Chest X-rays

What is a chest X-ray?

• projection of radiograph taken by radiographer of the thorax which is used to diagnose problems within that area (always taken on insp.)

• provides info about conditions of lungs + chest wall

• 4 densities visible on CXR → bone, air, water + fat

  • dense structures absorb rays → appear white (bone)

Indications for CXR

when physio needs to:

• detect changes in lung structure

• decide on course of treatment

• establish whether treatment is effective

• positioning of tubes and attachments

• monitor progression of lung disease

• identify normal/abnormal structures

• to localise pathlogy

• identify precautions/contraindications

Factors influencing quality of CXR

• distance

• patient position

• rotation

• state of respiration (insp. vs exp.)

• radiographic exposure

Types of CXR views

• Standard = PA (prefered) or lateral

• PA:

  • x-ray taken on insp.

  • beam passes back→front

  • person erect, arms ab.

• other = AP or decubitus (lying down → pt. lies on side w x-ray beam parallel to floor)

• AP:

  • heart magnified in this view

  • ant. ribs difficult to visualise

  • scapula in lung fields

Exposure on each x-ray view?

• should be able to see vert. bodies + disc spaces to t4/T5, should only see disc spaces from T5 down

AP view anatomy rev.

Lateral view anatomy rev.

Assessment of CXR

• name, date, time taken

• identify L & R sides

• projection: PA (common), AP, lateral

• position →clavicles equidistant from spinous processes

  • rotation: L = heart looks bigger, R = heart looks more central

• bony structures → identify any #, deformities, inspiration

• trachea position (midline or shifted)

• heart (size, borders→ are they clear)

• diaphragm (shape, costophrenic and cardiophrenic angles, R hemidiaphragm higher than left, is diaphragm clearly visualised)

• lung fields

  • upper, middle lower zones

  • fizzures (must be faint → if absent, prominent or abnormal = problem)

  • air

  • silloutte sign ( +ve = dissapearing of some border of thoracic cavity)

  • increased interstitial markings