Chest x-ray review is a key competency for medical students, junior doctors and other allied health professionals. Using A, B, C, D, E, F is a helpful and systematic method for chest x-ray review where E refers to external (chest wall, base of neck and shoulder girdles) and F refers to expected foreign material such as medical devices, foreign bodies and surgical clips or unexpected items such as gossypibomas. It is not sufficient to report these with the word “stable”. Every foreign item must be identified and assessed to make sure the appearances are satisfactory.
Finally, before concluding your assessment, review important check areas:
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apices
many people forget to look above the clavicles
look again at the lung above the clavicles
this is a common site for lung cancer and tuberculosis
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behind the heart
altered density in the retrocardiac region can be difficult
check for basal consolidation or a mass in this region
fluid-level of hiatus hernia
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below the diaphragm
diaphragmatic contour is the dome of the diaphragm
the lungs extend posteriorly below the diaphragm
look out for mass lesions below the diaphragm
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soft-tissue abnormalities
gas in the soft-tissues (surgical emphysema)
look for both breast shadows in female patients
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