Chest X-ray

Checklist

The following points may be used as a guide to assess a chest X-ray. 
(Note: some terms are explained later in the Pathology section)

1. Technique: how was the image made? (Supine, standing, AP, PA). What is the technique? (Rotation, inspiration). Has everything been imaged?
2. Artificial lines (if present): position of drains/deep venous lines/tracheal tubes/gastric tube?
3. Mediastinum: widened? (including aortic pathology, space-occupying lesion/lymphadenopathy) Free air? (pseudomediastinum) Position of trachea/bronchi? (when displaced: think of atelectasis) 
4. Lung hili: are the hili sharp? Can all be explained by vessels? (Think of SOL/lymphadenopathy) Lungs: Symmetric lung vessel markings? Normal tapering towards peripheral? 
5. Heart: are the heart contours sharp? Can you see through the heart? Enlarged heart? 
6. Pleura: pleural thickening? Pneumothorax?
7. Subdiaphragmal: free air? (fig. 13) Intestinal pathology? Hiatal hernia? 
8. Soft tissues: subcutaneous emphysema? Are there (superimposed) abnormalities of skin, breasts and other body parts? (fig. 13)
9. Bone: ribs intact? Fracture/vertrebral collapse? Bone lesions?