Protocol - Chest X-ray

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The American College of Radiology - Society for Pediatric Radiology (ACR-SPR) "Practice Parameter for the Performance of Chest Radiography" Amended 2014 (Resolution 39) outlines principles for performing high-quality chest X-rays in adult and pediatric participants. Topics covered include indications and contraindications for chest X-ray, qualifications and responsibilities of personnel, specifications of the examination, documentation and reporting, equipment specifications, radiation safety in imaging, quality control and improvement, safety, infection control, and patient education.


Chest Radiograph (i.e. X-ray)

The full American College of Radiology - Society for Pediatric Radiology (ACR-SPR) "Practice Parameter for the Performance of Chest Radiography" Amended 2014 (Resolution 39) is posted here and is also available at the ACR website: www.acr.org/~/media/ACR/Documents/PGTS/guidelines/Chest_Radiography.pdf

Protocol Name from Source:

This section will be completed when reviewed by an Expert Review Panel.


Publicly available

Personnel and Training Required


Radiologic Technologist

See "Section IV. Qualifications and Responsibilities of Personnel" in the "ACR-SPR Practice Parameter for the Performance of Chest Radiography" Amended 2014 (Resolution 39) at www.acr.org/~/media/ACR/Documents/PGTS/guidelines/Chest_Radiography.pdf

Equipment Needs

See "Section VII. Equipment Specifications" in the "ACR-SPR Practice Parameter for the Performance of Chest Radiography" Amended 2014 (Resolution 39) at www.acr.org/~/media/ACR/Documents/PGTS/guidelines/Chest_Radiography.pdf

Requirement CategoryRequired
Major equipment Yes
Specialized training Yes
Specialized requirements for biospecimen collection No
Average time of greater than 15 minutes in an unaffected individual No
Mode of Administration

Imaging assessment

Life Stage:

Infant, Toddler, Child, Adolescent, Adult, Senior, Pregnancy


All ages

Specific Instructions:

The American College of Radiology - Society for Pediatric Radiology (ACR-SPR) "Practice Parameter for the Performance of Chest Radiography" Amended 2014 (Resolution 39) is a clinical practice parameter. Hence the Sickle Cell Disease: Cardiovascular, Pulmonary, and Renal Working Group recommends investigators be aware that when performing chest X-rays in research studies, some uses of this X-ray are to:

  • determine, based on extent of disease, which arm of the study a patient is randomized to, or
  • assess response to a clinical intervention or treatment, or
  • define the natural course of the disease process
Selection Rationale

Chest radiograph (i.e., X-ray) is a valid, reliable, sensitive, and well-established imaging method for a comprehensive evaluation and assessment of the chest, including the respiratory, cardiovascular and upper gastrointestinal systems, and the musculoskeletal system of the thorax.



Common Data Elements (CDE) X-Ray Diagnostic Imaging Chest Assessment Status 2603738 CDE Browser
Process and Review

This section will be completed when reviewed by an Expert Review Panel.


American College of Radiology - Society for Pediatric Radiology (ACR-SPR). (2014). ACR-SPR Practice Parameter for the Performance of Chest Radiography Amended 2014 (Resolution 39). Retrieved from www.acr.org/~/media/ACR/Documents/PGTS/guidelines/Chest_Radiography.pdf

General References

Desai, P. C., & Ataga, K. I. (2013). The acute chest syndrome of sickle cell disease. Expert Opinion on Pharmacotherapy, 14(8), 991-999.

Mekontso Dessap, A., Deux, J. F., Habibi, A., Abidi, N., Godeau, B., Adnot, S., Brun-Buisson, C., Rahmouni, A., Galacteros, F., & Maitre, B. (2014). Lung imaging during acute chest syndrome in sickle cell disease: computed tomography patterns and diagnostic accuracy of bedside chest radiograph. Thorax, 69(2), 144-151.

