Chest X-ray Quality
Tutorial introduction

Tutorial key points

  • Image quality influences conclusions
  • Check the image for - Inclusion, Projection, Rotation, Inspiration, Penetration and Artifact
  • Quality is influenced by radiographic technique and patient factors
  • Check to see if a poor quality X-ray demonstrates a life threatening abnormality before dismissing it
  • Check to see if the clinical question can still be answered

Related tutorials

Before interpreting a chest X-ray it is important to assess the quality of the image. Without this step you may diagnose disease that is not genuine or you may be wrongly reassured.

This tutorial covers the principles of chest X-ray quality and discusses the limitations of sub-optimal images. Anatomical inclusion, projection, rotation, inspiration/lung volume, penetration and artifact all contribute to image quality. Each are discussed in turn.

Discarding/repeating images

If the image is not of best quality but the clinical question can still be answered, a chest X-ray need not be repeated. If you are not sure if a repeat image will be of use then discuss the case with a radiographer or radiologist.

Do not immediately discard a chest X-ray because it is not perfect. Even sub-optimal images demonstrate life-threatening abnormalities which may require your immediate attention.

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A certificated course completion assessment is available which is based on the material in this tutorial and the related sections.

All the certificated online course completion assessments provided by Radiology Masterclass award CPD/CME credits in accordance with the CPD Scheme of the Royal College of Radiologists, London, UK.

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Page author: Salisbury NHS Foundation Trust UK (Read bio)

Last reviewed: July 2019