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Chest x ray results normal: Chest X-Ray Reasons for Procedure, Normal and Abnormal Results

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What to Expect, Diagnosis, Safety, Results

Overview

What is a chest X-ray?

A chest X-ray is a test that creates an image of your heart, lungs and bones. Another name for a chest X-ray is chest radiograph.

What are X-rays?

X-rays use focused beams of radiation. These radiation beams create pictures of the inside of your body. X-ray images look like the negative images of black-and-white photographs.

When should I get a chest X-ray?

Chest X-rays help healthcare providers diagnose problems that cause symptoms in your heart or lungs. Some of these symptoms include:

Your healthcare provider may also recommend a chest X-ray to diagnose or monitor certain health conditions, including:

Who performs a chest X-ray?

A radiology technologist performs chest X-rays. These technologists have specific training in X-ray testing.

Test Details

How does a chest X-ray work?

Your body’s tissues vary in thickness. When radiation passes through your body, each structure in your body allows a different amount of radiation to pass through.

For example, your bones are very thick and don’t allow much radiation to pass through. Bones look white on an X-ray image. Your lungs, however, allow more radiation through. Your lungs look gray on an X-ray image.

Healthcare providers look at the colors and shading on an X-ray to diagnose and treat health conditions.

How do I prepare for a chest X-ray?

Chest X-rays require little to no preparation. When you get ready for the appointment, wear loose, comfortable clothing that does not contain metal (zippers, snaps, bra closures) and leave jewelry at home.

If you have body piercings, ask your X-ray center for specific instructions. Body jewelry can interfere with clear images. You may need to remove it or replace it with an acrylic retainer.

What can I expect during a chest X-ray?

You may change into a medical gown at your doctor’s office. The X-ray technologist will also ask you to remove all metal, such as eyeglasses, jewelry or hairpins.

Typically, your chest X-ray consists of two parts:

  1. You stand with your chest against the metal plate of the X-ray machine and your hands on your hips. This position produces an image of the front of your chest.
  2. You stand with your side against the metal plate of the X-ray machine and your arms in the air. This position creates an image of the side of your chest.

During the chest X-ray, you need to remain very still and hold your breath. Any movement, even breathing in and out, can blur the X-ray image.

Chest X-rays usually take a few minutes to complete.

What can I expect after a chest X-ray?

After the X-ray, your radiation technologist may ask you to wait a few minutes while they look at the images. If any of the images are blurry, the technologist may have to retake the X-rays.

The X-ray images are sent to a radiologist who reviews them for normal and abnormal findings. Your healthcare provider will then review the images and radiologist’s report so they can discuss your X-ray results with you.

What are the risks of a chest X-ray?

X-rays use a very small amount of radiation. The risks are minimal for adults. Lower radiation X-rays can be used in smaller children to minimize the risk in that population.

Is a chest X-ray safe if I am pregnant?

Always tell your healthcare provider if there is a possibility that you are pregnant. Radiation exposure can cause damage to a developing baby. In general, the amount of radiation used for simple chest x-rays is so small that it’s considered safe during pregnancy, but your healthcare provider will help make the decision to do the x-ray based on the urgency of your symptoms.

Results and Follow-Up

When should I know the results of my chest X-ray?

In non-emergency cases, you will usually know your X-ray results within one to two days. In an emergency, you will usually know your results in a few minutes or hours.

When should I call my healthcare provider?

Call your healthcare provider if you experience:

  • Chest injury, such as a suspected broken rib.
  • Chest pain that doesn’t go away.
  • Chronic coughing.
  • Difficulty breathing.

A note from Cleveland Clinic

A chest X-ray is a test that looks at your heart, lungs and bones. Chest X-rays use a small dose of radiation to create a black-and-white image. Healthcare providers can look at this image to diagnose and treat broken bones, heart conditions and lung problems. Chest X-rays are quick, noninvasive procedures done in a healthcare provider’s office or the hospital. In non-emergency situations, you will know your chest X-ray results in one to two days.

Chest X-Ray | HealthLink BC

Test Overview

A chest X-ray is a picture of the chest that shows your heart, lungs, airway, blood vessels, and lymph nodes. A chest X-ray also shows the bones of your spine and chest, including your breastbone, your ribs, your collarbone, and the upper part of your spine. A chest X-ray is the most common imaging test or X-ray used to find problems inside the chest.

A chest X-ray can help find some problems with the organs and structures inside the chest. Usually two pictures are taken, one from the back of the chest and another from the side. In an emergency when only one X-ray picture is taken, a front view is usually done. Doctors may not always get the information they need from a chest X-ray to find the cause of a problem. If the results from a chest X-ray are not normal or do not give enough information about the chest problem, more specific X-rays or other tests may be done, such as a computed tomography (CT) scan, an ultrasound, an echocardiogram, or an MRI scan.

Why It Is Done

A chest X-ray is done to:

  • Help find the cause of common symptoms such as a cough, shortness of breath, or chest pain.
  • Find lung conditions—such as pneumonia, lung cancer, chronic obstructive pulmonary disease (COPD), collapsed lung (pneumothorax), or cystic fibrosis—and monitor treatment for these conditions.
  • Find some heart problems, such as an enlarged heart, heart failure, and problems causing fluid in the lungs (pulmonary edema), and to monitor treatment for these conditions.
  • Look for problems from a chest injury, such as rib fractures or lung damage.
  • Find foreign objects, such as coins or other small pieces of metal, in the tube to the stomach (esophagus), the airway, or the lungs. A chest X-ray may not be able to see food, nuts, or wood fibres.
  • See if a tube, catheter, or other medical device has been placed in the proper position in an airway, the heart, blood vessels of the chest, or the stomach.

How To Prepare

Tell your doctor if you are or might be pregnant. A chest X-ray usually is not done during pregnancy because the radiation could harm the unborn baby (fetus). But the chance of harm to the fetus is very small. If you need a chest X-ray, you will wear a lead apron to help protect your baby.

Talk to your doctor about any concerns you have regarding the need for the test, its risks, how it will be done, or what the results mean. To help you understand the importance of this test, fill out the medical test information form .

How It Is Done

A chest X-ray is taken by a radiology technologist. The pictures are usually read by a radiologist, who writes the report. Other types of doctors, such as a family doctor, internist, or surgeon, also may review chest X-rays.

You will need to take off jewellery that might be in the way of the X-ray picture. You may need to take off all or most of your clothes above the waist (you may be allowed to keep on your underwear if it does not get in the way of the test). You will be given a gown to wear during the test.

Two X-ray views of the chest are usually taken. One view is taken from the back; the other view is taken from the side of the body. But other views may be needed, depending on what your doctor is looking for. In an emergency, only one picture may be taken, usually from the front.

You usually stand with your front against an X-ray plate for the pictures. If you need to sit or lie down, someone will help you get into the correct position.

You will need to hold very still during the X-ray to prevent blurring of the picture. You may be asked to hold your breath for a few seconds while the X-ray picture is taken.

Most hospitals and some clinics have portable X-ray machines. If a chest X-ray is done with a portable X-ray machine at your bedside in a hospital, an X-ray technologist and nurse will help you move into the correct position. Usually only one picture from the front is taken.

How It Feels

You will not feel pain during a chest X-ray. The X-ray plate may feel hard, and the room may be cool. If you have pain from your chest problem, you may feel some discomfort if you need to hold a certain position, breathe deep, or hold your breath while the X-ray is done.

Risks

There is always a slight chance of damage to cells or tissue from radiation, including the low levels of radiation used for this test. But the chance of damage from the X-rays is usually very low compared with the benefits of the test.

Results

A chest X-ray is a picture of the chest to see your heart, lungs, airway, blood vessels, and lymph nodes. A chest X-ray also shows the bones of your chest, including your breastbone, your ribs, your collarbone, and the upper part of your spine.

In an emergency, the results of a chest X-ray can be available within a few minutes for review by your doctor. If it is not an emergency, results are usually ready in 1 or 2 days.

Chest X-ray

Normal:

The lungs look normal in size and shape, and the lung tissue looks normal. No growths or other masses can be seen within the lungs. The pleural spaces (the spaces surrounding the lungs) also look normal.

The heart looks normal in size, shape, and the heart tissue looks normal. The blood vessels leading to and from the heart also are normal in size, shape, and appearance.

The bones including the spine and ribs look normal.

The diaphragm looks normal in shape and location.

No abnormal collection of fluid or air is seen, and no foreign objects are seen.

All tubes, catheters, or other medical devices are in their correct positions in the chest.

