Film: 14 x 17 in ( 35 x 43 cm ) or 7x17 in ( 18 x 43 cm ) lengthwise

Position of patient:
- lateral position, either recumbent or upright. If possible, left lateral position should be used to place the heart closer to the film and minimize shadow.
- Oppenheimer recommends the use of orthostatic (upright) position to reproduce the physiologic conditions, and allowed to stand in a normal position.
- the patient should be dressed in a open-backed gown so that the vertebral column can be exposed for the adjustment of the position.

* Recumbent Position
-place a firm pillow under patient’s head to elevate MSP of the level of the long axis of vertebral column.
- flex the hips and knees to a comfortable position
- Place a radiolucent support under the lower thoracic region and adjust the position of the support so that the long axis of vertebral column is horizontal.
- If the support is not placed under the lower thoracic region, the Cr is directed perpendicular to the long axis of the vertebral column requiring a cephalic angulation.. The degree of angulation required is approximately 10 to 15 degrees.
- Stand with your eyes in vertical plane that passes down the posterior surface of the patient’s back and adjust the body in true lateral position.



* Upright Position
- Have the patient stand straight without strain and adjust the height of the vertical bgrid device so that the midpoint of the film is at the level of the 6th thoracic vertebra.
- move the patient close enough to the grid to allow him or her rest the adjacent shoulder firmly against the grid front for support.
- the weight of the body must be equally distributed on the feet. If the limbs are unequal length, place the a support of correct height under the foot of the shorter side.
- to elevate the ribs, raise the arms to a position at right angles to the long axis of the body.

CR: direct the central ray perpendicularly to the midaxillary plane of the film at the level of the T7 located approximately 3 inches (7.5 cm ) below the sternal angle.
- If the vertebral column is not elevated to a horizontal plane when the patient is in recumbent position, the tube shoul be angled to direct the central ray perpendicular to the long axis of the thoracic column and then centered at the level of 6th thoracic vertebra.
- an average angle of 10 degrees cephalad on female patient and because of greater shoulder width an average angle of 15 degrees to the male patients are satisfactory for majority.

Improving radiographic quality
- the quality of the radiograph can be improved if a sheet of leaded rubber is placed on the table behind the patient. The lead will absorb the scatter radiation; scatter radiation that serves only to decrease the quality of the radiograph
- with the use of automatic exposure control ( AEC ), the scatter radiation coming from the patient is often sufficient to prematurely terminate the exposure.

Radiation Protection- a lead apron or other protective material may be placed over the patient’s pelvis to reduce the amount of radiation received by the gonads.

Structure shown:
- a lateral image of the thoracic bodies is demonstrated, showing their interspaces, the intervertebral foramina, and the lower spinous processes.

Evaluation Criteria:
- Vertebrae should be seen clearly through the rib and lung shadows.
- 12th thoracic vertebrae should be included
- Ribs should be superimposed posteriorly to indicate that he patient was not rotated.
- X-ray beam should be tightly collimated to reduce scatter radiation.