Runny nose

X-ray projections. Front projection photographs

The second option is fluorography. It is carried out for mass examination of the population in order to identify diseases.

Direct and lateral radiography (2nd projection) is performed for a thorough examination of the chest if pneumonia, tuberculosis and cancerous tumors are suspected.

X-ray of the lungs in two projections – indications and contraindications

In two projections, X-rays of the lungs are performed according to absolute indications when the benefits of X-ray examination outweigh the harm. When the pulmonary parenchyma becomes inflamed, life-threatening conditions are formed that will lead to respiratory failure.

X-ray of the lungs in two positions involves taking pictures in a straight and lateral position.

Chest X-ray in 2 projections – indications:

1. Inflammation of the alveoli of the lungs (pneumonia);

2. Tuberculosis of the pulmonary fields;

3. Peripheral and central cancer;

4. Diseases of the pleural cavity (pleurisy);

5. Cysts and abscesses;

6. Determination of heart size;

7. Airiness assessment;

8. Detection of pneumothorax (air of the pleural cavity).

The list goes on and on, but the diseases described above are studied using x-ray examination as often as possible.

Radiography in frontal and lateral projections

Chest X-ray in two projections consists of frontal and lateral images. A direct radiograph is also called anteroposterior, since the X-rays pass through the object under study (the patient's chest cavity) in the anteroposterior direction.

For any examination of the lungs, an AP X-ray is always performed. A lateral view is taken at the request of the radiologist.

What shadows does a direct photograph of the chest organs show:

– Increased airiness of the lung fields with emphysema;

– Intense darkening with pneumonia or tuberculosis;

– Violation of the innervation of the diaphragm (relaxation of the dome);

– Deformation, strengthening or thickening of the pulmonary pattern;

– Collapse of lung tissue – atelectasis;

– Pathology of bone and soft tissue.

The list of radiological syndromes associated with the disease is more extensive. A qualified radiologist knows about them. The authors described the most common symptoms of pulmonary pathology.

X-ray in lateral projection

A lateral X-ray is optional. It complements the diagnostic list of clinical studies. On a lateral radiograph, the entire thickness of the chest is visible, but nearby parts of the organs are visible as clearly as possible.

In case of pneumonia, radiologists prescribe radiography in two (two) projections to assess the volume and location of the lesion. The structural element of lung tissue is a segment. Inflammation of the lungs occurs in one or more segments. A lateral x-ray helps to establish the exact localization of the pathology.

Testing for tuberculosis is indispensable. When no infiltrative shadows of the upper lobe are visible on the direct radiograph, infiltrative shadows can be seen on the lateral image. If they are accompanied by paths to the roots, there is a high probability of respiratory tuberculosis.

X-ray of a child’s lungs in two projections – safety issues

X-rays of a child's lungs should be done very carefully. X-ray examination is not safe. It provokes mutations in cells that quickly divide. To prevent negative consequences from x-rays, we recommend that you consider safety issues regarding the examination in children more carefully.

The lower the radiation dose, the less harm.

Preventive fluorography for children under 14 years of age is prohibited, although it is characterized by a lower level of radiation than chest radiography. What is the reason for this approach?

Obviously, the “stick” has a low resolution, so it can only reveal pathology, but cannot reliably confirm it. If the radiologist detects pathological X-ray syndromes on the fluorogram, he sends the child for direct radiography. If it is sufficient to establish a diagnosis of pneumonia or tuberculosis, a lateral photo is not taken. An examination in 2 projections is carried out when previous images are not enough to make a diagnosis.

Note that up to 14 years of age, radiography in two positions is rarely performed. This is how doctors take care of the health of a growing organism.

X-ray examination of the lungs of adults - when to do two projections

Two projections during an x-ray examination of the lungs of adults should be done when the radiologist sees suspicion of pneumonia or tuberculosis in a direct image. The procedure is also performed when, according to clinical data, the patient is suspected of having these diseases. Then the study is carried out in two positions (antero-posterior and lateral).

This approach is used to avoid missing a small area of infiltration. It may not be visible on a direct radiograph, but on a lateral radiograph the infiltrate is clearly visible, since it is not hidden behind the sternum. A similar situation is observed in the presence of hilar edema near the roots of the lungs.

In adults, cells do not grow, so the risk of mutations when exposed to chronic doses of ionizing radiation is minimal. Because of this, radiography is used as much as possible for timely diagnosis. Diseases of the chest organs are insidious and can be fatal if detected late.

Description of x-ray of the lungs in frontal and lateral projection

We give an example of a description of an x-ray for pneumonia in two projections by a radiologist.

On the presented x-ray of the chest organs in direct and lateral projection, a mid-focal infiltrative shadow (up to 0.6 cm) is visualized in the area of the apex of the right lung. A path extends from it to the right root (due to lymphangitis). The image in the right lateral projection shows additional small focal shadows in S1 and S2. The contours of the diaphragm and sinuses are without pathological changes. Heart shadow of normal configuration.

Conclusion: X-ray signs of infiltrative tuberculosis S1-S2 of the right lung. A consultation with a phthisiatrician is recommended.

Medical history. Patient Z. consulted a physician with complaints of a persistent cough that did not go away after taking expectorants (bromhexine, ambroxol). Sputum production is accompanied by streaks of blood.

Auscultation: wheezing in the upper and lower lobes of the right lung. General blood test is normal. Biochemical study - increased levels of liver enzymes (AlAt, AsAt).

The interpretation of the radiograph (described above) indicated tuberculosis. The diagnosis was confirmed by a phthisiatrician - infiltrative tuberculosis of the upper lobe of the right lung.

What is a lung x-ray, what does it show, how often and where can it be done?

Chest X-ray

its soft tissues and bones;

cardiovascular;
lymphatic system;
pulmonary;

emphysema;
inflammation of the pleura (pleurisy);
bronchial asthma;
pulmonary edema.

What do healthy lungs look like?

above - collarbone;

patient's age.

X-ray of the lungs in two projections for accurate diagnosis of diseases

X-ray of the lungs in two projections is carried out for diagnostic purposes. When it is necessary to identify pathological changes in the chest (pneumonia, pneumothorax, cancer), there are no more reliable methods than radiation methods.

The study is carried out strictly according to indications, when the benefit from it is greater than the harm. For example, during pregnancy and for children, radiation exposure is dangerous due to the occurrence of genetic mutations. Doctors prescribe radiation exposure to these categories of the population only as a last resort.

Purpose and preparation for radiography in two projections

An X-ray of the lungs in the right or left lateral projections is prescribed in the following cases:

for the purpose of identifying heart diseases and pathological changes in the pulmonary fields;
control of catheter placement in the heart, pulmonary artery, as well as for the purpose of assessing pacemaker electrodes;
in the diagnosis of pneumonia, inflammatory changes in the bronchi, bronchiectasis.

X-ray of the lungs in two projections does not require special preparation, but a person will have to perform some manipulations:

Remove clothing and foreign objects that cover the examination area.
Leave your mobile phone and keys on the table, as well as other items that can accumulate radioactive radiation.

In the process of performing an X-ray of the lungs, it is necessary to follow all the recommendations of the x-ray technician. It is important to hold your breath while taking a photo to avoid dynamic blur.

Direct (posterior-anterior) projection during radiography of the lungs

Direct (posterior-anterior) projection during chest X-ray is performed as often as possible if pneumonia or tuberculosis is suspected. There are some technical subtleties when implementing it:

the ideal focal length between the X-ray tube and the human chest should be on average 2 meters;
when placing the patient on the stand, the x-ray technician ensures that the chin is positioned on a special holder;
The height of the clamp is adjusted so that the cervical spine is straightened. When installed, a person leans his hands against the screen, and his chest is projected in the central part of the cassette;
When exposing the photo, you must hold your breath.

This is how a posteroanterior (direct) projection is performed when diagnosing respiratory diseases.

Lower lobe pneumonia on x-ray of the lungs in direct projection

Anteroposterior view of the lungs

An anterior-posterior image of the lungs in combination with left or right lateral projections is performed in the supine position. How to take a direct shot:

the patient is placed on the couch;
the head end rises up;
the cassette is placed under the patient's back, and the distance between the X-ray tube and the object of study is selected as directed by the doctor. It should be taken into account that there should be no foreign objects in the path of X-ray penetration;
exposure is carried out with a deep breath.

Performing right and left lateral chest films

To perform lateral images of the lungs (left and right), special positioning is required:

hands are placed behind the head;
the left side leans against the cassette;
During exposure, one holds one's breath or takes a deep breath.

The patient is placed next to the cassette on the side that needs to be x-rayed.

Lower lobe pneumonia on an x-ray of the lungs in the left lateral projection

Precautions

Chest X-ray is contraindicated in pregnant women. Radiation exposure to the fetus due to ionizing radiation involves the appearance of genetic mutations, which can lead to developmental abnormalities.

When performing the study, it is necessary to protect the human pelvic and abdominal area with a special lead apron.

In an outpatient setting (in a clinic), when a doctor prescribes radiography in two projections, postero-anterior images should be taken rather than anteroposterior, which is due to the greater reliability of the former.

When choosing lateral images (left or right), you must rely on the doctor’s prescription with a description.

The norm in photographs in two projections

The norm in photographs in two projections is characterized by the following indicators:

the width of the chest on a direct radiograph is twice as large as the transverse size of the heart;
pulmonary fields are symmetrical on both sides;
the spinous processes are located evenly in the vertical plane;
intercostal spaces are uniform.

Deviation from normal values in photographs of the lungs in two projections during pneumonia is the presence of additional intense shadows on the frontal and lateral radiographs.

Venous congestion in the lesser circle will be characterized by a special shape of the roots, which in the image resembles “butterfly wings”. With edema, flaky, uneven darkening will appear in the lung tissue.

Changes in the heart on direct and lateral x-rays

Changes in the heart on x-rays of the lungs are combined with an enlargement of the right or left ventricles and atria. With an increase in size on the left, the roundness of the left border of the cardiac shadow will be visualized on the x-ray.

The image with expansion of the right contours of the heart will appear as an expansion of the shadow of the right ventricle. In this case, an increase in the shadow of the right ventricle is observed on the posteroanterior radiograph.