Abnormal:

An infection, such as pneumonia or tuberculosis, is present.

Problems such as a tumour, injury, or a condition such as edema from heart failure may be seen. In some cases, more X-rays or other tests may be needed to see the problem clearly.

A problem such as an enlarged heart—which could be caused by heart damage, heart valve disease, or fluid around the heart—is seen. Or a problem of the blood vessels, such as an enlarged aorta, an aneurysm, or hardening of the arteries ( atherosclerosis), is seen.

Fluid is seen in the lungs ( pulmonary edema) or around the lungs ( pleural effusion), or air is seen in the spaces around a lung ( pneumothorax).

Broken bones (fractures) are seen in the rib cage, collarbone, shoulder, or spine.

Enlarged lymph nodes are seen.

A foreign object is seen in the esophagus, breathing tubes, or lungs.

A tube, catheter, or other medical device looks like it has moved out of the correct position.

What Affects the Test

Reasons why the test results may not be helpful include:

  • Not being able to stay still and hold your breath when asked during the test.
  • Metal objects (such as spinal fixation rods and metal jewellery or belts) that get in the way of the X-ray picture.
  • Obesity, which can hide chest problems or make it hard to get a good X-ray picture.
  • Chest pain that can make it hard for you to take a deep breath during the X-ray.
  • Scarring from past lung surgery or changes from a chronic disease, which may make the X-ray pictures hard to read.

A picture taken with a portable machine may not be as clear as those made by a stationary machine.

Credits

Current as of:
September 23, 2020

Author: Healthwise Staff
Medical Review:
Adam Husney MD – Family Medicine
Martin J. Gabica MD – Family Medicine
Howard Schaff MD – Diagnostic Radiology

Current as of: September 23, 2020

Abnormal chest x-ray: what is it, symptoms and treatment

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Chest x-ray findings and temporal lung changes in patients with COVID-19 pneumonia | BMC Pulmonary Medicine

Patients’ characteristics

A total of 88 patients (50 (56.8%) females and 38 (43.2%) males) were admitted to the hospital with confirmed COVID-19 during the study period. The average (±SD) age was 35.2 ± 18.2 years (range 3–80 years). Forty-eight patients (54.5%) were symptomatic and 40 patients (45.5%) were asymptomatic. Cough and fever were the most frequent symptoms (33 and 17%, respectively). The most common co-morbidities among the patients were hypertension (15.9%) and diabetes (10.2%). The majority of the patients (96.6%) had a history of contact with infected individuals and 5.7% had history of travel overseas. The mean time from initial positive RT-PCR to negative RT-PCR was 13 ± 3 days (range 7–19 days). Table 1 shows patients’ demographic characteristics, clinical presentation, co-morbidities, and clinical outcomes.

Table 1 Patients’ demographics, characteristics, clinical presentation, co-morbidities, and clinical outcome (n = 88)

Chest x-ray features

A total of 190 chest x-rays were performed for the 88 patients; 88 chest x-rays as baseline, and 102 chest x-rays as follow up. Of the 88 patients, 13 (14.8%) demonstrated abnormalities on chest x-rays at some time point during their illness (ten patients at baseline and three developed abnormalities during the follow-up) with a total of 59/190 (31%) abnormal chest x-rays. Seventy-five (85%) patients had no chest x-ray abnormalities although they tested positive for COVID-19 by RT-PCR.

The mean time from initial positive chest x-ray to negative chest x-ray was 10.9 ± 3.6 days (range 6–14 days). Almost half (38/75, 50.7%) of the patients with normal chest x-ray were symptomatic and the majority (12/13, 92.3%) of patients with abnormal chest x-rays were symptomatic, there was a significant association between the chest x-ray findings and the symptoms (P = 0.005). Only one patient with positive chest x-ray findings remained asymptomatic throughout the course of the illness.

During the study period, three patients (23%) progressed rapidly over an average period of 4 days with increase in the total chest x-ray severity score on average from 1 to 7. Only one elderly female patient (80 years) passed away at day 18 of onset of symptoms (Fig. 1). Nine patients (69%) showed improvement in the chest x-ray findings with almost complete resolution of the abnormalities (Fig. 2). The chest x-ray findings in one patient remained stable.

Fig. 1

Series chest x-rays in an 80-year-old woman with COVID-19 pneumonia. a Chest x-ray obtained on illness day 5 showed peripheral GGO in the LLZ (score 1). b Chest x-ray obtained on illness day 7 showed increase extent of the GGO diffusely involving the left lung (score 4). c Chest x-ray obtained on illness day 11 showed increase extent of the GGO involving the right lung, with increase extent of consolidation involving the left lung diffusely (Total score 8). d Chest x-ray obtained on illness day 14 showed development of reticulations in both lungs with increase extent of involvement of the RUZ. (Total score 8). e Chest x-ray obtained on illness day 17 showed extensive bilateral consolidations mainly peripherally with increased reticulations (Total score 8). f Chest x-ray obtained on illness day 18 showed extensive consolidation involving both lungs diffusely (Total score 8). The patient died on illness day 18. (GGO: ground glass opacity. LLZ: left lower zone. RUZ: right upper zone)

Fig. 2

Series chest x-rays in a 49-year-old woman with COVID-19 pneumonia. a Chest x-ray obtained on illness day 1 showed bilateral central and peripheral (diffuse) GGO bilaterally (Total score 7, right 4 Vs left 3). b Chest x-ray obtained on illness day 5 showed peaking of the findings with diffuse patchy and nodular consolidations bilaterally (Total score 8). c Chest x-ray obtained on illness day 8 showed decrease in the degree of lung involvement with reduction in the overall severity score, however, there was development of reticulations in the upper zones (Total score 5 right 3 Vs left 2). d Chest x-ray obtained on illness day 15 showed the absorption phase with regression of the consolidations into peripheral GGO seen in the lower zones bilaterally with a total score of 2

Baseline chest x-rays were done on average at day three from symptom onset. Only ten patients (11.3%) had abnormalities on their baseline chest x-ray, GGO was the only radiographic lung abnormality detected on the chest x-rays in all ten patients. Peripheral location of the opacities and right lower zone distribution were the most common locations (9/10 (90%) and 7/10(70%), respectively). Pleural effusion was found in the chest x-ray of one patient only (Table 2). Nine out of 10 (90%) patients had mild radiographic findings with total severity score of 1–2. Only one patient had a total severity score of seven (score in the right lung was 4 in the left lung was 3).

Table 2 Radiographic findings and distribution on baseline chest x-ray in 10 patients

On serial follow up chest x-rays; GGO remained the most common lung abnormality pattern. At 0–5 days from onset of symptoms, the frequency of the GGO was 55% and consolidation was 20%.The rest of the chest x-rays (25%) were normal. At 6–11 days the percentage of x-rays with GGO and the consolidations increased to 70 and 30% respectively, with decrease in the number of normal chest x-rays (2/23 (9%)). One patient developed pleural effusion.

At 12–17 days, the consolidations regressed and the GGO increased (10 and 80%, respectively) with a mixed pattern of nodular consolidations and GGO in 17%. Reticulations developed within this phase comprising 8% of the abnormalities. The frequency of normal chest x-rays was zero in this group.

After 18 days, the lung abnormalities regressed (50% GGO and 17% consolidation), with increase in the frequency of normal chest x-rays (33%) indicating a healing phase. Figure 3 shows the distribution of lung abnormalities at different time intervals from onset of symptoms.

Fig. 3

Temporal change of chest x-ray findings. Stacked-bar graph showed the distribution of the lung abnormalities on chest x-ray at various time points from symptom onset. GGO was the most frequent abnormality on initial x-rays, consolidation increased in frequency till the second week then regressed into GGO which again was more frequent on subsequent chest x-rays. Mixed pattern of GGO and nodular consolidation and reticulations were noted in the second week. Normal chest x-rays increased in frequency with time as patients showed clinical improvement. GGO = ground glass opacity

The spatial distribution of the radiographic lung changes increased throughout the course of the disease. Earlier in the disease (days 0–5) bilateral involvement was seen in 30%, exclusive unilateral involvement was observed in 5/20 (25%) on the right, and 4/20 on the left (20%).The lower zones were more frequently involved (55% right, 40% left). The lung abnormalities were seen predominantly in the periphery of the lungs.

At days 11–6 from onset of symptoms, the percentage of involvement of the lower zones increased and remained the most common (65% right lower zone, 52% left lower zone). The lung abnormalities extended from the periphery to the central giving a diffuse pattern in 25%. Exclusive involvement of the right lung was noted in the majority of the x-rays (40%). Bilateral involvement was noted in 35% of the x-rays.

