Outline of the Approach to Chest X Ray Assessment

An outline of the approach to chest X ray assessment along with an interpretation of our patient's chest X rays follows.

One assesses the chest X ray by analyzing the bone structures, the lung fields and the cardiac silhouette. Bone abnormalities may be a clue to an underlying cardiac diagnosis, for example, rib notching in coarctation of the aorta.

Analysis of the lung fields includes assessment of both the pulmonary vasculature and the lung parenchyma.

Finally, the cardiac silhouette is analyzed both on its right and left borders. The great vessels should be evaluated for their size and position. One can analyze heart size by assessing the cardiothoracic ratio. It is normally less than 50 percent. Cardiac valves cannot be seen roentgenographically unless calcified.