What influences the result of the study

When taking x-rays, it is important that the patient learn to hold their breath until exposure, which will prevent the need to repeat the x-ray.

Incorrect centering of the chest during radiography may interfere with visualization of the costophrenic sinus.

Distortion of the results is also observed when a person has a lateral curvature of the spinal column.

In two projections, radiography is performed if any disease is suspected, which is accompanied by damage to the chest cavity, and the purpose of performing a lateral image is no different from the direct one.

Particular attention should be paid to the laterogram - a special study that allows you to determine the presence of fluid level in the costophrenic sinus. During the examination, the person is placed on his side and an X-ray image is taken with the X-ray beam directed anteriorly. In this case, the cassette is installed from the back of the back. In the presence of exudative pleurisy, a thin strip of darkening can be traced in the lower part of the costal arch, reflecting the accumulation of fluid in the costophrenic sinus.

X-ray examination of the heart is often supplemented by contrasting the esophagus with barium. This allows you to clearly monitor the pressure of the aorta on the esophagus or identify various deviations of the aortic arch.

Against the background of pathology, an increase in the pulmonary pattern may be observed. In this case, the results have a radial direction, and the veins are located in the horizontal plane.

Thus, in two projections, X-ray images are prescribed for diagnostic purposes to identify diseases of the cardiovascular and respiratory systems.

fluorography in 2 projections

fluorography in 2 projections what is it

In the section Other about health and beauty, there is a question about fluorography. Fluorography of the lungs in one projection or in two projections. What are these projections? asked by the author Tatyana Afanasyeva, the best answer is Poses. It’s like at a photo shoot - stand this way, stand that way.

Fluorography is done in one projection

Fluorography from the front side or from both sides (front and side). Is that clearer?

They will do it from the front and then from the side. Usually 2 projections are prescribed if some kind of lung disease is suspected. Then lateral projections allow you to better examine the lungs and not miss signs of the disease.

A full x-ray of the lungs is usually taken in two projections. And the projections are the same as those of the photographer - full face: from the front, and profile: from the side.

Chest X-ray. Indications and contraindications. Methodology. Description of a healthy chest x-ray

What is a chest x-ray?

On what principle do X-rays work?

Digital and standard chest x-ray

The quality of the resulting image. The sensors have a higher sensitivity compared to the agent used to treat the film. The result is an image with more contrast and sharpness.
Possibility of computer processing of X-ray images. The doctor can zoom in and out of a digital image, study the negative, and remove noise using software tools.
Low radiation dose. The sensors respond to less x-ray energy than the photosensitive agent, so less power from the x-ray machine is used.
Convenient storage of information. A digital image can be stored indefinitely in computer memory.
Convenient transfer. A digital x-ray can be sent via email, saving time for both the doctor and the patient.

What is the difference between chest x-ray and fluorography?

low sharpness and contrast ( On fluorography it is difficult to distinguish shadows smaller than 4 mm);
the radiation dose is higher at once;
reduced chest size.

Fluorography is an indispensable method for preventing tuberculosis epidemics. Previously, fluorographic examination was carried out for all people, but today, given the decrease in the prevalence of this terrible disease, fluorography is carried out selectively in the population. Employees of schools and kindergartens must undergo fluorography at least once a year.

What is the difference between X-ray and computed tomography ( CT) chest?

Indications and contraindications for chest radiography

Indications for chest x-ray due to lung diseases

elevated temperature, fever;
cough ( for at least a week);
dyspnea;
sputum production;
wheezing in the lungs;
chest pain;
hemoptysis, etc.

The listed symptoms reliably indicate lung diseases. After an external examination, the doctor makes only a presumptive diagnosis, which must be verified using x-rays. After examining a chest x-ray, the doctor can accurately diagnose and begin treatment of the disease.

acute and chronic bronchitis;
pneumonia ( pneumonia);
bronchial asthma;
emphysema;
tuberculosis;
lung tumors;
pulmonary edema;
pneumothorax;
respiratory failure.

Preventative chest x-ray ( fluorography) is performed in order to identify in advance lung diseases that occur without pronounced symptoms. Such diseases are tuberculosis, benign and malignant tumors of the lungs. Fluorography should be performed once a year.

Indications for chest x-ray due to heart and vascular diseases

Indications for chest x-ray due to diseases of the skeletal system ( ribs and spine)

Contraindications to chest x-ray

open bleeding;
multiple fractures of the ribs and spine;
severe general condition of the patient;
pregnancy;
children under 15 years of age.

All contraindications to chest x-ray are relative. This means that, if necessary, they can be neglected to save the patient’s life. On the other hand, you can always use an alternative research method, for example, magnetic resonance imaging, electrocardiography, ultrasound ( Ultrasound) and other methods.

How long is a chest x-ray valid?

Method of performing a chest x-ray. Preparing for a chest x-ray

Who issues a referral for a chest x-ray?

family doctors;
traumatologists;
vertebrologists;
neurologists;
cardiologists;
pulmonologists;
phthisiatricians;
surgeons;
oncologists, etc.

A doctor from any of the listed specialties can read a chest x-ray properly. Depending on the organ being studied and the complexity of the clinical situation, doctors prescribe special studies, such as radiography with contrast, computed tomography or magnetic tomography.

Where is a chest x-ray performed?

X-ray machine ( one or more);
mobile screens;
radiation protection equipment ( aprons, collars, skirts, plates);
devices that record radiation dose;
means for developing or printing photographs;
negatoscopes ( bright screens for illuminating film photographs);
desks and computers for record keeping.

The X-ray room is marked outside with a corresponding sign. It is distinguished by a heavy metal door and a lamp with the inscription “Do not enter!” Entry into the X-ray room is permitted only by invitation from the doctor, since it is undesirable to be exposed to additional radiation while examining other patients.

What is a chest X-ray machine?

Power supply. It receives electrical energy from the electrical network and transforms it into higher voltage electrical current. This is necessary to obtain x-ray radiation of sufficient power.
Tripod. A digital chest x-ray is usually performed in a standing position. A touch screen is attached to a vertical tripod, adjustable in height, on one side, and an X-ray emitter on the other. During the examination, the patient is located between the screen and the emitter.
X-ray emitter. Creates x-ray radiation of a given power. It has several focal lengths for studying organs located at different depths in the human body.
Collimator. This is a device that concentrates a beam of X-ray radiation. Thanks to this, lower radiation doses are used.
Digital X-ray receiver. Consists of sensors that perceive x-ray radiation and transmit it to a computer device.
Hardware and software complex. Receives and processes information from sensors. Thanks to the software, a radiologist can study a digital image in detail, as it contains powerful tools for working with images.

A computed tomograph consists of the same elements. However, its design is slightly different from an X-ray machine. The scanners and emitter form a short tunnel that can move relative to a horizontal plane. A chest CT scan is performed in the supine position, with a ring of scanning elements surrounding the patient's chest.

Who performs chest x-rays?

How is a chest x-ray performed in two projections ( straight, lateral)?

How to prepare for a chest x-ray?

Is it possible to eat or smoke before a chest x-ray?

Is it possible to perform a chest x-ray at home?

patients with high temperature, fever;
patients with severe infectious diseases;
non-transportable patients;
patients with lower extremity injuries ( immobilized with plaster);
patients with malignant tumors;
small children;
elderly patients;
disabled people.

X-rays at home are performed by a special medical team. To perform such x-rays, mobile x-ray units are used. The quality of the resulting image has no noticeable disadvantages compared to the traditional method of obtaining x-ray images.

Is it possible to perform an urgent chest x-ray?

After the patient is taken to the hospital, he is thoroughly examined. The urgency is determined by the severity of his condition. At the hospital stage, all necessary studies are performed, including a chest x-ray. Thus, a chest x-ray in itself is not an urgent examination, but if necessary, it is performed as soon as possible.

Harm from radiation diagnostic methods. Chest X-ray for children and pregnant women

Is it harmful to have a chest x-ray?

radiation sickness;
radiation burns;
bleeding;
cell mutations and malignant tumors.

The radiation to which a person is exposed during a chest x-ray is thousands of times less than that which causes the listed complications. However, even small doses of radiation are sometimes harmful to certain cells and tissues. Cells of the genital organs, bone marrow, and endocrine glands are sensitive to radiation ( thyroid gland, pancreas).

The body of a developing fetus and small child is especially susceptible to radiation, since all its cells and tissues are in a state of active growth and division.

What is the radiation dose for a chest x-ray? How many times can a chest x-ray be taken?

X-ray dose is measured in millisieverts ( mSv). The ionizing radiation that a person receives from the environment per year is 2.4 mSv.

fluorography of the chest organs – 0.6 – 0.8 mSv;
film radiography – 0.15 – 0.4 mSv;
digital radiography – 0.03 – 0.06 mSv;
computed tomography – mSv.

Thus, the radiation dose when performing digital chest radiography using modern devices is 40 times less than the annual radiation received from the environment. According to medical requirements, the dose of X-ray radiation should not exceed 1 mSv during the year. Thus, a digital chest x-ray can be performed once a year, but such a need is unlikely to arise.

Is it possible to do a chest x-ray for a child or newborn?

Can a chest x-ray be performed on a pregnant or nursing mother?

feed the child before the examination;
during an x-ray examination, ask for a protective apron;
It is recommended to express the next portion of milk;
take a break from breastfeeding for several hours;
planned fluorography should be postponed until as late as possible.

Description of a normal chest x-ray. What does a healthy chest x-ray show? photo)?

trachea and bronchi;
lungs;
heart and aorta;
spine and ribs;
collarbone;
mediastinum;
mammary glands.

Naturally, to better display certain organs, the radiologist selects the necessary projections and focal length. Sometimes it is better to do a computed tomography or magnetic resonance imaging scan instead of an x-ray. This is true for the study of blood vessels, intervertebral discs or in the presence of tumors.

Why are lung x-rays done?

Chest X-ray is a high-quality diagnostic method that helps to detect pneumonia, tuberculosis, cancer, and inflammatory changes in the pulmonary parenchyma in a timely manner. X-ray diagnostics are also used to determine changes in the mediastinal organs.

An x-ray is obtained by passing ionizing radiation through an object (the human body), and therefore has a side effect (radiation). Dense tissues reflect X-rays, while soft tissues transmit them. Due to this, the image shows a planar image of anatomical structures, which is deciphered by a radiologist.

