What anatomical landmarks are typically used for ETT placement verification on a chest X-ray?

The typical anatomical landmarks used for endotracheal tube (ETT) placement verification on a chest X-ray are the T2 and T3 vertebrae. When assessing an X-ray to confirm proper ETT placement, the tip of the tube should ideally be positioned between the T2 and T3 vertebrae. This location ensures that the tube is correctly seated in the trachea, just above the carina, which is crucial for effective ventilation and minimizing the risk of accidental intubation of the right mainstem bronchus.

Using T2 and T3 as landmarks is based on the anatomical relationship of the trachea and major bronchial structures. If the tube's tip is positioned too high or too low, it could lead to complications such as inadequate ventilation, or in the case of improper placement, it could enter one of the main stem bronchi, particularly the right, which branches off more vertically.

The other options involve landmarks that do not correspond to the ideal location for ETT confirmation. For instance, T4 and T5 may indicate a more distal placement, which is not desirable for ensuring the tube is in the trachea. Similarly, L1 and L2 vertebrae are too low in the lumbar