Chest X-ray
Systematic approach
Image quality
Image quality should always be assessed because it may not be possible to answer the clinical question if the image is inadequate.
The chest X-ray should be checked for rotation, inspiration, and penetration. The tutorial on chest X-ray image quality covers this in more detail.
Key points
- Assess the image quality
- Comment on the presence of medical artifiacts
- Can the clinical question still be answered?
Hover over image to show findings
Image quality
- Mnemonic - RIP - Rest In Peace
- Rotation - Spinous processes at midpoint between medial ends of the clavicles?
- Inspiration - 5 to 7 anterior ribs intersecting the diaphragm in the mid-clavicular line?
- Penetration - Spine visible behind the heart?
Click image to align with the top of the page
Artifact
When you present a chest X-ray it is good practice to comment on the presence of any artifact. Here is an example.
Hover over image to show findings
Click image to align with the top of the page
Many chest X-rays are performed to assess the position of medical equipment such as a naso-gastric tube or central line. When you are assessing a chest X-ray for this purpose, do not forget to look at the entire image systematically.
Central line position ?
- The left jugular line tip (red circle) is in the left subclavian vein
- It should take the cousre of the dotted line to lie in the region of the superior vena cava (red oval)
- Usually a central line is placed on the right side (green line)
- Oxygen tubing is also visible (blue)