The X-ray examination of the thorax (chest), briefly called X-ray thorax (synonym: chest X-ray), is the most common radiological examination and is part of the standard diagnostics, especially in the emergency room. In pulmonology (medicine of lung diseases), this X-ray examination is also of utmost importance and is part of basic diagnostics. Correct assessment of the images requires precise knowledge of the anatomical conditions. Further, fluoroscopy (X-ray imaging with projection on a television monitor in real time), computed tomography (CT), magnetic resonance imaging (MRI), and various examinations appropriate to the problem can be performed.
Indications (areas of application)
- Aspiration (inhalation of foreign bodies or fluids during breathing; due togastroesophageal reflux; esophagotracheal fistula)
- Bronchial asthma
- Chronic obstructive pulmonary disease (COPD; chronic obstructive pulmonary disease, less commonly chronic obstructive lung disease, COLD) – refers as a collective term to a group of diseases of the lungs characterized by cough, increased sputum and dyspnea (shortness of breath) on exertion.
- Dyspnea (shortness of breath)
- Diseases of the heart – eg cardiomegaly (enlarged heart) in heart failure (heart failure).
- Diseases of the trachea (windpipe)
- Diseases of the esophagus (esophagus)
- Hemoptysis – coughing up blood with large amounts of blood.
- Hemoptysis – coughing up blood with smaller amounts of blood.
- Cough
- Interstitial lung disease (parenchymal lung disease) – caused by damage to the cells surrounding the alveoli (air sacs), resulting in extensive inflammation and fibrotic scarring of the lungs
- Pulmonary edema – nonspecific name of leakage of blood fluid from capillary vessels into the interstitium and alveoli of the lungs.
- Cystic fibrosis (synonyms: CF (fibrosis cystica); Clarke-Hadfield syndrome (cystic fibrosis); cystic fibrosis (CF)).
- Pneumonia (pneumonia) in adults and children.
- Pleural effusion – abnormal accumulation of fluid in the pleural cavity, the narrow gap between the pleural sheets (between the lung pleura and the pleura)
- Pneumothorax – clinical picture in which air enters the pleural cavity, obstructing the expansion of one lung or both lungs so that they are not available for breathing or only to a limited extent
- Sarcoidosis (synonyms: Boeck’s disease or Schaumann-Besnier’s disease) – systemic disease of connective tissue with granuloma formation.
- Nonspecific thoracic pain (pain in the chest).
- Trauma (injury) to the thorax and abdomen (abdomen).
- Tuberculosis (consumption)
- Spatial growth or tumor (mediastinal, pulmonary, pleural) – e.g. bronchial carcinoma (lung cancer).
- Foreign body
In addition, X-ray thoracic examination is regularly performed in intensive care patients, in setting or serial examinations, and preoperatively. Note: In children and adolescents, chest X-ray is usually unnecessary, even for therapy decision.
The procedure
The examination is usually performed on a standing patient (if possible). During the exposure, the patient is instructed not to move, to take deep breaths, and to stop breathing briefly. The X-rays used in chest radiography may have different courses, allowing assessment in different planes. The following variations can be performed:
- P. a. Beam path (posterior anterior) – The radiation source is located behind the patient, while the beam detector or X-ray film is located in front of him.
- A. p. Radiation path (anterior posterior) – The radiation source is located in front of the patient, while the radiation detector or X-ray film is located behind him.
- Lateral (lateral) beam path – The radiation source is located to the right or left of the patient.
- Oblique images of the thorax, both from the left and from the right.
- Tip-tilt image – the tips of the lungs are clearly visible without clavicle overlap (overlap due to the clavicles)
- A. p. sitting
- A. p. lying down
- A. p. lying with erection – e.g. 45 ° elevation.
In everyday clinical practice, a chest radiograph is taken using the p.a.X-rays are taken in two planes, i.e. in the left-lateral beam path and in the left-lateral beam path. So-called hard beams are used, which means that a voltage of more than 100 keV (kilo electron volts) is applied to the X-ray tube (for further explanation see Introduction X-ray). The following anatomical structures can be assessed on the chest X-ray:
- Cor (heart) or heart size – Enlarged heart shadow?
- Pulmo (lung) – vascular drawing? Infiltrates? Symmetry? Hyperinflation? Spacial lesions?
- Hilum pulmonalis (lung tips).
- Pleura (pleura) – pneumothorax? Pleural effusion?
- Mediastinum (middle pleural space) – Free air? Symmetry? Width?
- Diaphragm (diaphragm) – Diaphragmatic protrusion? Sickle-shaped inclusions of free air in the abdomen?
- Thorax – bony chest (ribs, sternum, thoracic spine).
- Soft tissues (musculature, chest, etc.)
- Trachea (windpipe) – course? Contour? Lumen narrowing?
