There are three types of chest films: anteroposterior (AP), posteroanterior (PA), and lateral. The ideal timing is at the end of inspiration when the patient holds their breath and the x-ray tube is 180cm away. Image quality is assessed using the "RIPE" mnemonic of rotation, inspiration, position, and exposure to ensure visibility of key structures like the heart and vertebrae. Interpretation follows the "ABCDEF" schema of checking the airways, bones, cardiac, diaphragm, extrathoracic tissues, and fields and fissures for any abnormalities.

1. X ray chest

2. • There are 3 types of chest films;
• AnteroPosterior (AP)
• PosteroAnterior (PA)
• Lateral
• The ideal timing can be defined as the end of
inspiration, and the patient should hold his
breath at that time. Meanwhile, the X-ray tube
should be 180 cm away.

3. quality
• Assessing The Image Quality,
“RIPE” mnemonic is used;
Rotation, Inspiration, Position,
Exposure(Penetration).
• Rotation: The clavicles should
appear symmetrical and be seen
as equal length. The distance
between the thoracic spinal
process and clavicular heads
should be equal (Figure-1). If
there is a rotation, mediastinum
may look abnormal.

4. • Inspiration: On good inspiration, the
diaphragm should be seen at the level of
the 8th – 10th posterior rib or 5th – 6th
anterior rib.

5. • Position: PA, AP, or lateral view?
The standard chest X-Rays consists
of a PA and lateral chest X-Ray.
• On the AP film, the chest has a
different appearance. The heart and
mediastinal shadow are magnified
because of anterior structures,
mainly sternum
• The pulmonary vasculature is
altered when patients are examined
in the supine position. The size of
the pulmonary vasculature is more
homogeneous throughout the
upper and the lower lobes.

6. • Exposure / Penetration: Ideally,
you should be able to see the
heart, the blood vessels, and the
intervertebral spaces. Exposure
should be adequate if you are able
to see approximately T4 vertebra
and spinal process. If the film is
underexposed, you will not be able
to see them (Figure-6). If the film is
overexposed, details of bone
structures will be lost (Figure-7).

7. interpretations
• The interpretation of a chest X-
Ray should be approached
systematically. For chest X-
Rays, there is a classic
schematic: “ABCDEF.” You
should first check the patient’s
name and date of the film. You
should also check the side
marker, and the film position
(PA or AP). Finally, you should
check patient’s position such as
supine, erect or semi-erect.
• The analysis is ABCDEF:
• Airways
• Bones
• Cardiac
• Diaphragm
• Extrathoracic tissues
• Fields and Fissures

8. airway

9. bones

10. cardiac

11. diaphragm

12. Extrathorasic tissue (lungs)

13. Fluids and fissures

14. pathologies

23. Silhaete sign

25. Silhoutte can be applied to collapse