Norm of Chest Radiography (Chest X-Ray, CXR)
Normal anatomy and no pathologic changes evident.
Usage of Chest Radiography (Chest X-Ray, CXR)
Chest radiography may be used as a general screening tool preoperatively or for general physical examinations or may be prescribed for a specific diagnostic purpose. Provides information regarding the anatomic location and abnormalities of the heart, great vessels, lungs, soft tissue of the chest and mediastinum, and the bones. Many types of pulmonary, cardiac, and orthopedic abnormalities may be seen on a chest radiograph, particularly if serial films are available for study. Pulmonary uses include abscess, acute respiratory distress syndrome (ARDS), atelectasis, Bethel myopathy, bronchitis, cystic fibrosis, emphysema, fibrosis bullae, hemothorax, malignancies of the lung, pleural effusion, pneumonia, pneumothorax, pulmonary edema, and tuberculosis calcific changes. Cardiac uses include congestive heart failure and determination of heart size. Uses in the great vessels include abnormalities of aortic arch (calcification), some aneurysms, and transposition. Orthopedic uses include bone tumors, fracture of clavicles, kyphosis, rib fractures, scoliosis, and spinal fractures. General uses include placement of central lines, endotracheal tubes, tracheostomy tubes, chest tubes, nasogastric tubes, pacemaker wires and intra-aortic balloon pumps, foreign bodies, lymph node enlargement, mediastinal changes, and pulmonary artery catheter placement.
Description of Chest Radiography (Chest X-Ray, CXR)
X-rays are passed through the chest and react on a special photographic plate. Normally the lungs are radiolucent. Bones and fluid-containing bodies such as the heart, the aorta, and any tumor or infiltrate are denser than the lungs and can be easily visualized. Chest radiographs can be performed with the client standing or sitting upright, during inhalation, and in anteroposterior, posteroanterior, and lateral views. Portable, in-bed, anteroposterior chest radiographs can be performed for clients too ill to transport to the radiology department.
Professional Considerations of Chest Radiography (Chest X-Ray, CXR)
Consent form NOT required.
Fetal teratogenicity, vasovagal response (hypotension, bradycardia) to breath-holding.
Screen the client for contraindications to performing the Valsalva maneuver (recent myocardial infarction, bradycardia). If these conditions are present, teach the client how to hold breath without bearing down.
During pregnancy, risks of cumulative radiation exposure to the fetus from this and other previous or future imaging studies must be weighed against the benefits of the procedure. Although formal limits for client exposure are relative to this risk:benefit comparison, the United States Nuclear Regulatory Commission requires that the cumulative dose equivalent to an embryo/ fetus from occupational exposure not exceed 0.5 rem (5 mSv). Radiation dosage to the fetus is proportional to the distance of the anatomy studied from the abdomen and decreases as pregnancy progresses. For pregnant clients, consult the radiologist/ radiology department to obtain estimated fetal radiation exposure from this procedure.
- Remove from the chest area all jewelry, clothing with snaps, electrocardiographic patches (if not contraindicated), and other metal objects that may interfere with the interpretation of the results.
- Females should be asked if they are pregnant or if there is any possibility that they may be pregnant.
- The client is positioned sitting or standing upright in front of the x-ray machine, with arms held slightly out from the sides, chest expanded, and shoulders pressed forward. The radiographic film is placed against the anterior chest.
- For lateral views, the client stands with his or her arms elevated from the shoulders and with the forearms resting on the arm of the radiographic equipment, if necessary. The radiographic film is placed flush against the right or left side of the chest.
- As the client holds very still and takes in a deep breath and holds it, one or more radiographs are taken.
- For portable radiographs, the client is positioned sitting in a high-Fowler's position, and the portable x-ray machine is moved into place in front of the chest for the radiographic exposure onto the plate positioned behind the back and chest.
- Replace the electrocardiographic patches and wires if they have been removed.
- Return personal belongings to the client and help him or her dress.
- In the event of usage of a portable x-ray machine, help the client return to a comfortable position.
Client and Family Teaching
- It is important to breathe in deeply, hold your breath, and remain motionless while the radiograph is taken.
- A radiograph takes approximately 15 minutes to complete and verify that the images are properly exposed.
- No restrictions are necessary on food or fluid intake.
- No sedation is used for this procedure.
- Views are taken in various positions on the table or chair.
Factors That Affect Results
- Overall misinterpretation of a chest radiograph can occur because of tumor, post-op changes, massive pulmonary emboli, false ventricular aneurysm and esophageal varices. Knowledge of the client's history is essential to consider.
- Clothing, jewelry, and metal objects cause shadows on the film.
- Movement obscures the clarity of the picture.
- Improper positioning makes radiographs difficult to interpret.
- Portable radiographs are not as reliable as those performed in radiology departments. The anteroposterior position may cause the heart to appear larger than it is.
- Overexposure or underexposure results in inadequate visualization.
- The experience of the physician interpreting the films affects the accuracy of the findings.
- Chest radiography is not suggested as a first-line screening tool for tuberculosis or cancer because of possible dangers from frequent radiographic exposure.
- Health care workers in areas near frequent usage of x-rays should wear an x-ray badge to track exposure level. They should wear a lead apron when remaining in the room with the client during exposure. For portable radiographs, health care workers should stand at least 5 feet from the x-ray source during exposure.