10 qualities of a good chest x-ray

10 qualities of a good chest x-ray

A normal chest x-ray

A chest x-ray can only be interpreted properly if its good quality.

A good quality chest x-ray should demonstrate the following characteristics.

1. Appropriate labelling – with patient details
2. Marked left (or right) – appropriately
3. Marked PA or AP
4. Rotation – trachea should be equidistant between the clavicular heads, i.e. centred in the chest
5. Inspiration – 6 anterior (and 10 posterior) ribs should be visible if fully inspired
6. Penetration – the spine should be just transparent through the heart
7. Diaphragm – even diaphragmatic levels on both sides
8. Costo-diaphragmatic angles – sharp
9. Artefacts – no artefacts obscuring the image (e.g. jewellery)
10. Appropriate investigation – for the problem area?

Regarding rotation

Compare the positions of the left and right medial clavicular joints to the spinous processes. There should be an equal gap on each side, as shown in the following diagram.

Mnemonic to remember key aspects of a good chest x-ray: ‘RIP’ – Rotation, Inspiration, Penetration.