Chest
X-Ray
(Chest
Radiography, CXR)
What
is a chest x-ray?
A chest
x-ray is a type of diagnostic radiology procedure
used to examine the chest and the organs and structures
located in the chest. Chest x-rays may be used
to assess the lungs, as well as the heart (either
directly or indirectly) by looking at the heart
itself. Certain conditions of the heart may cause
changes in the lungs and/or the vessels of the
lungs. Changes in the normal structure of the
heart, lungs, and/or lung vessels may indicate
disease or other conditions.
Chest
x-rays may provide important information regarding
the size, shape, contour, and anatomic location
of the heart, lungs, bronchi, great vessels (aorta,
aortic arch, pulmonary arteries), mediastinum
(an area in the middle of the chest separating
the lungs), and the bones (cervical and dorsal
spine, clavicles, shoulder girdle, and ribs).
What
are x-rays?
X-rays
use invisible electromagnetic energy beams to
produce images of internal tissues, bones, and
organs on film. X-rays are made by using external
radiation to produce images of the body, its organs
and other internal structures for diagnostic purposes.
X-rays pass through body tissues onto specially
treated plates (similar to camera film) and a
“negative” type picture is made (the
more solid a structure is, the whiter it appears
on the film).
Depending
on the results of the chest x-ray, additional
tests or procedures may be requested by your physician
for further diagnostic information.
Other
related procedures that may be used to diagnose
problems of the chest and respiratory tract include
chest fluoroscopy, chest ultrasound, computed
tomography (CT scan) of the chest, lung biopsy,
lung scans, mediastinoscopy, positron emission
tomography (PET scan) of the chest, pleural biopsy,
thoracentesis, sinus x-rays, pulmonary angiogram,
bronchoscopy, and bronchography. Please see these
procedures for additional information.
Anatomy
of the respiratory system:
The
respiratory system is made up of the organs involved
in the interchanges of gases, and consists of
the:
- nose
- pharynx
- larynx
- trachea
- bronchi
- lungs
The
upper respiratory tract includes the:
- nose
- nasal cavity
- ethmoidal air cells
- frontal sinuses
- maxillary sinus
- larynx
- trachea
The
lower respiratory tract includes the lungs, bronchi,
and alveoli.
What
are the functions of the lungs?
The
lungs take in oxygen, which cells need to live
and carry out their normal functions. The lungs
also get rid of carbon dioxide, a waste product
of the body's cells.
The
lungs are a pair of cone-shaped organs made up
of spongy, pinkish-gray tissue. They take up most
of the space in the chest, or the thorax (the
part of the body between the base of the neck
and diaphragm).
The
lungs are enveloped in a membrane called the pleura.
The
lungs are separated from each other by the mediastinum,
an area that contains the following:
- the heart and its large
vessels
- trachea (windpipe)
- esophagus
- thymus
- lymph nodes
The
right lung has three sections, called lobes. The
left lung has two lobes. When you breathe, the
air enters the body through the nose or the mouth.
It then travels down the throat through the larynx
(voice box) and trachea (windpipe) and goes into
the lungs through tubes called main-stem bronchi.
One
main-stem bronchus leads to the right lung and
one to the left lung. In the lungs, the main-stem
bronchi divide into smaller bronchi and then into
even smaller tubes called bronchioles. Bronchioles
end in tiny air sacs called alveoli.
Chest
x-rays may be used to assess heart status (either
directly or indirectly) by looking at the heart
itself, as well as the lungs. Changes in the normal
structure of the heart, lungs and/or lung vessels
may indicate disease or other conditions.
Conditions
that may be assessed with a chest x-ray include,
but are not limited to, the following:
- heart enlargement (which
can occur with congenital heart defects or cardiomyopathy)
- pericardial effusion
- a build up of excess fluid in-between the
heart and the membrane that surrounds it, often
due to inflammation
- pleural effusion -
a collection of blood or fluid around the lung
- pneumonia, persistent
cough, and other lung conditions
- aneurysms - ballooning
of the walls of the great blood vessels, such
as the aorta
- bone fractures
- calcification of heart
structures (such as heart valves or aorta)
- tumors or cancer
- herniation of the diaphragm
(the breathing muscle, the diaphragm, moves
out of place)
- pleuritis - inflammation
of the lining of the lung
- pulmonary edema (“fluid
in the lungs,” which can occur with congenital
heart disease or congestive heart failure)
Other
reasons for performing a chest x-ray may include:
- as part of the physical
assessment before hospitalization and/or surgery
or as part of a complete physical examination
- to assess symptoms
of conditions related to the heart or lungs
- to assess progression
of a condition and/or effectiveness of treatments
- to check the position
of implanted pacemaker wires and other internal
devices such as central venous catheters, endotracheal
tubes, chest tubes, or nasogastric tubes
- to check status of
lungs and chest cavity after surgery
There
may be other reasons for your physician to recommend
a chest x-ray.
The
amount of radiation used during a chest x-ray
procedure is considered minimal; therefore, the
risk for radiation exposure is very low.
If you
are pregnant or suspect that you may be pregnant,
you should notify your physician. Radiation exposure
during pregnancy may lead to birth defects.
There
may be other risks depending upon your specific
medical condition. Be sure to discuss any concerns
with your physician prior to the procedure.
- The physician will
explain the procedure to you and offer you the
opportunity to ask any questions that you might
have about the procedure.
- If you are pregnant
or suspect that you may be pregnant, you should
notify your physician.
- Generally, no prior
preparation, such as fasting or sedation, is
required.
- Dress in clothes that
permit access to the area to be tested or that
are easily removed.
- Notify the radiologic
technologist if you have any body piercing on
your chest.
- Based upon your medical
condition, your physician may request other
specific preparation.
A chest
x-ray may be performed on an outpatient basis
or as part of your stay in a hospital. Procedures
may vary depending on your condition and your
physician’s practices.
Generally,
a chest x-ray follows this process:
- You will be asked to
remove any clothing, jewelry, or other objects
that may interfere with the procedure.
- You will be given a
gown to wear.
- The particular view
that the physician orders will determine how
you are positioned for the x-ray such as lying,
sitting, or standing. You will be positioned
carefully so that the desired view of the chest
is obtained. The physician will also specify
the number of films to be made.
- For a standing or sitting
film, you will stand or sit in front of the
x-ray plate. You will be asked to roll your
shoulders forward, take in a deep breath, and
hold it until the x-ray exposure is made. For
patients who are unable to hold their breath,
the radiologic technologist will take the picture
at the appropriate time by watching the breathing
pattern.
- It will be important
for you to remain still during the exposure,
as any movement will blur the film.
- For a side-angle view
of the chest, you will be asked to turn to your
side and raise your arms above your head. You
will be instructed to take in a deep breath
and hold it as the x-ray exposure is made.
- The radiologic technologist
will step behind a protective window while the
images are being made.
While
the x-ray procedure itself causes no pain, the
manipulation of the body part being examined may
cause some discomfort or pain, particularly in
the case of a recent injury or invasive procedure
such as surgery. The radiologic technologist will
use all possible comfort measures and complete
the procedure as quickly as possible to minimize
any discomfort or pain.
Generally,
there is no special type of care after a chest
x-ray. However, your physician may give you additional
or alternate instructions after the procedure,
depending on your particular situation.
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