Lungs AP Axial Lordotic is a radiography positioning projection of the Thorax. AP lordotic for pulmonary apices. Patient leans back ~30°. SID 72". The centering point is located mid-sternum (manubrium level). patient leaned back ~30 degrees so the lordotic position projects clavicles above the lung apices.. The central ray is lordotic: patient leaned back ~30 degrees; cr horizontal and perpendicular to the ir, to the mid-sternum. (alternative ap axial: cr 15-20 degrees cephalad if the patient cannot lean back.). Image-quality criteria include pulmonary apices clearly visualized free of the clavicles, which project above them., both apices and upper lung zones visible in their entirety.. Standard exposure ranges from 110 to 125 kVp, 2 to 5 mAs, at an SID of 72 inches (180 cm).
Anatomy demonstrated
- Bilateral pulmonary apices.
- Upper lung zones free from clavicular superimposition.
- Clavicles projected above the lung apices.
- Thoracic trachea and proximal main bronchi.
- Ribs 1-5 in their entirety.
Patient preparation
- Verify patient identity using two identifiers.
- Remove all radiopaque objects from the chest area.
- Explain breathing instructions: inspiration on the second breath in, hold.
- Position patient erect, then have patient lean backward into lordotic position.
- Ensure patient is stable; use support if needed to maintain the position.
Position & centering point
Mid-sternum (manubrium level). Patient leaned back ~30 degrees so the lordotic position projects clavicles above the lung apices.
Central ray
Lordotic: patient leaned back ~30 degrees; CR horizontal and perpendicular to the IR, to the mid-sternum. (Alternative AP axial: CR 15-20 degrees cephalad if the patient cannot lean back.)
Exposure / technique
- kVp
- 110–125
- mAs
- 2–5
- SID
- 72" (180 cm)
- Notes
- Lean-back lordotic with a horizontal CR. If the patient cannot lean back, stand upright and angle the CR 15-20 degrees cephalad.
Image-quality criteria
- Pulmonary apices clearly visualized free of the clavicles, which project above them.
- Both apices and upper lung zones visible in their entirety.
- Minimal superimposition of the shoulders over the apices.
- Clavicles projected above the lung apices, clear of the apical lung fields.
- Full inspiration noted with a minimum of 10 ribs visible above the diaphragm.
- No rotation evident from the position of the sternoclavicular joints.
Common errors / ARRT traps
- 1 Inadequate lordotic position fails to project apices clear of clavicles.
- 2 Rotation tilts the apices laterally and obscures the midline structures.
- 3 In the upright variant, less than 15 degrees cephalad fails to separate the clavicles.
- 4 CR aimed too high or low misses the apical region.
- 5 Patient unable to maintain lordotic position causes loss of the effect.
Clinical indications
- Evaluation of tuberculosis or other apical pathology.
- Assessment of pulmonary apical regions not clearly visible on standard projections.
- Detection of cavitary lesions or infiltrates in the apices.
- Follow-up studies of known apical pathology.
Aligned to the current ARRT Radiography Content Specifications.