Chest radiograph - Wikipedia, the free encyclopedia. In radiology, a chest radiograph, colloquially called a chest X- ray (CXR), or chest film, is a projection radiograph of the chest used to diagnose conditions affecting the chest, its contents, and nearby structures. Chest radiographs are the most common film taken in medicine. Like all methods of radiography, chest radiography employs ionizing radiation in the form of X- rays to generate images of the chest. The mean radiation dose to an adult from a chest radiograph is around 0. Sv (2 mrem) for a front view (PA or posterior- anterior) and 0. Sv (8 mrem) for a side view (LL or latero- lateral). Pneumonia and congestive heart failure are very commonly diagnosed by chest radiograph. Chest radiographs are used to screen for job- related lung disease in industries such as mining where workers are exposed to dust. Black spot on X-ray (radiologist pls help)? While looking on my chest x-ray I see a dark round spot under my left lung. Learn about chest X-ray pathology. Tutorial on chest X-ray disease. Diseases visible on a chest X-ray. A chest X-ray is the most common imaging test or X-ray used to find problems inside the chest. A chest X-ray can help find some problems with the. What Is a Chest X Ray? A disease in the chest that changes how radiation is absorbed also will appear on. Med-Spot on Med-Source: How To Read a Chest X-Ray. How To Read a Chest X-Ray. Look for thickness, subcutaneous emphysema (air bubbles-dark spots. When a condition is suspected based on chest radiography, additional imaging of the chest can be obtained to definitively diagnose the condition or to provide evidence in favor of the diagnosis suggested by initial chest radiography. Unless a fractured rib is suspected of being displaced, and therefore likely to cause damage to the lungs and other tissue structures, x- ray of the chest is not necessary as it will not alter patient management. The main regions where a chest X- ray may identify problems may be summarized as ABCDEF by their first letters. The most common views are posteroanterior, anteroposterior, and lateral. In an posteroanterior (PA) view, the x- ray source is positioned so that the x- ray beam enters through the posterior (back) aspect of the chest, and exits out of the anterior (front) aspect where the beam is detected. To obtain this view, the patient stands facing a flat surface behind which is an x- ray detector. A radiation source is positioned behind the patient at a standard distance (most often 6 feet, 1,8m), and the x- ray beam is fired toward the patient. In anteroposterior (AP) views, the positions of the x- ray source and detector are reversed: the x- ray beam enters through the anterior aspect and exits through the posterior aspect of the chest. AP chest x- rays are harder to read than PA x- rays and are therefore generally reserved for situations where it is difficult for the patient to get an ordinary chest x- ray, such as when the patient is bedridden. In this situation, mobile X- ray equipment is used to obtain a lying down chest x- ray (known as a . As a result, most supine films are also AP. Further imaging depends on local protocols which is dependent on the hospital protocols, the availability of other imaging modalities and the preference of the image interpreter. Additional views. In effusions, the fluid layers out (by comparison to an up- right view, when it often accumulates in the costophrenic angles). Lordotic view - used to visualize the apex of the lung, to pick up abnormalities such as a Pancoast tumour. Expiratory view - helpful for the diagnosis of pneumothorax. Oblique view - useful for the visualization of the ribs and sternum. Although it's necessary to do the appropriate adaptations to the x- ray dosage to be used. Landmarks. An increase in the number of viewable ribs implies hyperinflation, as can occur, for example, with obstructive lung disease or foreign body aspiration. A decrease implies hypoventilation, as can occur with restrictive lung disease, pleural effusions or atelectasis. Underexpansion can also cause interstitial markings due to parenchymal crowding, which can mimic the appearance of interstitial lung disease. Enlargement of the right descending pulmonary artery can indirectly reflect changes of pulmonary hypertension, with a size greater than 1. The right diaphragm is usually higher than the left, with the liver being situated beneath it in the abdomen. The minor fissure can sometimes be seen on the right as a thin horizontal line at the level of the fifth or sixth rib. Splaying of the carina can also suggest a tumor or process in the middle mediastinum or enlargement of the left atrium, with a normal angle of approximately 6. The right paratracheal stripe is also important to assess, as it can reflect a process in the posterior mediastinum, in particular the spine or paraspinal soft tissues; normally it should measure 3 mm or less. The left paratracheal stripe is more variable, and only seen in 2. If either hemidiaphragm is blurred, for example, it suggests the lesion to be from the corresponding lower lobe. If the right heart border is blurred, than the pathology is likely in the right middle lobe, though a cavum deformity can also blur the right heard border due to indentation of the adjacent sternum. If the left heart border is blurred, it implies a process at the lingula. Diagnosis is aided by noting: wall thicknesswall outlinechanges in the surrounding lung. The causes include: Pleural abnormalities. There needs to be at least 7. On a lateral decubitus, amounts as small as 5. Pleural effusions typically have a meniscus visible on an erect chest radiograph, but loculated effusions (as occur with an empyema) may have a lenticular shape (the fluid making an obtuse angle with the chest wall). Pleural thickening may cause blunting of the costophrenic angle, but is distinguished from pleural fluid by the fact that it occurs as a linear shadow ascending vertically and clinging to the ribs. Diffuse shadowing. It is seldom possible to reach a diagnosis on the basis of the chest radiograph alone: high- resolution CT of the chest is usually required and sometimes a lung biopsy. The following features should be noted: type of shadowing (lines, dots or rings). Langerhans cell histiocytosis)lower (e. Kaposi's sarcoma, PCP)peripheral (e. Pleural effusions may occur with cancer, sarcoid, connective tissue diseases and lymphangioleiomyomatosis. The presence of a pleural effusion argues against pneumocystis pneumonia. Reticular (linear) pattern(sometimes called . This is seen in Respiratory distress syndrome. For example, a patient with an acute myocardial infarction may have a completely normal chest radiograph. Gallery. Note both radio- opaque coils along the device lead. See also. Mettler, Walter Huda, Terry T. Yoshizumi, Mahadevappa Mahesh: . National Institute for Occupational Safety and Health.^medicalmnemonics. Chest X- ray interpretation 2. Bush, A; Gray, H; Denison, DM (February 1. Radiographics : a review publication of the Radiological Society of North America, Inc. Chest Radiology: Exam Revision Made Easy (1st ed.). Retrieved 9 February 2. 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. 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. Broadway, New York, NY 1. Box 3. 22. 4, Seminole, FL 3. Box 3. 01. 05, Bethesda, MD 2. 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 1. 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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