Oblique ribs X-ray positioning (erect)
One of the routine chest views. The patient stands turned at an angle, the beam passes front to back (AP), straight on to the receptor, and the centring point is the axillary ribs of the side examined, at T7.
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
Oblique, erect. After the PA chest, turn the patient 45° with the injured side nearest the detector, arms raised above the head (or held away from the body). Take both obliques.
Centring & collimation
Central ray
APCentre: the axillary ribs of the side examined, at T7.
Beam: AP, perpendicular to the receptor.
Collimate: the full hemithorax of the side examined
Distance, receptor & grid
| Setting | Value | Notes |
|---|---|---|
| SID | 110 cm | |
| Receptor | 35 × 43 cm | portrait |
| 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 | 70 | 3.2 | 3.2 |
| S | 70 | 5 | 5 |
| M | 70 | 6.3 | 6.3 |
| L | 70 | 10 | 10 |
These start from a classic film-screen chart (70 kV, 20 mAs at 140 cm) and are adjusted for a digital detector at 110 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 axillary portions of the ribs are shown free of overlap.
- Ribs above or below the diaphragm are exposed for their density.
- 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 |
|---|---|---|
| Ribs below the diaphragm too pale | Upper-rib exposure used | Image lower ribs on expiration with higher mAs. |
Common questions
- Where do you centre for a ribs oblique erect X-ray?
- The centring point is the axillary ribs of the side examined, at T7.
- What distance and beam angle does a ribs oblique erect need?
- 110 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 35 × 43 cm receptor, portrait, 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 ribs oblique erect?
- Ribs below the diaphragm too pale. Usual cause: upper-rib exposure used. The fix: image lower ribs on expiration with higher mAs.
Try it in ScanFlo: the ScanFlo XR X-ray Room, coming soon, lets you set up a ribs oblique erect in a 3D room and score your positioning. See ScanFlo XR →
Written by the ScanFlo team from everyday radiographic practice.