Manuscript for Chest Xray

Definition

• Chest x-ray uses a very small dose of ionizing radiation to produce pictures of the inside
of the chest. It is used to evaluate the lungs, heart and chest wall and may be used to help
diagnose shortness of breath, persistent cough, fever, chest pain or injury.

• It also may be used to help diagnose and monitor treatment for a variety of lung
conditions such as pneumonia, emphysema and cancer. Because chest x-ray is fast and
easy, it is particularly useful in emergency diagnosis and treatment.

History

Working with a cathode-ray tube in his laboratory, Roentgen observed a fluorescent glow

of crystals on a table near his tube. The tube that Roentgenwas working with consisted of a glass
envelope (bulb) with positive and negative electrodes encapsulated in it. The air in the tube was
evacuated, and when a high voltage was applied, the tube produced
a fluorescent glow. Roentgen shielded the tube with heavy black paper, and discovered a green
colored fluorescent light generated by a material located a few feet away from the tube.

He concluded that a new type of ray was being emitted from the tube. This ray was capable of
passing through the heavy paper covering and exciting the phosphorescent materials in the
room.He found that the new ray could pass through most substances casting shadows of solid
objects. Roentgen also discovered that the ray could pass through the tissue of humans, but not
bones and metal objects. One of Roentgen's first experiments late in 1895 was a film of the hand
of his wife, Bertha. It is interesting that the first use of X-rayswere for an industrial (not medical)
application, as Roentgen produced a radiographof a set of weights in a box to show his
colleagues.

Relative Densities

- In this image seen on chest radiograph results from differences in densities of the
materials in the body

- The hierarchy of relative densities form least dense (Black) to the most dense
( White)
- -Gas (Air in the lungs)
- -Fat (Fat layer in soft tissue)
- -Water (same density as the heart and blood vessel
- -Bone (The most dense of the tissues)
- -Metal (foreign body)
 Chest X-ray (Chest radiography, CXR) is one of the most frequently performed radiological
examinations. A chest x-ray is a painless, non-invasive test that uses electromagnetic waves to
produce visual images of the heart, lungs, bones, and blood vessels of the chest. Air spaces
normally seen in the lungs appear dark on the chest films. A basic chest x-ray includes a
posteroanterior (PA) view, in which x-rays pass from the back to the front of the body and a left
lateral view. Other projections such as lateral decubitus, lordotic views, or oblique views can
also be requested. For critically ill patients who cannot leave the nursing unit, a portable x-ray
machine is performed at the bedside using anteroposterior (AP) projections with an addition of a
lateral decubitus view if a free flow fluid or air is suspected.

Chest images should be examined in full inspiration and erect if feasible to reduce cardiac
magnification and demonstrate fluid levels. Expiration images may be needed to identify
a pneumothorax or locate foreign materials. Rib detail images may be taken to delineate bone
pathology, helpful when chest radiographs illustrate metastatic lesions or fractures. In the onset
of the disease process of asthma, tuberculosis, and chronic obstructive pulmonary disease, chest
x-ray results may not correlate with the patient’s clinical status and may even be normal.

Nurses are responsible for ensuring the patient’s comfort while at the x-ray room since some
may experience pain from injury or symptoms from a disease condition, as well as the
apprehension about what the result may show. In addition, producing a good quality image relies
on the ability of the patient to cooperate, such as holding breath for a while. Providing a calm
and relaxed environment for the patient is indeed vital.

This diagnostic and laboratory procedure study guide can help nurses understand their tasks
and responsibilities during a chest x-ray.