Protocol ID:


Export Variables
Variable NameVariable IDVariable DescriptionVersiondbGaP Mapping
PX810201_ChestRadiograph_Cardiopulmonary_Symptoms PX810201090000 Does the patient display cardiopulmonary signs and/or symptoms? 4 N/A
PX810201_ChestRadiograph_Date PX810201010000 What is today's date? 4 N/A
PX810201_ChestRadiograph_Date_Last_Menstrual_Cycle PX810201140000 What is the date of the patient's last menstrual cycle? 4 N/A
PX810201_ChestRadiograph_Equipment_Requirement1 PX810201230000 Does the radiograph equipment have a beam-limiting device that provides rectangular collimation? 4 N/A
PX810201_ChestRadiograph_Equipment_Requirement2 PX810201240000 For routine upright projections, is there at least a 72-inch source-image distance (SID) to minimize magnification? 4 N/A
PX810201_ChestRadiograph_Equipment_Requirement3 PX810201250000 For clinically necessary imaging (e.g. supine positioning, infants, young children, immobilized patients, etc), is there at least a 40-inch SID? 4 N/A
PX810201_ChestRadiograph_Equipment_Requirement4 PX810201260000 Does the nominal source (focal spot) exceed 2.0mm? 4 N/A
PX810201_ChestRadiograph_Equipment_Requirement5 PX810201270100 Is this procedure part of an analog study? 4 N/A
PX810201_ChestRadiograph_Equipment_Requirement5a PX810201270200 If so, is an intensifying screen being used? 4 N/A
PX810201_ChestRadiograph_Equipment_Requirement6 PX810201280100 Is a film-screen image receptor being used? 4 N/A
PX810201_ChestRadiograph_Equipment_Requirement6a PX810201280200 If so, is the image processing being automated through carefully controlled temperature, densitometry and maintenance settings? 4 N/A
PX810201_ChestRadiograph_Examination_Adult_Correct_Exposure PX810201420100 For adult patients, using the appropriate technical settings, does the exposed radiograph display the lung parenchyma at a mid-gray level? 4 N/A
PX810201_ChestRadiograph_Examination_Child_Correct_Exposure PX810201420200 For newborns, infants, and children, using the appropriate technical settings, does the exposed radiograph display the lung parenchyma at a mid-gray level? 4 N/A
PX810201_ChestRadiograph_Examination_Collimation_Limit_Exposure PX810201350000 What sort of appropriate collimation was used to limit exposure to the anatomic area of interest? 4 N/A
PX810201_ChestRadiograph_Examination_Date PX810201320000 What is the examination date? 4 N/A
PX810201_ChestRadiograph_Examination_Image_Included PX810201400000 Where both lung apices and the costophrenic sulci included in the radiograph images? 4 N/A
PX810201_ChestRadiograph_Examination_Image_Projection1 PX810201390100 Was an image of the erect PA projection taken? 4 N/A
PX810201_ChestRadiograph_Examination_Image_Projection2 PX810201390200 Was an image of a left lateral projection taken? 4 N/A
PX810201_ChestRadiograph_Examination_Image_Projection3 PX810201390300 If an erect PA or left lateral projection was not taken, what was the reason for the need of an alternative? 4 N/A
PX810201_ChestRadiograph_Examination_Image_Projection3a PX810201390400 What projections were taken as an alternative? Check all that apply 4 N/A
PX810201_ChestRadiograph_Examination_Position_Alternative PX810201410000 Was a cross-table lateral radiograph taken, where the patient was in supine position with his/her arms raised above their head? 4 N/A
PX810201_ChestRadiograph_Examination_Protocols_Shielding PX810201380000 Are there policies and procedures for appropriate shielding of patients? 4 N/A
PX810201_ChestRadiograph_Examination_Protocols_Techniques PX810201370000 Are technique charts and/or protocols in generator memory for all anatomic parts, listing exposure factors that will reliably produce diagnostic-quality images of patients of different sizes available? 4 N/A
PX810201_ChestRadiograph_Examination_Protocols_Views PX810201360000 What protocols for the standard view or views of each anatomic area of interest was used? These should be designed to optimize diagnostic information while minimizing radiation exposure 4 N/A
PX810201_ChestRadiograph_Examination_Side PX810201340000 Which side is the imaged anatomic site? 4 N/A
PX810201_ChestRadiograph_Examination_Time PX810201330000 What is the time of examination? 4 N/A