X-rays pass through low-density tissue and do not form an image in the picture. However, air tissues are structurally different from bones. Radiologists have learned through practical experience to distinguish the structure of shadows.

What does a chest x-ray (CH) show?

Chest X-ray shows infiltrative shadows, air cavities, foreign bodies and other pathological syndromes:

ring-shaped shadow (cyst, bronchiectasis);
limited, total and subsegmental darkening (pneumonia, tuberculosis, cancer);
diffuse and local clearing (emphysema, pneumothorax);
deformation of the pulmonary pattern and roots of the lungs;
“plus-shadow” syndrome (with tumor growth).

Due to the patient's radiation exposure, X-rays of the lungs are performed only according to strict indications (for comparison: the dose for a chest X-ray in frontal and lateral projections is 0.42 mSv, and for fluorography - 0.015 mSv).

When a chest x-ray is taken:

Sometimes x-rays of the chest cavity must be supplemented with bronchography, layer-by-layer and computed tomography. This increases the patient's radiation exposure.

The shadow of the sternum in the lateral image is highlighted with a square

Why does a chest x-ray give false results?

X-ray of the lungs gives a false positive result when shadows of other organs are superimposed on the anatomical structures: mediastinum, deformed vessels, diaphragm, pathological fractures of the sternum.

Layer-by-layer overlay of different structures on an image creates pathological X-ray syndromes, which are not confirmed by additional methods.

X-rays also create a false negative result when one darkening is overlapped by another anatomical structure.

X-ray of the chest and chest - how the methods differ

A chest x-ray is done if sternal fractures are suspected. The study is performed for traumatic injuries. Bone fragments due to deformations of the ribs and sternum can damage the pulmonary parenchyma and cause respiratory failure.

Breast x-rays are performed in frontal and lateral projections using “hard rays”. In such images it is difficult to see the structure of the pulmonary pattern and the airiness of the lungs.

Plain radiography of the lungs shows pathological processes in the lung fields and surrounding tissues. It should be distinguished from fluorography, which is done for preventive purposes (screening). When pathology is detected on a fluorographic image, an x-ray examination of the lungs is performed in two projections for the purpose of more accurate diagnosis (fluorography has low resolution).

Sometimes doctors do a chest X-ray if they suspect a mass in the mammary glands. This test is called mammography. It is carried out to identify primary cancerous foci of the mammary glands.

Mammography for tuberculosis: a white spot formed by a tuberculous inflammatory focus

Why is radiography of the lungs performed in several projections?

Sometimes patients have a question about why X-rays of the lungs are performed in several projections. Let us answer that the examination allows you to determine the shape, size and nature of the pathological shadow.

According to the standards for clinical examination of patients with X-rays, if pneumonia is suspected, radiologists take pictures in frontal and lateral projections. Using anteroposterior and lateral images, you can determine the localization of the pathological formation, as well as how many segments it affects.

Dynamic radiological monitoring of inflammatory changes in the chest can be carried out in the lateral and anteroposterior projections, depending on the decision of the radiologist.

Every patient has the right to refuse radiation exposure and take responsibility for their health!

X-ray of the chest cavity is an effective and efficient method for identifying pathology of the lungs and surrounding tissues, as well as dynamic monitoring of the patient’s treatment. X-rays are performed according to strict indications!

The lungs are a very important human organ, providing the body with oxygen, filtering microthrombi, regulating blood coagulation, responsible for breathing, removing harmful toxins and carcinogens, and for the optimal level of acid-base balance in the blood.

And with any pathological processes, damage, or malfunctions in their work, there is a high probability of extremely serious consequences, even fatal.

That is why it is very important to monitor their condition and undergo periodic medical examinations. An X-ray of the lungs will allow you to identify existing problems in time and begin the necessary treatment.

Chest X-ray

Using an X-ray, the lung is examined specifically (in whole, in parts) or the condition of all organs of the chest is assessed:

its soft tissues and bones;
anatomical structures: lungs, heart, pleura, bronchi, trachea, mediastinum, ribs, spine, lymph nodes, vessels, respiratory tract (chest x-ray).

Chest X-ray makes it possible to detect and exclude the development and complications of a number of diseases at the initial stage. Among them:

cardiovascular;
lymphatic system;
pulmonary;
inflammatory diseases of the pleura.

It helps to identify traumatic injuries to the lungs and rib joints, rib fractures, see foreign bodies in tissues, gastrointestinal tract organs, respiratory tracts, etc.

What does a lung x-ray show?

Up to 90% of cases of all serious pulmonary diseases can be detected by chest x-ray. What this diagnostic method shows:

Besnier-Beck-Shaiman disease (sarcoidosis);
emphysema;
inflammation of the pleura (pleurisy);
pneumonia (pneumonia);
neoplasms, including malignant tumors;
tuberculosis (formerly known as consumption, phthisis);
bronchial asthma;
pulmonary edema.

It also makes it possible to assess the volume of the lungs, the location of their roots, identify the presence of cavities in the lungs, fluid in the pleural cavity, thickening of the diaphragm, determine the level of airiness of the bronchi, etc. This greatly facilitates and speeds up making a correct diagnosis and prescribing the necessary treatment, as a result of which the sick person has a greater chance of a positive outcome of the disease and recovery.

Why do they do it in two projections?

Today, X-ray examination is not a screening method, that is, a referral for it is given if there are indications for it or if additional examination is necessary after an ambiguous interpretation of the fluorographic image.

When do you need an x-ray of the lungs in two projections, what does this type of research show? Indications for this procedure are:

Assumption of the presence of tuberculosis. With X-ray in direct projection, it is not always possible to trace the infiltrative darkening of the upper pulmonary lobe. Lateral x-rays provide this opportunity. It also shows better the paths to the roots of the lungs, indicating tuberculosis of the respiratory system.
Diagnosis of pneumonia when direct x-rays or clinical data indicate the likelihood of this disease. The lung consists of segments, inflammation affects 1 or more of them. The most accurate way to determine the extent of the lesion and the segments of the lungs affected by inflammation is an x-ray in the lateral projection.
Diagnosis of heart diseases. An X-ray in 2 projections allows you to determine its size, control the location of the catheter in it or in the pulmonary artery, and assess the condition of the electrodes in the installed pacemaker.
Central and peripheral lung cancer. Double radiography more thoroughly detects the presence of malignant neoplasms (cancerous tumors).
Pathological conditions of the pleura. X-rays in frontal and lateral projections are indicated for suspected pleurisy, accumulation of air in the pleural cavity (pneumothorax).
Radical edema at the pulmonary roots, enlargement of areas of the bronchi (bronchiectasis), small foci of infiltration, abscesses, cysts. It happens that on an X-ray in a direct projection they are not very clearly visible, in contrast to lateral photographs, when they are not hidden by the sternum.

How to do an x-ray of the lungs in a direct projection:

The subject stands between the X-ray tube and the detector (film): in the anterior projection - facing the detector, in the rear - facing the X-ray tube. In this case, the distance from the chest to the tube is about 2 m.
The chin is placed on the holder so that the cervical spine is in a straight position.
You must hold your breath while shooting.
Before the procedure, you need to remove jewelry, remove metal objects, and undress to the waist.

In order to take a picture in a lateral projection, the patient stands up, pressing the side being examined against the cassette. Keeps arms raised up or crossed above the head (at the crown of the head).

What do healthy lungs look like?

X-rays of the lungs of a healthy person and those with lung diseases make it possible to examine:

pulmonary fields on both sides of the spine, with linear shadows of the ribs projected onto them;
in the central area of the image - the sternum and shadow shading from the heart;
above - collarbone;
in the lower part of the image, under the pulmonary fields, there is the dome of the diaphragm.

What do healthy lungs look like on an X-ray? They have a bag-like shape, resembling a semi-cone with a rounded, widened apex. The lung fields are symmetrical on both sides, equally intense, without infiltrative or focal shadows, without enhancing the pulmonary pattern. Their peripheral parts are transparent (this gives a dark, black color on the pictures); the vascular pattern should not be visible in them.

The number of pulmonary lobes corresponds to the norm - 5 (3 lobes in the right and 2 in the left lungs). The roots of healthy lungs are clearly structured, have standard sizes, and have no expansions. A healthy organ does not block X-rays, looks uniform in the image, and has no spots. In the central part, near the roots, a network of blood vessels and bronchi is visible.

The cardiac shadow should normally protrude no more than 1 cm on the right side, and should not extend beyond the midclavicular line, which runs vertically down from the center of the clavicle, on the left side. The trachea is located in the center. There are clearings under the domes of the diaphragm, the intercostal spaces are uniform.

Transcript: what does the darkening in the picture mean?

The existing clearing (they are also darkening in the lungs on an x-ray, since the image is a negative), their shape, shade, and intensity of the lines allow the radiologist to make an accurate conclusion about the condition of the lungs and draw up a brief description of the x-ray.

The transcript must indicate in which projection the x-ray was performed. Various darkenings indicate the following diseases:

Pneumonia. Both on the frontal and lateral projections, pronounced high-intensity shadows, large and small focal darkening are noticeable. Reduced transparency of the lung fields.
Tuberculosis. There are many small darkened foci, an intense pulmonary line, and an increased pulmonary pattern.
Exudative pleurisy. Due to the accumulation of fluid in the costophrenic sinus, a thin darkened strip appears on the image on the lower edge of the costal arch. The trachea is displaced or pulled forward.
Pulmonary edema. Uneven shadows in the form of flakes.
Venous stagnation of the pulmonary circulation (pulmonary circle). Extension of the roots, giving them a shape similar to the wings of a butterfly.
Malignant neoplasms (lung cancer). The X-ray image shows rounded shadows of different sizes, with clear boundaries.
Emphysema. The image shows consolidation of the diaphragm and increased airiness in the lung fields.
Peritonitis. Interpretation of an X-ray of the lungs indicates an accumulation of gases in the abdominal cavity in the absence of a cleared area under the domes of the diaphragm.
Atelectasis (collapse of the lung lobe). X-ray in the lateral projection shows darkening of the posterior mediastinum.
Heart diseases. The enlargement of the ventricle and atria is indicated by the rounded border of the shadow of the heart: the left - on the right, the right - on the left. In addition, the enlarged right ventricle gives rise to shadowing on the left side on the x-ray in the posterior-anterior direct projection.

