How is a chest x-ray done and what does it show. X-ray of the chest and chest - what shows how and why a picture of a healthy chest is taken

Chest x-rays are used in medicine at very low doses of x-rays. Rays passing through the body are absorbed differently by tissues, resulting in an image of the lungs, heart, ribs, sternum and spine on the film or screen.

The method is useful for complaints of shortness of breath, cough, fever, chest pain. Radiography is used to diagnose and monitor the treatment of various lung diseases such as pneumonia, emphysema, and cancer.

Principle of chest x-ray

X-rays are a form of radiation, like radio waves or visible light, only with a different wavelength. They penetrate well through many physical objects. After focusing the beam beam on a specific anatomical area, such as the chest, the x-ray machine briefly increases the radiation intensity. It penetrates through the internal organs, being absorbed depending on the density of the tissues, and the data obtained are recorded on a film or a sensitive screen.

Bones retain the rays well, while the internal organs, muscle and adipose tissue let them through. That is why the image of the chest looks like light bones, around them there are gray soft tissues, and inside there are dark air fields of the lungs.

Until recently, radiographs were stored only on film. Most images today are digital files stored electronically. This format provides ease of analysis, transmission and storage of information. That is why modern X-ray rooms are equipped with digital fluorographs and X-ray machines.

When is a chest x-ray needed?

The study is prescribed by the doctor after the initial examination, percussion, palpation and auscultation of the lungs.

Indications for a chest x-ray:

• labored breathing, ;
• persistent cough;
• secretion of purulent sputum;
• chest pain;
• chest wall injury;
• fever of unknown origin.

With the help of x-rays, doctors can diagnose such diseases:

• , and ;
• emphysema;
• a malignant tumor of the bronchi or;
• an increase in intrathoracic lymph nodes;
• , hemothorax, and many other pathological processes.

Indications for a chest x-ray

The study is assigned to adults and children for the following purpose:

• assessment of signs and symptoms potentially caused by pathology of the respiratory, cardiovascular systems, upper gastrointestinal tract and musculoskeletal system of the chest wall;
• assessment of the involvement of the lungs in the pathological process in systemic diseases affecting the entire body, as well as in the metastasis of malignant tumors from other foci;
• studies with a known diagnosis to assess the quality of treatment (improvement, recovery, stabilization, progression);
• examination of patients in intensive care units;
• preventive examinations of different groups of the population, in particular, for the diagnosis of pneumoconiosis and tuberculosis;
• preparation for surgery for lung diseases.

Advantages and disadvantages of the method

Like any medical intervention, lung x-rays have pros and cons.

Advantages:

• there is no residual radiation after the completion of the diagnosis;
• subject to the rules of the study, the method does not cause side effects;
• the equipment is available in most medical institutions;
• obtaining an image, especially with a digital apparatus, is very easy and takes little time, which is especially important in critical medical situations.

Possible risks:

• there is a small chance that x-rays will start the process of tumor formation, but the benefits of diagnostics outweigh this risk;
• to obtain a high-quality image, highly qualified laboratory assistants are required to select the dose of X-ray radiation depending on the characteristics of the patient;
• pregnant women need additional measures to protect the fetus from radiation (lead aprons, blankets, etc.).

In modern devices, special attention is paid to reducing the radiation dose while improving image quality. National and international radiology organizations are constantly reviewing and updating the standards for techniques used by radiologists.

Modern equipment controls the radiation dose by minimizing the effect on other parts of the body.

Method Limitations

A chest x-ray is a very informative examination, but it has some limitations. Not all pathological conditions can be detected by conventional x-rays, such as small tumors or pulmonary embolism.

There are no contraindications for chest X-ray. During pregnancy, it is performed only in case of emergency. At the same time, the abdominal area is protected with a special apron that does not transmit x-rays. They also use a special partition that prevents radiation from penetrating through the abdominal cavity. However, the danger to the fetus still remains, especially in early pregnancy. Preventive studies (fluorography) during pregnancy are not carried out.