PX810201_ChestRadiograph_Facility_Id PX810201310000 What is the facility identification number? 4 N/A
PX810201_ChestRadiograph_Government_Compliance PX810201060000 Does the patient need a chest radiograph to be in compliance with government regulations? 4 N/A
PX810201_ChestRadiograph_Image_Interpretator PX810201290000 Is the image being processed and reviewed by the qualified professional? Is the image being procesed automated by the proprietary software? 4 N/A
PX810201_ChestRadiograph_Image_Metadata PX810201450000 Is each film/image permanently marked with the facility identification, patient's name, identification number, right or left side indication, patient position, and the date and time of the radiographic exposure? 4 N/A
PX810201_ChestRadiograph_Image_Review PX810201430000 When the examination is completed, were the images reviewed by qualified personnel, either a physician or radiologic 4 N/A
PX810201_ChestRadiograph_Image_Review_Not_Optimal PX810201440000 Were the images of less than optimal diagnostic quality? 4 N/A
PX810201_ChestRadiograph_Medical_Physicist_Certification PX810201180100 Does the medical physicist have certification in therapeutic medical physics, diagnostic medical physics, radiological physics, diagnostic radiological physics, and diagnostic imaging physics? 4 N/A
PX810201_ChestRadiograph_Medical_Physicist_Certification_Subfield PX810201180200 If no to previous question, is the medical physicist certified in any other subfield recommended by the American Board of Radiology (ABR), the Canadian College of Physics in Medicine, or by the American Board of Medical Physics (ABMP)? 4 N/A
PX810201_ChestRadiograph_Patient_Age PX810201020000 What is the patient's age? 4 N/A
PX810201_ChestRadiograph_Patient_Critically_Ill PX810201110000 Is the patient critically ill or medically unstable? 4 N/A
PX810201_ChestRadiograph_Patient_Difficulty_Transporting PX810201120000 Is it difficult to transport the patient for standard chest radiography because of his/her age or clinical condition? 4 N/A
PX810201_ChestRadiograph_Patient_Gestational_Age PX810201130200 If patient knows she is pregnant, what is the gestational age of the patient? 4 N/A
PX810201_ChestRadiograph_Patient_Id PX810201300000 What is the patient identification number? 4 N/A
PX810201_ChestRadiograph_Patient_Monitoring_LifeSupport_Devices PX810201100000 Is the patient connected to monitoring and/or life-support devices? 4 N/A
PX810201_ChestRadiograph_Patient_Pregnancy_Test PX810201130300 If patient is unsure if pregnant, what is the result of the pregnancy test? 4 N/A
PX810201_ChestRadiograph_Patient_Pregnant PX810201130100 Is the patient pregnant or potentially pregnant? 4 N/A
PX810201_ChestRadiograph_Physician_Radiograph_Certification PX810201170100 Is the licensed physician certified in Radiology or Diagnostic Radiology by the American Board of Radiology, the American Osteopathic Board of Radiology, the Royal College of Physicians and Surgeons of Canada, or the College des Medcins du Quebec? 4 N/A
PX810201_ChestRadiograph_Physician_Radiograph_Certification2 PX810201170200 If no to previous question, has the licensed physician completed a diagnostic radiology residency program approved by the Accreditation Council for Graduate Medical Education (ACGME), the Royal College of Physicians and Surgeons of Canada (RCPSC), the College des Medecins du Quebec, or the American Osteopathic Association (AOA) to include radiographic training on all body areas and documentation of a minimum of 6 months of formal dedicated training in the interpretation and formal reporting of general imaging, for patients of all ages? 4 N/A
PX810201_ChestRadiograph_Physician_Radiograph_Qualification2 PX810201170300 Does the licensed physician have documented training in and understanding of the physics of diagnostic radiography and have experience with the equipment needed to safely produce the images? 4 N/A
PX810201_ChestRadiograph_Physician_Radiograph_Qualification3 PX810201170400 Is the licensed physician familiar with the principles of radiation protection, the hazards of radiation, and radiation monitoring requirements? 4 N/A
