Synopsis
Interpret an adult chest radiograph systematically, recognise urgent thoracic abnormalities, account for technical limitations, and turn an imaging pattern into a safe clinical action rather than an unsupported final diagnosis.
- Confirm patient, date, indication and comparison films before interpretation; a correct description attached to the wrong patient or old image is still a dangerous error.
- Judge image quality first using projection, rotation, inspiration, exposure and coverage, because portable AP technique, supine position and poor inspiration can mimic cardiomegaly, basal opacity or vascular congestion.
- Use a reproducible search pattern: airway and mediastinum, lungs and pleura, cardiac silhouette and hila, diaphragms and upper abdomen, then bones, soft tissues and every line or device.
Key red flags
A sharp visceral pleural line with no lung markings beyond it supports pneumothorax. In a supine patient, pleural air may collect anterobasally and produce an abnormally deep costophrenic sulcus rather than a classic apical line. Mediastinal shift is a late radiographic clue and tension remains a clinical diagnosis.
Investigation priorities
Determine whether projection, position, rotation, inspiration, exposure or incomplete coverage could create or conceal the apparent abnormality.
Management branches
Every chest radiograph before diagnostic interpretation.
- Confirm patient identifiers, acquisition date and time, indication, side markers and whether a relevant earlier image is available.
- Identify PA or AP projection, erect or supine position, rotation, inspiratory volume, penetration and anatomical coverage, recording any limitation that changes confidence.