How to perform an X-ray (X-ray) on a patient in prone ventilation (prone positioning)?

Performing X-rays on Patients in Prone Ventilation

For patients requiring X-rays while in prone ventilation, portable anteroposterior (AP) chest radiography should be performed with the X-ray plate positioned on the patient's back and the X-ray beam directed from anterior to posterior, maintaining complete (180°) prone positioning throughout the procedure to preserve oxygenation benefits. 1

Preparation for X-ray in Prone Position

• Ensure the patient is in complete (180°) prone position as recommended for optimal oxygenation effects, rather than attempting incomplete prone positioning 1
• Stabilize the patient hemodynamically and optimize volume status before any manipulation for X-ray positioning 1
• For patients with increased intracranial pressure (ICP), ensure continuous monitoring during the procedure with the head positioned centrally and avoiding lateral rotation 1
• Carefully examine pressure points and areas at risk for pressure ulcers before and after the X-ray procedure 1

X-ray Technique for Prone Patients

• Position the X-ray plate (detector) on the patient's back 2
• Direct the X-ray beam from anterior to posterior (reverse of the standard AP view) 2
• Maintain complete prone positioning throughout the procedure to preserve ventilation-perfusion matching benefits 1, 3
• Consider using higher exposure settings to compensate for the increased tissue density encountered when shooting through the anterior chest wall and bed 4

Special Considerations

• For patients with unilateral lung damage, maintain the lateral position of about 90° with the healthy side down when performing lateral X-rays 1
• In patients with veno-venous ECMO therapy who require prone positioning, ensure all ECMO lines are secured and visible during the X-ray procedure 1
• For patients with increased risk of pressure ulcers, minimize the time spent on hard X-ray plates and ensure proper padding 1, 5
• Monitor oxygenation parameters continuously during the procedure, as any significant position changes may affect ventilation-perfusion matching 3, 6

Contraindications and Precautions

• Exercise extreme caution when performing X-rays in prone position for patients with:

  • Open abdomen 1
  • Spinal instability 1, 6
  • Increased intracranial pressure 1
  • Cardiac arrhythmias with hemodynamic consequences 1
  • Shock 1

• For patients with absolute contraindications to prone positioning, consider alternative imaging approaches or carefully weigh risks versus benefits of temporarily repositioning the patient 1

Timing of X-rays

• When possible, coordinate X-ray timing with the planned supine repositioning periods to minimize disruptions to the recommended 12-16 hour prone positioning schedule 1, 2
• For urgent X-rays that cannot wait for scheduled repositioning, maintain the prone position throughout the procedure rather than interrupting the therapeutic prone positioning 1, 3

Documentation

• Document the patient's position during X-ray acquisition to aid in proper interpretation, as prone positioning alters the normal radiographic appearance of anatomical structures 4, 7
• Record any changes in ventilator settings or oxygenation parameters that occur during the X-ray procedure 6, 7