It is very important to begin interpreting an x-ray by assessing the quality of the image, because incorrect projection and patient’s posture will result in inaccurate images. A correct radiograph shows 2–3 thoracic vertebrae, the spinous processes of the vertebrae are located at an equal distance between the clavicles. The right dome of the diaphragm is higher than the left, projected in the area of the 6th rib.

How many times can an adult take?

X-rays can detect a number of lung diseases at the very first stage, which significantly increases the patient’s chances of recovery.

But is an X-ray of the lungs harmless, and how often can this procedure be performed on an adult without causing harm to the body? Sanitary rules and regulations establish the permissible safe proportion of preventive ionizing radiation equal to 1 mSv per year. It is unacceptable to exceed a dose of 5 mSv in a year.

For information: when performing radiography on film X-ray machines of older modifications, in 1 procedure the human body acquires a radiation dose of approximately 0.3 mSv, on modern digital equipment - about 0.03 mSv.

The decision on how often to take an X-ray of the lungs is determined by a number of factors:

the health status of the person being examined;
nature and stage of the disease;
technical equipment of the X-ray room;
the pursued purpose of the x-ray is preventive or diagnostic;
patient's age.

A relatively healthy person should undergo preventive x-rays once a year. Diagnostic examination allows for 1-2 x-rays per year.

Citizens whose work activities are related to public catering establishments or work in children's institutions of various types are required to be examined every six months. For persons suffering from severe forms of disease, when the harm caused to the body is many times greater than the harm from the radiation received, and x-rays cannot be replaced by another, safer procedure, the doctor may prescribe the procedure much more often - even up to 3 times a week.

X-rays aimed at examining the lungs are prescribed to pregnant women only after carefully weighing all the risks, especially in the 1st trimester of pregnancy. If the procedure cannot be avoided, it is better to undergo it using the latest equipment, covering the abdomen and pelvic area with a lead protective apron. X-rays are not contraindicated for nursing mothers because they do not affect lactation and the composition of milk.

How often can a child be treated?

Many mothers and fathers are concerned about how often can an X-ray of a child’s lungs be done? Radiation exposure can harm the growing cells of a child’s body, sometimes causing gene mutations, damage and DNA strand breakage.

In this regard, it is advisable to carry out x-ray examinations of the lungs of children, as well as adults, no more than once a year.

The only exception is the suspicion of severe forms of pulmonary diseases (malignant neoplasms, tuberculosis, acute inflammation, etc.), when there are no other diagnostic methods, and complications from the disease are greater than the damage caused to health by the procedure. How many times can children be x-rayed in these cases? Each episode requires a personal decision, approximately 5-6 x-rays per year. In some cases:

if tuberculosis is suspected - once every 3 months to monitor the dynamics of the treatment process;
for pneumonia - 3–4 days after taking antibiotics, to establish the effectiveness of their use;
during radiation therapy of malignant tumors of the lungs, when the primary goal is the destruction of cancer cells, and not the effect of radiation on healthy cells - daily.

It is advisable for children to have x-rays performed using digital equipment, which will significantly reduce the amount of radiation exposure.

Attention: radiography of a minor child is performed only with the consent of the parents; up to the age of 12, one of the parents is present during the X-ray session in the X-ray room.

Where to do it?

When deciding where to get an X-ray of the lungs, a person is given a choice at his own discretion:

municipal clinic (hospital);
private paid clinic.

Many modern medical institutions have at their disposal a staff of experienced specialists and the latest equipment that gives accurate results and minimizes radiation exposure. Citizens are usually received by appointment; the results of the examination are explained in detail to the patient and handed over in 2 forms: printed and/or digital.

In a number of cities in Russia, Belarus, Ukraine, Kazakhstan, Invitro, a Russian medical company, does lung x-rays, as well as a number of other clinics. Their radiographs meet all accepted standards and are accepted in all medical institutions.

Is the procedure possible at home?

It happens that a person is not able to visit the X-ray room for a number of reasons:

due to old age;
for health reasons;
due to any physical disabilities.

In these cases, it is possible to take an x-ray of the lungs at home.

The procedure is performed using a portable, mobile X-ray device. The most modern of them - digital - have microprocessor control and work in parallel with a computer. Based on the results of the x-ray, the radiologist immediately draws up a detailed report. The radiographs are given to the patient.

X-ray or fluorography?

Like X-rays, fluorography is the photographing of images of organ shadows from an optical device (fluorescent screen) onto film, but, unlike X-rays, in a very small size (1 cm x 1 cm), or onto a computer display from a special chip built into the receiver .

Due to the increase in tuberculosis, mandatory preventive fluorography was introduced for the population, which must be completed annually.

Important: children under the age of 18 are prohibited from undergoing preventive fluorography!

Which is more accurate?

So what is more accurate - x-ray or fluorography of the lungs? Let's compare pictures of these two methods:

X-rays of the lungs. They have higher resolution and can be enlarged to very large sizes. Clear, allow you to obtain accurate data and make the correct diagnosis. X-rays make it possible to record changes occurring during the course of the disease, the dynamics of the disease, and the development of pathologies.
Fluorographic images of the lungs. The image has lower resolution than an x-ray. The small size of the images makes it possible to show only a general picture of the condition of the lungs and heart. Deviations from the norm of insignificant size (less than 0.5 cm) look like barely visible threads. Foci of infiltration in pneumonia exceeding 0.5 cm are noticeable, but only if they are located in clean areas of the lung fields. If a disease is suspected, the patient is also sent for an x-ray, which may not confirm the presumptive diagnosis. And this adds additional radiation exposure to the body.

Conclusion: X-ray of the lungs is a more accurate method than fluorography.

Which is more harmful?

What is more harmful - X-ray of the lungs or fluorography? Harm here refers to the dose of radioactive radiation acquired during the process. The radiation dose on a film X-ray machine ranges from 0.1 to 0.3 mSv per session. Fluorography today is performed using digital equipment. Digital fluorography gives an approximate dose of 0.04 mSv per session.

Conclusion: fluorography gives a lower dose of radiation than x-rays, which means it is less harmful.

Which is better: CT or X-ray?

The CT (computed tomography) method is also based on scanning with X-rays, but passing through the body at different angles.

The resulting images are combined using a computer into an overall picture, which makes it possible to examine the organ from all sides. CT scan or x-ray of the lungs - which is better and more informative, which is less harmful?

CT has great diagnostic capabilities, since thanks to it you can examine not only the structure of the lung, but also the blood vessels, anatomical processes taking place in the lungs, their internal structures, even differing from each other in density by only 0.1%. The use of a contrast agent increases the accuracy of the data obtained to 98%.

But x-rays have their advantages:

the dose of radioactive radiation is much lower (for CT scans it ranges from 3 to 10 mVs);
its cost is several times cheaper;
Almost all, even municipal, medical institutions have X-ray equipment, so it is more accessible.

When deciding where to take an X-ray of the lungs would be more correct, and where it is still necessary to undergo a CT scan, listen to the point of view of professionals: they will compare the proportion of radiation exposure received, take into account the nature of the disease being diagnosed and will be able to give the right direction.

Useful video

You can learn useful information about x-rays from the following video:

Conclusion

Nowadays, taking an X-ray of the lungs is not difficult. There are a number of medical institutions, both municipal and private, offering this service to the population.
The procedure allows you to examine the lungs and identify up to 90% of lung diseases.
In case of severe pathologies that threaten the health and life of the patient, it can be performed quite often.

One of the radiation methods for diagnosing internal organs is X-ray scanning, or radiography. The resulting image is applied to a hard drive, special film or paper.

Purpose of the examination

X-ray of the lungs is the most common and informative research method. This diagnostic method allows you to identify the presence of respiratory diseases:

sarcoidosis;
pneumonia (pneumonia);
malignant neoplasms;
tuberculosis;
chest injuries;
presence of foreign objects;
pneumothorax and other various pathological processes.

In order to prevent pulmonary diseases in citizens employed in hazardous industries (chemical industry, construction (masons), mining (miners), etc.), X-rays of the lungs are performed once a year (more often if necessary). What do the research results show in such cases?

The fluoroscopy response makes it possible to promptly prevent or recognize the disease and prescribe the necessary medication or other therapy.

The effect of radiation on the human body

Radiation exposure is considered radiation exposure, and some people refuse to undergo this procedure. However, this is in vain, medicine uses low-energy rays, the radiation dose is negligible, and the human body is exposed to them for a short period. A few years ago, scientists proved that even repeated X-rays (for medical indications) are not capable of harming health. In some cases, this procedure is also prescribed for pregnant women. Serious diseases that can be diagnosed using x-rays have more serious consequences than the minimum dose of radiation. As an alternative to conventional traditional X-rays, digital X-rays with an even lower radiation dose are now available.

Indications

Let's consider the symptoms for which the attending doctor prescribes a chest x-ray. What the image shows will determine the tactics for further management of the patient.

Periodic pain in the sternum.
Dyspnea.
High body temperature that lasts for a long time.
Blood in sputum.
Prolonged exhausting cough.
A large amount of sputum discharge.
Dry cough.

For the purpose of prevention, fluorography, or x-ray, is indicated to all citizens at least once every two years or more often in accordance with the recommendations of a medical professional.

Preparation and carrying out the procedure

You have been prescribed a lung x-ray, how can you prepare for it? No preliminary preparation is required. Before carrying out the procedure, you must remove jewelry (chains, beads, necklaces) so that they do not distort the result. Immediately before the procedure, your healthcare provider will ask you to wear a special skirt that wraps around your waist to protect your genitals from radiation. Next, the doctor selects the required projection (anterior, posterior, or sometimes the picture is taken in a side-lying position). Depending on the equipment on which the X-ray of the lungs was performed, the results will be instantaneous (digital method) or after some time after processing and developing the film.

X-ray results

Did you take an X-ray of your lungs? Let's look at what the transcript shows below:

Diaphragm defects.
The presence of fluid in the pleural cavity. A tumor or pleurisy is excluded.
A cavity in the lung indicates necrosis of the lung tissue. Diagnose tuberculosis, cancer or abscess.
Small focal darkening is a sign of pneumonia and tuberculosis. Large – bronchial tumor, metastases to the lungs.
Small lesions that are very common are sarcoidosis or tuberculosis.
A large, round shadow indicates advanced tuberculosis or a malignant neoplasm.

