Chest X-rays

Chest X-ray is a very helpful technique, and not requiring much time, to detect any kind heart or lung problem. There may be many different types of X-rays used for various parts of the body. The doctor may advise an X-ray for one of the following reasons:

• To check the area where a patient has discomfort or pain
• To monitor the progression of a disease.
• To examine the response of a particular treatment

Multiple disease conditions require a chest X-ray to be conducted on patients. These conditions are as mentioned below

• Bone Cancers – To detect tumor in the bones
• Blocked blood vessels
• Enlarged heart
• Abnormal heart and lung sound during the physical examination/auscultation.
• Infections
• Lung problems – Chest X-ray helps in detecting lung cancers and collapsed lung
• Fractures – X-rays are very helpful in detecting fractures after an accident.
• Joint Dislocations e.g. in shoulders
• To detect any calcium deposits in the arteries (heart) and other blood vessels.
• To examine the density of the bones
• Deformity in chest wall
• Continuous cough
• Blood in cough
• Hypoxia (poor oxygen supply)
• Chest X-rays taken over several years can assist doctor to examine if the problem is getting worse or better.
• To check pneumonia, emphysema and tuberculosis.
• Post- operative chest X-ray- This is done after a chest surgery to monitor the structures and functions for recovery. It is also helpful in detecting any air leakage or any fluid filled areas after the surgery especially in the cases where any tubes or pipes were inserted during the surgery.
• To remove any item swallowed – Especially used in children when they accidentally swallow some radio-opaque foreign body.

Some experts argue that X-ray is not a safe procedure as it sends harmful radiations, which can lead to cell mutations in some people and ultimately cancer.  However, when a chest X-ray is advised the amount of radiations exposed to a person's body are extremely low to cause any damage to the cells.

In case the women is pregnant or is expecting pregnancy, she should inform the doctor well before the X-ray is conducted. Although there is a small risk to the unborn baby in an X-ray still the doctor might suggest going for an alternative imaging technique like an Ultrasound or MRI as the unborn babies are very sensitive to any kind of radiations.

In some cases of severe fracture, there might be slight pain and discomfort while the X-ray is performed as the patient might have to put together the body in a certain position. In such a scenario, the doctor can advise some pain medications before the X-ray.

The doctor or nurse will inform the patient about the procedure and preparations, needed to be done before the test, as there can be different types of preparation needed for different types of X-ray conducted. Some of the steps, the patients are asked to follow include:

• The patient is asked to change into a hospital gown before the X-ray.
• All the jewelry, eyeglasses, any other metal object worn by the patient are removed, as these items can cause artifacts or distortions when the X-ray is taken.

During the Test:

• X-rays are usually performed in a radiology department or a clinic with diagnostic specialties.
• The patient is asked to stand in case of chest X-rays as it gives a better view.
• There are special X-ray plates put next to the patient. These plates consist of censors or X-ray films that capture images.
• A small burst of radiations is sent out towards the patient and according to the density of the structures in the body the image is captured.
• When the radiations are sent, the patient should not move and should try to hold breath in order to get a clear image. During the procedure, the patient is asked to take a deep breath and fill the lungs so as to enhance the visibility of tissues in the chest.
• The radiations which, pass through the body, are not felt by the patient and are completely painless.
• The X-ray images, which are captured, consist of a view from front to the back of the patient’s body and from the side. This is helpful for the doctor to get a clear picture of the specific areas of the infected chest.
• In some cases, in order to hold specific position, the technician can make a use of some sandbags and pillows.

Child X-ray:

• In case of a child is undergoing a chest X-ray, some immobilization techniques or restraints might be needed to make them still during an X-ray. Though, the procedure is completely harmless, but still it is recommended to prevent repeated X-ray exposure to the child, if a child moves during the test. The parents are allowed to stay with the child during the X-ray but are asked to wear lead aprons as the aprons prevent the unnecessary radiation exposure.

After the Test:

• The patient is asked to change into normal clothes and is allowed to go home and resume to daily routine activities.
• After the chest X-ray is taken and images are captured on the X-ray film, the technician puts the X-ray film into a developing machine and the images are developed and made ready for interpretation.
• The report of the chest X-ray can be made available in a few hours.
• The chest X-ray film and report prepared by the radiologist, is handed over to the doctor and the doctor examines the film and report carefully.
• This procedure helps the doctor to locate and examine the affected areas in the patient’s body easily.
• The doctor discusses the results with the patient in detail and advise medications or treatment for the detected problem, if needed.
• If the doctor feels that the results are unclear, then some other tests may be advised to the patient like CT-Scan and MRI.

The results will be discussed by the doctor in detail with the patient. If the report of the chest X-ray is normal, it means that the person is fit and healthy and there is no abnormality detected. If the reports are abnormal, it means that the patient is going through some abnormalities or disease conditions as mentioned below.

In the lungs:

• Lung cancer (Benign or Malignant)
• Collapsed Lungs
• Lung abscess
• Abnormality in blood vessels
• Scarring lung tissues
• Pneumonia
• Tuberculosis
• Fluid collection around lungs or in the lungs (Pulmonary edema)

In the heart:

• Enlarged heart (Cardiomegaly)
• Aortic aneurysm (Dilated Aorta)
• Calcium deposits (Calcifications in arteries)
• Diagnosing signs of heart failure

In the bones:

• Fractures in the chest and vertebral bones.
• Shoulder joint dislocations
• A chest wall deformity known as pigeon chest (projection of breastbones)

Q1. What abnormalities can be detected through a chest X-ray report?

A1. Chest X-ray helps in detecting multiple conditions including

• Asthma
• Bronchitis
• Excessive fluid in lungs or Pulmonary edema
• Fluid around the lungs or Pleural effusion
• Pneumonia
• Heart enlargement
• Fluid around the heart (known as pericardial effusion)
• Abnormality in the heart structure
• Heart failure
• Cysts
• Cancer
• Chest fractures (rib cage fractures or any other surrounding bone fractures)
• Spinal bone abnormality
• Spinal or vertebral fractures

Q2. What are the shadows seen on an X-ray film?

A2. The shadows usually form an image of the person’s body structures. The white areas (shadows) represent the hard, solid, bony structures and the black areas represent the soft structures. This usually depends on the density of various structures in the body. Such differences in the shades of the areas help to form an exact and clear image of a person’s distinctive body anatomy.

Q3. Is it safe to get a chest X-ray done during the lactation or breastfeeding period?

A3. The X-ray is completely safe during the breastfeeding period, as it does not have any adverse effects on the mother's milk or the baby. Although mammograms are difficult to study during the lactation period of a woman but the breastfeeding can be continued without any problem.

Q4. What are the things that are not seen in a chest X-ray?

A4. X-rays can show various fractures and bone abnormalities in varying sensitivity but, in some cases, it might not be of much help in soft tissue injuries as mentioned below

• Ligament Tear
• Muscle injury
• Tendon injury
• Rotator cuff tear in the shoulder
• Bone bruises or tiny fractures

In such cases, the doctor advises going for CT-Scan or MRI, which give enhanced and more magnified images of the soft tissues than X-ray.