X-ray of the chest: function, process, and when to undergo it

Definition

What is a chest X-ray?

A chest x-ray or chest x-ray is a chest radiograph that shows your heart, lungs, respiratory tract, blood vessels, and lymph nodes. A chest X-ray can also show your spine and chest, including your ribs, collarbone, and the top of your spine.

A chest x-ray is the most commonly used imaging test to find problems in the chest, especially to diagnose the cause of shortness of breath.

According to the Mayo Clinic, a chest x-ray can show a wide variety of conditions in your body, including:

• Lung problems, such as cancer, infection, or collection of air in the space around the lungs (pneumothorax) and other chronic lung conditions, such as emphysema or cystic fibrosis.
• Lung-related heart problems. A chest x-ray can show changes or problems in your lungs that are problematic from the heart. For example, fluid in the lungs (pulmonary edema) is the result of congestive heart failure.
• The size and shape of your heart. Changes in the size and shape of the heart can indicate heart failure, fluid around the heart (pericardial effusion), or heart valve problems.
• Blood vessel. The location of the large vessels close to your heart — the aorta and pulmonary arteries and veins — is visible on the X-ray. That is why conditions such as an aortic aneurysm, or other vascular problems and congenital heart disease can be seen.
• Calcium deposits. A chest X-ray can detect the presence of calcium in the heart or blood vessels. This indicates that there is damage to the heart cavity, coronary arteries, heart muscle, or the protective sac that surrounds the heart.
• Fracture ribs or spine.
• Post-operative changes. Chest X-rays are useful for monitoring the healing process after you have performed surgery on the chest, such as the heart, lungs or esophagus.
• Pacemaker, defibrillator, or catheter. A chest x-ray is usually taken after placement of a medical device to make sure everything is in the right position.

Usually two pictures are taken, one from the back of the chest and the other from the side. In an emergency when only one X-ray image is taken, usually the front will be used.

When should I have a chest X-ray?

A chest or chest x-ray is the first procedure you will undergo if your doctor suspects heart or lung disease in you. This test can also be used to check your response to treatment.

Your doctor will order a chest X-ray if you have any of the following symptoms:

• a cough that doesn't go away
• chest pain due to a chest injury (a possible rib fracture or pulmonary complication) or from a heart problem
• bleeding cough
• hard to breathe
• fever

This test can also be done if you have signs of tuberculosis, lung cancer, or other chest or lung disease.

Precautions & warnings

What should I know before undergoing this procedure?

There are several things you need to know before undergoing a chest x-ray, namely:

1. Doctors may not always get the information they need from a chest X-ray to find out the cause of the problem. You may need to have other tests, such as a CT scan, ultrasound, echocardiogram, or MRI scan to get a clearer picture.
2. Different clinics may use different types of tests. This can cause differences in results from previous test results.
3. Some conditions may not show up on a chest X-ray, such as minor cancer, pulmonary embolism, or other problems hidden in the normal structures in the chest.

Certain workers, such as those who work with asbestos, may need regular chest X-rays to check for problems caused by asbestos.

Process

What should I do before undergoing a chest X-ray?

Chest or chest x-rays do not require special preparation. You may be asked to remove some or all of your clothes and put on special clothing for the examination. You may also be asked to remove jewelry, dental utensils, glasses and metal objects or clothing that might interfere with the X-ray image.

Women should always tell their doctor or radiologist if there is a possibility that they may become pregnant. Many imaging tests are not performed during pregnancy to prevent the fetus from being exposed to radiation. If X-rays are needed, precautions will be taken to minimize radiation exposure to the baby.

How is a chest x-ray?

The process of carrying out a chest X-ray includes:

1. You will be asked to stand facing the x-ray plate to take pictures. If you need to sit or lie down, someone will help you to the correct position.
2. You will be asked to stay still during the x-ray to prevent the image from appearing blurry.
3. You may be asked to hold your breath for a few seconds while an X-ray is taken.

Most hospitals and some clinics have portable x-ray machines. If a chest x-ray is done on a portable machine next to your bed in the hospital, the radiologist and nurse will help you move into the correct position. Usually only one picture from the front position is taken.

What should I do after undergoing a chest X-ray?

You can return to your normal activities right after the test. Chest X-rays are readily available for a doctor to analyze.

A follow-up examination may be needed, and the doctor will explain the exact reasons why another examination is needed. If you have questions related to this test process, please consult your doctor for a better understanding.

Explanation of the Test Results

What do my test results mean?

In an emergency, chest x-rays will be available in a few minutes for your doctor to review.

Normal chest X-ray:

• X-rays of the lungs appear normal in size and shape, and lung tissue appears normal. There is no mass growth in the lungs. The pleural space (the space that surrounds the lungs) also looks normal.
• The heart looks normal in size and shape, and the heart tissue looks normal. The blood vessels from and leading to the heart are also normal in size, shape and appearance.
• The bones including the spine and ribs appear normal.
• The diaphragm looks normal in shape and position.
• No abnormal buildup of fluid or air was seen, and no foreign objects were visible.
• Any tube, catheter, or other medical device is correctly positioned inside the chest.

Abnormal chest X-ray results:

• Presence of infection, such as pneumonia or tuberculosis.
• A problem such as a tumor, injury, or condition such as edema due to heart failure may be seen. In some cases, further X-rays or other tests will be needed to see the problem more clearly.
• You can see problems such as an enlarged heart — which can lead to heart failure, heart valve disease, or fluid around the heart.
• There are visible problems with the blood vessels, such as enlarged aorta, aneurysms, or hardening of the arteries (atherosclerosis).
• Visible fluid in the lungs (pulmonary edema) or around the lungs (pleural effusion), or visible air around the lung cavity (pneumothorax).
• You can see a fracture in the ribs, collarbone, or spine.
• Lymph node enlargement is seen.
• Foreign objects are seen in the esophagus, breathing tube, or lungs.
• Tubes, catheters, or other medical devices have shifted from their original positions.