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Chest X-ray Interpretation http://www.scribd.com/doc/11537684/Chest-Xray-Interpretation
ABSTRACT
Chest imaging is an important tool in manag- learning some basic skills in interpreting and
ing critically ill patients. Basic chest radiology evaluating chest radiographs, nurses can
is still used to quickly detect abnormalities in recognize and localize gross pathologic
the chest. Critical care nurses are often the changes visible on a chest radiograph. This
ones who first read the radiologist’s report of article provides basic chest radiograph inter-
chest radiograph results and provide their pretation information that allows readers to
interpretation to a physician. Oftentimes, review relevant anatomy and physiology,
chest radiographs are obtained routinely on summarize normal and abnormal findings
a daily basis for every critical care patient, on chest radiographs, and describe radi-
with the goal of effective clinical manage- ographic findings in common pulmonary
ment. Critical care nurses can confirm car- and cardiac disorders.
diopulmonary assessment findings by also Keywords: APN, chest imaging, chest radi-
evaluating their patient’s chest radiographs ograph, chest radiograph evaluation, chest
and reviewing the radiologist’s report. By radiograph interpretation, critical care nurses
hest imaging is an important tool in findings, and 20% have new major findings
C managing critically ill patients. Basic that are clinically unsuspected and are seen
chest radiology is still used to quickly detect only on the radiograph.4
abnormalities in the chest. Critical care nurses Other research supports discontinuing daily
are often the ones who first read the radiolo- routine chest radiographs for critically ill
gist’s report of chest radiograph results and patients because subtle changes may not be
provide their interpretation to a physician. clinically significant and because of the use of
Oftentimes, chest radiographs are obtained resources and cost.5–7 Some consensus exists
routinely on a daily basis for every critical for routine but not daily chest radiographs
care patient with the goal of effective clinical depending on the nature of the acute illness.8
management. Many of these studies1,3,9 suggest using clinical
Debate exists about the efficacy of daily or assessment to guide the need to obtain confir-
routine chest radiology for critically ill matory chest radiographs whether or not they
patients. It has been suggested that daily or are daily or routine.
routine serial chest radiographs are not needed. Critical care nurses can confirm cardiopul-
Some research supports obtaining daily routine monary assessment findings by also interpreting
chest radiographs for critically ill patients to be
able to identify even subtle changes.1–3 Mettler4
supports daily chest radiographs in critically ill
Debra Siela is Assistant Professor, Ball State University
patients. Mettler reports that in daily chest School of Nursing, and ICU Clinical Nurse Specialist, Ball
radiographs, 60% do not disclose either new Memorial Hospital, 2000 University Ave, Muncie, IN 47306
major or minor findings, 20% have new minor (dsiela@bsu.edu).
444
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Chest X-ray Interpretation http://www.scribd.com/doc/11537684/Chest-Xray-Interpretation
their patient’s chest radiographs and review- heart, blood vessels, muscle, and diaphragm;
ing the radiologist’s report. This process can and
aid in planning appropriate nursing care. This • bone (or metal), which appears all white or
article provides information on basic chest completely radiopaque; examples are bones,
radiology interpretation that will allow calcium deposits, prostheses, and contrast
the reader to review relevant anatomy and media.
physiology, summarize normal findings on Figure 1 provides a review all of the chest
chest radiographs, and describe radiographic tissues and structures basic radiodensities in a
findings in common pulmonary and cardiac chest radiograph, and Figure 2 identifies each
disorders. chest structure or tissue on a frontal chest radi-
ograph (note that all figures appear at the end
Basic Chest Radiography of the article).
X-rays are very short wavelengths of electro- If 2 structures of equal density are adjacent
magnetic radiation that penetrate matter.4,10–12 A to each other, the border of neither structure
traditional radiograph is created when x-rays can be detected. This phenomenon, the silhou-
penetrate a structure and produce images on a ette sign, is used to identify normal chest struc-
piece of photographic film usually contained in tures and diagnose and localize lung
a cassette. However, in most hospitals and med- diseases.4,10–13 The silhouette sign may be used
ical centers, the traditional x-ray film has been to distinguish anterior from posterior struc-
replaced with digital images. Special detectors tures on a chest radiograph.4,10–13 For example,
are used to replace the film in the cassettes and a silhouette sign would be expected in an area
convert the x-ray energy into digital signals to of consolidation in the left upper lobe of the
construct a digital radiograph. The digital lung because this lobe borders the left sides of
images are stored on and distributed on a pic- the atrium and the mediastinum. Because both
ture archiving and communications system the area of consolidation and the heart are
(PACS).4,10–13 A PACS allows viewing access far water densities, the left border of the atrium
from the radiology department at any computer cannot be distinguished from the border of the
workstation at any time. Digital radiographs left upper lobe of the lung (Figure 3).
can be manipulated to alter contrast and bright-
ness or magnify images to see any abnormality. Views of the Chest
Every sample radiograph included in this docu- Two of the most common radiographs are pos-
ment is from a digital format. teroanterior (PA) and anteroposterior (AP) or
Each radiograph has a continuum of shades frontal views of the chest.4,10–13 For PA views, the
from black to white in its images due to the x-ray beam passes through the chest from the
way the body structures or tissues absorb the back to the front. For AP views, the beam
x-ray beam.4,10–13 X-rays penetrate body tissues
passes through the chest from the front to the
back. For acutely ill patients who cannot stand
that have minimal tissue density, such as air or
up for a PA view, AP views are obtained with a
air-filled structures, and produce black or dark
portable x-ray machine. Ketai and coworkers13
areas on the radiograph; these areas are referred
to as radiolucent. Areas or body tissues that report that more than half of all chest radi-
cannot be penetrated by x-rays are radiopaque ographs in hospitals are performed at the
and appear light or white on the radiograph. bedside. Many of the sample radiographs in this
Thus, each body tissue or structure has article are AP views.
different radiodensity. The next most common view of the chest
The 4 basic roentgen densities or radioden- after the frontal view is the lateral view.9 Lateral
sities4,10–13 are views of the chest enable detection of lesions
behind the heart, near the mediastinum, or near
• gas (air), which appears black or radiolu- the diaphragm.10,12 The lateral view also allows
cent; examples are gas or air in trachea, for visualizing the tracheal air column, inferior
bronchi, or stomach; vena cava, retrosternal space, posterior margin
• fat, which appears gray or less radiolucent of the heart, and diaphragmatic contour.10,11 A
than air; an example is lipid tissue around patient’s frontal and lateral view radiographs
muscle; allow the viewer to have a vision of the chest in
• water (soft tissue), which appears white 3 dimensions so that the viewer can more easily
with slight radiopacity; examples are the localize infiltrates and lesions.
445
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SIELA A A C N A d v a n c e d Cr it i c a l C a r e
446
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