chest radiograph
Last reviewed 01/2018
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
what to look for in the apparently normal radiograph
survey of lung fields, bones and soft tissues
some chest x-ray abnormalities
some chest X-ray appearances of particular conditions
guidance for urgent referral for a chest X-ray
chest xray in community acquired pneumonia (CAP)
X-ray (exposure to ionising radiation)
lung cancer (NICE guidance for urgent referral for suspected cancer)