Tips on how to interpret chest x-rays for nonradiologists

Dr Julian Dobranowski is a professor and chair of the Department of Radiology at McMaster University, chief of diagnostic imaging at Niagara Health, and provincial head for the Cancer Imaging Program at Cancer Care Ontario.

How would you summarize basic recommendations for chest x-ray interpretation for nonradiologists?

Julian Dobranowski, MD: To answer this question, it would take about 5 years and a lot of practice.

When a nonradiologist is looking at an x-ray, I think what is important is to first try and identify whether there is an abnormality, and that depends on your ability to understand what “normal” looks like. If you have some experience looking at “normal,” then you have to make a decision whether that x-ray is abnormal or normal.

Then I recommend that internists try and quantitate what the abnormality is, starting very simple: is it too black or too white? And then keep building on that until they can come up with a summary statement, which should be short and understandable. I give the analogy that when you are interpreting an x-ray, if you pick up the phone, call the radiologist, and explain it to him, that radiologist should be able to envision in his mind what the abnormality is.

That short summary statement should trigger in your mind the differential diagnosis for what the abnormality is. Very often physicians who are not trained in radiology try and make a definite diagnosis too, but radiology is the same as any other area in medicine in that we actually create differential diagnoses rather than just simple diagnoses

It is also important to have a systematic approach to x-rays. You need to have a way of approaching every examination in the same way.

So if you see an abnormality, you do not stop there—you still have to look at all the other parts of the image. If you do not see an abnormality, then you have to go through it systematically to make sure you do not miss something.