Dangerous conditions detected by research

The main diseases that can be diagnosed with a chest x-ray:

• pneumonia;
• congestive;
• pneumothorax;
• pleural effusion;
• cardiomegaly;
• pneumoperitoneum;
• emphysema.

Pneumonia appears on the radiograph as a light spot on a dark lung background. This is due to swelling of the walls of the alveoli and the ingress of inflammatory effusion into their lumen. The main causes of pneumonia are bacterial infection, chest trauma, inhalation of harmful chemicals or stomach contents.

Congestive heart failure is accompanied by an increase in pressure in the pulmonary vessels, and in more severe cases, the accumulation of fluid around the heart (in the pericardial cavity). On the radiograph, this looks like an increase in light linear shadows around the heart (increased lung pattern) and an increase in its size.

Pneumothorax is an accumulation of air in the pleural cavity as a result of a chest wound, bullous emphysema, and a decaying tumor. It looks like a thin dark line adjacent to the chest wall. In tension pneumothorax, X-rays of the lungs are taken during inhalation and exhalation, and it is found that the amount of air does not change or even increases.

With the accumulation of blood, pus or inflammatory exudate in the pleural cavity, they speak of a pleural effusion. It is caused by pleurisy, pleural empyema, congestive heart failure, pulmonary embolism, or chest trauma. Often, the effusion can be found only in the region of the diaphragmatic angles, so it is very important to follow the technique of taking the picture so that the entire chest is imaged.

Cardiomegaly is an enlargement of the heart, which may be a sign of valvular disease, dilated cardiomyopathy. It is diagnosed by measuring the size of the shadow of the heart and its relationship with the diameter of the chest.

An x-ray of the lungs can also detect an accumulation of air in the abdominal cavity - pneumoperitoneum. This condition occurs with injuries to the abdomen, complications after operations on the abdominal organs, with perforation of the intestine. It looks like a dark band of air under the diaphragm.

Emphysema is one of the most common causes of death in patients with chronic lung disease. Radiography is one of the main methods for diagnosing this dangerous condition, which is manifested by an increase in the airiness of the lung tissue, deformation and an increase in the size of the chest.

A chest x-ray is often critical in making a diagnosis and determining how to treat a patient. That is why it is important to conduct it not only with modern equipment, but also to ensure good training of radiologists and radiologists.

Radiography is used to examine the organs of the chest, assess the condition of the lungs, bronchi, trachea, lymph nodes, bones, and the cardiovascular system. Modern medical equipment allows you to get a clear image of the internal organs in the desired projection, which greatly simplifies and speeds up an accurate diagnosis. Radiography makes it possible to identify various pathologies, neoplasms, inflammation, mechanical damage, etc.

How to take a chest x-ray

Preliminary preparation of the patient before the examination is not required. It is not allowed to have metal objects on the body (body crosses, jewelry, etc.).

The examination takes place in a separate room, where the appropriate equipment is located. It is necessary to follow the instructions of the doctor, take the required position in front of the scanning device, hold your breath on command. Most often, before the delay, you need to take a shallow breath. The patient should not strain too much when inhaling, as this leads to a distorted arrangement of the chest organs in the picture.

Most often, the doctor needs an X-ray in a direct projection, an image in a lateral projection is needed much less often. With a properly conducted examination, the ribs, heart, respiratory organs, and partly the bones of the shoulder girdle are clearly visible.

The duration of the study is about 1 minute. After receiving the picture, the doctor makes a transcript, and brings the results of the examination to the patient, transmits a detailed conclusion.

The results of the examination of the chest organs and the interpretation of the radiograph

After receiving the picture, the radiologist makes a conclusion and passes it on to the attending physician, who referred the patient for an x-ray. The description contains information about the location and size of the heart, respiratory organs, the state of the vascular and lymphatic systems. In the presence of foreign objects, blackouts, neoplasms, this is also noted in the description of the results of the study.

