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Assessment of chest x-ray technical adequacy (approach)

Described below are some points on an approach to the assessment of the chest x-ray technical adequacy. Rarely, a technically inadequate chest x-ray will prohibit diagnostic interpretation but knowledge of the limitations will impact on diagnostic confidence. 

  • assessed by looking at the lower thoracic vertebral bodies, whose outline should just be visible on a PA projection
  • the spine should be seen through the heart 1
  • poor penetration: pulmonary vessels and interstitial markings appear more prominent, loss of detail at the lung bases and vertebrae, results in increased density
  • anterior aspect of at least six ribs must be noted above the dome of the right diaphragm
  • alternatively, posterior aspects of at least eight to nine ribs should be visualized 1
  • poor effort: the cardiac shadow may appear spuriously enlarged, crowding of vessels at lung bases
  • thoracic spinous processes are equidistant from the medial end of each clavicle on a frontal image
  • rotation to the right may cause: pseudo-mediastinal mass, hyperlucency of the right lung
  • rotation to the left may cause: aortic arch may appear spuriously enlarged, hyperlucency of the left lung
  • films on anteroposterior views slightly magnify the heart 1
  • medial ends of the clavicles should be projected over the posterior third or fourth ribs 1
  • clavicles will have a S shape 1

Article information

rID: 62203
System: Chest
Section: Approach
Tag: refs, refs
Synonyms or Alternate Spellings:

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