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.

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, 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 the x ray image 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 exam. 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, bronchitis, pleurisy, tuberculosis, and other acute illnesses. 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. It might also show vascular damage in the lung, which would require further evaluation.

Cancer

A chest x ray may be ordered by a physician to check for possible tumors of the lungs, thyroid, lymph nodes, or even the displacement of an organ by a tumor, if present. Chest x rays can oocasionally be used to check for secondary spread of cancer from one organ to another.

Cardiac disorders

Although less sensitive than echocardiography to evaluate the heart, chest x ray is preferred to check for disorders such as congestive heart failure or pulmonary edema. Pericardial effusion (fluid surrounding the heart), if present, and cardiac size will also be noted on the chest x ray.

Other

Chest x rays can be used to see foreign bodies that may have been swallowed or inhaled, and to evaluate response to treatment for various diseases. The chest x ray is also used to verify correct placement of chest tubes or catheters in acutely ill patients.

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, with the full coverage adjusted for the direction of the x-ray beam. 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 posterior-anterior or PA) and the lateral (side) view, with the left side against the x-ray board. It is preferred that the patient stand for this exam.

The patient must remain motionless, and will be asked to take in a big breath for each x ray. Filling the lungs with air expands the lung fields, and shows the anatomy at its most optimum. In addition, the deep inspiration of air also helps the patient remain motionless, which is critically important in such a short x-ray exposure.

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 the best possible image.

Preparation

There is no advance preparation necessary for chest x rays. Once the patient arrives at the exam area, the patient will undress to the waist, and wear a gown or drape as provided by the facility. All necklaces will be removed as well.

Aftercare

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

Complications

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, if IVs (intravenous lines) or chest tubes are in place.

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 findings on chest x rays are used in conjunction with a physician's physical exam, medical history, and other diagnostic tests to reach a final diagnosis. Often a patient can have normal appearing x rays and still have underlying diseases or conditions. Interpretation of chest x rays is most accurate when compared to previous chest studies. The patient may be asked to help the radiology facility in locating previous chest radiographs from other facilities.

Pulmonary disorders

Pneumonia shows up on radiographs as a patchy white area of density, as a result of fluid in the lung(s). If the bronchi, which are usually not visible, can be seen, a diagnosis of bronchial pneumonia may be made. Widening of the spaces between ribs, or very large, dark lung fields, also can be a radiographic sign of 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 signs, 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 to 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 diagnosed on the view of the heart and lung in a chest radiograph. Fractures of the sternum and ribs are sometimes also detected as breaks in the bone visible on the film. In some instances, the view of the diaphragm may indicate an abdominal problem. Foreign bodies which may have been swallowed or inhaled can usually be located by the radiologist as they will see the object either in the esophagus, or the upper part of the stomach, and will look different from any other tissue or structure in the chest. Serial chest x rays may be ordered to track changes in the position of an object over a period of time.

Health care team roles

The technologist performing the chest x ray is a highly trained professional and provides films for the radiologist to interpret. The technologist should be able to be versatile, should the patient have any physical challenges in complying with the x ray. In performing bedside, or portable chest x rays, often the assistance of nursing staff becomes necessary due to the condition of the patient. It should be the goal of both the technologist and/or nurse to ensure patient comfort while obtaining the best possible radiograph.

Patient education

The technologist will explain the exam to the patient so that they feel comfortable with the procedure. Most adult patients are familiar with a chest x ray, nevertheless, a brief discussion between technologist and patient is important. Keeping the patient immobile during the exposure will limit having to repeat the x ray.

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 over time 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.

Resources

ORGANIZATIONS

American Lung Association. 432 Park Avenue South, New York, NY 10016. (212) 889-3370. 〈http://www.lungusa.org〉.

Emphysema Anonymous, Inc. P.O. Box 3224, Seminole, FL 34642. (813) 391-9977.

The National Heart, Lung and Blood Institute. Building 31, Room 4A21, Bethesda, MD 20892. (301) 496-4236. 〈http://www.nhlbi.nih.gov〉.

OTHER

Pulmonary Perpectives. The American College of Chest Physicians. 3300 Dundee Road, Northbrook, IL 60062. (847) 498-1400. 〈http://www.chestnet.org〉.

