This document provides an overview of a normal chest x-ray examination. It discusses the major views used in chest x-rays including posteroanterior, anteroposterior, lateral, and lateral decubitus. It also covers technical aspects such as inspiration level, penetration, and patient rotation. Finally, it outlines the systematic approach used to analyze chest x-rays, including examining the trachea, hila, mediastinum, heart, lungs, pleura, diaphragm, bones, and soft tissues.

1. NORMAL CHEST X
RAY
BY DR.AKHIL ROHAN

2. • INTRODUCTION
• MAJOR VIEWS OF CHEST RADIOGRAPH
• TECHNICAL ASPECTS
• APPROACH
• SUMMARY

3. INTRODUCTION
• Radiographic examination of the lungs is
performed for a wide variety of medical conditions
providing an easily accessible,cheap and effective
diagnostic tool.
• Typical effective dose of chest X ray is around
0.2mSv

4. MAJOR VIEWS OF CHEST RADIOGRAPH
• Postero anterior
• Antero posterior
• Lateral
• Oblique
• Lateral Decubitus
• Lordotic

5. POSTERO ANTERIOR POSITION
• Patient stands upright with the anterior wall of chest placed
against the front of film.
• The shoulders are rotated forward enough to touch the film
or ask the patient to place hands on the waist ensuring that
the scapulae do not obscure a portion of lung fields
• Exposure usually taken with patient in full inspiration.
• Focus to film distance of 6 feet

7. ANTERO POSTERIOR POSITION
• Used when the patient is debilitated, immobilizer,
or unable to co operate.
• Film is placed behind the patient’s back with the
patient in a supine position

9. Scapula Seen in the periphery of
thorax
Seen over the lung fields
Clavicles Project over the lung Above the apex of lung
fields
Ribs Posterior ribs distinct Anterior ribs distinct

10. LATERAL POSITION
• Patient stands upright with the left side of chest
against the film and arms raised over the head
• Typically used in conjunction with other views

12. • esophagus(A),
trachea (B), lung hili
(C), heart silhouette
(D), lung apices (E),
scapulae (F), thoracic
vertebra (G), thoracic
intervertebral
foramen (H),
superimposed
posterior ribs (I),
costophrenic angles
(J), and diaphragm
(yellow arrows).

13. LATERAL DECUBITUS POSITION
• The patient lies on either side.The radiograph is
labeled according to the side that is placed against
the film .
• Useful in detecting small amount of pleural
effusion

15. OBLIQUE VIEW

16. LORDOTIC VIEW :

17. APICAL VIEW

18. FACTORS DETERMINING THE TECHNICAL QUALITY
OF THE RADIOGRAPH
• Inspiration
• Penetration
• Rotation

19. INSPIRATION
• The chest radiograph should be obtained with the
patient in full inspiration to help assess
intrapulmonary abnormalities.
• At full inspiration,the diaphragm should be
observed at the level of the 8-10 ribs posteriorly or
the 5-6 rib anteriorly.

21. PENETRATION
• Vertebral bodies and disc spaces should be just
visible through the cardiac shadow .
• Over penetration leads to loss of visibility of low
density lesions such as early consolidation.

23. ROTATION
• Medial aspects of clavicles equidistant from
vertebral spinous processes.

25. APPROACH
• Patient identication details , marker labeling.
• X ray view –PA ,AP, Lateral
• Breath : Inspiration or Expiration
• X ray penetration : Under or over penetrated
• Rotation

26. SYSTEMATIC SEARCH
• TRACHEA
Check whether the trachea is midline or
deviated.The carina lies at the level of T6 on
inspiration and at the level of T4 on expiration.In
adults the right main bronchus has a steeper angle
than the left , but the angles are symmetrical in
children.

28. HILUM
• Left hilum is usually higher than the right hilum
• The hilar shadows in both projections are produced
mainly by the right and left pulmonary arteries

30. MEDIASTINUM

31. HEART
• Position
• Cardiothoracic ratio :ratio between the maximum
transverse diameter of heart and max width of
thorax above costophrenic angles.

32. RIGHT HEART BORDER
1. SVC
2. RIGHT ATRIUM
3. IVC
LEFT HEART BORDER
1. AORTIC KNUCKLE
2. PULMONARY TRUNK
3. LEFT VENTRICLE

35. LUNG
• On a PA view , for descriptive purposes the lungs
are divided into three zones

40. ACCESSORY FISSURES

41. JUNCTION LINES:

42. HIDDEN AREAS

43. PLEURA
• Trace around the entire edge of lung to look for
pleural
abnormalities/thickening/calcifications/pneumotho
rax.
• B/l costophrenic angles are well defined in a
normal chest radiograph.

45. DIAPHRAGM
• Right hemi diaphragm is higher than the left.
• Assess the curvature of b/l hemidiaphragms to
identify diaphragmatic flattening or bulge .
• Assess b/l costophrenic angles .

47. BONES
• Clavicles
• Each rib
• Scapulae
• Vertebra

48. SOFT TISSUES
• Breast shadows
• Skin folds
• Muscles