By Yasser Al-Obudi (5th year Medical Student)
Patient identifiers

Date & time of film

Indication & previous imaging

Quality: Projection (usually PA erect), Exposure/Inspiration (top to diaphragm, 5-6 ribs anteriorly), Penetration (vertebrae visible behind heart)

Obvious abnormalities (include which zone), foreign bodies & artefacts (e.g. drains)

Airways: tracheal deviation, masses, carina & bronchi, hilar structures

Breathing: compare each lung field zone & trace pleural margins

Cardiac: cardiothoracic ratio if PA, borders and angles

Diaphragm: flattening, angles and air under the diaphragm

Everything else: soft tissue, fractures, artefacts, aortic knuckle displacement


Airways:
  • Trachea deviates towards a collapse or pneumonectomy, away from a tension pneumothorax or pleural effusion
  • Hila contain vessels and major bronchi. Enlargement can occur in sarcoidosis (usually bilateral) or malignancy (usually asymmetrical or unilateral)
Breathing
  • Divide into upper/middle & lower zones. Trace margins to identify a pneumothorax or pleural thickening
Cardiac
  • The cardiothoracic ratio should be less than 50%. RA makes the right border and LV makes most of the left border. Unclear borders suggest consolidation and collapse.