How to Read a Chest X-ray


Have you ever wondered how to read a chest x-ray, or have you ever tried, and been confused by the many different shades and contours? Well then lets jump straight in and learn about reading chest x-rays!

When examining any medical scan, it is important to understand the anatomy of the area you are looking at, the major structures and landmarks, and most importantly, what the normal arrangement of these structures are.

We will be working with this x-ray, so feel free to click on the image to download it.

Chest X-ray
Normal Chest X-ray.Source: Wikimedia

Step 1 – Alignment

X-Ray AlignmentThe most important step is to check the alignment of the image. Many healthcare pros still get confused by backward scans. For this reason, it is important to check the alignment before trying to identify the structures. Fortunately, the radiologists make this part easy for us. Just check that you can read any text of the scan. There will usually be an R or L on the corner of the scan, if these are backward or in some other strange orientation, so is the rest of the scan. In our example, there is a small “L” in the top right, indicating this scan is correctly oriented.

Step 2 – Identify Major Bony Structures

Bony Regions of the Chest X-rayThe next step is to identify the major structures of the scan. These are usually skeletal bones, as they are the most obvious landmarks in an x-ray image. In this example, we can clearly identify the vetebral column (blue), rib-cage (green), shoulders and clavicle (yellow). If we were investigating a suspected bony injury, such as a fracture or dislocation, we will look much closer at the bones of scan, and generally disregard the organ structures.


Step 3 – Identify Organ Structures

The next step is to identify the organ structures to identify soft landmarks and allow us to determine if there is any abnormal growths or structures in the organ anatomy. In this scan, we can see several major organs, such as the lungs, heart, aorta, trachea, diaphragm and the top of the abdominal cavity, including the top of the stomach and liver.

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