Interpreting chest X-rays

Dear House Officers,
When interpreting chest X-rays please present with the following format:

1. What kind of X-ray? Indicate the direction of the beam and the part of the body.
2. Name?
3. Taken when?
4.  Number of a series of what number?
5. Satisfactory inspiration?
•  Left hemidiaphragm must be below the sixth rib anteriorly.
6.  Central? Rotated?
• The medial end of the clavicles should be equidistant to the spinous processes of T1 to T5.
7. Exposure good?
• Just make out the vertebra behind the heart.
8. Position of scapula good?
9. Cardiothoracic ratio of < 50%?
10. Outlines clearly defined and seen?
• Diaphragm
•  Heart.
• Hila
•  Left higher than right
• Same density
• Bones
11.  Hidden conundrums
• Apex
•  Behind the heart
•  Hila
• Below the diaphragm

Example

This is a posterior-anterior (PA) chest X-ray of Mr. Smith taken on the 13^th of September 2015. This is the 3^rd chest X-ray of a series of 3. The assessment of its quality showed that inspiration was satisfactory, the X-ray was central, exposure adequate and scapula is well positioned. The cardiothoracic ratio is less than 50%. The outlines of the diaphragm, heart and bones are clearly seen and well defined with the left hilum being higher than the right and of equal density.

Mnemonic: (N)ame, (D)ate, (I)nspiration, (R)otation, (E)xposure, (S)capula, (C)ardiothoracic ratio, (O)thers/outlines; NDIRESCO