RSNA Radiology Info Online. 〈http://www.radiologyresource.org〉. (June 6, 2001).

Chest X Ray

Definition
Purpose
Description
Preparation
Aftercare
Risks
Normal results

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 the film produced by x rays is radiograph.

Purpose

Chest x rays are ordered for a wide variety of diagnostic purposes. In fact, this is probably the most frequently performed type of 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 the following.

Pulmonary disorders

Chest films are frequently ordered to diagnose or rule out pneumonia. One type, tuberculosis, can be observed on chest x rays, as can cardiac disease and damage to the ribs or lungs. Other pulmonary disorders such as pneumothorax (presence of air or gas in the chest cavity outside the lungs) or emphysema 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, lymphoid tissue, or bones of the thorax. These may be primary tumors, or the areas in which cancer originates in the body. X rays also check for secondary spread of cancer from another organ to the chest.

KEY TERMS

Bronchi— Plural of bronchus. The air passages in the lungs through which inhaled air passes on its way through 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 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.

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

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. Chest x rays can be used to check for fluid surrounding the lungs (pleural effusion).

Description

Routine chest x rays consist of two views, the frontal view (referred to as posterior anterior 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 breath 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 patients who cannot get out of bed, 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 when the patient cannot be moved or properly positioned for the chest x ray. Patients confined to bed 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 in 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 check carefully 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 of the patient. Findings, whether normal or abnormal, will be provided to the referring physician in the form of a written report.

Abnormal findings on chest x rays are used in conjunction with a physician’s physical exam findings, patient medical history, and other diagnostic tests, including laboratory tests, to reach a final diagnosis. For many diseases, chest x rays are more effective when compared to previous chest x-ray 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 (air passages in the lungs 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 enlarged lymph nodes of a malignancy. Widening of the spaces between ribs and increased lucency of the lung fields 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 increased prominence of the interstitial pattern, 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 sometimes detected as breaks on the chest x ray, though often dedicated bone films are needed. In some instances, the radiologist’s view of the diaphragm may indicate an abdominal problem. Foreign bodies that 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, usually to evaluate response to therapy of a malignancy.

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.

Teresa Norris, RN

Lee Shratter, MD

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Chin cosmetic surgery seeMentoplasty

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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, 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 the x ray image 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 exam. 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.

Pulmonary disorders

Chest films are frequently ordered to diagnose or rule out pneumonia , bronchitis , pleurisy, tuberculosis , and other acute illnesses. 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. It might also show vascular damage in the lung, which would require further evaluation.

Cancer

A chest x ray may be ordered by a physician to check for possible tumors of the lungs, thyroid, lymph nodes, or even the displacement of an organ by a tumor, if present. Chest x rays can oocasionally be used to check for secondary spread of cancer from one organ to another.

Cardiac disorders

Although less sensitive than echocardiography to evaluate the heart, chest x ray is preferred to check for disorders such as congestive heart failure or pulmonary edema . Pericardial effusion (fluid surrounding the heart), if present, and cardiac size will also be noted on the chest x ray.

Other

Chest x rays can be used to see foreign bodies that may have been swallowed or inhaled, and to evaluate response to treatment for various diseases. The chest x ray is also used to verify correct placement of chest tubes or catheters in acutely ill patients.

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, with the full coverage adjusted for the direction of the x-ray beam. 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 posterior-anterior or PA) and the lateral (side) view, with the left side against the x-ray board. It is preferred that the patient stand for this exam.

The patient must remain motionless, and will be asked to take in a big breath for each x ray. Filling the lungs with air expands the lung fields, and shows the anatomy at its most optimum. In addition, the deep inspiration of air also helps the patient remain motionless, which is critically important in such a short x-ray exposure.

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 the best possible image.

Preparation

There is no advance preparation necessary for chest x rays. Once the patient arrives at the exam area, the patient will undress to the waist, and wear a gown or drape as provided by the facility. All necklaces will be removed as well.

Aftercare

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

Complications

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, if IVs (intravenous lines) or chest tubes are in place.

