Chest Radiology > Technique > Technically Adequate > Rotation

Technique

Rotation

The technologists are usually very careful to x-ray the patient flat against the cassette. If there is rotation of the patient, the mediastinum may look very unusual. One can access patient rotation by observing the clavicular heads and determining whether they are equal distance from the spinous process of the thoracic vertebral bodies.

 

This is a normal PA film without any rotation.

 

Magnification of clavicular head and spinous process alignment demonstrating a straight film.

 

In this rotated film skin folds can be mistaken for a tension pneumothorax (blue arrows).  
Notice the skewed positioning of the heads of the clavicles (red arrows) and the spinous processes.