II. Protocol: Standard Views
- Standing (Upright Chest XRay)
- Posteroanterior (PA) Film
- Left Lateral XRay
- Request right lateral film if right-sided finding
- Normally more dark in the retrocardiac space and inferior spine approaching the diaphragm
- Increased white density ("spine sign") is seen in Pneumonia, aspiration, mass or Pleural Fluid
- Medjek (2015) Br J Radiol 88(1050): 20140378 +PMID:25827203 [PubMed]
- More sensitive than PA for abdominal free air
- Supine (Portable Chest XRay)
III. Protocol: Special Views
- Inspiration and Expiration Film Indications
- Pneumothorax accentuated on expiration
- Unilateral diaphragmatic paralysis
- Unilateral obstruction of major Bronchus
- Lordotic View Indications
- Posterior Apical Disease
- Middle Lobe disease
- Reverse Lordotic View Indications
- Anterior apical disease
- Oblique Film
- Peripheral small lesions
- Separated from overlying chest shadows
- Lesions poorly seen on lateral Chest XRay
- Rib Fractures (at axillary lines)
- Peripheral small lesions
- Lateral decubitus Film
- Detect small areas of air at uppermost pleural space
- Detect small areas of dependent Pleural Fluid
- Measure size and mobility of fluid collection
- Accessible with sampling needle (>1 cm size)
- Uncover Lung tissue obscured by Pleural Fluid
- Place side of interest up
- Mobility of mediastinal or pleural masses
- Assess mobility of solids and fluids within cavities
- Assist with maximizing inspiration of uppermost lung
- High Penetration Film with moving grid (Bucky Film)
- Obesity
- Dense pleural or pulmonary opacities
- Calcified lesions
- Lesions obscured by heart or diaphragms
- Air Bronchograms in densely infiltrated areas
- Intrathoracic Pressure Maneuvers
- Valsalva Maneuver: shrinks pulmonary vessels
- Muller Maneuver: distends pulmonary vessels
- Indications
- Distinguish blood vessel from Lymph Node
- Distinguish A-V malformation from solid lesion
- Barium Swallow
- Enlarged retro-mediastinal nodes
- Define Posterior intrathoracic mass
- Confirm ruptured diaphragm or Diaphragmatic Hernia
- Impaired Swallowing with aspiration
- Diagnostic Pneumothorax (instill air in pleural space)
- Distinguish peripheral Lung Mass from pleural lesion
- Define Mesothelioma
- Parenchymal disease extending towards chest wall
IV. Evaluation: Circumstances that decrease Chest XRay quality
- Semi-upright position (neither standing nor supine)
- May enlarge normal structures
- Changes air-fluid levels
- Lordosis or vertical axis rotation
- Widens heart and mediastinum
- Inadequate sustained inspiration
- Breathing film
- Lung structures and diaphragm blurred
- Expiration film
- Basilar infiltrates accentuated
- Interstitial structures accentuated
- Vessels
- Pleural Fluid
- Increased heart size
- Breathing film
- Supine Film
- Decreases Lung Volume
- Highlights infiltrates and interstitium
- Increases venous return to heart
- Distends azygous vein and pulmonary vein
- Diaphragm rises and intracardiac pressure increases
- Heart and mediastinal structures enlarge
- Fluid and air migrate
- Pleural Effusions disappear
- Small Pneumothorax disappears
- Air-Fluid levels (e.g. Lung Abscess) disappear
- Pneumothorax signs on supine film
- Deep Sulcus sign
- Costophrenic angle sharply outlined by air
- Diaphragm-mediastinal junction sharply outlined
- Hyperlucency superimposed over liver shadow
- Deep Sulcus sign
- Decreases Lung Volume
VI. Resources
VII. References
- Marini (1987) Respiratory Medicine, Williams & Wilkins
- Katz (1999) Clin Chest Med 20(3):549-62 [PubMed]
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Definition (NCI) | An x-ray examination of the chest. |
Definition (NCI_NCI-GLOSS) | An x-ray of the structures inside the chest. An x-ray is a type of high-energy radiation that can go through the body and onto film, making pictures of areas inside the chest, which can be used to diagnose disease. |
Definition (CSP) | X ray visualization of the chest and organs of the thoracic cavity; not restricted to visualization of the lungs. |
Concepts | Diagnostic Procedure (T060) |
ICD10 | 58500-00 |
SnomedCT | 55587003, 399208008 |
CPT | 71035, 1010335, 1010354 |
LNC | LA16043-4 |
Italian | Radiografia del torace, Radiografia NAS del torace |
Dutch | CXR, röntgenfoto NAO borstkas, borstkasröntgenfoto |
French | Radio thorax, Radiographie SAI du thorax, Radiographie du thorax |
German | Roentgen NNB des Brustraums, CXR, Roentgen Thorax |
Portuguese | RX do tórax, Raios X NE do tórax, Radiografia do tórax |
Spanish | Radiografía NEOM torácica, examen radiológico de tórax, radiografía de tórax (procedimiento), Rx de tórax, radiografía de tórax, radiografía simple de tórax (procedimiento), radiografía simple de tórax, Radiografía torácica |
Japanese | 胸部X線NOS, 胸部X線, キョウブXセンNOS, キョウブXセン |
English | chest X ray, chest radiography, chest xray, X-ray NOS chest, CXR, x-ray of chest (procedure), x-ray of chest, chest x-ray, thoracic x-ray, X-ray;chest, chest x ray, chest x rays, cxr, thoracic x rays, thorax x-ray, X-ray of chest, Radiography of chest (procedure), Radiologic examination, chest, Radiologic examination, Chest--Radiography, Plain chest X-ray, CXR - Chest X-ray, Chest X-ray, Chest exclusion X-ray, Chest x-ray, Radiography of chest, Plain chest X-ray (procedure), Radiologic examination of chest, Radiography of chest, NOS, Radiologic examination of chest, NOS, Chest x-ray, NOS, Chest Radiography, thoracic radiography, X-ray of chest NOS, chest X-ray |
Czech | Rentgenové vyšetření NOS hrudníku, Rentgenové vyšetření hrudníku |
Hungarian | Mellkasröntgen, Mellkas röntgen, Mellkas röntgen k.m.n. |