At days 12–17 from onset of symptoms; involvement of the left lower zone predominated (80%). Bilateral involvement was most common at this stage (80%).

After 18 days from the onset of symptoms; the right upper and right middle zones were the last to recover (66 and 50% respectively). The frequency of involvement of the other lobes decreased with fewer findings seen centrally and complete resolution of the left lung.

The left middle and left upper zones were the least to be involved throughout the course of the illness. Exclusive involvement of the central parts of the lungs was not observed in any of the chest x-rays. The rate of normal chest x-rays decreased from 25% at 0–5 days to none at 12–17 days, then increased to 33% as patients showed recovery. The specific frequencies of the spatial distribution of the lung changes are summarized in Fig. 4.

Fig. 4

The spatial distribution of the lung changes at various time intervals from symptom onset. a Zonal distribution. The right lower zone remained the most frequently involved over time, the left upper and left middle zones were the least to be involved. b Horizontal distribution. The lung changes were more frequently seen in a peripheral distribution. Isolated central involvement of the lung changes was not observed in any of the chest x-rays. c Distribution according to side. Bilateral distribution of the lung changes was more common than unilateral involvement

The highest severity score recorded was eight (of maximum possible score of eight). Peak severity score was reached at day 5–10 from symptom onset, known as the peak phase at which the median chest x-ray severity score was three. Nine out of 13 patients (69%) showed complete or near complete resolution of the chest x-ray findings which was reached at day 10–15 from symptom onset known as the absorption phase (Fig. 5).

Fig. 5

Temporal change of severity score. Scatter graph showed the maximum total severity score at the peak phase reaching at days 5–10 from onset of symptoms, with an average of severity score 3, (n = 13). The total severity score decreased over time as the chest x-ray findings regressed at days 10–15 from onset of symptoms (n = 9)

How to Read a Chest X-ray – A Step By Step Approach

Author(s): Dr Stephan Voigt, Consultant Radiologist

This article is an attempt
to give the reader guidance how to read a chest Xray and below are two methods. There is no perfect way
to read an x-ray. However, the important message I would like to give is, to
adopt one or the other approach, and to use the chosen approach consistently.

On all Xrays check the following:

  • Check patient details
    • First name, surname, date of birth.

 

  • Check orientation, position and side description
    • Left, right, erect, ap, pa, supine, prone

 

  • Check additional information
    •  inspiration,
      expiration

 

  • Check for rotation
    • measure the distance from the medial end of each clavicle to
      the spinous process of the vertebra at the same level, which should be equal

 

  • Check adequacy of inspiration
    • Nine pairs of ribs should be seen posteriorly in order to
      consider a chest x-ray adequate in terms of inspiration

 

  • Check penetration
    • one should barely see the thoracic vertebrae behind the heart

 

  • Check exposure
    • One needs to be able to identify both costophrenic angles and
      lung apices

 

Specific Radiological Check List:

 

A – Airway

 

  • Ensure trachea is visible and in midline
    • Trachea gets pushed away from abnormality, eg pleural
      effusion or tension pneumothorax
    • Trachea gets pulled towards abnormality, eg atelectasis
    • Trachea normally narrows at the vocal cords
    • View the carina, angle should be between 60 –100 degrees
    • Beware of things that may increase this angle, eg left atrial
      enlargement, lymph node enlargement and left upper lobe atelectasis
    • Follow out both main stem bronchi
    • Check for tubes, pacemaker, wires, lines foreign bodies etc
    • If an endotracheal tube is in place, check the positioning,
      the distal tip of the tube should be 3-4cm above the carina

 

 

  • Check for a widened mediastinum
    • Mass lesions (eg tumour, lymph nodes)
    • Inflammation (eg mediastinitis, granulomatous inflammation)
    • Trauma and dissection (eg haematoma, aneurysm of the major
      mediastinal vessels)

 

 

B – Bones

 

  • Check for fractures, dislocation, subluxation, osteoblastic
    or osteolytic lesions in clavicles, ribs, thoracic

 

  • Spine and humerus including osteoarthritic changes

 

  • At this time also check the soft tissues for subcutaneous
    air, foreign bodies and surgical clips

 

  • Caution with nipple shadows, which may mimic intrapulmonary
    nodules

    • compare side to side, if on both sides the “nodules” in
      question are in the same position, then they are likely to be due to nipple
      shadows

 

 

C – Cardiac

 

  • Check heart size and heart borders
    • Appropriate or blunted
    • Thin rim of air around the heart, think of pneumomediastinum

 

  • Check aorta
    • Widening, tortuosity, calcification

 

 

  • Check heart valves
    • Calcification, valve replacements

 

  • Check SVC, IVC, azygos vein

 

 

D – Diaphragm

 

  • Right hemidiaphragm
    • Should be higher than the left
    • If much higher, think of effusion, lobar collapse,
      diaphragmatic paralysis
    • If you cannot see parts of the diaphragm, consider infiltrate
      or effusion

 

 

  • If film is taken in erect or upright position you may see
    free air under the diaphragm if intra-abdominal perforation is present

 

 

E – Effusion

 

  • Effusions
    • Look for blunting of the costophrenic angle
    • Identify the major fissures, if you can see them more obvious
      than usual, then this could mean that fluid is tracking along the fissure

 

  • Check out the pleura
    • Thickening, loculations, calcifications and pneumothorax

 

 

F – Fields (Lungfields)

 

  • Check for infiltrates
    • Identify the location of infiltrates by use of known
      radiological phenomena, eg loss of heart borders or of the contour of the
      diaphragm
    • Remember that right middle lobe abuts the heart, but the
      right lower lobe does not
    • The lingula abuts the left side of the heart

 

 

  • Identify the pattern of infiltration
    • Interstitial pattern (reticular) versus alveolar (patchy or
      nodular) pattern
    • Lobar collapse
    • Look for air bronchograms, tram tracking, nodules, Kerley B
      lines
    • Pay attention to the apices

 

 

  • Check for granulomas, tumour and pneumothorax

 

 

G – Gastric Air Bubble

 

 

 

 

  • Look for bowel loops between diaphragm and liver

 

 

H – Hilum

 

  • Check the position and size bilaterally

 

 

 

 

  • Pulmonary arteries, if greater than 1. 5cm think about
    possible causes of enlargement

 

Extended Radiological Check List – Lateral Film:

 

A – Airway

 

  • Ensure trachea is visible and in midline
    • Trachea gets pushed away from abnormality, eg pleural
      effusion or tension pneumothorax
    • Trachea gets pulled towards abnormality, eg atelectasis
    • Trachea normally narrows at the vocal cords
    • View the carina, angle should be between 60 –100 degrees
    • Beware of things that may increase this angle, eg left atrial
      enlargement, lymph node enlargement and left upper lobe atelectasis
    • Follow out both main stem bronchi
    • Check for tubes, pacemaker, wires, lines foreign bodies etc
    • If an endotracheal tube is in place, check the positioning,
      the distal tip of the tube should be 3-4cm above the carina

 

 

  • Check for a widened mediastinum
    • Mass lesions (eg tumour, lymph nodes)
    • Inflammation (eg mediastinitis, granulomatous inflammation)
    • Trauma and dissection (eg haematoma, aneurysm of the major
      mediastinal vessels)

 

 

B – Bones

 

  • Check the vertebral bodies and the sternum for fractures or
    other osteolytic changes

 

 

C – Cardiac

 

  • Check for enlargement of the right ventricle and right atrium
    (retrosternal and retrocardiac spaces)

 

 

 

 

D – Diaphragm

 

  • Check for fluid tracking up, costophrenic blunting and the
    associated hemidiaphragm

 

 

E – Effusions

 

  • Check to see the fissures here as well – both major fissures
    and the horizontal may be found in the lateral view

 

F – Fields

 

  • Check the translucency of the thoracic vertebrae in the
    lateral view, when there is a sudden change in transparency, then this is
    likely to be caused by infiltrate

 

 

  • Also try to find the infiltrate that you think you saw on the
    pa-film to verify existence and anatomical location

 

 

  • Pay special attention to the lower lung lobes

 

I would like to close with a
clarification of two important radiological findings, whose understanding is
very useful for a correct interpretation of chest x-ray findings.

