1. Labeling x-rays. The rules are archaic, inconsistent, and sometimes confusing, but:
The x-ray is labeled in the direction in which the beam passes, e.g.,
PA Chest - Posterior to anterior
CC Mammogram - Cranial to caudalHowever, this is not always the case, e.g.,
Lateral elbow - Not labeled “medial-lateral”
Left lateral chest - Left side of chest closer to the film
Right decubitus - AP or PA view, patient lying with their right side down
Apical lordotic - AP chest, radiation tube angled cephalad
Waters’ view - AP face, head tilted up
2. Regardless of how the film was exposed, you always view the image as you would view the patient; patient’s right to your left, both on plain films and cross-sectional images.
Plain film - this is usually in the anatomic position, i.e. patient upright, facing you, palms forward.
Cross-sectional images - patient supine (lying in bed), you standing toward the patient’s feet.
Exceptions - neurosurgeons, orthopedists, and osteopaths who operate on the spine often view surgical films as the patient would lie during the surgery.
3. The correct answer to some questions is “I don’t know.”
It is the job of the radiologist to see that the film is correctly labeled and marked right and left.
4. How to look at a film:
a. Dim the lights.
b. Don’t get too close.Check name, gender, age, and date.
c. Look at the entire piece of film.
d. Consider all views.
5. Anatomy or physics can explain everything on the film.
6. Treat the patient, not the x-ray.