Lateral Chest

Lateral Chest Position Diagram

Reference Lateral Chest Radiograph

Exposure Factors

120-130

Kilovoltage (kV)

400

Milliamperage (mAs)

Fine Focus

Focus Type

150-180 cm

Source-to-Image Distance

With Bucky

Configuration

High Exposure: Parameters for optimal visualization of thoracic structures

Visible Anatomical Structure

The following must be clearly observed:

Aortic Arch
Lungs in their entirety
Posterior and anterior Ribs
Sternal Manubrium
Main Bronchi
Sternal Angle
Costodiaphragmatic Recesses (Costophrenic angles)
Left and right Diaphragmatic Cupulae
Thoracic Vertebral Bodies

Plate Size and Orientation

35 × 43 cm

Longitudinal

Longitudinal orientation to cover the entire thoracic cavity

Patient Positioning

Patient in standing position (upright) with the left side against the wall bucky

Left lateral position so the heart is not magnified

Upper edge of the cassette above the shoulders to visualize lung apices

Arm position: elbows flexed and forearms over the head

Alternative: elbows flexed and hands holding the bucky system bar

Chest centered with the central ray on the mid-coronal plane

Central Ray Point

T6 (Inferior Angle of Scapula)

Location: Directed to the mid-coronal plane at the level of the inferior angle of the scapula

Angulation: Horizontal (0°)

Important: The ray must be horizontal and directed to the center of the thoracic cavity

Optimal Image Characteristics

Non-magnified Heart

Thanks to left lateral position

Lung Apices

Completely visible

Diaphragm

Both cupulae differentiated

Vertebral Bodies

Thoracic vertebrae clearly visible

Common Technical Challenges

Frequent issues in lateral chest projection:

Arm superimposition over lung fields
Lung apices not included due to poor cassette positioning
Patient rotation affecting structural symmetry
Insufficient inspiration limiting lung visualization

Solution: Verify arms are correctly raised and patient performs deep inspiration

Patient Instructions

"Take a deep breath and hold it during the exposure"

Perform deep inspiration just before the exposure and hold breath (apnea)

SPECIAL CONSIDERATIONS

To obtain an optimal lateral chest image:

Patient always upright whenever possible
Left side against the bucky to minimize cardiac magnification
Full arm elevation to avoid superimposition
Verify that lung apices are included in the field

Goal: Full visualization of lung fields and mediastinum

Technical Variations

Bedridden Patient

Perform in lateral decubitus with direct cassette technique.

Geriatric Patient

Possible kyphosis requires adjustment in arm position.

Pediatric Patient

Reduce kV and mAs according to age and ALARA protocol.

Clinical Indications

Pulmonary pathology

Cardiac evaluation

Postoperative control

Routine checkup