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 findings on chest x rays are used in conjunction with a physician's physical exam, medical history, and other diagnostic tests to reach a final diagnosis. Often a patient can have normal appearing x rays and still have underlying diseases or conditions. Interpretation of chest x rays is most accurate when compared to previous chest studies. The patient may be asked to help the radiology facility in locating previous chest radiographs from other facilities.

Pulmonary disorders

Pneumonia shows up on radiographs as a patchy white area of density, as a result of fluid in the lung(s).

If the bronchi, which are usually not visible, can be seen, a diagnosis of bronchial pneumonia may be made. Widening of the spaces between ribs, or very large, dark lung fields, also can be a radiographic sign of 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 signs, 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 to 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 diagnosed on the view of the heart and lung in a chest radiograph. Fractures of the sternum and ribs are sometimes also detected as breaks in the bone visible on the film. In some instances, the view of the diaphragm may indicate an abdominal problem. Foreign bodies which may have been swallowed or inhaled can usually be located by the radiologist as they will see the object either in the esophagus, or the upper part of the stomach, and will look different from any other tissue or structure in the chest. Serial chest x rays may be ordered to track changes in the position of an object over a period of time.

Caregiver concerns

The technologist performing the chest x ray is a highly trained professional and provides films for the radiologist to interpret. The technologist should be able to be versatile, should the patient have any physical challenges in complying with the x ray. In performing bedside, or portable chest x rays, often the assistance of nursing staff becomes necessary due to the condition of the patient. It should be the goal of both the technologist and/or nurse to ensure patient comfort while obtaining the best possible radiograph.

Patient education

The technologist will explain the exam to the patient so that they feel comfortable with the procedure. Most adult patients are familiar with a chest x ray, nevertheless, a brief discussion between technologist and patient is important. Keeping the patient immobile during the exposure will limit having to repeat the x ray.

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.

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.

Resources

ORGANIZATIONS

American Lung Association. 432 Park Avenue South, New York, NY 10016. (212) 889-3370. http://www.lungusa.org.

Emphysema Anonymous, Inc. P.O. Box 3224, Seminole, FL 34642. (813) 391-9977.

The National Heart, Lung and Blood Institute. Building 31, Room 4A21, Bethesda, MD 20892. (301) 496-4236. http://www.nhlbi.nih.gov.

OTHER

Pulmonary Perpectives. The American College of Chest Physicians. 3300 Dundee Road, Northbrook, IL 60062. (847) 498-1400. http://www.chestnet.org.

RSNA Radiology Info Online. http://www.radiologyresource.org. (June 6, 2001).

Debra Novograd B.S., R.T.(R)(M)

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 the film produced by x rays is radiograph.

Purpose

Chest x rays are ordered for a wide variety of diagnostic purposes. In fact, this is probably the most frequently performed type of 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 the following.

Pulmonary disorders

Chest films are frequently ordered to diagnose or rule out pneumonia. One type, tuberculosis, can be observed on chest x rays, as can cardiac disease and damage to the ribs or lungs. Other pulmonary disorders such as pneumothorax (presence of air or gas in the chest cavity outside the lungs) or emphysema 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, lymphoid tissue, or bones of the thorax. These may be primary tumors, or the areas in which cancer originates in the body. X rays also check for secondary spread of cancer from another organ to the chest.

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

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. Chest x rays can be used to check for fluid surrounding the lungs (pleural effusion).

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 breath 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 patients who cannot get out of bed, 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 when the patient cannot be moved or properly positioned for the chest x ray. Patients confined to bed 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 in 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 check carefully 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 of the patient. Findings, whether normal or abnormal, will be provided to the referring physician in the form of a written report.

Abnormal findings on chest x rays are used in conjunction with a physician's physical exam findings, patient medical history, and other diagnostic tests including laboratory tests to reach a final diagnosis. For many diseases, chest x rays are more effective when compared to previous chest x-ray 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 (air passages in the lungs 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 enlarged lymph nodes of a malignancy. Widening of the spaces between ribs and increased lucency of the lung fields 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 increased prominence of the interstitial pattern, 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 sometimes detected as breaks on the chest x ray, though often dedicated bone films are needed. In some instances, the radiologist's view of the diaphragm may indicate an abdominal problem. Foreign bodies that 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, usually to evaluate response to therapy of a malignancy.

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>.

Teresa Norris, RN Lee Shratter, MD