 

The first is the silhouette sign, which can localise
abnormalities on a pa-film without need for a lateral view. The loss of clarity
of a structure, such as the hemidiaphragm or heart border, suggests that there
is adjacent soft tissue shadowing, such as consolidated lung, even when the
abnormality itself is not clearly visualised. The reason is, that borders,
outlines and edges seen on plain radiographs depend on the presence of two
adjacent areas of different density, Roughly speaking, only four different
densities are detectable on plain films; air, fat, soft tissue and calcium
(five if you include contrast such as barium). If two soft tissue densities lie
adjacent, then they will not be visible separately (eg the left and right
ventricles). If, however, they are separated by air, the boundaries of both
will be seen.  

 

The second important x-ray
finding is the lung collapse. A
collapse usually occurs due to proximal occlusion of a bronchus, causing
subsequently a loss of aeration. The remaining air is gradually absorbed, and
the lung loses volume. Proximal stenosing bronchogenic carcinoma, mucous
plugging, fluid retention in major airways, inhaled foreign body or malposition
of an endotracheal tube are the most common reasons for a lung collapse.
Tracheal displacement or mediastinal shift towards the side of the collapse is
often seen. Further findings are elevation of the hemidiaphragm, reduced vessel
count on the side of the collapse or herniation of the opposite lung across the
midline.

 

 

Figure
1: Left mid mediastinal / paraaortic tumour and left upper lobe satellite
lesion


 

Figure
2: Left basal pleural effusion and consolidation


 

 Figure
3: Left upper lobe tumour

 

 

Figure
4: Right pleural metastases and pleural effusion due to carcinoma of the ovary


 

 

Figure
5: Pleural calcifications and adhesions due to asbestos exposure

 

 

Figure
6: Pulmonary fibrosis and superimposed infection

 

 

Figure
7: Right middle lobe pneumonia

 

X-ray Atlas: Chest X-ray | GLOWM

X-ray Atlas: Chest X-ray

NORMAL CHEST X-RAY


The Chest X-ray is probably one of the most commonly seen plain films, and is one of the most difficult to master.   There are many ways to evaluate the chest. A systematic approach is usually the best. One method is described here.






Normal Posterior to Anterior (PA) Chest X-ray. Normally a PA and Lateral View are obtained. By convention on the PA View, the x-rays enter the patient posteriorly and exit anteriorly  (with the patients chest on the film cassette), therefore minimizing the cardiac magnification. On the lateral view, the patients left side is against the film, therefore the right side would be magnified.






Normal Lateral Chest X-ray



HOW TO READ THE CHEST X-RAY


  • Get a mental image of the patient:
    • Demographics
    • Gender
    • Size
    • Shape
    • Position of patient
    • Approximate age
    • Lines & tubes (position, course, complications)
    • Foreign bodies.
  • Evaluate soft tissues systematically: Don’t  forget:
    • Neck

    • Shoulders
    • Diaphragm (the right diaphragm usually is 2-3 cm higher than the left)
    • Abdomen
    • Breast tissue

  • Evaluate
    the lungs   (Interstitium, airways and Pleura): 



    • Inflation
      status

    • Pleural
      margins

    • Abnormal
      densities/lucencies


    • Masses

    • Infiltrates


    • Calcifications

    • Fissure
      locations and thickness.   The RUL Bronchus is always higher than the LUL bronchus.  
  • Change
    your attention to the blood vessels:  


    • The
      size, location and distribution (the left pulmonary artery usually is
      higher the left). 


    • Don’t
      forget to check the lateral as this is the best way to look at the
      posterior costophrenic recess, anterior/posterior mediastinum, and help
      you localize lesions suspected on the frontal view.


  • Note
    the “Special Interest” and often missed areas twice:  



    • Apices
      (esp. RUL- where  most
      cancer lives)

    • Peripheral
      lung margins

    • Hilar,



      retrocardiac, cardiophrenic and costophrenic angles.


  • Focus
    attention now to the Mediastinum: 

    Evaluate Size, shape, position in both views PA/LAT. 
    Attention to the mediastinal lines


    • Check both PA/LAT views.  Size,
      shape, and silhouette. Look for any chamber enlargement. 
      Evaluate course of Aorta and position of arch, Pulmonary
      Arteries.

    • of SVC (frontal View).

    • Paratracheal Stripe (normal is <5mm, usually 2-3mm), which terminates
      at the azygous vein (this portion should be 1.0cm or less). Never
      extends below the right bronchus.

    • Left
      Subclavian Stripe: Normally 1.0-1.5 cm. 

    • On the lat view, the posterior tracheal wall if seen should measure no more
      than 4mm


    • Paraesophageal
      line: seen only on the PA view. (interface between right lower lobe and
      mediastinal edge along the esophagus/azygous vein — also called the
      azygoesophageal line.) It should be straight, bulging could indicate a
      node or mass (90% of all localized paraspinal masses are neurogenic
      tumors (particularly neruofibromas and ganglioneuromas.)

    • Aorticopulmonary 
      window:  Seen on
      frontal view formed by overlap of the Aortic arch and left pulmonary
      artery.  Space should be
      clear as the left upper lobe fills in this area. It should also be
      concave, any bulge could signify nodes or mediastinal mass.


  • Bones:  


    • Chest wall

    • Bony thorax
      including spine.  

    • Look for abnormal
      joints, bony lytic/blastic or soft tissue lesions, 
      and free air, etc

Several signs help evaluate processes:


  • Silhouette sign: 

    Silhouette sign is extremely
    useful in localizing lung lesions.
    (e.g. loss of right heart border in RML pneumonia)
  • Air Bronchogram:
    As the bronchial tree branches, the cartilaginous rings become thinner and
    eventually disappear in respiratory bronchioles. The lumen of bronchus
    contains air as well as the surrounding alveoli. Thus usually there is no
    contrast to visualize bronchi.

    If you see branching
    radiolucent columns of air
    corresponding to bronchi
    , this usually means air-space (alveolar) disease.  Usually one of these: blood, pus, mucous, cells, protein.
  • Extra pleural sign: 

    Signifies Chest Wall disease.  Peripheral
    location with concave edges.

  • Anatomic landmarks

    • Anterior & Posterior
      junction lines:  respectively,
      the anterior and posterior conjunction of the right and left visceral
      and parietal pleural layers at the midline of the thorax.   
    • 2mm linear line projecting
      over the trachea. Note the posterior junction line extends above the
      clavicles

Back to Top


PNEUMONIA

Pneumonia (consolidation)

Infection of the air spaces (air
bronchograms) and/or interstitium of the lung.


Finding:   

  • Depending upon the amount and
    distribution of the airspaces involved, this may present as confluent

    parenchymal (lobar or segmental) opacity or merely patchy opacity. 
  • If the Interstitium is
    predominantly involved, it may appear as a reticulonodular pattern. 
  • Air bronchograms would confirm an
    alveolar process.  
  • The lung volume should not be
    lost (may even be increased).  

  • Usually all radiographic
    abnormalities should disappear after 6 weeks of appropriate antibiotic
    therapy.   However, pneumonia may
    be complicated by abscess or empyema formation.

Examples of Pneumonias and how to
determine location. (look for the silhouette sign…loss of usual visualized
borders.)


CONSOLIDATION






Right Middle Lobe Consolidation






Right Middle Lobe Pneumonia






Right Lower Lobe Pneumonia






Right Lower Lobe Pneumonia, Anterior Segment






Right Lower Lobe Pneumonia, Superior Segment






Right Upper Lobe Pneumonia




Left Lingular Pneumonia









Left Lower Lobe Pneumonia, Anterior Segment








Left Lower Lobe Pneumonia, Posterior Segment


Back to Top


ROUND PNEUMONIA




Chest X-Ray | Johns Hopkins Medicine

What is a chest X-ray?

A chest X-ray is an imaging test that uses X-rays to look at the structures
and organs in your chest. It can help your healthcare provider see how well
your lungs and heart are working. Certain heart problems can cause changes
in your lungs. Certain diseases can cause changes in the structure of the
heart or lungs.

Chest X-rays can show your healthcare provider the size, shape, and
location of the following:

It uses a small amount of radiation to make pictures of these areas.

Why might I need a chest X-ray?

Your healthcare provider may order a chest X-ray to see how well your heart
or lungs are working. You may need a chest X-ray if it is suspected that
you have any of the following:

  • Enlarged heart which can mean you have a congenital heart defect or
    cardiomyopathy

  • Fluid in the space between your lungs and your chest wall (pleural
    effusion)

  • Pneumonia or another lung problem

  • Ballooning of the aorta or another great blood vessel (aneurysm)

  • Broken bone

  • Hardening of a heart valve or aorta (calcification)

  • Tumors or cancer

  • Diaphragm that has moved out of place (hernia)

  • Inflammation of the lining of the lung (pleuritis)

  • Fluid in the lungs (pulmonary edema) which can mean you have
    congestive heart failure

You may also need a chest X-ray:

  • As part of a complete physical exam or before you have surgery

  • To check on symptoms related to the heart or lungs

  • To see how well treatment if working or how a disease is
    progressing

  • To check on your lungs and chest cavity after surgery

  • To see where implanted pacemaker wires and other internal devices
    are located

These other devices include central venous catheters, endotracheal tubes,
chest tubes, and nasogastric tubes.

