David S. Feigin, M.D.
- Verify patient information and date on both films and position of LEFT or RIGHT marker on frontal.
- Note adequacy of penetration and any technical defects.
- Look briefly at the entirety of both films for obvious abnormalities.
- Study the lungs, both up and down and side to side. Include lung volumes and symmetry of markings.
- Check periphery of lungs for pneumothorax and effusions.
- Evaluate mediastinal contours, edges and shape.
- Follow trachea to carina and main bronchi.
- Look at both hila for enlargement and abnormal bulges.
- Trace periphery of the chest – neck, chest wall, bones, diaphragms. Check the upper abdomen for free air and abnormal air collections
- Judge the size and shape of the lungs and diaphragms.
- Follow the airway from neck to hilum. Note shape of pulmonary arteries.
- Note back of heart and darkening toward diaphragm.
- Look upward for darkening of anterior mediastinum to the neck.
- Follow the spine downward for vertebral bodies and darkening.
- Trace periphery – forward through abdomen, up anterior chest wall and down posterior ribs to the costophrenic angles.
- Markings (Vessels)
- Minor Fissure (not always visible but must know location)
- Right Paratracheal Line
- Right Atrium
- Left Ventricle
- Main Pulmonary Artery (Trunk)
- Aortic Knob
- Descending Aorta
- Left Paratracheal Edge
- Main Bronchi
D. Hila – Left and Right Pulmonary Arteries
E. Soft Tissues
- Chest Walls
- Breast Shadows
- Bowel Gas
- Ribs (Anterior and Posterior)
- Bodies and Disc Spaces
- Spinous Processes
- Trachea and Main Bronchi
- Left Bronchus on End
B. Hila – Left and Right Pulmonary Arteries
- Fissures – Major, Minor (not always visible but must know location)
- Left Ventricle
E. Posterior Chest
- Spine – Bodies and Disc Spaces
F. Diaphragms, Costophrenic Angles and Bowel Gas
G. Anterior Chest
- Chest Wall
David S. Feigin, M.D., Professor of Radiology, Johns Hopkins University