Chest Radiograph Reporting System: From Quality Assessment to the Impression

REPORTING SYSTEMATICS / RADIOGRAPHY

A systematic approach for PA, AP, and lateral chest radiographs that prioritizes image quality, covers blind spots, and translates into a concise report.

The first step is not to search for disease, but to assess image adequacy

Although a chest radiograph is often reviewed quickly, projection, rotation, inspiratory effort, penetration, motion, and patient position can substantially alter the appearance of findings. Technical effects such as magnification of the cardiac silhouette on a portable AP image or increased basal opacity at low lung volumes should be recognized before clinical interpretation.

The technique section does not need to list every detail, but it should clearly state limitations that affect interpretation. Particularly on intensive care and emergency department radiographs, devices, tubes, lines, and interval change from prior imaging may be central to the report.

Start with quality assessment: the RIPE approach