With the exception of the above, other changes in the lung tissue and lungs are detected, which help make the correct diagnosis and prescribe treatment. Unfortunately, there are cases of false results, or in cases where the study is carried out in the early stages of the disease, it may not be seen. For an accurate conclusion, in addition to the results obtained, other diagnostic methods are used in addition to X-rays, and the necessary laboratory tests are also carried out.

Dark spots on an x-ray

X-ray showed spots on the lungs? The reasons for their appearance may be: incorrect position of the patient during the procedure, poor-quality equipment, or the presence of pathology. Only a doctor can accurately interpret X-ray data.

Formations in the form of white spots indicate the presence of tuberculosis, bronchitis, pneumonia, pathology in the pleura, and occupational diseases. If a person has had bronchitis or pneumonia, then spots can be detected on an x-ray. They are regarded as residual manifestations of the disease, and they will disappear after some time.

If light spots are found in the upper parts of the lung, then tuberculosis is diagnosed, the main sign at the first stage of which is a light path running from the place where there is an inflammatory process to the root system. With timely and correct treatment, inflammation decreases and tissues undergo scarring. Instead of white, a dark spot appears in the photo.

If an X-ray of the lungs shows that black spots are visible, this indicates an exacerbation and the presence of chronic pneumonia. After a course of drug treatment and complete recovery, the spots disappear. Dark formations can also cause malignant pathologies. The detection of dark spots in a practically healthy person indicates many years of smoking; in children, it indicates a foreign body.

Does X-ray show pneumonia?

X-ray examination for pneumonia is both a method of identifying the disease and monitoring its progress. In order to recognize pneumonia, you need to know what the spots look like on pictures with this pathology. They may differ in size and location:

global spotty formations on the entire surface of the lungs;
subtotal – completely all fields (exception – upper lobes);
segmental - spots within the boundaries of a segment;
small spotted formations up to 3 mm with limited margins.

As a result of the development of the inflammatory process in the human lungs, fuzzy spots with blurred contours are formed and an x-ray shows inflammation of the lungs. The manifestation of spotty formations depends on the stage of the disease. The spots are more pronounced in advanced cases.

X-ray for bronchitis

The symptoms of the disease are similar to pneumonia. To confirm the diagnosis during a protracted course of the disease, certain types of examinations are prescribed, including x-rays, which will assess the condition of the respiratory system and clarify the diagnosis. Symptoms in the patient for which fluorography is indicated (x-ray of the lungs shows bronchitis in this case):

changes in the blood, according to laboratory tests;
severe constant shortness of breath;
prolonged increase in body temperature;
suspicion of inflammation in the lungs;
signs of obstruction.

Based on the results of the study, X-ray photographs pay attention to the following points in the lungs:

fuzzy outlines;
presence of root deformation;
changes in the drawing;
presence of lamellar lesions;
areas of fluid accumulation.

The opinions of specialists about the information content of X-rays in identifying the disease bronchitis are divided. However, this type of research is widely used in practical medicine.

X-ray for tuberculosis

If you suspect this serious disease, this type of lung examination will allow you to exclude or confirm pathology. The advantages of fluoroscopy for pulmonary tuberculosis are the ability to:

carry out various diagnostics of the disease;
exclude other pathologies of the respiratory system, such as pneumonia, cancer, abscess and others;
determine the nature of damage to lung tissue;
see the extent of the lesion;
see the location of pathological foci.

Therefore, the question of whether an x-ray will show pulmonary tuberculosis can be answered in the affirmative. However, this does not exclude additional manipulations to accurately confirm the diagnosis. X-rays reveal different types of tuberculosis:

intrathoracic lymph nodes;
disseminated;
focal;
infiltration;
caseous pneumonia;
fibrous-cavernous;
cirrhotic.

Does X-ray show lung cancer?

This disease is one of the most serious human ailments in recent decades. Chest X-ray is considered a diagnostic method for identifying this pathology at the earliest stages of its development. Signs or symptoms of the disease may include:

lethargy, constant drowsiness and weakness;
performance at zero;
regular fevers with apparent well-being;
dyspnea;
whistling breathing;
lingering cough that does not respond to therapy;
secretion of sputum with blood;
lack of appetite;
during coughing attacks, the presence of pain.

To exclude the disease, the doctor prescribes an examination. An X-ray will definitely show lung cancer, since this method is highly informative. Depending on the type of tumor and its location, the appearance on X-ray images will be different. To make an accurate diagnosis, the attending doctor will conduct additional examinations and, after assessing the general condition of the patient, prescribe adequate therapy.

X-ray of the lungs in children

If your child is prescribed an x-ray, you should familiarize yourself with the following points:

is there an alternative type of examination;
Is there a vital need for this procedure?

If in doubt, seek advice from another specialist.

In exceptional cases, the younger generation is prescribed radiography. Basically, when this is the only manipulation with which it is possible to exclude or confirm the diagnosis. One of the parents also comes into the office with the child. In order to reduce the negative effects of radiation, all areas of the body of the baby and his representative are protected with lead shields. The procedure lasts a few minutes, and your baby will not get tired. If an X-ray of the lungs shows that there is a focus of pathology, the doctor will prescribe treatment and the child will recover quickly.

Fluoroscopy is an effective method for diagnosing various diseases and, in experienced hands, provides invaluable assistance to the medical community.

And with any pathological processes, damage, or malfunctions in their work, there is a high probability of extremely serious consequences, even fatal.

Chest X-ray

Using an X-ray, the lung is examined specifically (in whole, in parts) or the condition of all organs of the chest is assessed:

its soft tissues and bones;
anatomical structures: lungs, heart, pleura, bronchi, trachea, mediastinum, ribs, spine, lymph nodes, vessels, respiratory tract (chest x-ray).

Chest X-ray makes it possible to detect and exclude the development and complications of a number of diseases at the initial stage. Among them:

cardiovascular;
lymphatic system;
pulmonary;
inflammatory diseases of the pleura.

It helps to identify traumatic injuries to the lungs and rib joints, rib fractures, see foreign bodies in tissues, gastrointestinal tract organs, respiratory tracts, etc.

What does a lung x-ray show?

Up to 90% of cases of all serious pulmonary diseases can be detected by chest x-ray. What this diagnostic method shows:

Besnier-Beck-Shaiman disease (sarcoidosis);
emphysema;
inflammation of the pleura ();
pneumonia ();
neoplasms, including malignant tumors;
(former name - consumption, phthisis);
pulmonary edema.

Why do they do it in two projections?

When do you need an x-ray of the lungs in two projections, what does this type of research show? Indications for this procedure are:

Assumption of the presence of tuberculosis. With X-ray in direct projection, it is not always possible to trace the infiltrative darkening of the upper pulmonary lobe. Lateral x-rays provide this opportunity. It also shows better the paths to the roots of the lungs, indicating tuberculosis of the respiratory system.
Diagnosis of pneumonia when direct x-rays or clinical data indicate the likelihood of this disease. The lung consists of segments, inflammation affects 1 or more of them. The most accurate way to determine the extent of the lesion and the segments of the lungs affected by inflammation is an x-ray in the lateral projection.
Diagnosis of heart diseases. An X-ray in 2 projections allows you to determine its size, control the location of the catheter in it or in the pulmonary artery, and assess the condition of the electrodes in the installed pacemaker.
Central and peripheral. Double radiography more thoroughly detects the presence of malignant neoplasms (cancerous tumors).
Pathological conditions of the pleura. X-rays in frontal and lateral projections are indicated for suspected pleurisy, accumulation of air in the pleural cavity ().
Radical edema at the pulmonary roots, enlargement of areas of the bronchi (bronchiectasis), small foci of infiltration, abscesses, cysts. It happens that on an X-ray in a direct projection they are not very clearly visible, in contrast to lateral photographs, when they are not hidden by the sternum.

How to do an x-ray of the lungs in a direct projection:

The subject stands between the X-ray tube and the detector (film): in the anterior projection - facing the detector, in the rear - facing the X-ray tube. In this case, the distance from the chest to the tube is about 2 m.
The chin is placed on the holder so that the cervical spine is in a straight position.
You must hold your breath while shooting.
Before the procedure, you need to remove jewelry, remove metal objects, and undress to the waist.

What do healthy lungs look like?

X-rays of the lungs of a healthy person and those with lung diseases make it possible to examine:

pulmonary fields on both sides of the spine, with linear shadows of the ribs projected onto them;
in the central area of the image - the sternum and shadow shading from the heart;
above - collarbone;
in the lower part of the image, under the pulmonary fields, there is the dome of the diaphragm.

Transcript: what does the darkening in the picture mean?

The transcript must indicate in which projection the x-ray was performed. Various darkenings indicate the following diseases:

Pneumonia. Both on the frontal and lateral projections, pronounced high-intensity shadows, large and small focal darkening are noticeable. Reduced transparency of the lung fields.
Tuberculosis. There are many small darkened foci, an intense pulmonary line, and an increased pulmonary pattern.
Exudative pleurisy. Due to the accumulation of fluid in the costophrenic sinus, a thin darkened strip appears on the image on the lower edge of the costal arch. The trachea is displaced or pulled forward.
Pulmonary edema. Uneven shadows in the form of flakes.
Venous stagnation of the pulmonary circulation (pulmonary circle). Extension of the roots, giving them a shape similar to the wings of a butterfly.
Malignant neoplasms (lung cancer). The X-ray image shows rounded shadows of different sizes, with clear boundaries.
Emphysema. The image shows consolidation of the diaphragm and increased airiness in the lung fields.
Peritonitis. Interpretation of an X-ray of the lungs indicates an accumulation of gases in the abdominal cavity in the absence of a cleared area under the domes of the diaphragm.
Atelectasis (collapse of the lung lobe). X-ray in the lateral projection shows darkening of the posterior mediastinum.
Heart diseases. The enlargement of the ventricle and atria is indicated by the rounded border of the shadow of the heart: the left - on the right, the right - on the left. In addition, the enlarged right ventricle gives rise to shadowing on the left side on the x-ray in the posterior-anterior direct projection.

