Protocol - Chest X-ray

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


Publicly available


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 [link[www.phenx.org/Portals/0/phenx-content/Supplements/SickleCell/WG1/DocumentsForReview/Documents_for_Additional_Information/02_Chest_Radiography.pdf|here]] and is also available at the ACR website: [link[www.acr.org/~/media/ACR/Documents/PGTS/guidelines/Chest_Radiography.pdf|www.acr.org/~/media/ACR/Documents/PGTS/guidelines/Chest_Radiography.pdf]]

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 [link[www.acr.org/~/media/ACR/Documents/PGTS/guidelines/Chest_Radiography.pdf|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 [link[www.acr.org/~/media/ACR/Documents/PGTS/guidelines/Chest_Radiography.pdf|www.acr.org/~/media/ACR/Documents/PGTS/guidelines/Chest_Radiography.pdf]]


Requirement CategoryRequired
Average time of greater than 15 minutes in an unaffected individualNo
Major equipmentYes
Specialized requirements for biospecimen collectionNo
Specialized trainingYes

Mode of Administration


Life Stage:

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

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
Research Domain Information

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.

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 Status2603738CDE 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_Image_MetadataPX810201450000Is 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?4N/A
PX810201_ChestRadiograph_DatePX810201010000What is today's date?4N/A
PX810201_ChestRadiograph_Patient_AgePX810201020000What is the patient's age?4N/A
PX810201_ChestRadiograph_SignsSymptoms_Disease_ThoraxPX810201030000Does 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?4N/A
PX810201_ChestRadiograph_SignsSymptoms_Disease_ThoracicPX810201040000Does the patient need to be evaluated for thoracic disease processes, including systemic and extrathoracic diseases that secondarily involve the chest?4N/A
PX810201_ChestRadiograph_SignsSymptoms_Disease_FollowUpPX810201050000Does the patient need a follow-up of known thoracic disease processes to assess improvement, resolution, or progression?4N/A
PX810201_ChestRadiograph_Government_CompliancePX810201060000Does the patient need a chest radiograph to be in compliance with government regulations?4N/A
PX810201_ChestRadiograph_Preoperative_EvaluationPX810201070000Does 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?4N/A
PX810201_ChestRadiograph_Recent_Medical_EventsPX810201080000Has the patient recently had cardiac or thoacic surgery or suffered from trauma?4N/A
PX810201_ChestRadiograph_Cardiopulmonary_SymptomsPX810201090000Does the patient display cardiopulmonary signs and/or symptoms?4N/A
PX810201_ChestRadiograph_Patient_Monitoring_LifeSupport_DevicesPX810201100000Is the patient connected to monitoring and/or life-support devices?4N/A
PX810201_ChestRadiograph_Patient_Critically_IllPX810201110000Is the patient critically ill or medically unstable?4N/A
PX810201_ChestRadiograph_Patient_Difficulty_TransportingPX810201120000Is it difficult to transport the patient for standard chest radiography because of his/her age or clinical condition?4N/A
PX810201_ChestRadiograph_Patient_PregnantPX810201130100Is the patient pregnant or potentially pregnant?4N/A
PX810201_ChestRadiograph_Patient_Gestational_AgePX810201130200If patient knows she is pregnant, what is the gestational age of the patient?4N/A
PX810201_ChestRadiograph_Patient_Pregnancy_TestPX810201130300If patient is unsure if pregnant, what is the result of the pregnancy test?4N/A
PX810201_ChestRadiograph_Date_Last_Menstrual_CyclePX810201140000What is the date of the patient's last menstrual cycle?4N/A
PX810201_ChestRadiograph_SexuallyActive_Last_Menstrual_CyclePX810201150100Was the patient sexually active after her last menstrual cycle?4N/A
PX810201_ChestRadiograph_SexuallyActive_ContraceptionPX810201150200If sexually active, were any contraceptive methods used?4N/A
PX810201_ChestRadiograph_Radiograph_InterpreterPX810201160000Which of the following best describes the individual responsible for interpeting and supervising the generation of these radiographic images?4N/A
PX810201_ChestRadiograph_Physician_Radiograph_CertificationPX810201170100Is 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?4N/A
PX810201_ChestRadiograph_Physician_Radiograph_Certification2PX810201170200If 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?4N/A
PX810201_ChestRadiograph_Physician_Radiograph_Qualification2PX810201170300Does 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?4N/A
PX810201_ChestRadiograph_Physician_Radiograph_Qualification3PX810201170400Is the licensed physician familiar with the principles of radiation protection, the hazards of radiation, and radiation monitoring requirements?4N/A
PX810201_ChestRadiograph_Physician_Radiograph_Qualification4PX810201170500Does 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?4N/A
PX810201_ChestRadiograph_Physician_Radiograph_Qualification5PX810201170600Has the licensed physician performing these general radiography examinations demonstrated evidence of continued competence in the interpretation and reporting of these examinations?4N/A
