Chest X-rays: Sorting out problems in your chest

Even with today's high-tech medical devices, the basic chest X-ray remains an important tool in diagnosing various conditions. Here's a look at how it works.

If a picture is worth a thousand words, the images from a chest X-ray can be invaluable in detecting problems with your heart or lungs.

When you go to the emergency room with chest pain, for instance, a chest X-ray (radiograph) can help determine whether you have heart failure or a collapsed lung. Chest X-rays can also reveal fluid in your lungs, enlargement of your heart, pneumonia and many other conditions — they're not just for detecting a broken rib or two.

Who is a chest X-ray for?

Despite the numerous high-tech imaging procedures now available, the basic chest X-ray remains a core tool in helping diagnose problems with your cardiovascular and pulmonary systems — your heart, lungs and blood vessels. Chest X-rays are painless, quick and relatively inexpensive. They allow doctors to see inside your body without surgery and with minimal risk.

Your doctor may suggest a chest X-ray if you have a persistent cough, an injury involving your chest, chest pain, a heart murmur or difficulty breathing. Along with a physical examination and medical history, a chest X-ray is often among the first procedures you'll undergo if your doctor suspects you have heart or lung disease.

What a chest X-ray can show A chest X-ray has many uses. It can show:

• The size and outline of your heart. Changes in the size and shape of your heart may indicate a variety of conditions, such as heart failure, congenital heart disease, fluid around the heart (pericardial effusion), and problems with one or more of your heart valves.
• Blood vessels. Because the outlines of the large vessels near your heart — the aorta and pulmonary arteries and veins — are visible on X-rays, they may reveal aortic aneurysms or other blood vessel problems, or congenital heart disease.
• Calcium deposits. Chest X-rays can detect the presence of calcium in your heart or blood vessels. Its presence may indicate damage to your heart valves, coronary arteries, heart muscle or the protective sac that surrounds the heart (pericardium). Calcium deposits in your lungs may be from an old, resolved infection or a more serious disease.
• The condition of your lungs. Chest X-rays can reveal changes or abnormalities in your lungs that stem from heart problems. Fluid may accumulate in your lungs (pulmonary edema), for instance, as a result of congestive heart failure. X-rays can also detect cancer or infection in your lungs.

How do you prepare for a chest X-ray?

You don't need much preparation for a chest X-ray. Be sure to tell your doctor if you're pregnant because chest X-rays are generally avoided during pregnancy. However, if the X-ray is necessary, precautions can be taken to minimize the unborn baby's exposure to radiation.

You can have an X-ray even if you have a pacemaker or an implanted cardioverter-defibrillator. In fact, a chest X-ray can help determine if such devices are located where they should be and whether they've sustained any mechanical damage.

Before the chest X-ray, you generally undress from the waist up and wear an exam gown. Remove jewelry from the waist up, too, since both clothing and jewelry can obscure the X-ray images.

How is a chest X-ray done?

Chest X-rays can be done by an X-ray technician or radiologist in a hospital radiology department or in a clinic.

An image is created by directing X-rays at your chest and positioning a large piece of photographic film or a digital recording plate against your back. The X-ray machine produces a tiny burst of radiation that passes through your body and produces an image on the film or digital plate.

X-rays penetrate body structures and tissue in different ways. Bone is very dense and blocks much of the radiation, so the image of bone on the film appears white. Your heart also blocks some of the radiation and so appears as a lighter area on the film. Lungs, on the other hand, are filled with air, so they block little of the radiation, creating a dark image.

What can you expect during a chest X-ray?

During the procedure, your body is positioned between the X-ray camera and the X-ray film or digital recorder. You may be asked to move into different positions or angles in order to take views from both the front and the sides of your chest.

During the front view, you stand against the plate that contains the X-ray film or digital recorder. You hold your arms up or to the sides and roll your shoulders forward. You take a deep breath and hold it for several seconds while the X-ray image is taken. Holding your breath after inhaling helps your heart and lungs show up more clearly on the image.

During the side views, you turn and place one shoulder on the plate and raise your hands over your head. Again, you take a deep breath and hold it during the filming process.

Having X-rays taken is generally painless. You don't feel any sensation as the X-ray passes through your body. You may feel some discomfort from leaning against the cold plates. If you have arthritis or certain injuries, you may find it uncomfortable to move your arms into the required positions. The technician can help you find a position that's both comfortable and ensures accuracy. If you have trouble standing, you may be able to have X-rays while seated.

Results of a chest X-ray

A radiologist — a doctor trained in X-rays and other imaging exams — analyzes the images, looking for clues that may suggest you have heart failure, fluid around your heart, pneumonia or other lung problems, a congenital heart defect, or other conditions. Your doctor will communicate the results to you, and what treatments or other tests or procedures may be necessary.

Risks of a chest X-ray

Chest X-rays can offer a lot of information about your health for little risk and expense. Getting an X-ray is a relatively quick and easy procedure. You can have a series of chest X-rays over time for comparison.

You may be concerned about radiation exposure from chest X-rays, especially if you have them regularly. However, the amount of radiation from a chest X-ray is low — even lower than what you're exposed to through natural sources of radiation in the environment, such as radon from rocks and soil. In addition, care is taken during X-rays to minimize what small exposure you do have. The smallest possible dose of radiation is used. When multiple X-rays are taken, a protective lead apron is often provided.

Although you should generally avoid X-rays during pregnancy, a lead apron that covers your pelvis and abdomen can shield your unborn baby.

As useful as chest X-rays are in detecting problems with your cardiovascular system, they're generally just one step in the process of making a diagnosis. Chest X-rays can't detect all conditions. And even if the X-ray does suggest an abnormality, you may need to undergo a variety of other tests or procedures, such as an echocardiogram, magnetic resonance imaging (MRI) scan or computerized tomography (CT) scan, to help confirm a diagnosis.

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