This document provides guidance on interpreting a chest x-ray. It describes how to analyze the lung fields by dividing them into upper, middle and lower zones. It also explains how to examine the heart size and position, bones, diaphragm and other structures. The document emphasizes looking for asymmetries and following a systematic approach to identify any abnormalities and determine their location. It lists common radiographic findings and conditions that may present on a chest x-ray.

1. X RAY CHEST

2. 1. Patient particulars
2. View- PA / AP / LATERAL / OBLIQUE
3. Exposure/penetration
4. Centralisation
5. Skeleton
6. Lung fields
7. Cardiovascular silhouette
8. Mediastinum
9. Costo phrenic & cardio phrenic angles
10. Diaphragm
11. Soft tissue abn.
12. Conclusion

3. Radiologically, lung fields are divided into 3
ZONES……
UPPER ZONE - From above upto 2nd
costal
cartilage
MIDDLE ZONE - 2ND
TO 4TH
Costal cartilage
LOWER ZONE - Below 4th
costal cartilage

5.  Patient particulars
 View- Pa / AP / Lateral / Oblique

6. Should see ribs through
the heart
Barely see the spine
through the heart
Should see pulmonary
vessels nearly to the
edges of the lungs

7. OVERPENETRAT
ED FILM
• Lung fields darker
than normal—may
obscure subtle
pathologies
• See spine well beyond
the diaphragms
• Inadequate lung detail

8. Underpenetrated
Film
•Hemidiaphragms
are obscured
•Pulmonary
markings more
prominent than they
actually are

9.  Should be able to
count 9-10
posterior ribs
 Heart shadow
should not be
hidden by the
diaphragm
1
2
3
4
5
6
7
8
9
10

10. Medial ends of
bilateral clavicles
are equidistant from
the midline or
vertebral bodies

12. If spinous process appears closer to the right clavicle (red
arrow), the patient is rotated toward their own left side
If spinous process appears closer to the left clavicle (red arrow),
the patient is rotated toward their own right side

13. Check for
 Symmetry
 Deformities
 Fractures
 Masses
 Calcifications
 Lytic lesions

14. Check for
Cardiomegaly
Mediastinal and Hilar
contours
Trachea- upper med.
Apex of heart- lower med.

15.  Check sharpness of
borders
 Right is normally
higher than left
 Check for free air,
gastric bubble, pleural
effusions
 >1.5 cm - normal
 < 1.0 cm- flat diaphragm

16.  To help you
determine
abnormalities and
their location…
 Use silhouettes of
other thoracic
structures

17. This is chest radiograph, PA view with normal
exposure, no rotation and without any apparent
bony abnormality. Trachea is placed centrally & lung
fields are clear with normal broncho-vescicular
markings. Cardiovascular silhouette is within normal
limits with normal cardiothoracic ratio. Mediastinum,
costo-phrenic, cardio-phrenic angles, dome of
diaphragm & soft tissue shadow within normal limits.

18. Remember… be systematic!

19. Consolidation

20. a) PNEUMONIA
b) COLLAPSE
c) FIBROSIS
d) PULMONARY INFARCTION
e) CA LUNG
f) TUBERCULOSIS

21. Multiple bilateral cavitary lesions with air-
fluid levels

22. 1. LUNG ABSCESS
2. HYDROPNEUMOTHORAX
3. INFECTED LUNG CYST

25.  PERICARDIAL EFFUSION
 DCMP
 RHD
 IHD
 ASD
 VSD
 SYST HTN

27. Non homogenious infiltrates

28. Non homogenious infiltrates

29. 1. PULMONARY TB
2. RESOLVING BACTERIAL PNEUMONIA
3. ALVEOLAR CELL CA
4. PULMONARY EDEMA
5. FUNGAL INFECTION OF LUNG

30. Dextrocardia

31. Emphysema

32. emphysema

33. 1) EMPHYSEMA
2) B/L PNEUMOTHORAX
3) LARGE MULTIPLE BULLAE
4) B. ASTHMA
5) OVER EXPOSED FILM

34. Normal broncho-vescicular
markings
2/31/3

35. UPTO 2/3 – Normal
BEYOND 2/3 – Chronic bronchitis

38.  Fibosis
 Collapse
 infiltration

39. Foreign body
? Trachea
? esophagus

40. Ans. Is…Lateral X-Ray Chest.
& Symptoms

41. pneumothorax

42. 1) Pneumothorax
2) Bullae
3) Lung cyst
4) Obtructive emphysema
5) Mastectomy
6) Poor technique

43. Miliary tuberculosis

44. 1. Miliary tb
2. Tropical eosinophilia
3. Pneumoconiosis
4. Lymphangitis carcinomatosa
5. Extrisic allergic alveolitis
6. Haemosiderosis
7. Sarcoidosis
8. Fungal ds

45. Homogeneous opacity

46. Homogenious opacity

47. Homogenious opacity

48. Homogenious opacity
Homogenious opacity

49. 1) Pleural effusion
2) Empyema thorasis
3) Collapse
4) Consolidation
5) Thickened pleura
6) Pleural mesothelioma
7) Agenesis of lung
8) Surgical removal
9) Fibrosis

50. Right lung opacity

51. Left lung opacity

52.  Ca lung
 Loculated pleural effusion

53. Thank you
all The besT