X-ray of the lungs allows you to assess their condition, size, shape, structure of tissues, as well as the location of other organs of the chest. To obtain the most complete information about the state of the lungs, the doctor needs an x-ray in 2 projections, where the lung tissue, domes of the diaphragm, the shadow of the heart and mediastinal organs, the bones of the spine, shoulder girdle, and sternum are clearly visible. The image of various organs and bones is superimposed on each other.

For correct interpretation of the image, a clear idea of ​​\u200b\u200bhow healthy organs of the chest look on the x-ray. For example, even subtle darkening, enlightenment, asymmetric pulmonary pattern may indicate a serious illness. Regular examinations allow you to identify pathologies at an early stage and immediately begin treatment.

When deciphering, the radiologist evaluates the quality of the image. Incorrect procedure (incorrect position of the patient, incorrect projection, etc.) does not allow an accurate conclusion to be made, so a second examination may be required.

The reason for the incorrect result of the examination may be:

• Additional artifacts - shadows of various metal products that can obscure the foci of pathologies and disrupt the holistic perception of the image by the doctor
• Completeness of the image - due to the incorrect location of the screen, the tops, margins, sines of the diaphragm may not be displayed correctly
• Insufficiently clear and contrasting image - appears when the X-ray machine mode is selected incorrectly. Modern equipment allows you to choose the dose of radiation for people of various sizes. For example, for patients with significant body weight, obesity, stronger radiation is required to obtain a clear radiograph. When digitizing an image, it is possible to change the contrast of the image
• Body position - if the patient is in the wrong position, untimely expiration, opening of the shoulder blades, incorrect installation of the screen or X-ray tube, the radiograph is likely to be distorted

X-ray interpretation protocol

Any qualified general practitioner will recognize serious pathological changes and damage on an x-ray. However, in order to draw up a detailed conclusion and identify diseases at an early stage, a detailed analysis of the radiograph is necessary. For the convenience of radiologists, an algorithm has been developed, according to which a transcript protocol is compiled.

• The exact name of the examination - the anatomical region of the image is indicated, in which projection (lateral, direct) it was made
• Assessing the symmetry of the lung fields
• Identified or not pathological fields (focal, diffuse infiltrative), enlightenment in the lung tissue
• Description of the pulmonary pattern (if it is disturbed, then this indicates pathological changes in the vessels of the lungs)
• Description of the roots of the lungs - the structure of the lymph nodes is disturbed or not, pathological changes in the large bronchi are present or not
• Description of the shadow of the mediastinal organs - especially important in the diagnosis of heart disease
• Description of the arc of the ventricles of the heart, large vessels
• The condition of the diaphragm and pulmonary-phrenic nodes of the sinuses - an assessment of the symmetry of the standing of the diaphragm, the angle of the sinus, whether it is filled or not (presence of effusion with pleurisy)

Inflammatory processes and tuberculosis

When analyzing a radiograph, one should clearly distinguish between diseases associated with tissue inflammation and pulmonary tuberculosis. Tuberculoma in most cases is localized at the tops of the pulmonary tract, the shadow from it is rounded, more often with enlightenment in the center - a focus of destruction. Expanded roots of the lungs are clearly visible.

Inflammation of the lungs (pneumonia) is clearly visible on the x-ray. It looks like an infiltrative shadow against the background of an increase in the pattern of the lungs, the focus of pneumonia is often surrounded by enlightenments - local compensatory emphysema.

Service cost

X-ray examination

Suspicion of inflammatory processes in the lungs, cardiomegaly and other pathologies of the thoracic organs often become the reason for one of the oldest diagnostic procedures in modern medicine.

This procedure is called a chest x-ray, more precisely, an x-ray of the chest organs, which means a description (from the Greek “graphy”) or visualization of these organs in the light of x-rays. The fact that this manipulation is associated with radiological exposure often causes many doubts and questions among patients regarding the safety of this diagnostic method. We will try to answer the most popular of them.