Your healthcare provider may have other reasons to recommend a chest X-ray.

What are the risks of a chest X-ray?

You may want to ask your healthcare provider about the amount of radiation
used during the test. Also ask about the risks as they apply to you.

Consider writing down all X-rays you get, including past scans and X-rays
for other health reasons. Show this list to your healthcare provider. The
risks of radiation exposure may be tied to the number of X-rays you have
and the X-ray treatments you have over time.

Tell your healthcare provider if you are pregnant or think you may be
pregnant. Radiation exposure during pregnancy may lead to birth defects.

You may have other risks depending on your specific health condition. Talk
with your healthcare provider about any concerns you have before the
procedure.

How do I get ready for a chest X-ray?

  • Your healthcare provider will explain the procedure to you. Ask any
    questions you have about the procedure.

  • You may be asked to sign a consent form that gives permission to do
    the procedure. Read the form carefully and ask questions if
    anything is not clear.

  • You usually do not need to stop eating or drinking before the test.
    You also usually will not need medicine to help you relax
    (sedation).

  • Tell your healthcare provider if you are pregnant or think you may
    be pregnant.

  • Wear clothing that you can easily take off. Or wear clothing that
    lets the radiologist reach your chest.

  • Tell your healthcare provider if you have any body piercings on
    your chest.

  • Follow any other instructions your healthcare provider gives you to
    get ready.

What happens during a chest X-ray?

You may have a chest X-ray as an outpatient or as part of your stay in a
hospital. The way the test is done may vary depending on your condition and
your healthcare provider’s practices.

Generally, a chest X-ray follows this process:

  1. You will be asked to remove any clothing, jewelry, or other objects
    that may get in the way of the test.

  2. You will be given a gown to wear.

  3. You may be asked to lie down, sit, or stand. Your position depends
    on what images the technologist needs.

  4. For a standing or sitting image, you will stand or sit in front of
    the X-ray plate. You will be asked to roll your shoulders forward,
    take in a deep breath, and hold it until the X-ray is made. If you
    are unable to hold your breath, the technologist will take the
    picture by watching how you breathe.

  5. You will need to stay still during the X-ray. Moving during the
    X-ray may affect the quality of the image.

  6. For a side-angle view of the chest, you will be asked to turn to
    your side and raise your arms above your head. You will be told to
    take in a deep breath and hold it as the X-ray is made.

  7. The technologist will step behind a special window while the images
    are being made.

The chest X-ray is not painful. But you may have some discomfort or pain
from moving into different positions if you have had recent surgery or an
injury. The technologist will use all possible comfort measures and do the
scan as quickly as possible to minimize any discomfort or pain.

What happens after a chest X-ray?

You do not need any special care after a chest X-ray. Your healthcare
provider may give you other instructions, depending on your situation.

90,000 X-rays or fluorography of the lungs? – article in the blog Medskan

The question in 2018 is almost no longer relevant, but it is often asked anyway.

Let’s figure it out.

1) In the X-ray of the lungs, X-ray film was previously used as an information carrier. The image on it turned out to be large (1: 1) and high quality. But the film contained silver, so it was expensive and was not suitable for mass examinations (prophylactic medical examination).Therefore, they came up with a “stick”

2) During fluorography, the patient stood not in front of a cassette with a film, but in front of a fluorescent screen. On this screen, at the moment of taking a picture, the image of the chest “flashed”, which was photographed on a special film. The result was essentially an analog photo from the screen (aka “screen”). Then the radiologist looked through these images under a magnifying glass and concluded: the patient is healthy or needs additional examination (for example, a normal X-ray image or a lateral projection needs to be completed).

The flash drive turned out to be much cheaper than X-ray, because only inexpensive photographic film was needed from a consumable. However, the quality of the image, of course, was the same as that of the screen – it was enough to sort the healthy from the sick, but as a rule, the picture was not suitable for anything larger. At the same time, the radiation exposure during fluorography was not less than with X-ray.

What do we have in the XXI century?

Analog films have been replaced by digital X-ray detectors, and the X-ray consumable has completely disappeared.At the same time, the need to separate fluorography and radiography has disappeared – now it has all become a digital X-ray examination of the chest.

In essence, a “digital fluorograph” is a simplified X-ray apparatus, adapted only for examinations of the lungs; it is either impossible or extremely inconvenient to examine the ankle or hip joints on it.

Therefore, if you suddenly need fluorography for some reason, do not look for it all over the city, but find the nearest digital X-ray and take it.

And by the way, chest x-ray is only effective for screening for tuberculosis, not lung cancer. Low-dose CT of the lung is used to screen for lung cancer in high-risk patients.

Don’t get sick!

In medicine, the maximum permissible dose of radiation is 1 mSv / year for a healthy person during preventive examinations. Physicians should strive for a minimum level of radiation exposure without compromising the quality of diagnostics.According to statistics in Russia, the average radiation dose during examinations is several times less than the indicators in America and France.

Fluorography provides much less information than radiography. The disadvantage is also the higher radiation exposure of the patient during the diagnosis. That is why WHO does not recommend the use of film fluorography, even in countries with undeveloped medicine. The solution to the problem is the transition to digital fluorography. The procedure reduces radiation exposure by several times.

Prophylactic examination of the lungs is carried out 1 (one) time per year. The procedure is contraindicated for children under the age of 14 and pregnant women.

Sources:

  1. https://cyberleninka.ru/article/n/rentgen-velikiy-i-uzhasnyy/viewer
  2. https://www.dissercat.com/content/vozmozhnosti-ispolzovaniya-tsifrovoi-flyuorograficheskoi-kamery-dlya-provedeniya-proverochny

Chest X-ray for a child – DocDoc.ru

X-ray is one of the most accurate and
informative ways that allow the doctor to consider the state of internal
organs and in time to detect pathologies and changes that can lead to
the development of serious diseases.X-ray examination is also
irreplaceable for various bruises, injuries and fractures, when the usual visual
inspection cannot give an idea of ​​the nature and extent of the damage.

The essence of such a diagnostic method is irradiation
a person with special ionizing waves that pass through all
internal organs, lingering on dense tissues and displayed in the picture in
in the form of a contrasting picture. Despite the fact that the X-rays are short, they have
strong enough energy, penetrating the human body, they pass
through almost all internal organs, in connection with which many people ask
the question of how much harm X-rays cause to a person.Especially this question
worries mothers with small children.

Can I do
child chest x-ray

Anyone knows that fluorography for prophylaxis
appointed at the age of at least 18 years due to the fact that a young fragile
the body is very susceptible to the dose of radiation received, and about the X-ray
examination and say nothing. Passing through the developing tissues of the child,
radiation can affect their development, change their structure and slow down processes
division.All this can lead to the development of mutational processes or
formations of a different nature.

But there are situations
when, without conducting such an examination, the correct diagnosis cannot be made
seems possible.

Chest fluoroscopy for children is done, if any
suspicion of anomalies
heart, lungs, blood vessels, or bones. In this
situation, there is no alternative method for making an accurate diagnosis, and
the benefits of the survey far outweigh the potential harm.

Many parents unknowingly claim that
the consequences of fluoroscopy may be radiation sickness, but
this is not true. The radiation dose is not as large as to cause such
manifestations, however, people prone to such a disease should be
careful.

When directing a child for a chest x-ray, the doctor should
calculate an acceptable dose of radiation and weigh the potential harm from such
survey.

How is it done
X-ray to newborn

Unfortunately, and
newborn babies often have to take x-rays, while the doctor’s arguments
must be iron and well-reasoned.

Under no circumstances
X-ray the baby’s lungs for prophylactic purposes.

When heading to the X-ray room, do not forget to take with you
a diaper and a child’s favorite toy. For too active children in the office
special braces are provided to help immobilize the child and
conduct a quality examination.

The dose of radiation during an X-ray to a newborn should
be minimal, so the risk of negative consequences is minimized.