How many times can an adult take?

X-rays can detect a number of lung diseases at the very first stage, which significantly increases the patient’s chances of recovery.

For information: when performing radiography on film X-ray machines of older modifications, in 1 procedure the human body acquires a radiation dose of approximately 0.3 mSv, on modern digital equipment - about 0.03 mSv.

The decision on how often to take an X-ray of the lungs is determined by a number of factors:

the health status of the person being examined;
nature and stage of the disease;
technical equipment of the X-ray room;
the pursued purpose of the x-ray is preventive or diagnostic;
patient's age.

A relatively healthy person should undergo preventive x-rays once a year. Diagnostic examination allows for 1-2 x-rays per year.

How often can a child be treated?

In this regard, it is advisable to carry out x-ray examinations of the lungs of children, as well as adults, no more than once a year.

if tuberculosis is suspected - once every 3 months to monitor the dynamics of the treatment process;
for pneumonia - 3–4 days after taking antibiotics, to establish the effectiveness of their use;
during radiation therapy of malignant tumors of the lungs, when the primary goal is the destruction of cancer cells, and not the effect of radiation on healthy cells - daily.

It is advisable for children to have x-rays performed using digital equipment, which will significantly reduce the amount of radiation exposure.

Attention: radiography of a minor child is performed only with the consent of the parents; up to the age of 12, one of the parents is present during the X-ray session in the X-ray room.

Where to do it?

When deciding where to get an X-ray of the lungs, a person is given a choice at his own discretion:

municipal clinic (hospital);
private paid clinic.

Is the procedure possible at home?

It happens that a person is not able to visit the X-ray room for a number of reasons:

due to old age;
for health reasons;
due to any physical disabilities.

In these cases, it is possible to take an x-ray of the lungs at home.

X-ray or fluorography?

Due to the increase in tuberculosis, mandatory preventive fluorography was introduced for the population, which must be completed annually.

Important: children under the age of 18 are prohibited from undergoing preventive fluorography!

Which is more accurate?

So what is more accurate - x-ray or fluorography of the lungs? Let's compare pictures of these two methods:

X-rays of the lungs. They have higher resolution and can be enlarged to very large sizes. Clear, allow you to obtain accurate data and make the correct diagnosis. X-rays make it possible to record changes occurring during the course of the disease, the dynamics of the disease, and the development of pathologies.
Fluorographic images of the lungs. The image has lower resolution than an x-ray. The small size of the images makes it possible to show only a general picture of the condition of the lungs and heart. Deviations from the norm of insignificant size (less than 0.5 cm) look like barely visible threads. Foci of infiltration in pneumonia exceeding 0.5 cm are noticeable, but only if they are located in clean areas of the lung fields. If a disease is suspected, the patient is also sent for an x-ray, which may not confirm the presumptive diagnosis. And this adds additional radiation exposure to the body.

Conclusion: X-ray of the lungs is a more accurate method than fluorography.

Which is more harmful?

Conclusion: fluorography gives a lower dose of radiation than x-rays, which means it is less harmful.

Which is better: CT or X-ray?

The CT (computed tomography) method is also based on scanning with X-rays, but passing through the body at different angles.

But x-rays have their advantages:

the dose of radioactive radiation is much lower (for CT scans it ranges from 3 to 10 mVs);
its cost is several times cheaper;
Almost all, even municipal, medical institutions have X-ray equipment, so it is more accessible.

When deciding where to take an X-ray of the lungs would be more correct, and where it is still necessary to undergo a CT scan, listen to the point of view of professionals: they will compare the proportion of radiation exposure received, take into account the nature of the disease being diagnosed and will be able to give the right direction.

Useful video

You can learn useful information about x-rays from the following video:

Conclusion

Nowadays, taking an X-ray of the lungs is not difficult. There are a number of medical institutions, both municipal and private, offering this service to the population.
The procedure allows you to examine the lungs and identify up to 90% of lung diseases.
In case of severe pathologies that threaten the health and life of the patient, it can be performed quite often.

X-ray of the lungs in two projections is carried out for diagnostic purposes. When it is necessary to identify pathological changes in the chest (pneumothorax, cancer), there are no more reliable methods than radiation methods.

Purpose and preparation for radiography in two projections

An X-ray of the lungs in the right or left lateral projections is prescribed in the following cases:

for the purpose of identifying heart diseases and pathological changes in the pulmonary fields;
control of catheter placement in the heart, pulmonary artery, as well as for the purpose of assessing pacemaker electrodes;
in the diagnosis of pneumonia, inflammatory changes in the bronchi, bronchiectasis.

X-ray of the lungs in two projections does not require special preparation, but a person will have to perform some manipulations:

Remove clothing and foreign objects that cover the examination area.
Leave your mobile phone and keys on the table, as well as other items that can accumulate radioactive radiation.

Direct (posterior-anterior) projection during radiography of the lungs

Direct (posterior-anterior) projection during chest x-ray is performed as often as possible if pneumonia is suspected or. There are some technical subtleties when implementing it:

the ideal focal length between the X-ray tube and the human chest should be on average 2 meters;
when placing the patient on the stand, the x-ray technician ensures that the chin is positioned on a special holder;
The height of the clamp is adjusted so that the cervical spine is straightened. When installed, a person leans his hands against the screen, and his chest is projected in the central part of the cassette;
When exposing the photo, you must hold your breath.

This is how a posteroanterior (direct) projection is performed when diagnosing respiratory diseases.

Lower lobe pneumonia on x-ray of the lungs in direct projection

Anteroposterior view of the lungs

An anterior-posterior image of the lungs in combination with left or right lateral projections is performed in the supine position. How to take a direct shot:

the patient is placed on the couch;
the head end rises up;
the cassette is placed under the patient's back, and the distance between and the object of study is selected as directed by the doctor. It should be taken into account that there should be no foreign objects in the path of X-ray penetration;
exposure is carried out with a deep breath.

Performing right and left lateral chest films

To perform lateral images of the lungs (left and right), special positioning is required:

hands are placed behind the head;
the left side leans against the cassette;
During exposure, one holds one's breath or takes a deep breath.

The patient is placed next to the cassette on the side that needs to be x-rayed.

Precautions

Chest X-ray is contraindicated in women. Radiation exposure to the fetus due to ionizing radiation involves the appearance of genetic mutations, which can lead to developmental abnormalities.

When performing the study, it is necessary to protect the human pelvic and abdominal area with a special lead apron.

When choosing lateral images (left or right), you must rely on the doctor’s prescription with a description.

The norm in photographs in two projections

The norm in photographs in two projections is characterized by the following indicators:

the width of the chest on a direct radiograph is twice as large as the transverse size of the heart;
pulmonary fields are symmetrical on both sides;
the spinous processes are located evenly in the vertical plane;
intercostal spaces are uniform.

Deviation from normal values in photographs of the lungs in two projections during pneumonia is the presence of additional intense shadows on the frontal and lateral radiographs.

Changes in the heart on direct and lateral x-rays

Changes in the heart on x-rays are combined with an enlargement of the right or left ventricles and atria. With an increase in size on the left, the roundness of the left border of the cardiac shadow will be visualized on the x-ray.

What influences the result of the study

When taking x-rays, it is important that the patient learn to hold their breath until exposure, which will prevent the need to repeat the x-ray.

Incorrect centering of the chest during radiography may interfere with visualization of the costophrenic sinus.

Distortion of the results is also observed when a person has a lateral curvature of the spinal column.

In two projections, radiography is performed if any disease is suspected, which is accompanied by damage to the chest cavity, and the purpose of performing a lateral image is no different from the direct one.

Particular attention should be paid to the laterogram– a special study to determine the presence of fluid level in the costophrenic sinus. During the examination, the person is placed on his side and an X-ray image is taken with the X-ray beam directed anteriorly. In this case, the cassette is installed from the back of the back. In the presence of exudative pleurisy, a thin strip of darkening can be traced in the lower part of the costal arch, reflecting the accumulation of fluid in the costophrenic sinus.

Against the background of pathology, an increase in the pulmonary pattern may be observed. In this case, the results have a radial direction, and the veins are located in the horizontal plane.

Thus, in two projections, X-ray images are prescribed for diagnostic purposes to identify diseases of the cardiovascular and respiratory systems.

MINISTRY OF HEALTH AND SOCIAL DEVELOPMENT OF THE RF

STATE EDUCATIONAL INSTITUTION

HIGHER PROFESSIONAL EDUCATION

RUSSIAN STATE

MEDICAL UNIVERSITY

FEDERAL HEALTH AGENCY

AND SOCIAL DEVELOPMENT

X-RAY BASICS OF DIAGNOSIS OF LUNG DISEASES

MOSCOW 2006

Reviewers:

M.Yu.Mishin- Doctor of Medical Sciences prof. head Department of Phthisiology of the State Educational Institution of Higher Professional Education MGMSU, V.A. Koshechkin- Doctor of Medical Sciences prof. course of tuberculosis at the Faculty of Medicine of the State Educational Institution of Higher Professional Education of RUDN University.

Authors: V.A. Stakhanov- Doctor of Medical Sciences prof., V. F. Razumovskaya- Doctor of Medical Sciences Associate Professor, N.D. Medunshchyna- Ph.D. Associate Professor, NOT. Galygina- Ph.D. Associate Professor, M.I. Borisova- Ph.D. Associate Professor, N.A. Katorgin- Ph.D. Associate Professor, O. K. Kiselevich- Ph.D. Associate Professor, E.V. Bogdanova - Ph.D. Associate Professor, T.I. Sharkova- Ph.D. ase, KV. Kostpenko - ase, L.A. Turkina- ace.

X-ray basis for diagnosing lung diseases. Study guide. - SCH State Educational Institution of Higher Professional Education RSMU Roszdrav, 2005. - 39 pp. ISBN5-88458-151-3

The textbook summarizes and presents information about the normal x-ray picture of the respiratory organs, taking into account age-related characteristics and developmental options, proposes an algorithm for reading and describing x-rays, and details and illustrates the main syndromes characteristic of various forms of pulmonary tuberculosis.

The manual is intended for independent classroom and extracurricular work of students of medical and pediatric faculties of medical universities.