In contact with

Classmates

What is a chest x-ray?

X-rays, as you know, penetrate the tissues of the human body and are able to leave on a photographic film or digital matrix an image of the internal organs “translucent” by them. X-ray of the chest is considered the most popular diagnostic procedure in radiology, due to the fact that in the thoracic region there are several of the most significant organs, the condition of which can be assessed, including by radiography.

The better the tissue absorbs X-ray radiation (that is, it does not pass it through itself), the lighter it looks on the radiographic image. That is why the bone tissue (ribs, spine, other bones of the skeleton) looks white or light gray on the radiograph. And the lungs, as a rule, look somewhat darkened, which is explained by the weak ability of the lung tissue and the air in it to absorb R-radiation.

The current unit of measure for R-radiation today is the milliSievert.

What organs does it show?

What part of the body does the chest x-ray cover, what does the x-ray show, which organs are visible on it? Any person who did not miss school anatomy lessons should know this. Here are located:

• heart and aorta;
• lungs and airways;
• costal arches and sternum (anterior central bone of the chest);
• upper spine.

X-ray of the thoracic region allows not only to see these organs, but also to assess structural changes in tissues, various anatomical disorders, malformations (for example, valvular), as well as the degree of the inflammatory process, according to certain signs. Modern devices are able to fix problem areas less than 1 millimeter in size.

X-rays of light

It is believed that if a person has been x-rayed, then the x-ray procedure cannot be repeated within the next two years.

Is it so? What, for example, to do if during these two years he is injured and he has to do an x-ray of the ribs of the chest? Or will there be suspicions of the development of pulmonary tuberculosis, and in order to clarify the diagnosis, it will be necessary to take a chest x-ray and “highlight” the lungs?

In such a situation, the question of the need for additional X-ray examination should be decided by the doctor. Why is a chest x-ray done, for which pathologies of the lungs is this procedure indicated? X-ray of the lungs is recommended if the following diseases are suspected:

As you can see, the listed diseases pose a serious danger to humans, so the benefits of their timely detection and treatment far outweigh the risk of receiving a dangerous dose of milliSieverts. During a chest x-ray, a person receives radiation at a dose of approximately 0.3 mSv, which is 8% of the allowable annual radiation dose.

Why do in two projections?

Since the lungs are located under the costal arches, and the basal zone of the lungs is under the sternum, these areas can be hidden from ionizing rays and are not visible in direct projection.

To obtain more reliable data on the condition of the lungs, a chest x-ray is used in two projections - the so-called anteroposterior (direct) and lateral. This is especially useful in case of suspected pneumonia or tuberculosis, as well as a tumor lesion of the lung.

"Side view" allows you to see those parts of the body that could be invisible due to the sternum or costal arches. As a rule, doctors try not to prescribe a "double" chest x-ray to a child in order to minimize the effect of radiation on a growing body.

Is it harmful?

The issue of safety of X-ray examination of organs is relevant not only for children, but also for adults. Many are interested in whether it is harmful to be exposed to R-radiation for diagnostic purposes, whether it is possible to combine radiography and fluorography.

An x-ray examination is allowed for the purpose of diagnosis as prescribed by a doctor if serious pathologies or injuries are suspected.

In terms of radiation, the most dangerous are outdated X-ray machines, which are still used in some medical institutions in the country. Although the dose of radiated waves on these devices is so scanty that it is not worth expecting immediate cell mutation from a single X-ray procedure.

How often can you do it?

As it turned out, there are no regulations or recommendations regarding the frequency of x-rays of the thoracic region or other parts of the body in the Ministry of Health. Radiation doses should be controlled by the radiologist and recorded by him in the patient's outpatient record, but in practice, few people do this. Although modern X-ray machines are equipped with built-in dosimeters that allow you to immediately determine the dose of radiation received.

