How to take Portable Chest X-rays

Portable Chest X-rays are nearly always taken AP (Anterior Posterior) with the imaging cassette behind the patient's back in a bed or chair. This is usually due to the patient being too unwell to come to department. Ideally, all X-rays are departmental PA films, this is because of radiation risk to others, enlargement of the heart and scapula artefact on AP films - so if the patient can come to department with a nurse escort then this would be ideal.

Always introduce yourself to staff members and the patient as everyone will be more willing to help if you appear approachable. Ensure you obtain 3 forms of identification from the patient (according to IRMER regulations) and explain the examination to them, if they are happy to proceed then remove any objects which will obscure your image (e.g. necklaces), or your access to the patient (e.g. trolleys). 

Don't be afraid to ask for help - if the patient cannot sit forward on their own, ask for at least two nurses to assist sitting the patient forward, while you place the cassette behind their back. It is easier to sit the patient forward using the bed sheet, and reduces discomfort as the board will be not so cold.

Place the board landscape so the top is just above the shoulders and central so that you get outer-skin margins on.

AP erect Chest X-ray

Centering point: Mid-Sternum

Collimation:

Superiorly: Above top of shoulders

Inferiorly: Lower-costal margins

Medially: Outer skin margins

Laterally: Outer skin margins

Angle the tube cordially to the angle of the sternum. Depending on how sat-up the patient is, this varies from 5-45 degrees (if the patient is supine this would be 180 degrees cordially). Try to get the patient as erect as their condition will allow them.

Create a Controlled Environment - Ensure everybody who is able to leave the 6 meter radius around the patient (relatives, nursing staff etc) is a safe distance away and shout audibly "X-ray!" prior to exposure. Ensure you have a lead apron, give the patient correct breathing instructions (or if they are intubated, watch their chest rise and fall) and expose on inspiration.

Remove the cassette, label it clearly with the patient's name. Make sure you leave the patient/ward as you entered it - replace any valuables/trolleys/relatives.

Portable X-rays can be difficult! If you don't get it right the first time, call the referrer and ask if it is adequate for their diagnosis, a lot of the time it will be.