PX810201_ChestRadiograph_Physician_Radiograph_Qualification4 PX810201170500 Does the licensed physician have documented training and understanding of other medical imaging modalities (fluoroscopy, computed tomography, ultrasound, magnetic resonance imaging, nuclear medicine, etc) and their value relative to general radiography in order to determine the best imaging examination to evaluate the patient's clinical symptoms? 4 N/A
PX810201_ChestRadiograph_Physician_Radiograph_Qualification5 PX810201170600 Has the licensed physician performing these general radiography examinations demonstrated evidence of continued competence in the interpretation and reporting of these examinations? 4 N/A
PX810201_ChestRadiograph_Physician_Radiograph_Qualified PX810201170700 Does the physician meet the last 5 requirements? If no, then physician is not qualified to perform general radiography examinations. 4 N/A
PX810201_ChestRadiograph_Preoperative_Evaluation PX810201070000 Does the patient require a preoperative radiographic evaluation due to cardiac or respiratory symptoms or because there is a significant potential for thoracic pathology that may influence anesthesia or the surgical result or lead to increased perioperative morbidity or mortality? 4 N/A
PX810201_ChestRadiograph_Radiograph_Interpreter PX810201160000 Which of the following best describes the individual responsible for interpeting and supervising the generation of these radiographic images? 4 N/A
PX810201_ChestRadiograph_Radiological_Assistant_Certification PX810201190000 Is the radiological assistant certified and registered as a radiological assistant by the American Registry of Radiologic Technologists (ARRT) after successfully completing an advanced academic program encompassing an ACR/ASRT (American Society of Radiologic Technologists) radiologist assistant curriculum and a radiologist-directed clinical preceptorship? 4 N/A
PX810201_ChestRadiograph_Radiological_Assistant_Certification2 PX810201200000 Is the radiologic technologic certified by the American Registry of Radiologic Technologist (ARRT) or an unrestricted state licese? 4 N/A
PX810201_ChestRadiograph_Recent_Medical_Events PX810201080000 Has the patient recently had cardiac or thoacic surgery or suffered from trauma? 4 N/A
PX810201_ChestRadiograph_Request PX810201210000 Is there a written or electronic request for chest radiography? 4 N/A
PX810201_ChestRadiograph_Requestor PX810201220000 Who was responsible for the request for radiological examination? 4 N/A
PX810201_ChestRadiograph_SexuallyActive_Contraception PX810201150200 If sexually active, were any contraceptive methods used? 4 N/A
PX810201_ChestRadiograph_SexuallyActive_Last_Menstrual_Cycle PX810201150100 Was the patient sexually active after her last menstrual cycle? 4 N/A
PX810201_ChestRadiograph_SignsSymptoms_Disease_FollowUp PX810201050000 Does the patient need a follow-up of known thoracic disease processes to assess improvement, resolution, or progression? 4 N/A
PX810201_ChestRadiograph_SignsSymptoms_Disease_Thoracic PX810201040000 Does the patient need to be evaluated for thoracic disease processes, including systemic and extrathoracic diseases that secondarily involve the chest? 4 N/A
PX810201_ChestRadiograph_SignsSymptoms_Disease_Thorax PX810201030000 Does the patient need to be evaluated for his/her signs and symptoms related to respiratory, cardiovascular, and upper gastrointestinal systems, and the musculoskeletal system of the thorax? 4 N/A
Research Domain Information
Measure Name:

Chest X-ray

Release Date:

July 30, 2015


Chest radiograph (i.e., X-ray) is a medical imaging assessment of the chest wall, airways, lungs, pulmonary vessels, heart, mediastinum, and pleura.


This measure is used to show the size, shape, and structures of the chest. Information from this measure is used to determine the presence and etiology of disorders that involve the chest, evaluate the signs and symptoms potentially related to the respiratory, cardiovascular and upper gastrointestinal systems and the musculoskeletal system of the thorax, and to follow the course of disease.


Chest X-ray, pulmonary, radiology, radiograph, sickle cell disease, SCD, lung, respiratory, airway, pulmonary vessels, mediastinum, heart, pleura, chest wall, gastrointestinal, musculoskeletal, thorax, chest, smoking