It is believed that a patient receives such a small dose of millisieverts during an X-ray procedure that in order to develop radiation sickness, he would have to undergo a thousand spinal X-rays or 25,000 digital fluorography scans at a time.

There is a SDA (maximum permissible dose) for employees of X-ray rooms who are exposed to radiation while working with each patient - 50 mSv per year. Taking into account the above figures, we calculate that exposure for a second in two projections will “give” your body no more than 0.6 mSv, which is 83 times less than the standard for radiologists. So the frequency of X-ray examination is determined by the doctor, based on the dynamics of the inflammatory process. That is, as much as the doctor considers possible, as many times it will be possible to “enlighten”.

Where to make a child?

The child's body is particularly sensitive to radiation. This is due to the fact that the effect of R-radiation is most effective in relation to rapidly growing or replacing cells. In adults, this is the bone marrow and cells of the reproductive system, and in children, the whole body.

Therefore, if it becomes necessary to perform a pediatric chest x-ray, care should be taken to ensure that the procedure is performed on the latest devices, which are usually available in private diagnostic centers.

In addition, it is necessary to protect all other parts of the child's body from exposure to ionizing rays with special aprons and collars with lead inserts. So it will be possible to secure the chest x-ray to the child as much as possible. Where to make a radiograph is better - naturally, where there is more modern equipment.

Is it possible to go at home?

The latest technology makes it possible to perform a chest x-ray at home. For this, portable X-ray machines are used, designed to examine a patient who is unable to leave a hospital bed. In state medical institutions, such an examination is possible only for patients in the intensive care unit or intensive care units, strictly according to the doctor's indications.

Even if you have a referral from a doctor, you will have to use a paid procedure at a private clinic that provides chest x-ray services to conduct an examination at home of your own free will. Where to make or, more precisely, order such a service - obviously, on the websites of medical and diagnostic centers.

Images obtained during the procedure at home, as well as the opinion of the radiologist who performed the chest X-ray at home, can and should be used by doctors of public institutions at the level of official diagnostic studies. The state doctor is not entitled to require the patient to undergo an additional X-ray examination in the district clinic if the data of the R-image is not expired and is well readable.

True, the expiration date of a chest x-ray is not indicated, since there are no documents regulating the “expiration date” of an x-ray. An image taken in the previous year can be considered “expired” if it refers to the diagnosis of tuberculosis. And when it comes to fractures, the dynamics of events develops faster and pictures to determine the correct fusion of bones need to be taken much more often. That is, the determination of the need to update the X-ray data is again in the hands of the doctor.

Which is better: X-ray or CT?

For some reason, some patients have the opinion that they have the right to choose the diagnostic method that seems to them the most modern, the best in terms of reviews and all other parameters.

Yes, a person has the right to invest in better diagnostics if it makes medical sense and makes any sense. But when we ask about a chest x-ray or a CT scan - which is better, we simply show our ignorance in this matter.

There are situations when an X-ray, which is less "radioactive" than computed tomography, is quite enough to make a diagnosis and determine the degree of organ damage. Why not settle for this simple and relatively safe method?

When conducting an x-ray of the thoracic region, exposure occurs within a fraction of a second. CT involves multiple scanning of the studied areas in different planes (“slices”), which creates an additional radiation load on the body (up to 12 mSv). Of course, it is also not too dangerous, but not particularly useful. Therefore, this method of clarifying the diagnosis is resorted to only when other methods, including x-rays, turned out to be uninformative. Most often, this is necessary during the differential diagnosis of tuberculosis and bronchopulmonary neoplasms.

If you think a chest X-ray is harmful to a child, is it harmful to give him an even more powerful CT scan? Comparing these diagnostic methods is simply incorrect. Only a doctor can determine which of them will be appropriate in each case.

