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What is a Chest X-ray? 

A chest x-ray is a diagnostic procedure that produces images of the inside of the chest using x-ray radiation. 

During this test, an x-ray machine sends a small burst of radiation to the part being examined and records an image on a photographic film placed on the other side of the patient. Bones absorb most of the x-rays and appear white in the image, while soft tissues allow x-rays to pass through them and appear dark.

On a chest x-ray, the ribs and the spine absorb maximum radiations and appear white, whereas the lung tissue and the air in the lungs appear black.

A chest x-ray typically checks for abnormalities in the lungs, heart, large blood vessels and bones in the chest. It is a quick and easy procedure that is used in the emergency diagnosis of certain conditions.

The chest x-ray can be performed in the following projections:

  • PA view- posteroanterior (PA) view
  • AP view- anteroposterior (AP) erect view

PA view is the standard position for a chest x-ray. In this, the x-ray radiation is passed from the posterior (back) to the anterior (front) of the chest. It is an excellent test to image the lungs, heart and mediastinum, but the patient needs to be standing for this procedure. 

AP view is the alternative to PA view. It may be performed in either an erect or supine position. In this, the x-ray radiation is passed from the front to the back of the chest. This test can be performed on people who are unwell or intubated and cannot stand, but it has some disadvantages such as:

  • The X-ray is more likely to show skin folds 
  • The heart is further away and thus the mediastinal structures (structures including the heart, trachea and oesophagus) may appear magnified
  • Scapulae (shoulder bones) may hide some portion of the lungs
  1. Who cannot have a Chest X-ray?
  2. Why is a Chest X-ray done?
  3. How should I prepare for a Chest X-ray?
  4. What is the procedure for a Chest X-ray?
  5. How does a Chest X-ray feel like?
  6. What do the results of a Chest X-ray mean?
  7. What are the risks and benefits of a Chest X-ray?
  8. What happens after a Chest X-ray?
  9. What are the other tests that can be done with a Chest X-ray?

Although x-ray is a safe procedure, it is usually avoided in pregnancy as the x-ray radiation may cause birth defects.

A chest x-ray is generally the first test performed to diagnose the cause of symptoms such as:

Your doctor will also order this test in the following conditions:

  • To check the health of your lungs, heart and chest wall
  • As a part of a routine check-up or before surgery 
  • To check how a disease is progressing and how well a treatment is working
  • To check on your lungs after surgery 
  • To locate implanted pacemaker wires, chest tubes or other internal devices 
  • To check for broken bone or injury to lungs
  • To reveal swallowed metal objects like coins (usually in kids)

PA view is the most common view and preferred view to capture images of lungs, mediastinum, thoracic cavity and blood vessels.  

However, an AP view is preferred for those who are unable to stand due to sickness or intubation.

No specific preparations are required before a chest x-ray. Women should tell their doctor if they are pregnant

You will be given a hospital gown to wear and will have to remove all your jewellery and any other metal objects before the test.

Your doctor may also ask you to sign a consent form granting him permission to conduct the procedure.

The following procedure is performed for a chest x-ray test:

  • Depending on the images needed, a technologist will ask you to sit, stand or lie down in front of the X-ray plate. A chest x-ray may be taken from the back to front (PA) or from the front to back (AP). For a side view, you may have to lie down on your side and raise your hands above your head.
  • The technologist will position you and then step behind a special window to operate the x-ray machine.
  • He/she will ask you to remain still and hold your breath for 2-3 seconds while the x-ray is taken so as to prevent blurring of the image.
  • The test usually takes about 15 minutes.

The procedure is non-invasive and usually painless. You won’t feel anything as the radiation passes your body. However, a person with arthritis or chest injuries may find it uncomfortable to remain still during the procedure. 

Also, you may find the coldness of the x-ray plate and the cold temperature of the room slightly uncomfortable.

The following conditions can be diagnosed using a chest x-ray:

  • Lung conditions, such as:

    • Tuberculosis
    • Pneumonia 
    • Lung tumour 
    • Collapsed lungs 
    • Pulmonary oedema (collection of fluid around or in the lungs)
    • Pleuritis (inflammation of the lining of the lungs)
    • Scarring of lung tissue
  • Heart conditions, such as:
    • Abnormal shape or size of the heart
    • Aneurysm (ballooning of the blood vessels)
    • Altered position or shape of the large blood vessels
    • Evidence of heart failure 
  • Other conditions including:
    • Hernia (defect in the muscle located below the lungs)
    • Osteoporosis (thinning bones)
    • Broken ribs or backbone

The benefit of an x-ray is that it has no side effects when used in the safe diagnostic range. 

However, excessive exposure to x-ray radiations can slightly increase your risk of cancer but the risk is negligible and generally nothing to worry about.

You don’t need any special care after a chest x-ray. However, your healthcare provider may ask you to wait for a few minutes while they check if the images are clear or if they need to repeat the procedure.

Depending on the condition suspected, your doctor may order the following tests along with a chest x-ray:

Disclaimer: All results must be clinically correlated with the patient’s complaints to make a complete and accurate diagnosis. The above information is provided from a purely educational point of view and is in no way a substitute for medical advice by a qualified doctor.

 
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References

  1. Felker GM, Teerlink JR. Diagnosis and management of acute heart failure. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier; 2019:chap 24.
  2. Radiological Society of North America (RSNA) [internet]. Oak Brook. Illinois. USA; X-ray (Radiography) - Chest
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  8. Cystic Fibrosis Foundation [Internet]. Bethesda. Maryland. US; Newborn Screening for CF
  9. Genetics Home Reference [internet]. National Institute of Health: US National Library of Medicine. US Department of Health and Human Services; Alpha-1 antitrypsin deficiency
  10. National Heart, Lung, and Blood Institute [Internet]. Bethesda (MD): U.S. Department of Health and Human Services; Sarcoidosis
  11. Portal, José A. Rodríguez, et. al. February 2009. Serum Levels of Soluble Mesothelin-Related Peptides in Malignant and Nonmalignant Asbestos-Related Pleural Disease: Relation with Past Asbestos Exposure. Cancer Epidemiology, Biomarkers & Prevention. 2009 Feb; 18(2).
  12. Porcel Jose M., Light Richard W. Diagnostic Approach to Pleural Effusion in Adults. Am Fam Physician. 2006 Apr 1;73(7):1211-1220.
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