Chest X-ray Systematic Approach
Tutorial introduction

Checklist for a systematic approach

  • Patient identity
  • Image data
  • Image quality
  • The obvious abnormality - description/location
  • Systematic check of anatomy
  • Review areas
  • Consider the clinical question

A systematic approach for viewing chest X-rays ensures no important structures are ignored, but a flexible approach is required to suit each clinical setting.

When formally presenting a chest X-ray, it is necessary to demonstrate a logical system. Although there is no agreed order of observation, you may find the sequence described in the chest X-ray anatomy tutorial helpful.

Here it is in brief.

Anatomical structures to check

  • 1. Trachea and bronchi
  • 2. Hilar structures
  • 3. Lung zones
  • 4. Pleura
  • 5. Lung lobes and fissures
  • 6. Costophrenic angles
  • 7. Diaphragm
  • 8. Heart
  • 9. Mediastinum
  • 10. Soft tissues
  • 11. Bones

This tutorial will help you develop your own system, starting with patient and image data, and image quality. You will go on to learn how abnormalities can be described and located. The tutorial also discusses the review of areas where abnormalities are easily missed.