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Why does a chest x-ray have to be PA and lateral?

Meet our chest X-ray, one of the simplest tests to be ordered in medicine. Attending physicians love to ask you about it because that's what they were taught to ask about. A patient gets admitted through the ER and guess what, he got a chest x-ray, but too bad it was an AP (anterior-posterior view). The X-ray technician didn't have enough time to ask the patient for a proper "stand up and hug the film" to get a PA and lateral view.

This can also happen if your patient was already admitted and you decided that the patient needs a chest x-ray let's say at 1am. Well good luck convincing the nurse to send him downstairs for a proper PA and Lateral. I bet, 95% of the times, you will get a call from your nurse asking you "hey doctorrrrr {with a rolling R sound}, can you please change that to a portable AP?"

Watch out, if your attending asks, "did the patient get a chest x-ray?" and you answer, "Yes, but an AP". Get prepared to hear "AP is not a chest x-ray" !!!

You might get frustrated by that, or even get offended especially if you were the one to sign the order "portable film" and your name is all over the place. There is a reason why our professors hate AP films, indeed some think "it is not worth a dime'. Other than the fact that it obscures many of the features of the chest, its value in changing management is near zero, that's if you were lucky to have an appropriate x-ray penetration.

If you are not convinced of what I am mentioning above, have a look at the pictures below, showing Prince William (Duke of Cambridge) raising "the finger" to his loving crowd. At the same instance, another photographer took another picture from the other side and apparently, the first photographer missed 2 fingers and got all the world surprised by the prince's behavior. The prince was trying to say "I now have 3 kids" and he tried to convey that by raising 3 finger and didn't realize that one of his pictures will be taken at a certain time where only 1 finger will show up! If you are a physician and you don't want to miss any case of pneumonia or a retro-cardiac mass, make sure you order PA and Lateral.

CXR PA and Lateral

CXR PA and Lateral
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