Today’s Technician Peer reviewed

Imaging Essentials Series

Small Animal
ThorAcic
radiography
Danielle Mauragis, CVT, and
Clifford R. Berry, DVM, Diplomate ACVR

RadiOgRaphy LingO
• anode: an electrically positive terminal of a
radiographic tube that emits x-rays from the point of
impact of the electron stream from the cathode.
T his article is the first in a series of arti-
cles that will discuss various radio-
graphic positions and techniques.
The veterinary technician plays a critical
role in the development and maintenance
• Cathode: The negative side of the radiographic tube of a radiographic program at a veterinary
where electrons are emitted; it consists of the focusing practice. Thus, it is the responsibility of the
cup and filaments. technician to be familiar with the basics of:
• Cassette/detector plate: a light-proof housing for • Anatomy and positioning
radiology film, containing front and back intensifying • Technique and image formation
screens between which the film is placed. • Quality control of images made within
the radiographic suite.
• Collimation: This term refers to the process of adjusting
The purpose of this article is to review
an optical instrument so that the x-ray image includes
the 3 basic components of creating high-
the area of interest.
quality thoracic radiographs of the dog and
• Milliampere × second (mas): describes the exposure cat, including positioning, technique, and
setting of a radiology machine and determines the quality control of the final images.
radiographic density. mas is calculated by: With advances in imaging technology
mA (station number setting) x time (setting) = mAs (computed and digital radiography), errors
(eg, 100 mA × 0.10 sec = 10 mAs) in technique are less common; however,
• peak kilovoltage (kVp): The maximum voltage applied if anatomy is not appropriately collimated
across an radiographic tube, which controls the x-ray and positioning is inadequate, all imaging
penetration of the subject being imaged. studies can be rendered nondiagnostic.
A routine thoracic radiographic study
• peak inspiration: exposing film at peak inspiration
includes 3 projections: right and left lateral
maximizes the air in the lungs and the subject contrast
images and a ventrodorsal (VD) or dorso-
within the thorax.
ventral (DV) image.

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a B

Figure 1. (A) Dog in right lateral recumbency with thoracic limbs pulled cranially. See text for anatomic boundaries of
collimated thorax. (B) Right lateral thoracic radiograph of dog in Figure 2A; notice the cranial location of the thoracic
limbs relative to the thoracic inlet.

a B

Figure 2. (A) Dog in left lateral recumbency with thoracic limbs pulled cranially. See text for anatomic
boundaries of collimated thorax. (B) Left lateral thoracic radiograph of the dog in Figure 2A; notice the cranial
location of the thoracic limbs relative to the thoracic inlet.

ThORaCiC RadiOgRaphiC ExpOSuRE

MEOw MEETS BaRk: diffEREnCES From a technical standpoint, thoracic radiographic
BETwEEn CaTS & dOgS exposure should be obtained using a high peak kilo-
voltage (kVp) (80–120 kVp) and low milliampere × sec-
even though the same anatomic landmarks are ond (mAs) (1–5 mAs) technique. This technique allows
used in the dog and cat, there are some key for latitude (long gray scale) images, which are impor-
tant when evaluating the structures of the thorax.
differences when it comes to quality control of
Several examples would include:
the thoracic image. • 82 kVp at 2 mAs for 15-cm dog for analog film
• In the cat, the caudal dorsal lung margins (400 speed system) or
• 80 kVp at 5 mAs for a 15-cm dog for a digital plate
(diaphragmatic crura) will extend beyond the
radiographic system.
13th thoracic vertebra, which will not be true For any dog measuring 15 cm or greater (measured at
in the dog (T10-11). the liver or thickest part of the thorax), a grid (8:1, 110
lines per inch) should be used. Grids are available from
• In addition, while the thoracic limbs in the most radiology manufacturers and a grid tray comes
cat are easier to pull forward, cats may with all radiology units. For almost all radiology units,
a grid is sold with the radiographic machine and table.
resent lateral recumbency positioning. Take
The rotor for the anode and the low-voltage circuit
your time and allow the patient to calm down for the focusing cup/electrons of the cathode should be
rather than rushing through a study. coupled to a foot or hand switch so that accurate timing
of the exposure at peak inspiration can be made (Table).

