The first thing to always check is that the film is associated with the correct patient. After doing so, to read a PA view, I utilize a mnemonic called RIP ABCDEFGH. Here is how it works:
- Rotation: Check to see that the patient is not rotated. You can look at the clavicles and make sure the vertebral processes line up nicely in between them.
- Inspiration: Check to see that you can see about 9 ribs on each side. Less than 8? It is likely poor inspiration.
- Penetration: You should be able to see lucencies in the middle of the film representing the intervertebral discs. If there are none, the film is over-penetrated; if they are too well-defined, the film is under-penetrated.
- Airway: Trace the lucency from the neck down towards the carina. It should be midline and you should be able to see two bronchi splitting from it.
- Bones: Look at the shoulder joint and trace out each rib contour to check for fractures or other abnormalities.
- Cardiac Silhouette: Check the right and left heart borders.
- Diaphragms: These should be well-defined with no obscuration of their margins.
- Empty Space Fields: Look at the lung fields bilaterally and compare. Don’t forget the apices.
- Gastric Bubble: Check for a lucency in the left upper abdominal quadrant.
- Hardware: Make sure the placement of any lines or other hardware is appropriate.
How To Read A Chest X-Ray [The Radiology Blog]