4. Rotation
Medial ends of clavicles
should be equidistant from the
spinous process.
Check for scoliosis
5. Degree of Inspiration
Poor inspiration Good inspiration
Midpoint of the right hemidiaphragm should be between the 5th and 7th ribs
anteriorly or around 10th rib posteriorly.
Note: lung bases appears whiter and heart larger (poor inspiration)
6. Penetration
Underpenetrated Overpenetrated
The vertebral bodies should only just be visible through the cardiac
Shadow. Important when comparing X-ray
7. Orientation
Which is the Left/Right side. Note if
any Dextrocardia
8. Describing chest x-ray part 1
Trachea
◦ Position – central or tracheal
deviation
Mediastinum
◦ Is mediastinal edge clear?
◦ Is mediastinum widened?
Lung fields
◦ Equal transradiancy on both
fields (one brighter/darker than
the other?)
◦ Horizontal fissure. Check its
position (should run from hilum to
6th rib in axillary line) – is it
displaced?
◦ Loss of lung volume
◦ Any discrete or generalised
shadows?
◦ Costophrenic angles – should be
well defined
9. Describing chest x-ray part 2
Hilum
◦ Left hilum should be higher than
right (difference should be
<2.5cm
◦ Compare shape and densitiy
Heart
◦ Shape
◦ Max diameter <half of
transthoracic diameter at
broadest part of chest
◦ Any abnormally dense areas of
heart shadow?
Diaphragms
◦ Right higher than left (difference
should be <3cm)
◦ Smooth outline
Area under diaphragm
◦ Look for air under diaphragm or
dilated loops of bowel
10. Localising lesions
Describe position of lesion in
terms of zone
◦ Upper zone: above anterior
border of 2nd rib
◦ Middle zone: between anterior
border of 2nd rib and 4th rib
◦ Lower zone: between anterior
border of 4th rib and diaphragm
Note the borders of the lesion
◦ If lesion is next to dense
structure (e.g. heart) then the
border between lesion and that
structure will be lost –
silhouette sign
