Chest X-rays


TheMain Steps for Examining a Chest X-Ray

Clarke,(2011) proposes that the use of the ABCDE approach is the easiestapproach of reading a chest X- ray.The main steps include

Step A Involves examining the trachea and its subdivisions. Thestep entails looking at the shape, the size, shadow and site of themainstream bronchi and the intermediate bronchus.The key questionsto be examined is whether the trachea is narrowed or clear anindication of the existence of stenosis or edema .The second questionis whether the trachea is central (Clarke, 2011).

Also during the first step, examination of the Periphery of film isimportant. The step involves checking any existing writings on theX-ray for instance inspiration, decubitus, supine, expiration or anarrow pointing on the artefact. An additional examination at theperiphery is checking the details of the patient. This includescheckingthe name of the patient, the date in which the radiographwas taken, the gender and date of birth of patient. Checking suchdetails is essential for affirming that it’s indeed the patient inthe event that the X- ray is compared with previous ones. It alsovital to examine the peripheral artefacts on the radiographs of thechest that provide significant clues such as the existence of abrassiere can show the sex of the patients and the existence of aninhaler may signify that the patient is asthmatic and many otherimportant clues (Gelderen, 2012).

StepB:Involves looking at the breathing. Here it is essential toexamine if the lungs are uniformly extended in comparison to the lungfields.Additionally, it is essentially to examine the edges of thelung and the four silhouettes (Clarke, 2011). Other scholars such asKarpick (2012) denote step B with checking the bones. Checking thebones entails looking for the existence of any fractures on the bone,any lytic lesions, body deformities, missing bones and lateraldeviations.

StepC entails looking at the Cardiac or circulation. One should examinethe cardiac shadows, size, site and borders. The key aspects toexamine include the aorta and the pulmonary vessels (Clarke, 2011).

Step D entails looking at the existence of any disability. Thisinvolves looking for fractures essentially in the shoulder girdle orribs (Clarke, 2011).

StepE involves checking for any other disabilities which includes lookingfor the presence of air under the diaphragm, looking at the edges forsurgical emphysema, the existence of breast shadows and looking forforeign bodies and other unnatural presences (Clarke, 2011).

Determinationof an overexposed and underexposed X-ray

Ifa chest X-ray has a normal exposure, the invertible spaces should beobvious on the shadow of the trachea. In addition, they should bemuch less apparent superimposed on the shadow of the heart (Long, etal, 2012).

AnX-ray that is overexposed has investable spaces that are clearlyapparent superimposed on the shadow of the heart which makes it toobright as depicted in Figure I. Below. The existence of too muchbrightness may result to the loosing of details in the essentialareas (Long, et al, 2012).


Anunderexposed x- ray has intervertebral spaces that are not apparentsuperimposed on the shadow of the heart and the trachea. This makesthe X-ray to be too black, as depicted by Figure 2 Below. Due to theexistence of darkness shows that the X-ray may not have crucialdetails on the shadow areas (Long et al, 2012).



Clarke,C. (2011). ChestX-rays for Medical Students.John Wiley &amp Sons.

Gelderen,F. (2012). Understanding X-Rays: A Synopsis of Radiology. SpringerScience &amp Business Media.

Karpick,R. (2012). Basicsof Chest Radiography. NJGlobal Tuberculosis Institute.

Long,E, Frank, E and Ehrlich, R/(2012). Radiography Essentials for LimitedPractice. Elsevier Health Sciences, 2012