Copyright © 2009 [Gerald R. Aben, MD MSU Department of Radiology]. All rights reserved.
Revised: April 08, 2009
Step-by-Step Approach


Evaluating the Chest Radiograph

Step 1: Identification

The first and most important step in evaluating the chest radiograph is evaluation of the patient information.  Before looking at the image itself, it is essential that you evaluate the identification on the film.   The questions that you should ask yourself are:

Is this my patient? (Correct name, correct birth date, correct identification number)

Is this the film that I want to evaluate? (correct date and time)


Step 2: Labeling

After you have determined that you are reviewing the appropriate film, you must observe the labeling of the film to determine what type of film you are reviewing and the patient's position at the time of the film.  The identification on the film will most likely include an indication of the right or left side of the patient.   Does this indicator correlate to what you see?  Is the heart on the left?  Is the stomach bubble on the left?   If there is a discontinuity with the marker and what you observe, you must determine if this is an error in marking, or does the patient really have a right-sided heart?Labeling of the film with opaque markers or stickers, may also tell you if the patient's film was obtained in an upright, semi-erect or supine position.   These features will affect how the film is evaluated.   The film should also be marked as portable if it was obtained at the bedside.Typically, in reviewing radiographs, the film is placed on the view box as if the patient were standing in front of us, facing us.  By using this convention, it will always be clear to you and to others what you are looking at.

After all of this discussion, it must be noted that as we move to the future, that these steps will change somewhat.  With the dissemination of digital imaging, you will soon be viewing all of your radiographs on a screen, much as you are reviewing this tutorial at this time.  The same rules however still hold true.  Be sure you are viewing the patient you want and the specific film that is pertinent to what you are trying to evaluate.