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Chest (X-ray)

Learning objectives

Going through this study unit will enable you to:

  1. Identify the different structures seen on the normal X-ray of the thorax. 
  2. Learn the anatomical appearance and relations of the organs in the thorax as seen on the scans in two different projections. 

Explore x-ray

An x-ray of the chest (also known as a chest radiograph) is a commonly used imaging procedure in the world. It can be performed from different angles; postero-anterior projection (PA), antero-posterior projection (AP), left and right lateral projections (LL, RL). PA and AP are the most commonly used, while lateral projections are needed to evaluate the spine and how close a structure is to the chest walls. When reviewing an x-ray, first we need to determine the image quality by following the RIPE rule; rotation (clavicles and spine equidistance), inspiration (at least 9 pairs of ribs should be seen), projection (is it an AP, PS, LL or RL image), and exposure (lung apices, costophrenic angles and thoracic vertebrae should all be seen).

Then we can progress to assessing the image. The easiest way to analyze a CXR is by following the ABCDE rule, which stands for Airways, Breathing, Cardiac, Diaphragm and Everything else (bones, soft tissues, breast).

Let’s now use these techniques to evaluate the following chest x-rays in order to assess the normal anatomical appearance of the thorax

You can study each structure individually with the following galleries:

Take a quiz

Solidify your knowledge with our quiz:

If you wish to get tested on a variety of structures seen on the chest X-ray  try out our fully customizable quiz:

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