1. CHEST XRAYS

4. DRS ABCDE
Details  ie vitals | type of film (PA/AP, erect supine, correct L/R marker), date & time
RIPE 
rotation  medial clavicle ends equidistant from spinous process
inspiration  5-6 anterior ribs in MCL or 8-10 posterior ribs above diaphragm, poor inspiraiton? hyper expanded?
picture  straight vs oblique, entire lung fields, scapulae outside lung fields?
exposure  hemidiagphram visible through cardiac shadow
Soft tissue & bones
ribs, sternum, spine, clavicle  symmetry, #, dislocations, lytic lesions, density
soft tissues  symmetry, swelling, subcutaneous air, masses
breast shadows
calcifications  great vessels, carotids
Airway  trachea (central), masses?
Breathing & Bones  lung fields (vascularity), fissures, (pneumothorax, infiltrates, coin lesions, cavitary lesions, pleura (thickening, effusions (blunting of CPA)
Circulation  heart position, size, borders, shape
Diaphragm  CPA, gastric bubble
Extras  ETT, CVP line, NG line, ECG electrodes, PICC line, chest tube

5. NORMAM AP CHEST

6. imulated silhouette signs 1
1 - Left heart border - Lingula disease
2 - Hemidiaphragm - Lower lobe lung disease
3 - Paratracheal stripe - Paratracheal disease
4 - Chest wall - Lung, pleural or rib disease

8. Review areas - Apices
There is a small pneumothorax on the right.
A pneumothorax is often a very subtle finding, and may only be seen on a second review of each lung apex.
You should also check the lung apices for tumours.

11. Lung CA

12. Cavitary lesion

13. Pleural effusion

14. a. Bilateral infiltrates – pneumonia
B – after treatment

15. pneumonia

16. Congestive heart failure
First study the images, then continue reading.
The findings are:
bilateral perihilar consolidation with air bronchograms and ill-defined borders
an increased heart size
subtle interstitial markings
probably a large vascular pedicle
All these findings indicate, that we are dealing with pulmonary edema due to heart failure.
You probably would like to look at old films to see if there are any changes.

17. Interstitial edema usually presents as reticulation.
Sometimes Kerley B lines are visible.
Here another example.
Kerley B lines are 1-2 cm long horizontal lines near the lateral pleura.
The main differential diagnosis of Kerley B lines is:
interstitial edema in heart failure
lymphangitis carcinomatosa

18. pulmonary edema
peribronchial cuffing
Pulmonary Edema: Pulmonary edema is a redistribution of vascular fluid into the interstitium first, and then possibly the alveoli. The causes can be cardiogenic, renal failure, or due to respiratory conditions like ARDS.
Peribronchial Cuffing: Normal bronchi do not have the circumferential thickening depicted in the image below.

19. A common finding in atelectasis of the right upper lobe is 'tenting' of the diafphragm (blue arrow).
This patient had a centrally located lungcarcinoma with metastases in both lungs (red arrows).

20. pneumothorax

21. Tension pneumothorax

22. Tension pneumo

23. Evidence of a pericardial effusion can be as follows:
A globular heart
Loss of the indentations of the left mediastinal border
Separation of peri- and epi-cardial fat pads on the lateral film

24. Emphysema – PA and Lateral Film
Emphysema (PA Film) (left image)
Hyperinflation, darkened lung fields, and decreased vascular markings.
Emphysema (Lateral Film) (right image)
Large retrosternal airspace, increased AP diametre (barrel chest), flattened hemi-diaphragms.