X-ray

Educational use only. These images are not for diagnosis, treatment or any clinical decision-making.

• Normal chest radiograph (PA)

  Normal example

  Posteroanterior (PA) chest film of a young adult. The source describes it as a normal chest. Use it as the reference for what a normal film looks like.

  Educational use only. These images are not for diagnosis, treatment or any clinical decision-making.

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  What to look at

  • Orientation: the patient's right is on the image left. The letters Dx (right) and Sin (left) on the film mark the sides.
  • Lung fields: both are similarly dark because they contain air, with fine vessel markings that become thinner toward the edge.
  • Heart and mediastinum: on a PA film the heart is usually less than half of the internal width of the chest, and the trachea lies near the midline.
  • Diaphragm: smooth domes with sharp costophrenic angles; the right dome is often slightly higher than the left.
  • Bones: ribs, clavicles and scapulae should look symmetrical.

  ! Teaching points are AI-drafted and have not been reviewed by a clinician.

• Chest radiograph (PA): systematic review exercise

  Example with a finding described by the source

  A second PA chest film. The source gives no clinical history or report, so no finding is claimed here. Practise the same routine on every film.

  Educational use only. These images are not for diagnosis, treatment or any clinical decision-making.

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  What to look at

  • Technique first: is the patient straight (medial ends of the clavicles equally distant from the spinous processes) and is the inspiration adequate?
  • Airway: follow the trachea from the neck to the carina and note any shift.
  • Breathing: compare the two lungs zone by zone, then check the pleura and costophrenic angles.
  • Circulation: assess the heart size and borders and the mediastinal contour.
  • Bones and soft tissues, then the areas that are easy to miss (behind the heart, apices, below the diaphragm).

  ! Teaching points are AI-drafted and have not been reviewed by a clinician.

• Chest radiograph: airspace opacity (described as lobar pneumonia)

  Example with a finding described by the source

  The source describes this film of a 67-year-old man as lobar pneumonia of the right middle lobe. It is shown to teach how an airspace opacity looks, not to diagnose anyone.

  Educational use only. These images are not for diagnosis, treatment or any clinical decision-making.

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  What to look at

  • Compare both lungs: one lower zone looks whiter (denser) than the other because air in the airspaces has been replaced by fluid or cells.
  • The right lung is on the image left; the film is labelled Sin on the patient's left side.
  • In disease of the right middle lobe the right heart border can become hard to see (the silhouette sign), because the diseased lung touches the heart.
  • In an airspace opacity, small dark branching airways may remain visible inside it (air bronchograms).
  • A film cannot name the germ or the cause: the history, examination and tests decide what the opacity means.

  ! Teaching points are AI-drafted and have not been reviewed by a clinician.

• Normal right foot (dorsoplantar view)

  Normal example

  Normal right foot of a 31-year-old man, X-ray beam passing from the top of the foot to the sole. Use it to learn the bones and the normal alignment.

  Educational use only. These images are not for diagnosis, treatment or any clinical decision-making.

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  What to look at

  • Count the rays: five metatarsals, each with a base, shaft and head; the big toe has two phalanges and the other toes have three.
  • The tarsal bones lie at the back of the foot; the tarsometatarsal (Lisfranc) joints at the bases of the metatarsals should line up smoothly.
  • Joint spaces are even and the cortex of each bone is a continuous thin bright line.
  • Trabecular bone is seen as a fine mesh inside the denser cortex.
  • Always read the soft tissues too, then correlate with the oblique and lateral views.

  ! Teaching points are AI-drafted and have not been reviewed by a clinician.

• Wrist radiograph, lateral view (described as Barton's fracture)

  Example with a finding described by the source

  The source describes this lateral film of a 33-year-old man's right wrist as a palmar Barton's fracture. It is a small image: use it to learn what to look for in a distal radius fracture.

  Educational use only. These images are not for diagnosis, treatment or any clinical decision-making.

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  What to look at

  • Identify the bones: the distal radius at the bottom, the carpal bones above it, and the base of the metacarpals out of view.
  • A Barton's fracture is a fracture of the rim of the distal radius that involves the joint surface, so look at the articular surface for a step or a break.
  • Check the relationship between the carpus and the radius: in this injury the carpus can shift with the broken fragment.
  • Follow the cortex of the radius: a break in the thin bright line, or a change in angle, is the sign of a fracture.
  • A single view is never enough: two views at right angles are standard, and further imaging may be used for planning.

  ! Teaching points are AI-drafted and have not been reviewed by a clinician.