Useful video

For more information about chest x-rays, see this video:

Conclusion

1. When diagnosing diseases of the respiratory or cardiovascular system, as well as injuries of the thoracic region, a chest x-ray is used. What does an x-ray show? Foci of inflammation, pulmonary infiltrates, cracks in the bones and other pathological changes.
2. X-ray examination, used today for diagnosis, can be considered completely safe in terms of radiation exposure.
3. With insufficient information obtained from x-rays, the doctor may prescribe a more powerful study - computed tomography.
4. If it is not possible to transport the patient to the X-ray room, it is possible to perform an X-ray at home, this service is provided by private medical centers.

In contact with

A chest x-ray is done to look at the lungs, heart, and chest wall. This is a non-invasive technique in which the patient's body is exposed to ionizing radiation. The result of the procedure are film shots or digital images.

The study is based on the difference in the ability of organs and tissues to absorb x-rays. It is known that the denser the anatomical structure, the more it "absorbs" radiation. For example, during radiography, the ribs absorb almost the entire dose of radiation transmitted through them, while the lungs absorb no more than 5%. As a result, the bone tissue in the pictures looks almost white, and the air cavities look black.

Indications and contraindications

The indications for the appointment of the procedure are:

• suspicion of diseases of the respiratory system (, lung cancer,),
• rib injury,
• pain in the chest area,
• dyspnea,
• swelling and high blood pressure.

For the purpose of early diagnosis of bronchopulmonary diseases, the procedure is carried out annually for patients with occupational hazards.

There are no absolute contraindications for radiography. The relative constraint is .

Do you need to prepare for the study?

Special training is not required. Immediately before the procedure, the doctor asks the patient to undress to the waist and remove metal jewelry from the chest.

Methodology

Chest X-ray can be performed in 3 projections: anterior, posterior and lateral. Most often, the image is taken from the front. For this, the patient's chest is pressed against a special photographic plate. Behind is an x-ray tube that produces beams of radiation.

The doctor asks the patient not to move, take a deep breath and hold his breath. This will help prevent blurry images. The technician then turns on the machine for a few seconds. X-rays, passing through the body, fall on a photographic plate and form an image on a sensitive film.

To obtain a rear or side projection, the patient is pressed against the screen with his back or side. If the specialist needs to examine additional areas of the chest, he can take pictures from other angles.

Evaluation of results

The radiologist interprets the obtained images. It evaluates the structure of the bones and soft tissues of the chest. Matter:

• location of the apex of the lungs
• transparency of lung tissue,
• the shape and size of the shadows of the mediastinal organs,
• the presence of additional blackouts (foci and foci) on the projection of the lungs.

Among the pathological changes, bronchial granulomas, exudate or air in, lung cysts, etc. can be found.

The radiologist draws up the diagnostic results in the form of a conclusion, which, together with film images or digital images, passes to the attending physician.

How dangerous is an x-ray?

In modern diagnostics, radiography is considered an absolutely safe procedure. The dose of radiation that the patient receives in one session is:

• on a film machine - 0.3 millisievert (mSv),
• on digital - 0.03 mSv.

For comparison: during an airplane flight in one hour, a person receives exposure to 0.01 mSv.

According to the WHO recommendation, the maximum allowable dose of radiation is 150 mSv per year, so officially there are no restrictions on performing x-rays. If necessary, the study is repeated as many times as required. However, for security reasons, excessively frequent appointments are avoided.

X-ray radiation is more harmful for a growing organism, therefore, the procedure is carried out for children only with the permission of their parents. Before doing so, the doctor must explain in detail to the family the consequences of not taking the study. The fact is that in 70% of cases, radiography is the only way to confirm the diagnosis and helps to avoid mistakes when choosing therapy. During the examination of the chest, a protective apron is put on the child, covering the abdomen and pelvic area.

It is undesirable to carry out the procedure during pregnancy. And yet there are emergency situations (rib fractures, etc.) when this diagnostic method is indispensable. In such cases, the procedure is carried out at the discretion of the doctor. The area of ​​​​the abdomen of the pregnant woman is also covered with a protective screen.