What are the symptoms
can be the basis for referral for fluoroscopic examination

The X-ray itself has absolutely no age
restrictions, however, it is necessary to agree to such a diagnosis only if
if it is not possible to make a diagnosis in another way.Mandatory indications for chest X-ray, regardless of
age, serve:

  • heart defects, suspected tachycardia;
  • 90,088 scoliosis;

  • congenital or acquired immunodeficiency;
  • bronchial asthma with frequent attacks;
  • cystic fibrosis;
  • signs of vegetative-vascular dystonia;
  • pneumonia and other respiratory diseases.

Mandatory X-ray is prescribed when
suspicion of developmental disorders of the gastrointestinal tract.In that
case, the method of artificial contrasting is used, which consists in
the introduction through the mouth of a special liquid, which is distributed over
stomach and
the intestine allows you to clearly determine the shape and relief of organs, their structure and
possible pathologies. Iodolipol is used as a contrast agent
or gastrografin, barium sulfate is prescribed for older children.

How to conduct
fluoroscopic examination for a child

No special preparation for x-rays is required, but there are
General principles that parents should be aware of:

  • X-rays of the lungs are performed when undressing the child
    waist-high;
  • all hairpins, jewelry, buttons should be removed
    and other metal objects to make the picture clear;
  • according to the age of the child examination
    can be performed in a standing, sitting or lying position;
  • older children, the doctor asks to detain for some
    breathing time, for small patients the specialist must guess the best
    time for a snapshot.

Without fail, the rest of the child’s body must
protect yourself with a special apron. To give courage and confidence, little patients on
the survey may be attended by parents.

Measures
safety to take when giving an X-ray to a child

Modern X-ray machines with little or no harm
the health of the child is not applied, therefore, before the fluoroscopy, parents
you should ask how long the device has been installed and by what method it
is functioning.

It is imperative to ensure that the lead apron covers
organs of the abdominal cavity and small pelvis. It is better to x-ray a child in good
proven clinics where really professionals with extensive experience work
work with children.

Subject to all precautions, the benefits of such
diagnostics will significantly exceed the possible harm, and therefore be afraid
negative consequences are not worth it.

If you are worried about a health problem, sign up for a diagnosis. The success of treatment depends on the correct diagnosis.

This article is posted for educational purposes only, does not replace a doctor’s appointment and cannot be used for self-diagnosis.

10 August 2016

90,000 X-ray diagnostics: discovering the “secrets” of our body

09.03.2016

The head of the X-ray diagnostic department of the REAVIZ multidisciplinary clinic, candidate of medical sciences Anton Osadchiy

Hello, my name is Tatyana Mikhailovna.What is more precise – CT or MRI? How often can a CT scan be done?
– Computed tomography (CT) and magnetic resonance imaging (MRI) are based on different principles of action. CT uses X-ray radiation, with the help of CT, you can clarify the physical and biological indicators of organs and tissues. MRI shows the chemical and biological structure of the organs. The application of these techniques depends on the pathology. CT is a priority for diseases of the chest (including the respiratory system), osteoarticular system, diseases of the endocrine system, diseases associated with the brain (including strokes), cardiovascular system, abdominal and pelvic organs.MRI is most effective for diagnosing inflammatory processes of the brain (encephalitis, meningitis, etc.), with pathologies of the spinal cord, joints (orthopedics), mammary glands, bile ducts, and oncology. As for the frequency of research, if there is evidence, CT can be done no more than once every six months.

Hello, my name is Julia. The doctor told my father that he needed to have a CT scan before removing kidney stones. What is it and why is it needed? Do you need any preparation for this procedure?
– The doctor is right: computed tomography – is widely used in urology to determine the diameter, location of kidney stones before the operation to remove them, and also shows if there are any violations of the outflow of urine. It is a painless procedure that takes 5-10 minutes. Within an hour after that, the doctor will describe and give you the results. CT does not require special preparation, there are no contraindications.

I am periodically disturbed by wheezing in the lungs, but the fluorography is clear. Does it make sense for me to do an X-ray or CT scan?
– Fluorography is a screening method that allows you to identify the main abnormalities. Therefore, if the results are clear, then there are most likely no serious pathologies. But for detailing the state of the lungs, computed tomography will be effective: it will allow visualizing smaller details or foci of infection that are not visible on fluorography.

Hello, this is Tamara Sergeevna. My son underwent a CT scan and received a radiation dose of 28-30 mSv. How dangerous is this radiation and what are its consequences?
– 28 mSv is a completely non-critical dose of radiation, which is excreted on its own without consequences for the body in a couple of months. The maximum permissible dose for a person is more than 90 mSv in six months – then there really is a danger of developing radiation sickness. By the way, the more slices are performed during the study on a computed tomography, the less this load.The REAVIZ multidisciplinary clinic uses a modern 64-slice computed tomograph Seimens Sensation 64.

Good afternoon, my name is Tatiana. I did an ultrasound of the vessels of the brain, which revealed that my blood flow was reduced, possibly due to osteochondrosis. Now the optometrist says that a decrease in vision is also possible because of this. Should you get a CT scan? What can this study find out?
– Tomography allows you to clearly visualize the vessels and diagnose the causes of blood flow disorders, which were identified by ultrasound.On CT, all narrowings, thrombosis, atherosclerotic plaques, pathological bends from osteochondrosis and other pathological changes are clearly visible. Ultrasound and CT are two complementary diagnostic methods, the results of which allow the doctor to get an accurate picture and choose the right treatment.

Good afternoon, this is Anastasia. Mom has a pacemaker, and we were told that MRI cannot be done. Is CT scan possible?
– If a pacemaker is installed, MRI is really contraindicated, since magnetic radiation can cause malfunctions in its operation and even lead to the death of the patient.With CT, X-ray radiation does not affect the operation of the pacemaker in any way.

Good afternoon, Olga Ivanovna worries. Tell me, can an x-ray show a pinched sciatic nerve, or is it necessary to do an MRI?
– In your case, there is no MRI to do. Computed tomography (CT) is also effective in diagnosing a pinched radicular nerve. You can pass the examination at the REAVIZ multidisciplinary clinic. If necessary, immediately after the examination, it will be possible to invite a neurologist for a consultation.

Hello, my name is Lyudmila. I was prescribed an MRI of the brain and was told that contrast would need to be injected. Is it obligatory? After all, this is an additional load on the body….
– MRI is first performed without contrast, but if the doctor is in doubt, contrast may be needed. The substance that is used for this is harmless, and is excreted from the body in just a few minutes.

– Z Hello, my name is Vladimir.I had a CT scan of the abdomen with the introduction of contrast three times, I received a dose of about 26 mSv. Is it harmful?
– Triple CT is a standard, you should not be intimidated. A radiation load of 26 mSv is absolutely not dangerous for the body. And the contrast is removed from the body within an hour.

Hello, my name is Irina Vladimirovna. Can you please tell me how to check the performance of the vessels? What type of diagnostics should you choose?
– If you have no complaints about your well-being, then, most likely, the vessels are working normally.If you are worried about arrhythmia or dizziness, then it is worth doing an ECG, then an ultrasound scan with a Doppler study to diagnose the state of blood flow. After that, you will need to do CT angiography, which will allow you to assess the structure and location of the vessels, if available, see atherosclerotic plaques, stenoses, pathological tortuosity and other abnormalities.

Hello, my name is Elena, my pregnancy is 16 weeks, my spine is bothering me. Can I have a CT scan at this time?
– You cannot do CT during pregnancy.You are better off getting an MRI, but only after consulting your gynecologist.

Good afternoon, this is Lyubov Viktorovna. How is MRI different from CT? What examination is better for spine problems?
– Computed tomography (CT) and magnetic resonance imaging (MRI) are based on different principles of action. CT uses X-ray radiation, with the help of CT, you can clarify the physical and biological indicators of organs and tissues. MRI shows the chemical and biological structure of the organs.The application of these techniques depends on the pathology. For the diagnosis of pathologies of the spine, hernias, protrusions, pinching, etc. CT is also used.

Hello, my name is Svetlana. I am worried about frequent headaches, a neurologist recommended an MRI scan. But it is very expensive … Can you replace it with CT?
– Yes, you can have a CT scan instead of an MRI, this is no less informative research than an MRI. A computed tomography scan of the brain will help identify problems that can cause dizziness and headaches, and will allow the neurologist to choose a treatment strategy.

90,000 Computed tomography: why not all COVID-19 patients need it and how it can harm | Hromadske TV

1

What is CT and why you shouldn’t do it often?

Computed tomography is an X-ray scan method that can be used to check a person’s organs. CT scan helps to detect bleeding, tumors or, for example, blood clots in time.

