Chest X - Ray: Physiotherapy in Cardio-Respiratory Disorders & Intensive Care Management

CHEST X - RAY
Physiotherapy in Cardio-respiratory Disorders

& Intensive Care Management
By: Renjith Chandrasekharan Nair
Professor of Physiotherapy
School of Medical Education
([email protected])
Chest X-ray
A chest X-ray is a radiology test that involves exposing the
chest briefly to radiation to produce an image of the
chest and the internal organs of the chest.
An X-ray film is positioned against the body opposite the

camera, which sends out a very small dose of a radiation
beam. As the radiation penetrates the body, it is
absorbed in varying amounts by different body tissues
depending on the tissue's composition of air, water,
blood, bone, or muscle.
For example, Bone absorb much of the X-ray radiation
while lung tissue (which is filled with mostly air) absorbs
very little, allowing most of the X-ray beam to pass
through the lung.
Physicist by name Roentgen in 1901 was awarded a Nobel Prize for
his study on X ray.
Although it is important, the diagnostic imaging portion of the
examination is usually used only to confirm a clinical opinion. As
with special tests, diagnostic imaging should be viewed as one part
of the assessment, to be used when it will help confirm or establish
a diagnosis.
Advantage:
•The advantages of being readily available, being relatively cheap,
and providing good anatomic resolution.
Disadvantage:
•It does expose the patient to radiation, and it offers poor
differentiation of soft-tissue structures.
•X-rays have the potential for causing cell damage, there should be
a clear indication of need before a radiograph is taken
PA View
In this view, postero anterior refers to the direction of
the x-ray beam which traverses the patient from
posterior to anterior direction.
Patient should be upright and the film is taken in a full
inspiration
X-ray beam is horizontal
Advantages :-
o Increased sharpness and decreased
magnification of the images
o Erect patient inspire more deeply & hence shows
more lung
o Pleural air & fluid are easier to see on erect film.
Disadvantages :-
Cannot be used for all patients
AP View
Patients is supine or sitting on bed
Advantages :-
Usually made with portable x-ray unit on very sick
patients who are unable to stand and also in infants
Disadvantages :-
Portable x-ray units are mostly used for this purpose
which are less powerful & also space is limited in the
bedside and hence the AP views are usually taken at
shorter distances from the film·
Therefore, the AP radiograph has increased
magnification and decreased sharpness of the images
AP vs PA views
In PA view
 The clavicles won't project too high into the
apices or thrown above the apices.
 The heart won't be magnified over the
mediastinum.
 The ribs will not appear distorted or unnaturally
horizontal like in lordotic chests.
CHEST X RAY
 Basic Reading
 Check patient info
 View
 Exposure
 Inspiratory/ expiratory film
 Rotation
 Bony landmarks
 Soft tissue shadows
 Lungs
 Cardiac shadow
 Terminologies
 Radio opaque shadow
 Radio translucent shadow
 Opacity (Homogenous/Heterogenous)
 Pulmonary oligemia/ Plethora
1)Trachea, 2) Clavicle, 3) 4th posterior rib, 4) Right main
bronchus, 5) Right breast shadow, 6) Gastric air bubble, 7)Left hemi
diaphragm, 8) Left ventricle, 9) Descending aorta, 10) Left
pulmonary artery, 11) Left upper lobe, 12) Left atrium, 13) Right
ventricle, 14) Right pulmonary artery and right pulmonary veins,
15) Vertebral body (Thoracic spine),16) Posterior costo phrenic
angle.
Atelectasis Right Lung
Homogenous density
right hemithorax
Mediastinal shift to right
Right hemithorax smaller
Right heart and
diaphragmatic silhouette
are not identifiable
Air Fluid Levels
Multiple lung cavities with fluid levels
Projecting over lung field in both PA and lateral view
Other findings include:
Egg shell calcification of lymph nodes
Diaphragmatic pleural calcification
Silicosis
Air Fluid Level
Across entire hemithorax in PA and lateral view
Pleural space
Post-pneumonectomy
RML Lateral Segment Atelectasis
Bronchiectasis
Left lung atelectasis due to mucus plugging
Mucus plugs suctioned with bronchoscopy
Bronchogram done after bronchoscopy
Saccular bronchiectasis in bronchogram below
Consolidation / Lingula
Density in left lower lung field Lateral
Loss of left heart silhouette Lobar density
Diaphragmatic silhouette intact Oblique fissure not significantly shifted
No shift of mediastinum Air bronchogram
Blunting of costophrenic angle
Consolidation Right Upper Lobe /
Air Bronchogram
Density in right upper lung field
Lobar density
Loss of ascending aorta silhouette
No shift of mediastinum
Transverse fissure not significantly shifted
Air bronchogram
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Segmental Pneumonia
Aspiration Pneumonia
Superior segment of RLL
Chest Tube
Tracheostomy
Multiple metastatic cavities
Cancer of larynx
Pacemaker
Note the path of the

catheter from the
right side.
THANK YOU

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CHEST X - RAY

Physiotherapy in Cardio-respiratory Disorders

An X-ray film is positioned against the body opposite the

Patients is supine or sitting on bed

Note the path of the

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