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Table. how to determine Whether Radiograph Was Taken at Peak inspiration

Patient Size Lateral Ventrodorsal/Dorsoventral

Small-breed dogs • diaphragmatic crura at level of T10 • costophrenic angle (Figure 4) at level of
(hardest to (minimum); preferably at T12 10th rib (minimum); preferably at 12th rib
consistently catch on • cupula at T8 • diaphragmatic cupula (center) at T8
peak inspiration) • May see overlap between the borders of
the cardiac silhouette and diaphragm
Medium-breed dogs • diaphragmatic crura at T12–T13 (cats, • costophrenic angle located at T10–T11
Large-breed dogs T1–l1) • diaphragmatic cupula at T10
Cats • cupula at T10 • separation of heart and diaphragm
• separation of heart and diaphragm

ROutine ViewS ly between dorsal and ventral. Palpate the manu-

Lateral images brium and place the cranial edge of the collima-
Positioning tion beam at the cranial edge of the manubrium;
For a right and left lateral image, the patient is posi- this places the caudal edge of the beam at the
tioned on the table with the dependent side down and level of the 13th rib head and T13.
marked with a lead marker to indicate the dependent Remember to always include the sternum of the
side in the collimated area as right (R) or left (L). patient so as not to exclude vital anatomy:
1. The thoracic limbs should be taped together even- • In large-breed dogs, it may be necessary to
ly and pulled cranially so that the elbows and tis- exclude the spinous processes. A separate image
sues of the triceps muscle are not superimposed might be necessary if indicated.
over the cranial thorax (Figures 1 and 2). • In deep-chested breeds, such as Great Danes,
2. To determine whether or not a patient is aligned Doberman pinschers, or mastiffs, the cassette/
in a lateral position and parallel to the table, use detector plate may be turned vertically to encom-
an imaginary plane through the sternum and pass the entire thoracic cavity in the dorsal and
dorsally through the spinous processes of the ventral plane.
thoracic vertebrae. • Turning the cassette/detector plate vertically does
3. A foam wedge may be placed under the elbows not allow for the entire thorax to be included;
in order to maintain laterality of the patient (ster- therefore, cranial and caudal views need to be
num and vertebrae are equidistant to the table). taken, for completeness.
4. In order to keep the patient in
a true lateral position, the pel-
vic limbs are also taped and
pulled caudally. A B

Collimation
To set the collimation for the
thoracic anatomic boundaries of a
lateral image (right or left):
• Vertical Line of the Collima-
tion Light: Palpate the caudal
border of the scapula dorsally
and place the vertical line at
this point. This allows for the
cardiac silhouette to be in the
center of the image, giving a
true representation of the car-
diac size and shape. Figure 3. (A) Dog in ventrodorsal recumbency with thoracic limbs taped
• Horizontal Line of the Colli- and pulled cranially. The light marks the cranial border of the image that
mation Light: The horizon- is collimated to the level just cranial to the thoracic inlet. (B) Ventrodorsal
lateral thoracic radiograph of the dog in Figure 3A; notice the cranial loca-
tal line should be placed in
tion of the thoracic limbs relative to the thoracic inlet.
an imaginary plane so as to
bisect the thoracic cavity even-

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a B

Figure 4. (A) Dog in dorsoventral recumbency with thoracic limbs taped

and pulled cranially. The light marks the cranial border of the image that Figure 5. A conventional ventro-
is collimated to the level just cranial to the thoracic inlet. (B) Dorsoventral dorsal projection (with the legs
thoracic radiograph of the dog in Figure 4A; notice the cranial location of pulled forward); notice that the
the thoracic limbs relative to the thoracic inlet. caudal portion of the scapulae
are superimposed over the cranial
lung fields.

Ventrodorsal images
Positioning • Chondrodystrophic breeds, such as dachshunds
For the ventrodorsal view, the patient should be or basset hounds, because they are physically
placed in dorsal recumbency. unable to do so.
1. Using a V-trough helps keep the patient’s spine When presented with these types of patients ensure
and sternum aligned. that the head and neck are straight out in front of the
2. The thoracic limbs are taped together evenly and body and not obliqued to the left or right.
pulled forward with the patient’s muzzle placed
between the limbs (Figure 3, page 47). Collimation
3. The pelvic limbs are pulled caudally and secured. To set collimation for the ventrodorsal view, the land-
The technique described in Step 2 does not work marks are the same as the lateral projection:
well for: • Vertical Line of the Collimator Light: Place the
• Brachycephalic breeds, such as English bull- vertical line at the caudal border of the scapula.
dogs or pugs, that might have issues with upper This allows the cardiac silhouette to be in the cen-
airway disease or obstruction ter of the image.

