Chest X-Ray

Chest x-rays may be used to assess heart status (either directly or indirectly) by looking at the heart itself, as well as the lungs. Certain conditions of the heart may cause changes in the lungs and/or the vessels of the lungs. Changes in the normal structure of the heart, lungs, and/or lung vessels may indicate disease or other conditions. Conditions that may be assessed with a chest x-ray include the following:

• enlarged heart
  
• aortic aneurysm - a weakened area of the aorta, the main artery that carries oxygenated blood to the rest of the body.
  
• aortic trauma
  
• pericardial effusion - a collection of blood or fluid in the sac surrounding the heart.
  
• calcification of heart structures (such as valves)

What are X-Rays?
X-rays are made by using external radiation to produce images of the body, the organs, and other internal structures for diagnostic purposes. X-rays pass through body structures onto specially treated plates (similar to camera film) and a "negative" type picture is made (the more solid a structure is, the whiter it appears on the film). For this reason, bones appear very white on an x-ray film, but less dense tissue such as muscle, blood, skin, and fat, appears darker.

The picture above is a chest x-ray. The large, white space in the middle is the heart. The dark spaces on either side are the lungs. The small object in the upper corner is an implanted pacemaker.

However, more definitive tests, such as computed tomography scans (CT scans), magnetic resonance imaging scans (MRI scans), or cardiac catheterization may be performed to make a final diagnosis of these conditions.

Reasons for the Procedure
Chest x-rays may be ordered as part of a physical examination, before hospitalization and/or surgery, or to assess signs or symptoms of conditions such as those related to the heart or lungs. Some signs or symptoms that may indicate the need for a chest x-ray include, but are not limited to, the following:

• persistent cough
  
• swelling of the feet and ankles
  
• an inability to lie flat without breathing difficulty
  
• other breathing difficulties

Chest x-rays are also used to check the position of implanted pacemaker wires and other internal devices such as pulmonary artery catheters or central venous catheters. Pulmonary artery catheters and central venous catheters are usually inserted through a vein in the neck (the jugular vein) or under the collarbone (the subclavian vein). A pulmonary artery catheter is advanced through the two chambers on the right side of the heart into the pulmonary artery in order to measure pressures in the heart to assess its function. A central venous catheter is advanced to the upper right chamber of the heart in order to assess fluid status and to infuse certain medications that cannot be given through a smaller vein in the arm or hand.

Risks of the Procedure
Women who are pregnant or suspect they may be pregnant should not have x-rays unless it is an emergency or urgent reason. In this case, the woman's abdomen should be shielded with a lead apron. Men should have their groin areas shielded during x-ray. NOTE: If you have had a chest x-ray within the previous few weeks, let your physician know. It is possible that the previous x-ray will be sufficient for your physician's current purpose. This can save money, time, and exposure to x-rays.

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What to Expect

What to Do the Night Before
No special preparation, such as fasting or NPO (nothing by mouth) overnight is required.

Diagnostic Tests Before the Procedure
None.

Scheduling/Registration Information
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Where the Procedure is Done
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Who Performs the Procedure
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Directions to the Hospital
(Client to insert the following information, if appropriate: directions to the hospital, area map, directions to the admission area, valet parking information, virtual tour link, etc.)

It is important to arrive at your scheduled time. Your procedure may not begin immediately due to varying lengths of procedures scheduled before your procedure. You will be updated as frequently as possible.

Preparing for the Procedure in the Hospital

• Description of IV, site preparations, and medications that may be administered - You will be asked to remove any clothing or jewelry from your neck and chest area that might interfere with the exposure. You will be given a gown without snaps to wear. If you are pregnant, or think you may be pregnant, you should tell your physician or the x-ray technician prior to the procedure.
  
  
• Consent forms - A consent form is not required, but a physician's order is necessary.
  

During the Procedure

• Description of the room, monitoring devices, positions, and equipment that will be used - There may be a table in the room, and there will be a large x-ray camera suspended from the ceiling that can be moved in many directions in order to obtain various views. Portable x-ray equipment can be used to make films on patients in other areas of the hospital, such as the operating room, the emergency department, or the intensive care unit.
  
  
• Anesthesia - None required.
  
  
• Position during the procedure - A chest x-ray may be performed in a standing, sitting, or lying position, depending on the condition of the patient. For a standing or sitting film, you will stand or sit in front of an x-ray plate. The technician will position you properly in front of the plate, and then will step away to the controls of the machine. You will be asked to take in a deep breath and hold it for a few seconds while the x-ray exposure is made.
  
  In some situations, the physician may request a film made from a side angle. This procedure is the same as the one just described, except that you will stand or sit at a right or left angle to the x-ray plate and your arms will be raised out of the way.
  
  In the lying position, the plate is placed beneath you while you are lying on your back.
  
  
• Procedure time - It normally takes only a few minutes to obtain the films. However, events such as unexpected delays in previous procedures, inadequate exposure due to patient movement, insufficient intake of air in the lungs, or other factors may delay the start of your procedure or prolong the length of it.

After the Procedure

• Recovery - There is normally no recovery necessary after this procedure.
  
  
• Length of stay - No hospital stay is necessary, unless your physician determines that your condition required further observation or hospital admission.
  
  
• Recuperation time - There should be no recuperation time associated with this procedure, unless another type of procedure has been done that might require a recuperation period. Your physician will give you any special instructions if they are required.
  
  
• Outcome - The results of the chest x-ray will be considered along with other factors relating to your condition. If your chest x-ray is normal but you are having signs or symptoms of possible cardiac problems, your physician will most likely schedule other diagnostic procedures based on your symptoms. If the x-ray reveals an abnormality such as an enlarged heart or abnormal heart, lung or lung vessel structures, your physician will most likely schedule other diagnostic procedures based on these findings.
  

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Discharge Instructions

Medications
You will most likely continue any medications you are currently taking. Your physician will let you know about any changes that need to be made.

Diet
You should be able to resume your normal diet, unless your physician instructs you differently.

Activity
You should be able to resume your normal activity, unless your physician instructs you differently.

Sexual Activity
You should be able to resume your normal sexual activity, unless your physician instructs you differently.

Bath Care
No special instructions.

Site Care
No special instructions.

Driving a Vehicle
No restriction, unless your physician instructs you differently.

Returning to Work
No restriction, unless your physician instructs you differently.

Office Visit
Depending on the results of the chest x-ray, your physician may want you to schedule a visit within a certain period of time in order to discuss treatment options, additional testing/diagnostic options, and/or to follow up on your status.

Warning Signs/Symptoms to Monitor
Notify your physician if you develop any signs or symptoms you had prior to the test (e.g., chest pain, shortness of breath, dizziness, fainting, etc.).