However, during this procedure, a person receives radiation – approximately 4-7 mSv (sievert is a unit of measurement of the dose of ionizing radiation).For comparison, during a conventional chest X-ray, a patient receives approximately 0.02 mSv.

Such doses are not considered high, but a person may have several CT procedures during a lifetime, which may increase the risk of cancer.

2

Why do people with COVID-19 get computed tomography?

It allows you to establish how much the lungs of the patient are affected. However, the National Health Service of Ukraine (NHSU) notes that patients with coronavirus or suspected coronavirus do not always need an X-ray examination.Everything is decided by the doctor, based on the clinical condition of a particular person.

3

When does a coronavirus patient really need to have a CT scan?

Physician-therapist Ivan Kondratenko says: CT scan should be done only when the doctor assumes that the patient’s lungs are severely damaged.

“It may also be necessary when the PCR test is negative but the patient has severe symptoms of the virus, such as having difficulty breathing.In this case, CT will confirm that there is an infection in the body ”, explains Kondratenko.

If a person easily tolerates the disease and has no indications for hospitalization, computed tomography is not justified. If the result of the examination will affect further treatment, then the doctor may prescribe a CT scan.

Also, the appointment of a CT scan may be justified if:

• the doctor must obtain additional information in order to determine whether it is necessary to hospitalize a patient who is seriously ill;

• the patient is at risk: obesity, diabetes mellitus, cardiovascular diseases;

• it is necessary to monitor the patient’s condition if the person is already in the hospital and doctors need to find out if the patient is being helped by the treatment.

4

How to get a CT scan free of charge

If a doctor has written an electronic referral for an X-ray or CT scan, the patient can undergo such a diagnosis free of charge. But only in those institutions that have an agreement with the National Health Service of Ukraine for medical services in an outpatient package.

In addition to the contract with the NSZU, the institution, of course, must have the necessary equipment – an X-ray machine or a tomograph.

5

If CT shows pneumonia, are antibiotics necessary to treat it?

This is for the doctor to decide.According to Ivan Kondratenko, bacterial pneumonia is treated with antibiotics, but not always bacterial pneumonia is added to viral pneumonia.

“The coronavirus will pass, but then we will get antibiotic resistance . It will be a disaster, because a vaccine against coronavirus was almost developed in a year, and it will take years to make a new antibiotic. If we get a bacterium that is not sensitive to antibiotics, we will not be able to save people, ” says the doctor.

6

What can replace computed tomography?

An alternative to CT can be ultrasound (ultrasound diagnostics) of the lungs. However, now in Ukraine, only a small number of doctors do it.

“Doctors have just started to master it. Although I am sure that it is possible to understand whether a person needs hospitalization or how much his lungs are affected without CT or ultrasound. The very saturation (saturation of the blood with oxygen, – ed.) Of the patient already speaks volumes “, – notes Kondratenko.

Artificial intelligence found anomalies in medical images

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Scientists from Skoltech, a research arm of Philips and Goethe University of Frankfurt have trained a neural network to find abnormalities in medical images to simplify and speed up the diagnosis of pathologies.The new method described in the IEEE Access journal is adapted to work with medical data and finds abnormalities in images better than similar solutions of a wide profile.

Finding anomalies in images is a common task in data analysis. Although it is relevant in various fields, medical images are of particular difficulty. It is much easier for algorithms to find, for example, a photo of a car with a flat tire or broken glass among other images of cars than to notice the first signs of such a pathology as, for example, pneumonia due to covid on a chest x-ray.

“Medical imaging is difficult for several reasons at once,” explains the head of the study, Professor Skoltech Dmitry Dylov , who heads the computational visualization group at the institute. – Firstly, abnormal cases here are very similar to the norm. Cells are cells, and it usually takes a specially trained expert to notice that something is wrong. ”

“In addition, there is always a lack of examples of medical anomalies for training neural networks,” he adds.- And the machine does the best with the so-called binary classification, when there are two distinct classes, each of which is well represented by examples for teaching. Cats and dogs, roughly speaking. But in the case of medical images, the norm obviously dominates and only occasionally there are separate anomalies, and they are not necessarily similar to each other and therefore do not form a clear class. ”

Dylov’s group tested their method on chest x-rays and histological tissue images for the diagnosis of breast cancer, demonstrating its accuracy and applicability to various diagnostic data.The neural network consistently outperformed existing analogs, although the magnitude of the advantage and absolute accuracy fluctuated markedly depending on the sample of images. According to the authors of the study, this is possible due to the fact that their AI solution is characterized by a “perception” of a general impression, similar to that of a specialist working with images: the system seeks to highlight the very signs that a physician would be guided by in making a decision.

The study also proposes a framework for standardizing an approach to the problem of detecting anomalies in medical images, which will help different research teams achieve greater uniformity and reproducibility of results for comparing their models.

IT systems of the Pension Fund of Russia and Moscow courts help to arrange payments for children

IT in the public sector

“We propose to use the so-called training with partial involvement of a teacher,” says Dylov. Since there are no two explicit classes, the problem is usually solved with unsupervised models or with non-distribution patterns. In other words, abnormal cases are not flagged as such in the training data. But presenting a class of anomalies in a clinical task as a complete unknown is too pessimistic a scenario, because doctors can always show several examples.Therefore, we have shown such examples of the network in order to use an arsenal of methods with partial involvement of a teacher. The results turned out to be very good, and there is even benefit from one anomalous image in 200 normal ones, which is quite realistic. ”

According to scientists, the approach they used – deep autoencoders of perception – can be easily extended to medical images of various types, since the solution is adapted to the nature of such images in general: it is sensitive to small-scale anomalies and is designed for their small number in the training set.

“We hope that our new method will significantly speed up the work of histopathologists, radiologists and other specialists who review a large number of images in search of various kinds of abnormalities. After conducting a preliminary analysis, the machine can weed out cases where there are clearly no problems, and leave the specialist more time to work with more complex cases, ”- noted the co-author of the study, director of the Moscow office of Philips Research Irina Fedulov a .

90,000 CT or X-ray of the lungs: which is better?

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CT or X-ray of the lungs: which is better?

For pneumonia, tuberculosis, and even as part of preventive screening, patients are prescribed CT or X-ray of the lungs.

What is the difference between these survey methods? When is it better to do a CT scan of the lungs, and when is an X-ray? Let’s take a closer look at this article.

What is the difference between CT and lung X-rays?

Computed tomography is a modern method of radiation diagnostics of various diseases, which is based on radiography. … The method was developed and proposed by scientists, Nobel Prize winners G. Hounsfield and A. Cormack in 1972. Classical radiography was invented in 1896, most often it was used in dentistry and for examining the lungs, since at the turn of the 19th and 20th centuries.deaths from pneumonia, tuberculosis and asthma were extremely high.

The key difference between digital X-ray and computed tomography of the lungs is the trajectory of the X-rays and the imaging technique. In a conventional X-ray, X-rays pass through the area of ​​the body to be examined only once perpendicularly, so the X-ray is a two-dimensional, single-layer image. X-ray of the lungs is the most affordable study, which is often prescribed first of all if the patient has signs of pneumonia, tuberculosis, obstructive pulmonary disease, tumors.The problem with this type of diagnosis is that, for example, in case of pneumonia, X-rays can reliably determine only lung damage of III and IV degrees, and shadows from large organs can obscure other tissues.

CT scans are distinguished by higher image clarity and informational content. In the course of computed tomography, the X-ray tube, together with the sensitive sensors, makes several turns along a spiral trajectory, scanning the area of ​​interest. The CT machine makes many scans up to 1 mm thick, on the basis of which a three-dimensional model of the lungs, blood vessels, organs and bones of the chest in high resolution is recreated.Thus, after computer processing of images, tissues and organs can be examined in three projections, the effect of overlaying shadows from organs in the case of computed tomography is absent.

High clarity of the image in computed tomography is associated with the diagnostic technique and the physical properties of radiation. X-ray has a 20% attenuation factor, while tomography has a 0.5% factor, and therefore a higher resolution.

Both radiography and computed tomography can be done with contrast.X-rays or CT of the lungs with contrast will help visualize blood vessels and tumors. However, the primary differentiation of neoplasms into benign and oncogenic is possible only within the framework of CT, which is also associated with the quality of images.

Since a chest X-ray is essentially 1 picture, and many tomograms are taken, the radiation on a CT scan of the lungs is higher due to multiple exposures. On average, a patient receives 0.1 mSv of radiation in one lung X-ray procedure, while a CT scan of the lungs receives 2.5 mSv.However, this dose of ionizing radiation is safe for the patient. It is permissible to do CT scans of 5 zones per year. When referring to one or another X-ray examination method, doctors are always guided by the criterion of the appropriateness and safety of the patient.

