Apical lordotic chest X-ray positioning
An extra chest view, used when a routine one is not enough. The patient sits, the beam passes front to back (AP), straight on to the receptor, and the centring point is the sternal angle.
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
Still being checked: a radiographer is reviewing this guide. If your department does it differently, follow your department.
Patient position
Sitting. Sit the patient about 30 cm in front of the bucky and let them lean back until the shoulders rest against it, hands behind the head. Image each apex separately.
Centring & collimation
Central ray
APCentre: the sternal angle (projects the clavicles above the apices).
Beam: AP, perpendicular to the receptor.
Collimate: the upper third of the lung on the side examined
Distance, receptor & grid
| Setting | Value | Notes |
|---|---|---|
| SID | 180 cm | |
| Receptor | 24 × 30 cm | landscape |
| Placement | Erect (wall) bucky | Grid in |
| Angulation | None | Perpendicular to the receptor |
Marker & breathing
- Marker: R or L marker on the side nearest the detector
- Breathing: Breathe in and hold.
Exposure by patient size
Treat these as a starting point. Your detector, your generator and the patient in front of you will all move the numbers.
| Patient size | kV | mAs (chart) | mAs (DR default) |
|---|---|---|---|
| XS | 120 | 1.25 | 1.25 |
| S | 120 | 2 | 2 |
| M | 120 | 2.5 | 2.5 |
| L | 120 | 4 | 4 |
These start from a classic film-screen chart (120 kV, 2.5 mAs at 140 cm) and are adjusted for a digital detector at 180 cm. The DR column is what ScanFlo's console suggests; each step up or down changes the mAs by about a quarter.
Image quality checklist
- The clavicles are projected above the lung apex.
- The apex is free of rib and clavicle overlap.
- The anatomical side marker is visible, correct and clear of the anatomy.
- Collimation borders are visible on all sides, no wider than the area requested.
Faults & how to fix them
| Fault | Cause | Fix |
|---|---|---|
| Clavicle still across the apex | Not enough backward lean | Increase the lordosis or add a cephalad angle. |
Common questions
- Where do you centre for a chest apical (lordotic) AP X-ray?
- The centring point is the sternal angle (projects the clavicles above the apices).
- What distance and beam angle does a chest apical (lordotic) AP need?
- 180 cm from the tube to the receptor. The beam passes front to back (AP), straight on to the receptor.
- What size receptor, and do you need a grid?
- Use a 24 × 30 cm receptor, landscape, in the wall bucky. A grid is needed.
- What should the patient do with their breathing?
- Ask them to breathe in and hold it while you expose.
- What goes wrong most often on a chest apical (lordotic) AP?
- Clavicle still across the apex. Usual cause: not enough backward lean. The fix: increase the lordosis or add a cephalad angle.
Try it in ScanFlo: the ScanFlo XR X-ray Room, coming soon, lets you set up a chest apical (lordotic) ap in a 3D room and score your positioning. See ScanFlo XR →
Written by the ScanFlo team from everyday radiographic practice.