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.
3. Prepare the patient.
a. Bring the patient into the X-ray room.
b. Ensure the patient is dressed properly.
(1) Ensure foreign objects are removed from the patient as necessary.
(2) Ensure the patient's clothing is removed as required.
(3) Provide the patient with a gown.
c. Explain the procedure to the patient.
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 film cassette(s).
NOTE: Use an 10" x 12" cassette for both views.
7. Place the cassette in the bucky lengthwise.
8. Position the overhead tube.
a. Set the tube angle perpendicular to the film.
b. Set the source to image receptor distance (SID) to 40 inches (101 cm).
NOTE: For the lateral view use an SID of 72 inches to reduce magnification of sternum.
c. Center the tube to the cassette.
d. Adjust the conefield to full film coverage.
9. Position the sternum.
NOTE: Patient position can be erect or semi-prone.
a. RAO view.
(1) Place the patient in a semi-prone position, with right arm down by their arm.
(2) Oblique patient to their right side between 15 to 20 degrees.
(3) Align long axis of sternum to midline of x-ray table and film.
(4) Place the cassette about 1.5 inches above the jugular notch.
(5) Center ray directed to center of film.
NOTE: Midway between the jugular notch and the xiphoid process.
(6) Collimate to area of sternum.
b. Lateral view.
(1) Patient will be erect (standing or seated) with shoulders and arms brawn back as far as possible.
(2) Place the median plane parallel to the wall bucky.
(3) Central ray midway between the jugular notch and xiphoid process.
(4) Collimate to four sides of the sternum.
10. Place the appropriate letter marker on the cassette.
11. Place the lead shielding around the patient's waist.
12. Provide the breathing instructions.
a. RAO view: "PLEASE DO NOT MOVE" (will continue normal breathing).
b. Lateral view: "TAKE IN A DEEP BREATH, HOLD IT, AND DO NOT MOVE."
13. Make the exposure.
14. Tell the patient, "RELAX AND BREATHE NORMALLY."
15. Develop the exposed radiograph(s) with the patient's identification