PX810201_ChestRadiograph_Physician_Radiograph_QualifiedPX810201170700Does the physician meet the last 5 requirements? If no, then physician is not qualified to perform general radiography examinations.4N/A
PX810201_ChestRadiograph_Medical_Physicist_CertificationPX810201180100Does the medical physicist have certification in therapeutic medical physics, diagnostic medical physics, radiological physics, diagnostic radiological physics, and diagnostic imaging physics?4N/A
PX810201_ChestRadiograph_Medical_Physicist_Certification_SubfieldPX810201180200If 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)?4N/A
PX810201_ChestRadiograph_Radiological_Assistant_CertificationPX810201190000Is 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?4N/A
PX810201_ChestRadiograph_Radiological_Assistant_Certification2PX810201200000Is the radiologic technologic certified by the American Registry of Radiologic Technologist (ARRT) or an unrestricted state licese?4N/A
PX810201_ChestRadiograph_RequestPX810201210000Is there a written or electronic request for chest radiography?4N/A
PX810201_ChestRadiograph_RequestorPX810201220000Who was responsible for the request for radiological examination?4N/A
PX810201_ChestRadiograph_Equipment_Requirement1PX810201230000Does the radiograph equipment have a beam-limiting device that provides rectangular collimation?4N/A
PX810201_ChestRadiograph_Equipment_Requirement2PX810201240000For routine upright projections, is there at least a 72-inch source-image distance (SID) to minimize magnification?4N/A
PX810201_ChestRadiograph_Equipment_Requirement3PX810201250000For clinically necessary imaging (e.g. supine positioning, infants, young children, immobilized patients, etc), is there at least a 40-inch SID?4N/A
PX810201_ChestRadiograph_Equipment_Requirement4PX810201260000Does the nominal source (focal spot) exceed 2.0mm?4N/A
PX810201_ChestRadiograph_Equipment_Requirement5PX810201270100Is this procedure part of an analog study?4N/A
PX810201_ChestRadiograph_Equipment_Requirement5aPX810201270200If so, is an intensifying screen being used?4N/A
PX810201_ChestRadiograph_Equipment_Requirement6PX810201280100Is a film-screen image receptor being used?4N/A
PX810201_ChestRadiograph_Equipment_Requirement6aPX810201280200If so, is the image processing being automated through carefully controlled temperature, densitometry and maintenance settings?4N/A
PX810201_ChestRadiograph_Image_InterpretatorPX810201290000Is the image being processed and reviewed by the qualified professional? Is the image being procesed automated by the proprietary software?4N/A
PX810201_ChestRadiograph_Patient_IdPX810201300000What is the patient identification number?4N/A
PX810201_ChestRadiograph_Facility_IdPX810201310000What is the facility identification number?4N/A
PX810201_ChestRadiograph_Examination_DatePX810201320000What is the examination date?4N/A
PX810201_ChestRadiograph_Examination_TimePX810201330000What is the time of examination?4N/A
PX810201_ChestRadiograph_Examination_SidePX810201340000Which side is the imaged anatomic site?4N/A
PX810201_ChestRadiograph_Examination_Collimation_Limit_ExposurePX810201350000What sort of appropriate collimation was used to limit exposure to the anatomic area of interest?4N/A
PX810201_ChestRadiograph_Examination_Protocols_ViewsPX810201360000What 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 exposure4N/A
PX810201_ChestRadiograph_Examination_Protocols_TechniquesPX810201370000Are 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?4N/A
PX810201_ChestRadiograph_Examination_Protocols_ShieldingPX810201380000Are there policies and procedures for appropriate shielding of patients?4N/A
PX810201_ChestRadiograph_Examination_Image_Projection1PX810201390100Was an image of the erect PA projection taken?4N/A
PX810201_ChestRadiograph_Examination_Image_Projection2PX810201390200Was an image of a left lateral projection taken?4N/A
PX810201_ChestRadiograph_Examination_Image_Projection3PX810201390300If an erect PA or left lateral projection was not taken, what was the reason for the need of an alternative?4N/A
PX810201_ChestRadiograph_Examination_Image_Projection3aPX810201390400What projections were taken as an alternative? Check all that apply4N/A
PX810201_ChestRadiograph_Examination_Image_IncludedPX810201400000Where both lung apices and the costophrenic sulci included in the radiograph images?4N/A
PX810201_ChestRadiograph_Examination_Position_AlternativePX810201410000Was a cross-table lateral radiograph taken, where the patient was in supine position with his/her arms raised above their head?4N/A
PX810201_ChestRadiograph_Examination_Adult_Correct_ExposurePX810201420100For adult patients, using the appropriate technical settings, does the exposed radiograph display the lung parenchyma at a mid-gray level?4N/A
PX810201_ChestRadiograph_Examination_Child_Correct_ExposurePX810201420200For newborns, infants, and children, using the appropriate technical settings, does the exposed radiograph display the lung parenchyma at a mid-gray level?4N/A
PX810201_ChestRadiograph_Image_ReviewPX810201430000When the examination is completed, were the images reviewed by qualified personnel, either a physician or radiologic4N/A
PX810201_ChestRadiograph_Image_Review_Not_OptimalPX810201440000Were the images of less than optimal diagnostic quality?4N/A