Chest X-ray positioning
How to position for each of the 13 chest X-ray views: where the patient goes, where to centre, which receptor and distance to use, and what a good image looks like.
By the ScanFlo Editorial Team · Updated
In this section · X-ray positioning
- X-ray positioning guides
- Skull positioning
- Face & sinuses positioning
- Soft tissue neck positioning
- C-spine positioning
- Chest positioning
- Shoulder positioning
- Humerus positioning
- Elbow positioning
- Forearm positioning
- Wrist positioning
- Hand positioning
- T-spine positioning
- Abdomen positioning
- L-spine positioning
- Sacrum & SI joints positioning
- Pelvis positioning
- Hip positioning
- Femur positioning
- Knee positioning
- Tibia & fibula positioning
- Ankle positioning
- Foot positioning
X-ray positioning/Chest
The routine chest views are Chest AP erect (infant), Chest AP supine (infant), Chest lateral erect, Chest PA erect, Ribs oblique erect and Sternum lateral. Chest AP sitting, Chest AP supine, Chest apical (lordotic) AP, Chest lateral decubitus, Chest lateral sitting, Ribs oblique supine and Sternum oblique PA come in when you need to answer a particular question, or when the patient can't manage a routine view. Each guide walks you through the set-up step by step, with a short video, exposure settings for different patient sizes and what a good image should show.
A radiographer is still checking these guides.
Routine views
Extra views
All views in this region
- Chest AP erect (infant)
- Chest AP supine (infant)
- Chest lateral erect
- Chest PA erect
- Ribs oblique erect
- Sternum lateral
- Chest AP sitting
- Chest AP supine
- Chest apical (lordotic) AP
- Chest lateral decubitus
- Chest lateral sitting
- Ribs oblique supine
- Sternum oblique PA
Quick reference
Where to centre, how far and which receptor, for every chest view at a glance. Open a guide for the full set-up.
| Projection | Centre on | SID | Receptor | Breathing |
|---|---|---|---|---|
| Chest AP erect (infant) | between the nipples | 110 cm | 24×30 portrait, grid | No breathing instruction needed |
| Chest AP supine (infant) | between the nipples | 100 cm | 18×24 portrait | No breathing instruction needed |
| Chest lateral erect | the mid-axillary line at T7 | 180 cm | 35×43 portrait, grid | Breathe in and hold |
| Chest PA erect | T7, in the midline | 180 cm | 35×43 portrait, grid | Breathe in and hold |
| Ribs oblique erect | the axillary ribs of the side examined, at T7 | 110 cm | 35×43 portrait, grid | Breathe in and hold |
| Sternum lateral | the mid-sternum | 150 cm | 24×30 portrait, grid | Breathe in and hold |
| Chest AP sitting | the sternum, midway between the jugular notch and xiphoid | 180 cm | 35×43 portrait, grid | Breathe in and hold |
| Chest AP supine | the sternum at the level of T7 | 110 cm | 35×43 portrait, grid | Breathe in and hold |
| Chest apical (lordotic) AP | the sternal angle | 180 cm | 24×30 landscape, grid | Breathe in and hold |
| Chest lateral decubitus | T7, mid-sagittal | 110 cm | 24×30 landscape, grid | Breathe out and hold |
| Chest lateral sitting | the mid-axillary line at T7 | 180 cm | 35×43 portrait, grid | Breathe in and hold |
| Ribs oblique supine | the axillary ribs of the side examined | 100 cm | 35×43 portrait, grid | Breathe in and hold |
| Sternum oblique PA | the mid-sternum | 100 cm | 24×30 portrait, grid | Quiet breathing |
Mistakes that lead to repeats
- Image blurred on the chest AP erect (infant): expose when the child is still, ideally on inspiration.
- Rotation on the chest AP supine (infant): hold the head straight in the midline.
- Posterior ribs separated widely on the chest lateral erect: keep the mid-coronal plane perpendicular; check the shoulders.
- Clavicles asymmetric about the spine on the chest PA erect: bring both shoulders evenly against the bucky.
- Ribs below the diaphragm too pale on the ribs oblique erect: image lower ribs on expiration with higher mAs.
- Humeral heads overlie the manubrium on the sternum lateral: clasp the hands behind the back.
Common questions
- Which chest views are routine?
- Usually Chest AP erect (infant), Chest AP supine (infant), Chest lateral erect, Chest PA erect, Ribs oblique erect and Sternum lateral.
- What distance (SID) do chest X-rays use?
- Anywhere from 100 to 180 cm, depending on the view. Each guide gives the exact figure.
- Do chest X-rays need a grid?
- Most do. The exceptions, taken without a grid, are Chest AP supine (infant).
Try it in ScanFlo: the ScanFlo XR X-ray Room, coming soon, lets you set up every chest projection in a 3D room and score your positioning. See ScanFlo XR →