions in intensive care units and wards.
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