a B

Figure 6. (A) Dog in ventrodorsal recumbency with the thoracic limbs taped in the humanoid position, down along
the dog’s side. This position results in the scapulae rotating externally and cranially instead of being superimposed
over the cranial lung lobes. The light marks the cranial border of the image that is collimated to the level just
cranial to the thoracic inlet. (B) Ventrodorsal thoracic radiograph corresponding to the dog in Figure 6A; notice the
externally rotated scapulae (arrows) and lack of superimposition over the cranial lung fields (compared with Figure 5).

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1. The patient is placed dorsally and the thoracic

limbs are taped separately and pulled caudally to
lie adjacent to the lateral body wall (Figure 6).
2. The landmarks will be the same as the ventrodor-
sal view.

horizontal Beam projections

Horizontal beam sternal or dorsal projections are
used for assessing the cranial mediastinum or fluid/air
distribution within the thoracic cavity.
These views are dependent on the ability of the radi-
ology machine tube to be manipulated in a 90° angle.
In addition, using a positioning trough makes these
views easier to obtain.
1. To determine fluid or free air distribution,
position the patient as if performing a ventrodor-
Figure 7. Dog in ventral recumbency with the sal view (ie, dorsal recumbency).
radiograph cassette (detector plate) placed along 2. To visualize the cranial mediastinum, position
the lateral thorax. This view will help differentiate the patient as if performing a dorsoventral view.
fluid (remains ventral on exposure) and air 3. Place the cassette/detector against the lateral body
accumulation (remains dorsal on exposure) in wall, making sure to mark the dependent side L or R.
the pleural space, pulmonary parenchyma, or 4. The landmarks are the same as the lateral projec-
mediastinum. tion (Figure 7).

QuaLiTy COnTROL
• Horizontal Line of the Collimator Light: The For quality control of any diagnostic image, keep a
horizontal line should be placed directly over simple 4-step approach in mind:
the sternum so as to bisect the thoracic cavity 1. Determine if the technique is appropriate.
from left and right lateral. Palpate and place the 2. Ascertain if the appropriate anatomy is present
edge of the collimation beam at the cranial edge within the image.
of the manubrium; this places the caudal edge of 3. Check the positioning for laterality and straightness.
the beam to the 13th rib head at the level of the 4. Determine if projection was taken at peak of
thoracic spine. inspiration.
• In large-breed dogs (eg, Great Dane), it will be
necessary to take a cranial and caudal projection.
pOSiTiOning VETERinaRy paTiEnTS
dorsoventral images The following positioning devices can be used to
Positioning & Collimation help position patients and reduce staff members’
The dorsoventral radiograph is one of the hardest radio- exposure to radiation:
graphs to position consistently. The dorsoventral image • Elastic tape
best visualizes lesions in the caudodorsal lung lobes. • Plastic tongs
1. The dog is either in: • Positioning trough (foam or plastic)
• Ventral recumbency without the legs taped, • Rope and cleats along the side of the table
resulting in a “sphinx” position (Figure 4) or • Sandbags (particularly long snake-like sand bags)
• A frog-leg position (pelvic limbs).
The comfort of the patient is of utmost importance.
2. The thoracic limbs are pulled cranial and abducted.
3. The anatomic landmarks are the same as for a
ventrodorsal image.

addiTiOnaL ViEwS
humanoid projection
In a conventional ventrodorsal projection (with the
thoracic limbs pulled cranial), the caudal portion of Patient in lateral recumbency showing correct use
the scapulae are superimposed over the cranial lung of tape and sandbags; the dog is muzzled due to
fields (Figure 5). The humanoid projection obtains its history of biting (see Dog Bites: Protecting
no summation of the scapula with the cranial lung Your Staff & Clients, page 66)
fields.

