The call for mastering chest radiography - an urgent priority for training radiologists and trainees

Santiago Martinez-Jimenez, Department of Radiology, University of Missouri-Kansas City and Department of Radiology, Thoracic Imaging Division, Saint Luke’s Hospital, Kansas City, Missouri, USA;

Chest radiography remains the most frequently performed imaging examination and the primary diagnostic tool for thoracic evaluation worldwide. Despite its central clinical role, interpretive expertise has declined with the widespread adoption of computed tomography (CT), which offers greater contrast resolution but introduces higher radiation exposure, increased cost, and limited accessibility in many settings. This article argues that renewed emphasis on chest radiograph interpretation is an urgent educational and professional priority. Chest radiography is technically and diagnostically unique, employing high kilovoltage techniques to optimize grayscale latitude and enable detection of subtle pulmonary and mediastinal abnormalities. Accurate interpretation requires understanding both imaging physics and structured analytic approaches. Foundational concepts popularized by Benjamin Felson and others – including gestalt-based pattern recognition and classic signs such as the silhouette, hilum overlay, or cervicothoracic signs remain essential but risk being underemphasized in contemporary training. Strengthening education in these principles can improve diagnostic consistency, reduce unnecessary downstream imaging, and enhance patient outcomes. While systemic workflow challenges influence radiology practice, responsibility for interpretive excellence rests with educators and clinicians. Reinvesting in mastery of chest radiography is therefore both a practical necessity and an ethical obligation, ensuring that this fundamental modality continues to support accurate, efficient, and accessible patient care in modern medicine.

Keywords: Chest radiography. Aunt Minnie. Felson. Chest imaging. Gestalt.