The portable chest radiograph (pCXR) plays a key role in the evaluation of critically ill patients, frequently revealing abnormalities that cannot be detected clinically. Unfortunately, high-quality pCXRs may be difficult to obtain in the intensive care unit, where poor patient cooperation, inconsistent technique, and other obstacles may lead to inadequate studies. The value of the pCXR is enhanced by proper technique and state-of-the-art equipment. When interpreting the pCXR, a comprehensive, orderly approach is mandatory. Life-threatening complications, such as malpositioning of the endotracheal tube and tension pneumothorax, must be ruled out immediately. Next, it is important to identify common processes, such as pneumonia, pulmonary edema, and atelectasis, recognizing that their appearance may be altered by preexisting disease. Because patients are often supine, it is critical to recognize the features of disorders such as pneumothorax and pleural effusion when viewed in this position. Finally, when uncertainty exists, other modalities such as CT and ultrasound may prove to be invaluable.
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