Chest X Ray


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Chest X Ray

 

Definition

A chest x ray is a procedure used to evaluate organs and structures within the chest for symptoms of disease. Chest x rays include views of the lungs, heart, small portions of the gastrointestinal tract, thyroid gland and the bones of the chest area. X rays are a form of radiation that can penetrate the body and produce an image on an x-ray film. Another name for x ray is radiograph.

Purpose

Chest x rays are ordered for a wide variety of diagnostic purposes. In fact, this is probably the most frequently performed x ray. In some cases, chest x rays are ordered for a single check of an organ's condition, and at other times, serial x rays are ordered to compare to previous studies. Some common reasons for chest x rays include:

Pulmonary disorders

Chest films are frequently ordered to diagnose or rule out pneumonia. Other pulmonary disorders such as emphysema or pneumothorax (presence of air or gas in the chest cavity outside the lungs) may be detected or evaluated through the use of chest x ray.

Cancer

A chest x ray may be ordered by a physician to check for possible tumors of the lungs, thyroid, lymphoid tissue, or bones of the thorax. These may be primary tumors. X rays also check for secondary spread of cancer from one organ to another.

Cardiac disorders

While less sensitive than echocardiography, chest x ray can be used to check for disorders such as congestive heart failure or pulmonary edema.

Other

Tuberculosis can be observed on chest x rays, as can cardiac disease and damage to the ribs or lungs. Chest x rays are used to see foreign bodies that may have been swallowed or inhaled, and to evaluate response to treatment for various diseases. Often the chest x ray is also used to verify correct placement of chest tubes or catheters.

Precautions

Pregnant women, particularly those in the first or second trimester, should not have chest x rays unless absolutely necessary. If the exam is ordered, women who are, or could possibly be, pregnant must wear a protective lead apron. Because the procedure involves radiation, care should always be taken to avoid overexposure, particularly for children. However, the amount of radiation from one chest x ray procedure is minimal.

Description

Routine chest x rays consist of two views, the frontal view (referred to as posterioranterior or PA) and the lateral (side) view. It is preferred that the patient stand for this exam, particularly when studying collection of fluid in the lungs.
During the actual time of exposure, the technologist will ask the patient to hold his or her breath. It is very important in taking a chest x ray to ensure there is no motion that could detract from the quality and sharpness of the film image. The procedure will only take a few minutes and the time patients must hold their breaths is a matter of a few seconds.
The chest x ray may be performed in a physician's office or referred to an outpatient radiology facility or hospital radiology department. In some cases, particularly for bedridden patients, a portable chest x ray may be taken. Portable films are sometimes of poorer quality than those taken with permanent equipment, but are the best choice for some patients or situations. Bedridden patients may be placed in as upright a position as possible to get a clear picture, particularly of chest fluid.

Preparation

There is no advance preparation necessary for chest x rays. Once the patient arrives at the exam area, a hospital gown will replace all clothing on the upper body and all jewelry must be removed.

Aftercare

No aftercare is required by patients who have chest x rays.

Risks

The only risk associated with chest x ray is minimal exposure to radiation, particularly for pregnant women and children. Those patients should use protective lead aprons during the procedure. Technologists are cautioned to carefully check possible dislodging of any tubes or monitors in the chest area from the patient's placement during the exam.

Normal results

A radiologist, or physician specially trained in the technique and interpretation of x rays, will evaluate the results. A normal chest x ray will show normal structures for the age and medical history or the patient. Findings, whether normal or abnormal, will be provided to the referring physician in the form of a written report.

Abnormal results

Abnormal findings on chest x rays are used in conjunction with a physician's physical exam findings, patient medical history and other diagnostic tests to reach a final diagnosis. For many diseases, chest x rays are more effective when compared to previous chest studies. The patient is asked to help the radiology facility in locating previous chest radiographs from other facilities.

Pulmonary disorders

Pneumonia shows up on radiographs as patches and irregular areas of density (from fluid in the lungs). If the bronchi, which are usually not visible, can be seen, a diagnosis of bronchial pneumonia may be made. Shifts or shadows in the hila (lung roots) may indicate emphysema or a pulmonary abscess. Widening of the spaces between ribs suggests emphysema. Other pulmonary diseases may also be detected or suspected through chest x ray.

Cancer

In nearly all patients with lung cancer, some sort of abnormality can be seen on a chest radiograph. Hilar masses (enlargements at that part of the lungs where vessels and nerves enter) are one of the more common symptoms as are abnormal masses and fluid buildup on the outside surface of the lungs or surrounding areas. Interstitial lung disease, which is a large category of disorders, many of which are related to exposure of substances (such as asbestos fibers), may be detected on a chest x ray as fiberlike deposits, often in the lower portions of the lungs.

Other

Congestive heart failure and other cardiac diseases may be indicated on the view of a heart and lung in a chest radiograph. Fractures of the sternum and ribs are usually easily detected as breaks on the chest x ray. In some instances, the radiologist's view of the diaphragm may indicate an abdominal problem. Tuberculosis can also be indicated by elevation of the diaphragm. Foreign bodies which may have been swallowed or inhaled can usually be located by the radiologist as they will look different from any other tissue or structure in the chest. Serial chest x rays may be ordered to track changes over a period of time.

Resources

Organizations

American Lung Association. 1740 Broadway, New York, NY 10019. (800) 586-4872. http://www.lungusa.org.
Emphysema Anonymous, Inc. P.O. Box 3224, Seminole, FL 34642. (813)391-9977.
National Heart, Lung and Blood Institute. P.O. Box 30105, Bethesda, MD 20824-0105. (301) 251-1222. http://www.nhlbi.nih.gov.

Key terms

Bronchi — Plural of bronchus. The air passages in the lungs through which inhaled air passes on its way to the lungs.
Diaphragm — The large muscle that is located between the abdomen and the chest area. The diaphragm aids in breathing.
Gastrointestinal — The digestive organs and structures, including the stomach and intestines.
Interstitial lung disease — About 180 diseases fall into this category of breathing disorders. Injury or foreign substances in the lungs (such as asbestos fibers) as well as infections, cancers, or inherited disorders may cause the diseases. They can lead to breathing or heart failure.
Lymphoid — Tissues relating to the lymphatic system. A thin, yellowish fluid, called lymph fluid, travels throughout the body. The lymphatic system helps control fluids in the body.
Portable chest x ray — An x ray procedure taken by equipment that can be brought to the patient. The resulting radiographs may not be as high in quality as stationary x ray radiographs, but allow a technologist to come to the bedridden patient.
Pulmonary — Refers to the lungs and the breathing system and function.
Serial x rays — A number of x rays performed at set times in the disease progression or treatment intervals. The radiographs will be compared to one another to track changes.
Sternum — Also referred to as the breast bone, this is the long flat bone in the middle of the chest.
Thorax — The chest area, which runs between the abdomen and neck and is encased in the ribs.
X ray — A form of electromagnetic radiation with shorter wavelengths than normal light. X rays can penetrate most structures.
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