From the Guidelines
For a conscious patient with suspected chest trauma, an upright posterior-anterior (PA) chest radiograph is the preferred initial imaging view [ 1 ]. This view allows for optimal assessment of the lungs, pleural spaces, and bony thorax, and is typically performed with the patient standing or sitting upright to facilitate detection of pneumothorax or hemothorax.
Key Considerations
- The radiograph should be obtained with a standard dose of 120 kilovoltage peak (kVp) and 2-3 milliamperes per second (mAs) to ensure adequate penetration and image quality.
- While bedside anteroposterior (AP) chest radiographs are commonly used in hemodynamically unstable patients [ 1 ], they have limited ability to identify direct findings of blunt cardiac injuries.
- Noncontrast CT of the chest can detect most injuries, but has a lower sensitivity for detecting vascular injuries [ 1 ], and contrast-enhanced CT of the chest is the preferred imaging workup of suspected chest trauma.
Important Points to Note
- Chest radiographs have a lower sensitivity for detecting pneumothorax, hemothorax, lung contusions, rib fractures, and cardiac and vascular injury [ 1 ].
- A significant portion of patients with a “normal” chest radiograph may have injuries on CT, and vice versa [ 1 ].
From the Research
Chest X-ray Views for Conscious Patients with Chest Trauma
- For a conscious patient with chest trauma, the most suitable chest X-ray view is the anteroposterior (AP) view or posteroanterior (PA) view, as these views provide a clear image of the chest cavity and can help identify any injuries or abnormalities 2.
- The PA view is considered the standard chest X-ray view, as it provides a more accurate representation of the chest cavity and is less affected by the patient's position or movement 3, 2.
- However, the AP view may be more suitable for patients who are unable to stand or sit upright, as it can be taken with the patient in a supine position 2.
- Oblique views of the chest may also be useful in certain situations, as they can provide a better view of the chest cavity and help identify any lesions or abnormalities that may be obscured in the PA or AP views 4.
Considerations for Chest X-ray Views
- The choice of chest X-ray view will depend on the patient's condition and the suspected injury or abnormality 5.
- The patient's position and movement can affect the quality of the X-ray image, and the technician should take steps to minimize any movement or distortion 3.
- The use of convolutional neural networks can help improve the accuracy of chest X-ray view positioning and detection 2.