The trachea is deviated to the left. It is possible to say this with confidence because the patient is not rotated - the spinous processes lie midway between the medial ends of the clavicles. Any deviation of the trachea from the midline is therefore genuine.
Whenever you see deviation of the trachea, ask yourself if it has been PUSHED or PULLED. Here the trachea has been PULLED to the left by the volume loss in the left upper lobe caused by localised lung fibrosis. In this case this was due to previous radiation treatment.