1. Select the required view(s) based on the request.
2. Gather the necessary materials and supplies.
a. Appropriate cassettes.
b. Lead shielding.
c. Letter markers.
f. Positioning sponges.
3. Prepare the patient.
a. Bring the patient into the X-ray room.
b. Ensure the patient is properly dressed.
(1) Ensure all foreign objects are removed from the patient as necessary.
(2) Ensure the patient's clothing is removed as necessary.
NOTE: All clothing from the waist up should be removed, and the patient will wear a gown.
c. Explain the procedure.
4. Measure the body part at the entry-exit site of the central ray.
5. Set the control panel.
a. Consult the technique chart.
b. Set the appropriate mAs and kVp on the control panel.
6. Select the proper size cassette.
NOTE: Use a 14" x 17" cassette for all views.
7. Place the cassette in the upright cassette holder lengthwise.
NOTE: For the decubitus view a moving or stationary grid may be used.
8. Position the overhead tube.
a. Set the tube angle perpendicular to the cassette.
b. Set the source to image distance (SID) to 72 inches (182 cm).
c. Center the tube to the cassette.
d. Adjust the conefield to full field coverage.
9. Place the lead shielding around the patient's waist.
10. Position the chest.
a. PA view.
(1) Patient standing, feet spread slightly, weight equally distributed on both feet.
(2) Chin raised, resting against film holder.
(3) Hands on hips, palms out, and elbows partially flexed.
(4) Shoulders rotated forward against film holder.
NOTE: This allows scapulae to move laterally, clearing the lung fields. NOTE: This depresses the shoulders downward to move clavicles below the apices.
(5) Align midsagittal plane midline of the film holder.
NOTE: Insure no rotation of thorax.
(6) Central ray perpendicular to the film and centered to the midsagittal plane at the level of T-7.
NOTE: Acromion process should be 3 inches below the upper film border.
b. Lateral view.
(1) Patient erect with their left side against the film.
(2) Weight evenly disturbed on both feet.
(3) Arms raised above their head, with chin up.
(4) Center the patient to film by checking anterior and posterior aspects of the thorax.
NOTE: There should be no rotation of the thorax.
(5) Central ray perpendicular and centered at level of T-7.
NOTE: Acromion processes 3 inches below the upper film border.
c. Decubitus view.
NOTE: Place a positioning sponge below the patient.
(1) Patient in a lateral recumbent position, with their back firmly against the film holder.
(2) Raise both arms above the patient's head to clear the lung fields.
(3) Flex the knees slightly and ensure that the coronal plane is parallel to the film with no body rotation.
(4) Adjust the height of the film holder to center thorax to the film.
(5) Adjust the patient to center midsagittal plane and T-7 to the central ray.
NOTE: Acromion processes about 2-3 inches below the upper film border.
(6) Central ray horizontal perpendicular, directed to the center of the film.
11. Immobilize the patient as required.
12. Place the appropriate letter marker on the cassette.
13. Tell the patient, "TAKE IN A FULL BREATH, BLOW IT OUT, TAKE IN ANOTHER FULL BREATH, AND HOLD IT."
14. Make the exposure.
15. Tell the patient, "RELAX AND BREATHE NORMALLY."
16. Develop the exposed film with the patient's identification.