Radiology Wife: How To Read A Chest Radiograph

In the past I have not always whole-heartedly participated in the husband's education. I remember fondly the day that he invited me to see his cadaver, which he had put so much time into dissecting. I remember it fondly because I said no. That was six years ago and I still do not regret that choice, even though the husband warned me I might.

But I am moving into a new phase, where I want to begin to embrace the husband's passion for medical things. I want to be an active conversational partner, or at least not completely confused. So I'm learning. I picked up a copy of Clinical Radiology Made Ridiculously Simple and started to figure things out, la vache! (Just to be clear, la vache literally means “the cow” but is used as an expression of surprise. At least so I have been told. Someone could have been making fun of me, but I guess you never know until you put it out there.)

So here is the first thing I learned. There is a specific approach to reading a chest X-ray. I know, right? It’s really very simple. You just follow these five steps:

1. Check the image for the marker that tells you which side is left and which side is right. Having the image up backwards and not noticing can be embarrassing. It can also cause you to report that things are not where they are suppose to be in the image. This would be une couille dans le potage (a problem). Literally this means “a testicle in the soup which,” which I would have to agree, would indeed be a problem.

2. Count the number of ribs you see in the image. If you see nine or more than the person pictured took a nice deep breath and you have a good view. If the technicians are having trouble getting patients to take deep breaths and you are routinely only getting eight, seven, or six ribs you may want to start posting mantras on the exam room walls.

3. Make sure the X-ray is properly exposed. This kind of goes without saying, but if you can't see everything you need to you are heading for more couille dans le potage. Just saying.

4. Also, make sure the person was not all lopsided when the image was taken. If the bones are all out of place it should not be because the patient was falling off the table.

5. Now we get to search the image for... stuff. I think this is the part that takes skill. I mean, I could do all the other steps pretty well but this c'est une autre paire de manches (is another story). Literally this means “that's another pair of sleeves,” and I feel it gives the impression of someone rolling their shirt up above the elbows before throwing me out of the radiologist's chair with the firm warning to put down my ridiculously simple book and get out of the reading room.

Okay, so I'll never be a radiologist...

... but I am learning. Maybe next I can learn about some of the “stuff” the radiologist searches for in a radiograph. Maybe I'll learn about the gastric bubble. After all, according to an article in Radio Graphics (The gastric bubble: Roentgen observations) "abnormalities in the position or shape of the stomach bubble may be the initial or sole manifestation of thoracic or abdominal pathology." Good to know. See how smart I'm getting?

At any rate, I am very excited to test out my new knowledge when my husband comes home. Granted, he is not coming home tonight, but I am ready to wow him with my advances someday when I do see him again. Let's just hope he starts talking about chest X-rays.

Elizabeth Goss, a.k.a. Radiology Wife, has a degree in writing, a radiologist husband, a radiologist father, two daughters, and a few things to tell you. As she puts it, “Both radiologists are Mayo Clinic trained so my osmotic-radiology is pretty hard core... as far as osmosis goes.”