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Technique & anatomy • For the ventrodorsal projection, each thoracic

Given that the desired technique has been attained, spinous process is viewed end-on and has a dis-
make sure that the appropriate anatomy is included. tinct diamond or tear-dropped shape without the
The laterals, ventrodorsal, dorsoventral, humanoid, ability to see the sternum and the thoracic verte-
and horizontal beam projections should: brae as separate structures.
• Extend from the cranial margin of the manu- • For the dorsoventral projection, positioning
brium to the caudodorsal margin of the lung is similar to the ventrodorsal in that the thoracic
margin/diaphragmatic crus. spinous process is viewed end-on and has a dis-
• Not exclude the sternum on the lateral or lateral tinct diamond or tear-dropped shape without the
aspect of the ribs on the ventrodorsal view. ability to see the sternum and the thoracic verte-
brae as separate structures.
positioning
If the technique exceeds quality standards and the peak inspiration for image acquisition
correct anatomy is present, check patient positioning. Finally, determine if the projection was taken at the
• For the lateral projection, use superimposition peak of inspiration:
of the rib heads throughout the thoracic spine to • For the lateral view, the caudal aspect of the cardi-
determine if a patient is in a true lateral position ac silhouette will not be superimposed over the dia-
(Figures 1B and 2B). phragm and there is an upside down triangle that
is visualized using the caudal vena cava, diaphragm,
and caudal border of the heart as the margins.
Danielle Mauragis, CVT, • For the ventrodorsal view, the cupola or central
is a radiology technician portion of the diaphragm will be separated from
in the Diagnostic Imaging the caudal border of the cardiac silhouette. The
Service at University of lateral margins of the diaphragmatic crura will
Florida College of Veterinary come to the 11th or 12th intercostal space and the
Medicine. Her responsibilities right and left cranial lung lobes will extend to the
include performing level of the thoracic inlet.
radiography, computed • The exception to these rules is the extremely
tomography, and nuclear obese patient that cannot take a deep inspiratory
medicine studies; assisting breath.
with ultrasonography; and
teaching physics, techniques, SuMMaRy
and quality control of radiology to veterinary Thoracic radiographs are often used as a first-line test
students. Ms. Mauragis coauthored the handbook of for possible intrathoracic disease. High-quality, cor-
Radiographic Positioning for Veterinary Technicians and rectly positioned radiographs are required in order to
was a contributing author for Principles and Practice provide as accurate an assessment as possible.
of Veterinary Technology. She was also the recipient In addition, a 3-view thorax (right lateral, left lateral,
of the Florida Veterinary Medical Association’s 2011 and dorsoventral or ventrodorsal view) is considered
Certified Veterinary Technician of the Year Award. Ms. the standard of care in veterinary medicine. Following
Mauragis received her associate’s degree in veterinary a consistent, repeatable pattern for obtaining thoracic
technology from St. Petersburg College in Largo, radiographs ensures that the quality of the images will
Florida. always be diagnostic. ■
Clifford R. Berry, DVM, kVp = peak kilovoltage;
Diplomate ACVR, is a mas = milliampere × second
professor in diagnostic
imaging at the University of Suggested Reading
Florida College of Veterinary Burk rL, Feeney dA. Small Animal Radiology and Ultrasonography:
Medicine. His research A Diagnostic Atlas and Text, 3rd ed. Philadelphia: Saunders
elsevier, 2003.
interests include cross-
KeelyJK, McAllister h, Graham JP. Diagnostic Radiology and
sectional imaging of the Ultrasonography of the Dog and Cat, 5th ed. Philadelphia:
thorax, nuclear medicine Saunders elsevier, 2011.
applications in veterinary Sirois M, Anthony e, Mauragis d. Handbook of Radiographic
medicine, and biomedical applications of imaging in Positioning for Veterinary Technicians. clifton Park, New York:
delmar cengage Learning, 2010.
human and veterinary medicine. Dr. Berry has been Suter PF, Gomez JA. Diseases of the Thorax – Radiographic
a faculty member at North Carolina State University Diagnosis. Ames, iowa: iowa State University Press, 1987.
and the University of Missouri. He received his DVM Thrall de (ed). Textbook of Veterinary Radiology, 5th ed. Philadelphia:
from University of Florida and completed a radiology Saunders elsevier, 2008.
residency at University of California–Davis. Thrall de, robertson id. Atlas of Normal Radiographic Anatomy and
Anatomic Variants in the Dog and Cat. Philadelphia: elsevier
Saunders, 2011.

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