At the specialized CT center “Ami” the procedure is performed on a new generation Siemens Somatom go.Now apparatus with reduced radiation exposure.

Which is better: CT or X-ray of the lungs?

CT scan of the lungs and X-ray are prescribed for pneumonia, tuberculosis, bronchial asthma.Both studies show the condition of the lungs, bronchi, trachea, mediastinum. Both CT and X-rays reveal tumors, foreign objects in the lung cavity and respiratory tract. Like computed tomography, x-rays show fluid accumulation in the alveoli or fibrosis (lung damage from pneumonia), the presence of emphysema (chronic smoker’s bronchitis), pulmonary edema and sarcoidosis (granulomas and nodular neoplasms of the lungs).

However, most doctors are inclined to believe that if it is possible to do CT of the lungs instead of X-rays, then it is better to examine the chest organs in this way.Firstly, the doctor will definitely not miss the disease or tumor in the initial stage. Secondly, after CT of the lungs, there is no need for an additional clarifying examination (except for laboratory diagnostics, since infectious, viral and bacterial agents-pathogens are determined using the analysis of biological material). Thirdly, small calcifications, destruction and tumors are visible only on CT scans.

Lung cancer continues to threaten the lives and health of millions of people, according to reports from the World Health Organization.Therefore, patients over 40 years old, especially those at risk, are recommended annual preventive screening. Fluorography and X-rays are considered traditional prophylaxis, but low-dose computed tomography of the lungs is best suited for this purpose.

Advantages of lung X-rays

  • Low cost of examination.
  • Irradiation about 0.1 mSv.
  • Many medical institutions are equipped with X-ray machines.

Disadvantages of X-ray of the lungs

  • Low information content.
  • Low specificity.
  • 2D images, suspicious areas may be obscured by organ shadows.
  • Does not show pneumonia, tumors and other lung pathologies in the early stages. Also, CT is more informative for examining the lymph nodes.
  • It is impossible to give a primary assessment of neoplasms, to differentiate them into benign and oncogenic.
  • There is a possibility of getting an incomplete picture.

Advantages of CT of the lungs

  • Three-dimensional (spatial) image of the lungs, comprehensive informational content.
  • Shows diseases and pathologies of the lungs in the early stages.
  • Early diagnosis of lung cancer.
  • The doctor can initially differentiate neoplasms.
  • It is prescribed for atypical course of diseases, as a clarifying method of examination after X-ray.

Disadvantages of CT of lungs

  • Higher price.
  • Higher dose of ionizing radiation.
  • Relatively low prevalence of medical centers equipped with tomographs.

Which is more informative: CT of the lungs or X-ray?

Computed tomography is the most modern and informative X-ray examination method. On scans, soft tissues, internal organs, bones and blood vessels are visualized in three projections. Two-dimensional radiography gives a more general idea of ​​the condition of the lungs, but sometimes this is enough for the subsequent successful treatment of the patient.

Isn’t it dangerous to have a CT scan of the lungs after an X-ray?

Ionizing (X-ray) radiation is not useful for humans, but in excess amounts causes radiation syndrome and can become a “trigger” for the development of cancer in patients predisposed to them. According to the current “Radiation Safety Standards”, up to 30-50 mVz of radiation is permissible per year, but one should not forget about the natural radiation background. CT of the lungs (about 2.5 mSv) after X-ray (about 0.1 mSv) is safe, and such a precise diagnosis can save the patient’s life.

However, in order to avoid additional radiation exposure, it is most advisable to immediately do a CT scan of the lungs without resorting to X-ray.

What is the best thing to do for pneumonia: CT or X-ray?

Only a doctor will be able to prescribe a CT scan or X-ray of the lungs for pneumonia after studying the symptoms, laboratory tests, and the individual clinical picture of the patient. The presence of fluid or pus in the alveoli, as well as fibrosis, is visualized on both x-ray and CT scans.However, conventional X-rays may not be sufficient in grade I-II pneumonia, while on CT it is seen more definitely as “frosted glass”. For SARS and coronavirus, CT of the lungs is recommended.

Can CT of the lungs be done instead of X-rays?

Yes, CT of the lungs can replace X-rays. However, the doctor who prescribes this or that study always takes into account the individual characteristics of the patient, for example, how many X-ray studies have already been carried out during the year, are there any contraindications to CT.Also, ionizing radiation is harmful to pregnant women and the fetus, therefore, in this case, with pneumonia, MRI of the lungs is preferable.

90,000 X-rays – an affordable diagnostic method – Articles

The need to take an X-ray may arise suddenly. In the trauma centers of the TERVE Medical Center, X-ray examinations are available daily and are performed not only in connection with injuries.

The X-ray image has long become synonymous with the generally accepted diagnostic method – accessible, informative, accurate, inexpensive.Many modern research methods have been created on the basis of X-ray radiation – computed tomography, angiography, densitometry, mammography, digital radiography. And even a new branch of medicine – X-ray diagnostic and treatment methods. What is the basis of all of the above?

A bit of history:

An article by Wilhelm Konrad Röntgen (this is how his surname is spelled correctly), in which he described the discovery of rays that would later be called by his name, was published in 1896.X-rays are capable of penetrating many opaque materials; however, it is not reflected or refracted. The transparency of substances in relation to the investigated rays depended not only on the thickness of the layer, but also on the composition of the substance. Although the eye does not respond to radiation, it illuminates photographic plates; he took the first pictures using X-rays. The discovery of the German scientist greatly influenced the development of science. After a short period of time, X-ray tubes found application in medicine and various fields of technology.For this discovery in 1901 he was awarded the Nobel Prize in Physics.

X-ray diagnostics is widely used in medicine. Let us recall some of the terms that you may have heard in medical institutions.

X-ray – an image of the internal structure of the object under study, created by X-rays, on film or paper.

Fluoroscopy – the image of the internal structure of the object under study, created by X-rays, is displayed on a luminous screen.

Digital X-ray graphy – recording of studies obtained using X-rays on a digital carrier, which makes remote X-ray diagnostics possible.

Computed tomography is a modern diagnostic method that allows you to obtain 3D images of organs and tissues.

Overview image – for example, a general view of the chest. Allows you to assess the condition of a significant part of the body as a whole.

Aiming image – a snapshot of a specific organ or its area.As a rule, special layouts are performed for an aiming shot to achieve maximum visualization.

An image with a radiopaque substance – for a more accurate diagnosis, a drug with radiopaque properties is injected into the organs or vessels. It is your responsibility to notify your doctor if you have previously noted an allergic reaction to iodine or barium.

What can a doctor see in the picture? With the help of X-rays, injuries are successfully diagnosed, the lungs are examined, various formations (stones, tumors), areas of obstruction can be identified.With a contrast study of blood vessels, the doctor sees aneurysms, areas of blood vessels affected by atherosclerosis, etc. Different tissues transmit X-rays in different ways: bone tissue almost completely absorbs them, soft tissues partially retain them, and air completely passes. Depending on this, shadows of varying intensity are obtained on the film: white areas in place of bones, gray areas in place of soft tissues, air layers on an X-ray image look black. X-rays are inherently negative, so the lighter areas on them are called “darkening”.For example, healthy lungs filled with air appear black on x-rays. The area of ​​pneumonia (pneumonia) is a lighter spot that doctors call a shadow (see photo).

With the help of X-rays, you can make an accurate diagnosis of various injuries. For example, a fracture is seen as a darker “fracture” in the light “field” of the bone. Inflammation is usually visualized as a lighter area. Intestinal obstruction can be judged by the presence of gas in the organ or by a change in the shape of the intestinal loops.The stones in the organs look like light formations with clear boundaries and contours. If an X-ray is performed with a contrast agent and the image shows uneven filling of the organ, then the doctor may assume the presence of a benign or malignant tumor. When examining vessels with a contrast agent, dilatations are clearly visible – in this place ruptures (aneurysms) are possible.

How is an X-ray taken? Before the procedure, the patient must take off his jewelry, belt, remove all metal objects, telephone, etc. from his pockets.e. In some cases, for example, when examining the chest or spine, the doctor may ask you to undress to the waist. Extremity X-rays can be done while wearing clothing. Those parts of the body that are not examined are covered with special protective lead-coated aprons. The doctor also puts on a protective suit and leaves to the next room. Pictures are taken in different positions – mostly lying or standing. Depending on the projection in which the image is needed, the doctor may ask you to change the position.