HOW TO READ A X-RAY CHEST.. A SYSTEMATIC APPROACH….. Chest x-ray remain an important and cost effective diagnostic tool for all of us. Reading a chest X-ray needs a systematic approach.. It helps us not to miss the lesions.. And no over diagnosis.. To Begin we should check the position marker (left or right), AP or PA.. Erect or Supine, Date male/female. Age etc X-ray should be free from water marks and artefacts Most films are PA view and Erect… AP is for a patient who is confined to bed. A PA view shows the scapulae clear of the lungs whilst in AP projection they usually overlap. The heart looks bigger on an AP view. The distance from the tube to the patient is also usually reduced in portable films and this also enlarges the cardiac shadow. if supine blood will flow more to the apices of the lungs than when erect… this may lead to a misdiagnosis of pulmonary congestion. Gastric bubble is absent in a supine film. Rotation should be minimal. It can be assessed by comparing the medial ends of both the clavicles to the margins of the vertebral body. CXR should usually be taken with the patient in full inspiration. A CXR in full inspiration should have the diaphragm at the level of the 6th rib anteriorly and a little higher in the right than on the left. Expiratory film if taken, is to diagnose air trapping or small pneumothorax… it should be marked so. Penetration.. An under-penetrated chest x-ray cannot differentiate the vertebral bodies from the intervertebral spaces. An over-penetrated film shows the intervertebral spaces very distinctly Breast shadows should be noted in adult women A Normal x-ray chest PA is attached… WE CAN TELL THAT IT IS A NORMAL X-RAY CHEST PA VIEW OF A FEMALE PATIENT.. IN ERECT POSITION IN INSPIRATION NOT ROTATED WELL EXPOSED NO ARTEFACT DETECTED.. PA and AP both of one male patient is also attached to compare the difference.. .. Next part of the series will be how to read an Abnormal x-ray.. I hope this article will be helpful…



Dear Poddar, I still remember the medical college days, when the first class taken by HOD of Radiology took a class about X Ray Chest. I think this was the best out of all I have ever heard about In toto description of X Ray chest. You are always a constant source of inspiration to me Poddar, Real Pulmonary Magician, People of your place are bledded to have the best Pulmonologist on the earth. I bow my head before you dear Poddar. We are all fortunate to be associated with you . Thanks again.

Dr. Krishna.. Hearing so much about me from means a lot to me.. Thanks for your continued inspiration...

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fantastic teaching sir..whatever the books we read. .unable to collect this much clinical oriented information in a nutshell. .congrats sir..plz continue ur X ray class...After that how to read CT chest also we need sir..Thanks for ur dedication and teaching sir..

Thanks Dr Suresh for your appreciation.. My Main idea is always to simplify the subject..and make it as practical as possible... Thanks again

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Wow fantastic explanation Dr K N Poddar sir really appreciable I never missed ur post .pl be continue. Thanx for your valuable post and u gave ur valuable time . Thanx a lot once again.

This Gives Us The Basic Idea To Read Chest Xray.. Believe Me This Valuable Information So Worth For Us Like New Practioner... Thanx Sir For Sharing This Valuable With Us

This is a helpful post

Thanks for your appreciation Dr. Yograj

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Well done, Dr. Poddar. This is going to be very helpful for the young doctors and medical students of this group. Our teachers used to teach us like that, but nowadays good teachers are scarce in the medical colleges.

Thanks Dr Das.. For your valuable comments

Very useful information. Thanks for uploading it.

regarding CRC we can say whether the film is inspiratory or expiratory we can divide each lung into zones(uz lz mz) we can count the no of ribs we can assess the position of diaphragm

thnks sir

Thanks Dr Tushar for your attention

Thank you sir that was very useful. Continue with more such useful description of X rays .

Thanks.. Sure I'll try
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