A fixed search pattern is the best protection against error when reading a chest radiograph. The order matters less than doing it the same way every time.
Technical quality
- Projection: PA (standard, erect) or AP (portable, magnifies the heart)
- Rotation: medial clavicle ends equidistant from the spinous processes
- Inspiration: about 6 anterior or 10 posterior ribs above the right hemidiaphragm
- Exposure: vertebrae just visible behind the heart
A structured search
- Airway: trachea central, carina, main bronchi
- Breathing: compare zones left with right, trace the pleura
- Cardiac: size (cardiothoracic ratio), contour and borders
- Diaphragm: contour, free gas, costophrenic angles
- Everything else: bones, soft tissues, lines and tubes
Review areas
Apices, behind the heart, below the diaphragm, the hila and the bones are where findings hide. Compare with previous films whenever possible.
Cases and figures
References
- Raoof S, Feigin D, Sung A, et al. Interpretation of plain chest roentgenogram. Chest. 2012;141(2):545–558.
Cite this entry
Chest radiograph: systematic review. Radflow Encyclopedia. Last revised 27 October 2026. https://radflow.cc/encyclopedia/chest-radiograph-review (accessed 15 November 2026).
Related entries
Cardiothoracic ratioThe maximum horizontal width of the heart divided by the maximum internal width of the thorax on a PA chest radiograph.PneumothoraxAir in the pleural space, separating the visceral and parietal pleura and allowing the lung to collapse away from the chest wall.Silhouette signLoss of a normal border between soft tissue and air when an adjacent structure fills with fluid or tissue, used to localise chest disease.
Educational reference for healthcare professionals and students. It is not medical advice and does not replace clinical judgement or local guidelines.