In this methodological guide, we suggest that you use a logical scheme for assessing a plain X-ray of the chest organs in frontal and lateral projections, used in both the simplest and most complex diagnostic cases. A logical analysis of all available data will allow us to pay attention to early radiological signs of a particular pathology, which often does not manifest itself clinically. Timely detection of the disease will make the task of treatment easier for you, will most fully preserve the patient’s quality of life and will save the state’s costs on the treatment.

INTRODUCTION TO RADIOLOGY

An x-ray is negative, so the white areas on the x-ray are called “shades” and the black areas are called “clearances.”

X-ray- a summarized shadow picture of all organs and tissues of the chest on the film plane, which, naturally, changes depending on the change in the direction of the X-ray beam and the position of the patient. Radiographs are important objective clinical documents, the study and comparison of which is possible without time limits.

In clinical radiology, there are eight main standard projections of the chest, which have their own specific features and advantages for better viewing of certain parts of the chest.

Based on the direction of the central beam of X-rays in relation to the frontal plane of the subject, two direct projections are distinguished - anterior and posterior, when the rays pass perpendicular to

frontal plane of the chest, two lateral projections - right and left, when they go almost in the transverse direction along the longest diameter of the chest, and four oblique projections - right and left nipple and right and left scapular, when the central ray forms with the frontal plane of the patient angle 45 - 60.

The names “anterior and posterior direct projection”, as well as “right and left lateral”, etc., indicate the adherence to the film of the corresponding surface of the chest of the examined nipple or scapula in oblique positions.

The anterior direct, right and left lateral projections are the main ones for X-ray examination of the patient. The remaining projections are of an additional (clarifying) nature.

Depending on the completeness of coverage of the chest, radiographs can be overview or targeted.

Analysis of a survey radiograph in the anterior direct projection of the chest organs of a healthy person

It is advisable to start the analysis of the radiograph with the passport data indicated on the film:

Full name subject - make sure that the proposed radiograph is the result of a study of the patient in question.

AGE - As the body ages, it will naturally have some differences in the X-ray image.

The DATE of the study will help you compare the data from X-ray and other examination methods, and if there is a series

radiographs - build a clear picture of the dynamics of the pathological process.

A diagnosis is not a list of conclusions from the methods used to examine the patient, but is the result of an analysis of all the data obtained. happening in the human body.

Before you begin evaluating a radiograph, you must correctly install it on the X-ray viewer. To do this, you should pay attention to the shadow of the heart: in a healthy person, one third of this shadow is located to the right of the midline, and two thirds to the left.

When you are convinced that this radiograph belongs to the subject and is correctly installed on the X-ray viewer, proceed to its analysis and description.

To objectively evaluate a radiograph, it is necessary to know its normal parameters.

The lungs form the so-called pulmonary fields in the image - right and left. Each of them is much smaller than the true size of the lung, since a significant part of them is hidden on the anterior image behind the shadow of the diaphragm and subphrenic organs, as well as behind the shadow of the heart and the upper mediastinum.

X-ray description diagram

Technical specifications.

Condition of the soft tissues of the chest.

Condition of the skeletal structure of the chest.

Pulmonary pattern analysis.

Assessment of transparency and symmetry of pulmonary fields.

Analysis of the roots of the lungs.

Analysis of the mediastinum (middle shadow).

Condition of the diaphragm and phrenic sinuses.

During diagnostic radiography and when pathology is detected on a plain chest x-ray in a direct projection, it is mandatory to conduct a study in lateral projections.

Technical characteristics analysis

COMPLETENESS OF COVERAGE OF THE CHEST ORGANS is considered sufficient when the film shows all parts of the chest - from the apex of the lung to the costophrenic sinuses.

INSPIRATION DEPTH. The radiograph should be taken at an average depth of inspiration. In this case, the highest point of the dome of the diaphragm on the right is at the level of the 5th intercostal space or VI rib along the midclavicular line, on the left - 1 - 1.5 cm lower. Depending on the depth of inspiration, the transparency of the pulmonary fields changes. With insufficient inhalation depth, the transparency of the lung fields decreases, especially in the lower sections. When you inhale too deeply, the airiness of the lungs, on the contrary, increases, which makes it difficult to objectively assess the condition of the lung tissue.

CORRECT SETTING OF THE PATIENT. When the patient is correctly positioned in front of the apparatus, the clavicles should be at the same level and the distances between the medial contours of the clavicles and the midline of the body, drawn to represent the spinous processes of the vertebrae, are the same on both sides. The approach of one of the contours of the clavicle to the midline indicates a forward turn of the patient with the same shoulder. In this case, the symmetry of the pulmonary fields is disrupted, the position of the shadow of the heart and the roots of the lungs changes. The location of the clavicles at different levels indicates an inclination

patient. The shoulder blades should be moved beyond the projection of the pulmonary fields. The shoulders must be lowered, otherwise the shadows of the collarbones are layered on the tops of the lungs and partially overlap them.

RIGIDITY. With standard rigidity, 3-4 intervertebral spaces are identified in the upper part of the thoracic spine; the shadows of the ribs do not overlap the pulmonary pattern. On a “hard” radiograph, the intervertebral spaces are visible all the way to the lumbar spine. On a “soft” radiograph, the spine is represented as a solid shadow.

CONTRAST. A contrast radiograph should show several shades of black and white image. The color of the middle shadow is close to white. The color of the ribs is gray, and the lung fields in areas where there are no shadows of the ribs are close to black. The absence of any of these shades leads to a decrease in the contrast of the image and makes it difficult to analyze.

DEFINITION. Definition implies the presence of well-defined (distinct) contours between tissues of different densities (skin, soft tissue, bone). Clarity depends on the degree of breath holding and the absence of the slightest movements of the patient.

ARTIFACTS. The surface of the radiograph should have a uniform matte shine in reflected light. This quality of the x-ray image can be impaired by scratches, areas of the film that have not been washed from reagents, exposed or blackened, or defects in the production of the film. After assessing all technical characteristics in the description protocol

it is necessary to draw the following conclusion: “A survey radiograph of the chest in the anterior direct projection was performed with satisfactory or unsatisfactory technical characteristics.” In the second case, it is necessary to indicate specifically which of the parameters is unsatisfactory.

In cases where existing technical errors do not interfere with the objective assessment of the radiograph, you can continue to analyze it and give your conclusion.

Analysis of the X-ray picture of the soft tissues of the chest

A good quality radiograph often shows shadows of the pectoralis major muscles, especially their lower borders. They are layered on the middle section of the pulmonary fields on each side between the anterior segments of the II and IV (V) ribs. The upper contour of the pectoralis major muscle is blurry, while the lower, especially in muscular people, is clearly outlined by a straight line running obliquely upward and outward beyond the pulmonary field. In persons engaged in physical labor, less transparency of the middle belt of the right pulmonary field is often determined due to the greater development of the pectoralis major muscle on this side. The internal parts of the apices of the lungs, as a rule, are less transparent than the external ones, due to the shadows of the sternocleidomastoid muscles, the lateral edge of which is often clearly visible. Parallel to the upper edge of the clavicle and slightly above it, a strip is visible, extending outward beyond the limits of the pulmonary field, and inside merging with the shadow of the neck. This is a display of a fold of skin that follows the line of the upper edge of the clavicle and passes into the supraclavicular fossa. Dark stripes running parallel to the lower edge of the posterior segments of the 1st, 2nd and 3rd ribs are formed by intercostal muscles and vessels located at the lower edge of the ribs. These stripes differ from pleural moorings in their uniform color and smooth contours. The lower sections of the pulmonary fields (from the level of the IV-VII ribs) in women are usually less transparent than the rest, due to the overlap of the shadows of the mammary glands, the boundaries of which are clearly visible and extend beyond the pulmonary fields. In most cases, the mammary glands

give homogeneous, structureless shadows, somewhat asymmetrically located. Against their background, small, round, more intense and fairly clearly contoured shadows from well-developed nipples can be identified; the latter can also be radiographically imaged in men, simulating clearly defined lesions. In women with an atrophic state of the mammary glands, their sclerotic vascular branches may appear, which enriches the pulmonary pattern of the lower parts of the pulmonary fields (Fig. 1).

Rice. 1. X-ray projections of the soft tissues of the chest (diagram): 1 - skin fold; 2 - pectoralis major muscle; 3 - nipple; 4 - mammary gland; 5 - accompanying stripes of the I-II rib.

In the absence of soft tissue pathology, the X-ray report states: “No visible pathology is determined from the soft tissues.”

If any changes in soft tissues and muscles are detected, these changes are described in detail in the protocol.

Analysis of the X-ray picture of the thoracic bone skeleton

The pulmonary fields in adults are limited above by the lower contour of the posterior segment of the second rib, and laterally by the shadows of the intersecting costal arches. Strip-shaped shadows of the ribs, projected on a transparent pulmonary background, are clearly defined in the number of 9-10 pairs on both sides. The rear, denser segments of the ribs give more intense shadows, are narrower than the front ones and first have a short upward bend, and then go from top to bottom and outward. The anterior segments of the ribs run from the midline from bottom to top and outwards (the anterior segment of the rib intersects with the collarbone). The shadow of unmodified ribs normally have the appearance of a strip-shaped horseshoe-shaped shadow, extending with a gradual expansion anterior to the shadow of the spine. The central part of the shadow of the rib has a uniform fine mesh structure, higher density in the posterior fragments of the rib and lower density in the anterior ones. The cortical sections of the ribs are distinguished by the highest density, homogeneous structure and sharp contours. The cartilaginous sections of the ribs, transparent to x-rays, are not visible; their shadow ends at a distance of 2 - 5 cm from the sternum. In older people, cartilage usually calcifies and becomes visible. There may be additional cervical ribs, which can be developed to varying degrees. Therefore, their shadows, sometimes low in intensity and not entirely uniform, can simulate various pathological changes in the area of the apexes of the lungs.

Changes in the appearance of the shadows of the ribs can be represented by: various types of synostoses and bridges between the ribs; bifurcation of the rib (Lyushka rib) - most often the anterior segments of the 1st - 5th rib; club-shaped thickenings at the ends of the ribs and “rosary beads”.

Age-related ossifications in the cartilaginous part of the ribs can be represented by high-intensity shadows of various sizes and shapes, often located symmetrically at different levels of the radiograph in the projection of the cartilaginous part of the ribs.

