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chest radiograph

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A chest radiograph should be examined in a systematic way:

  • check the name on the film
  • make an estimate of age and sex of patient if this information is not provided
  • check the projection which should be posterior-anterior - PA
  • the whole of the chest should be visible on the film, check for rotation and that there has been satsifactory penetration
  • check chest expansion and the diaphragm - the right hemidiaphragm is 2 cm higher than the left
  • check for normal lung markings - the horizontal fissure is visible in 60% of normal chest X-rays; it runs from the centre of the right hilum, laterally and horizontally, to meet the sixth rib in the mid-axilla.

The following are described in more detail in subsequent nodes:

  • check the mediastinum
  • assess the cardiothoracic ratio (only on the PA film)
  • look at the pulmonary vessels
  • lung fields
  • bones
  • soft tissues


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