 
 Indications of Chest X-ray
 Contraindication
 Interfering Factors
 Procedure
 Nursing Responsibilities for Chest X-ray
o Before Chest X-ray
o After Chest X-ray
 Normal Results
 Abnormal Results
 Gallery
 References and Sources

Indications of Chest X-ray

Here are some of the reasons why a Chest x-ray is performed:

 Assist in the diagnosis of diaphragmatic hernia, lung tumors, and metastasis

 Detect known or suspected pulmonary, cardiovascular, and skeletal disorders
  Identify the presence of chest trauma
 Confirm correct placement and position of the endotracheal tube, tracheostomy tube,
chest tubes, central venous catheters, nasogastric feeding tube, pacemaker wires,
intraortic balloon pump, Swan-Ganz catheters, and automatic implantable cardioverter
defibrillator
 Evaluate positive purified protein derivative (PPD) or Mantoux test for pulmonary
tuberculosis.
 Monitor progressions, resolutions, or maintenance of disease
 Evaluate the patient’s response to a therapeutic regimen (antibiotic, chemotherapy)
Contraindication

Chest X-ray is not advisable for:

 Patients who are pregnant or suspected of being pregnant unless the potential benefits of
a procedure using radiation outweigh the risk of maternal and fetal damage
Interfering Factors

These are factors or conditions that may alter the outcome of Chest X-ray:


Procedure

The procedure for chest x-rays is as follows:

ADVERTISEMENTS
1. Items are removed
Patients will be asked to remove any clothing, jewelry, or other articles that may interfere
with the study.
2. Appropriate clothing is given
Patients will be provided by an X-ray gown to wear.
3. Positioning the patient
The patient in a standing or sitting position will face the cassette or image detector with
hands on hips, inhale deeply, hold one’s breath until the X-ray image is made. For a
lateral view, the chest is position on the left side against the image holder with hands
raised above the head.
4. Images are taken
The x-ray technician will stand behind a protective shield while the films are being
developed within a few minutes.
Nursing Responsibilities for Chest X-ray

The following are the nursing interventions and nursing care considerations for the patient

Before Chest X-ray

The following are the nursing interventions before chest x-ray:

 Remove all metallic objects. Items such as jewelry, pins, buttons etc can hinder the
visualization of the chest.
 No preparation is required. Fasting or medication restriction is not needed unless
directed by the health care provider.
 Ensure the patient is not pregnant or suspected to be pregnant. X-rays are usually not
recommended for pregnant women unless the benefit outweighs the risk of damage to the
mother and fetus.
 Assess the patient’s ability to hold his or her breath. Holding one’s breath after
inhaling enables the lungs and heart to be seen more clearly in the x-ray.
 Provide appropriate clothing. Patients are instructed to remove clothing from the waist
up and put on an X-ray gown to wear during the procedure.
 Instruct patient to cooperate during the procedure. The patient is asked to remain still
because any movement will affect the clarity of the image.
After Chest X-ray

The nurse should note the following nursing interventions after chest x-ray:

 No special care. Note that no special care is required following the procedure

 Provide comfort. If the test is facilitated at the bedside, reposition the patient properly.
Normal Results

Normal findings in a chest x-ray will show a:

 Normal lung fields, cardiac size, mediastinal structures, thoracic spine, ribs,
and diaphragm
Abnormal Results

The following abnormalities can be seen on a chest x-ray test. These includes:

 Atelectasis (collapse or incomplete expansion of pulmonary parenchyma)

 Bronchitis (inflammation of the bronchial tube)
 Cardiomegaly (enlargement of the heart)
 Flattened diaphragm associated with hyperinflation of the lung (indicator for COPD)
 Foreign bodies lodged in the pulmonary system as seen by a radiopaque object
 Irregular patchy infiltrates in the lung fields (suggestive of pneumonia)
 Lung tumors (irregular and abnormal white shadow on the lung fields)
 Malposition of tubes or wires
 Misalignment or break of bones (indicating fracture)
 Pericardial effusion (fluid accumulation around the heart)
 Pericarditis (inflammation of the pericardium)
 Pleural effusion (fluid accumulation within the pleural space)
 Pneumothorax (presence of air within the pleural space)
 Pulmonary bases, infiltrates, fibrosis,
 Scoliosis (curvature of the spinal column)
 Swollen lymph nodes
 Tuberculosis (patchy, nodular infiltrates usually located on the upper lobe lung fields;
cavities in the lung)
 Widened mediastinum (suggesting neoplasm or aortic aneurysm)