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Introduction ⬇

The chest x-ray is the most frequently requested x-ray. It is used to diagnose cancer, tuberculosis and other pulmonary diseases, and disorders of the mediastinum and bony thorax. The chest x-ray provides a record of the sequential progress or development of a disease. It can also provide valuable information about the condition of the heart, lungs, GI tract, and thyroid gland. A chest x-ray must be obtained after the insertion of a chest tube or subclavian IV catheter to determine anatomic position and detect possible pneumothorax related to the insertion procedure. A post bronchoscopy chest x-ray is done to ensure there is no pneumothorax following a biopsy.

Procedure ⬆ ⬇

  1. Routine chest radiography consists of two images: a frontal view (posterior to anterior) and a left lateral view. Upright chest x-rays (digital images) are preferred and are of utmost importance because images taken in the supine position do not demonstrate fluid levels. This observation is especially important when obtaining images for patients on bed rest.

  2. Ask the patient to remove street clothing that is covering the chest. Provide the patient with a cloth or paper hospital gown that is free of buttons and snaps to be worn during the x-ray. Have the patient remove jewelry on or adjacent to the chest.

  3. Ensure that monitoring cables and patches do not obscure the chest area, if possible.

  4. Instruct the patient to take a deep breath and to exhale and then to take another deep breath and to hold it while the x-ray image is taken. After the x-ray is completed, the patient may breathe normally.

  5. Tell the patient that the actual procedure takes only a few minutes.

  6. Follow guidelines in Chapter 1 for safe, effective, informed intratest care.

Clinical Implications ⬆ ⬇

  1. Abnormal chest x-ray results may indicate the following lung conditions:

    1. Presence of foreign bodies

    2. Aplasia

    3. Hypoplasia

    4. Cysts

    5. Lobar pneumonia

    6. Bronchopneumonia

    7. Aspiration pneumonia

    8. Viral pneumonia

    9. Lung abscess

    10. Middle lobe syndrome

    11. Pneumothorax

    12. Hemothorax

    13. Pulmonary edema

    14. Pleural effusion

    15. Atelectasis

    16. Pneumonitis

    17. Congenital pulmonary cysts

    18. Pulmonary tuberculosis

    19. Sarcoidosis

    20. Pneumoconiosis (e.g., asbestosis)

    21. Coccidioidomycosis

  2. Abnormal conditions of the bony thorax include the following:

    1. Scoliosis

    2. Hemivertebrae

    3. Kyphosis

    4. Trauma

    5. Bone destruction or degeneration

    6. Osteoarthritis

    7. Osteomyelitis

  3. Abnormal conditions of the heart include the following:

    1. Cardiac enlargement/heart failure

    2. Congenital heart disease

Interventions ⬆ ⬇

Pretest Patient Care

  1. Explain test purpose and procedure, benefits, and risks. Assure the patient that there will be no discomfort. Screen for pregnancy status of female patients prior to testing. If positive, advise the radiology department.

  2. Ask the patient to remove all clothing that covers the chest, as well as jewelry and other ornamentation in the chest area. Provide the patient with an appropriate chest covering.

  3. Remind the patient of the need to remain motionless and to follow all breathing instructions during the procedure.

  4. Follow guidelines in Chapter 1 for safe, effective, informed pretest care.

Clinical Alert

A portable x-ray machine may be brought to the nursing unit if the patient cannot be transported to the radiology department. The nurse may need to assist radiology personnel in positioning the patient and image receptor (IR). It is the technologist’s responsibility to clear all unnecessary personnel from the radiation field before radiation exposure

Posttest Patient Care

  1. Review test results; report and record findings. Modify the nursing care plan as needed. Monitor for pulmonary disease and chest disorders. Explain changes in therapy based on chest x-ray results (e.g., diuretic drugs for pulmonary edema, endotracheal tube repositioning, starting or stopping mechanical ventilation) per the healthcare provider’s orders.

  2. Follow guidelines in Chapter 1 for safe, effective, informed posttest care.

Interfering Factors ⬆ ⬇

An important consideration in interpreting chest x-rays is to ask whether the film was taken in full inspiration. Certain disease states do not allow the patient to inhale fully. The following conditions may alter the patient’s ability to breathe properly and should be considered when evaluating x-rays:

  1. Obesity

  2. Severe pain

  3. Heart failure

  4. Scarring of lung tissues

  5. COPD

Reference Values ⬆

Normal

Normal-appearing and normally positioned chest, bony thorax (all bones present, aligned, symmetrical, and normally shaped), soft tissues, mediastinum, lungs, pleura, heart, and aortic arch