Synopsis
Interpret an adult chest radiograph in a reproducible sequence that separates technical artefact from pathology and links every important finding to an appropriate next action.
- Start with patient, date, indication and comparison, then assess projection, rotation, inspiration, exposure, field coverage and motion before naming disease.
- Use one repeatable search pattern through airway, mediastinum and hila, lungs and pleura, heart and vessels, diaphragms, bones, soft tissues and devices.
- A technically limited or apparently negative film cannot close a dangerous clinical question: state the limitation, correlate with physiology and escalate to definitive imaging when concern persists.
Key red flags
A pleural line with absent peripheral lung markings plus haemodynamic or severe respiratory compromise raises tension pneumothorax and requires urgent clinical decompression assessment.
A widened or changing mediastinal contour with compatible acute pain or trauma cannot exclude acute aortic injury; keep the definitive CT pathway active.
Free subdiaphragmatic gas, a misplaced airway or enteric tube, or a newly displaced central line can demand immediate action outside the thorax itself.
A normal or near-normal chest radiograph does not exclude pulmonary embolism, early infection, acute aortic syndrome or important airway disease.
Any unexpected critical finding must be communicated and acknowledged; simply placing a report in the electronic record may not protect the patient.
Answer the referral question, list the principal finding and material differential, state limitations, compare prior examinations and identify the action or communication required.
Investigation priorities
Identify major thoracic patterns, treatment complications and device position quickly.
Management branches
A patient becomes breathless after central venous access and a portable chest radiograph is available.
- Assess the patient and immediate observations while confirming identity, timing, projection, rotation and whether both apices and costophrenic angles are included.
- Trace the line from skin entry to tip, inspect both pleural margins and lung markings, and look for haemothorax, mediastinal change or new air-space opacity.