How to read a chest X-ray
Other platforms explain it with text and video. In VMS you practice it on the patient.
The chest X-ray is the most common imaging test. A fixed order makes sure you check tubes and lines and do not stop at the first finding.
Step by step
Check the details
Confirm the patient, date and view. An AP film taken at the bedside makes the heart look bigger than a standing PA film. [1]
Check quality
The spinous processes should sit midway between the clavicle heads. Count about 9 to 10 back ribs above the diaphragm for a good breath in. [2]
Airway and mediastinum
The trachea should be in the middle. A shift away from one side can mean a tension pneumothorax or large effusion. [2]
Lungs and pleura
Compare both sides top to bottom. Look for consolidation, masses, fluid and a missing lung edge from a pneumothorax. [2]
Heart and diaphragm
On a PA film, the heart should be less than half the chest width. Check for air under the diaphragm and blunted angles from fluid. [2]
Tubes and lines
A breathing tube tip sits about 3 to 5 cm above the carina. A feeding tube should pass below the diaphragm into the stomach. [2]
Bones, soft tissue and comparison
Check ribs, clavicles and soft tissue, then compare with prior films and give a clear summary. [1]
Common errors
- Calling an enlarged heart on an AP film.
- Not checking the position of tubes and lines.
- Stopping after the first abnormal finding.
Practice it in VMS
In VMS you do this on the patient, not on paper: every step goes on the checklist with a score, and in Teach mode Blocky tells you what comes next.
VMS cases that train this skill
Sources
Facts and steps follow AAMC Core Entrustable Professional Activities (Core EPAs); NCCPA PANCE Content Blueprint. VMS is not affiliated with these organizations. Updated: 2026-10-11.