The shadow of the clavicle in adults is projected onto the upper sections, separating the apexes from the rest of the pulmonary fields. When the patient is positioned correctly, the medial ends of the clavicle are symmetrically spaced from the shadow of the spine and located at the level of the third intervertebral space. Her bone structure is not uniform everywhere. In the region of the medial end of the clavicle, at the site of attachment of the sternocleidomastoid muscle, a more compact arrangement of bony trabeculae is usually clearly visible. The latter sometimes close a more transparent spongy section of bone tissue in this part of the clavicle, simulating a cavity.

The shadow of the sternum is partially visible: to the right and left, outward from the median shadow, slightly below the inner ends of the clavicle, only the facets of the manubrium protrude (if interpreted incorrectly, these shadows can be mistaken for enlarged lymph nodes of the paratracheal or tracheobronchial groups).

The shadows of the scapulae are usually projected with their greater mass outside the lung fields. This is facilitated by a special positioning of the hands when taking the picture.

The shadows of individual elements of the vertebrae are poorly distinguishable. The bodies of the I-IV thoracic vertebrae with the posterior arches of the ribs overlapping them are most clearly visible. On some x-rays, the spinous processes are visible in the middle of the vertebra in the form of a teardrop. The transverse processes of the vertebrae from I to VI-VII thoracic vertebrae on the right and to IV-V on the left are clearly visible. Clear

the contours of their shadows with signs of trabecular bone structure are easily distinguished from enlarged and compacted lymph nodes (Fig. 2).

If there is no pathology of the bone structures, the X-ray report says: “No pathology is determined from the bone structures.” If any changes are detected in the bone structures, these changes are described in detail in the protocol.

Rice. 2. X-ray projections of the bone structures of the chest (diagram). 1 - cervical rib; 2 - bone bridge between the anterior segments of the I-II rib; 3 - dense bridge in the posterior sections of the 5-6 ribs; 4 - Lyushka fork (split rib); 5 - calcified costal cartilages; 6 - blade.

Analysis of transparency and symmetry of pulmonary fields

The radiological term “pulmonary fields” is usually understood as that part of the chest x-ray on which the projection of the lungs is visible. The boundaries of the pulmonary fields do not always correspond to the contours of the lungs. In particular, the medial and lower borders of the lung are covered by the median shadow and diaphragm, respectively, and are not visible on the image.

Normally, the lung fields are transparent due to the airiness of the lungs. The transparency of the pulmonary fields in different sections is not the same. In particular, in men, the lower sections are the most transparent and the middle ones the least. In women, the lower sections are less transparent due to the overlap of shadows of the mammary glands, and the most transparent are the upper sections.

The pulmonary fields should be considered symmetrical if the ratio of the left pulmonary field to the median shadow and the right pulmonary field is 3:5:4 (in parts). The symmetry of the pulmonary fields is affected by incorrect positioning of the patient when taking an x-ray (turning one shoulder forward).

In the absence of pathology, the X-ray report states: “The pulmonary fields are transparent and symmetrical.”

Pulmonary pattern analysis

Pulmonary pattern- this is a set of linear shadows crossing the lung fields from the roots to the peripheral parts. The main basis of these shadows of the pulmonary pattern are blood vessels in various projections. The pulmonary vessels visible on the radiograph belong to the branches of the pulmonary artery and pulmonary veins. Bronchial branches

in the normal state of the bronchial walls, although they participate in the shadow pattern of the lung, their share in the formation of the pulmonary pattern is significantly less than the vascular trunks (Fig. 3).

The pulmonary pattern is most pronounced in the medial sections, where the roots of the lungs and large vascular trunks are located. In the middle sections it becomes somewhat poorer due to a decrease in the caliber of blood vessels. In the lateral sections within 1.5 - 2 cm from the edge of the pulmonary field, the pulmonary pattern is practically not visible, since in the peripheral sections of the lungs the vessels are so small that they are normally not visible. They only contribute with their total mass to a slight decrease in the transparency of these sections of the lungs fields. In addition, the densest pulmonary pattern is observed in the lower parts of the pulmonary fields, where the terminal branches of the pulmonary arteries and the basins of the lower pulmonary veins are projected. The volume of the lungs in the lower parts is greatest, and therefore the number of vessels is greater here.

Fig.3. Vascular-bronchial bundles of the lung (according to K.V. Pomelyev).

Right lung: 1 - apical, 2 - posterior and 3 - anterior bundles of the upper lobe; 4 - external and 5 - internal bundles of the middle lobe; 6 - apical, 7 - medial-basal, 8 - anterior-basal, 9 - lateral-basal and 10 - posterobasal bundles of the lower lobe.

Left lung: 1 - apical, 2 - posterior. 3 - anterior, 4 - upper and 5 - lower bundles of the upper lobe, 6 - apical, 8 - anterior-basal, 9 - lateral-basal and 10 - posterobasal bundles of the lower lobe.

V.A. - azygos vein (v. azygos)

Characteristic signs of the shadows of the vessels that make up the pulmonary pattern:

A regular decrease in the width of shadows towards the periphery.

Dichotomous type of branching.

Y-shaped nature of the terminal branches.

Clarity of contours.

In symmetrical areas of the lung fields per unit area (costal rhombus), the same number of linear shadows is determined.

The pulmonary pattern consists not only of the linear shadows of the vessels lying in the plane of the radiograph. Along with them, round and oval shadows of higher density are noted in the pulmonary fields, formed by the shadows of vessels running in a transverse projection (perpendicular to the plane of the radiograph).

The shadows of the vessels running in the transverse projection have:

rounded shape;

clear contours;

homogeneous structure;

the diameter of the shadow is equal to the width of the vessel lying in the plane of the radiograph at a given level;

the shadow has an incoming and outgoing path.

As mentioned above, the bronchial tree does not participate in the formation of the pulmonary pattern. However, the appearance on the radiograph of the bronchus running in the transverse projection is ring-shaped shadows (cross section of the bronchus). It is characteristic that next to the ring-shaped shadow of the bronchus there is an intense shadow of the cross section of the vessel of the same diameter (Fig. 4).

Rice. 4. Elements of the pulmonary pattern on a plain X-ray of the chest organs (diagram).

A - view of elements in orthograde projection: 1 - shadow of the vessel; 2 - ring-shaped clearing of the bronchus;

B - view of the elements in direct projection: 1 - terminal branches of the vessels; 2 - dichotomous branching of vessels; 3 - head of the lung root.

In the absence of pathology of the pulmonary pattern, the X-ray report states: “The pulmonary pattern is not changed.”

If any changes in the pulmonary pattern are detected, they are described in detail in the protocol.

Root lung analysis

The roots of the lungs are formed by the largest trunks of the pulmonary vascular system. Not only arteries and veins take part in the shadow formation of roots, but also the bronchial system, lymph nodes and connective tissue along with lymphatic vessels -SH nerve trunks.

In the shadow picture of the lung root, it is customary to distinguish three sections: upper (head), middle (body) and lower (tail) (Fig. 5).

Rice. 5. Root of the right lung (diagram):

1 - head; 2 - body; 3 - lumen of the intermediate bronchus; 4 - tail.

The shadow of the root head corresponds to the arch of the pulmonary artery, which it forms when entering the lung, as well as to the vessels extending from the arch to the upper and outer parts of the lung. The root body corresponds to the vertically directed trunk of the pulmonary artery, medially from which there is an intermediate bronchus, separating the artery from the median shadow. Arterial vessels extending to the anterior and posterior zones, and venous trunks - the upper and sometimes the lower pulmonary vein - also take part in the formation of the shadow of this part of the root. The caudal part of the root is formed by proximal segments of the terminal branches of the pulmonary vessels that supply blood to the lower zones. The intermediate and lower lobe bronchi in the structure of the right bronchus are represented by a light strip separating the vascular shadow from the median shadow; on the left, the root shadow is adjacent to the median shadow.

X-ray parameters characterizing the roots of the lungs

J "^.--Topography. The head of the right root is localized at the level of the anterior segment of the second rib. On the left it is located 1 - 1.5 cm higher. The caudal part of the root on the right is localized at the level of the anterior segment of the 4th rib.

Form. On the right, the root configuration resembles a comma, on the left, it is an oval.

Structure. The root normally has a heterogeneous structure. It clearly differentiates the shadows of individual vessels lying both in the plane of the radiograph and running perpendicularly. The outer contour of the roots of the lungs is smooth and clear. Determined by the border of the pulmonary artery shadow.

Width. On the right, the width of the root is measured from the outer contour to the lumen of the bronchus and is equal to 1.5-2 cm. The shadow of the left root is somewhat wider, but on the radiograph in the anterior direct projection it can be partially covered by the median shadow. The ratio of root width to bronchial lumen is normally 1:1 or 1:1.5.

Presence of pathological inclusions. Normally, it is not possible to see the shadows of the lymph nodes separately, since they are small and their tissue has almost the same density as the vascular elements of the blood. However, in some individuals, shadows of calcified lymph nodes can often be found, which indicates tuberculosis in the past.

In the absence of pathology of the lung root, the X-ray report says: “The roots of the lungs are not changed.” Any detected changes in the root of the lung should be described in detail in the protocol.

Median shadow analysis

On a direct plain radiograph, the median shadow is formed by the trachea, large vessels and the heart. The lumen of the trachea is visible due to its wall and is determined approximately up to the III-IV thoracic vertebra. Due to the lumen of the trachea, the bodies of the III-IV upper thoracic vertebrae are clearly visible on the x-ray. Below is the shadow of the cardiovascular bundle. The heart and blood vessels form an oval-shaped shadow on the radiograph, obliquely located with respect to the axis of symmetry of the radiograph. According to the topographic-anatomical features of the location of the vessels and various parts of the heart, the median shadow is presented on the right in the form of two, and on the left in the form of four fairly clearly defined arcs. On the right, the edge of the median shadow is formed by the right atrium and the ascending part of the aortic arch, on the left - the descending part of the aortic arch, the conus of the pulmonary artery, the appendage of the left atrium, and the left ventricle (Fig. 6).

Rice. 6. Median shadow of a plain X-ray of the chest organs in a direct projection:

Right atrium;

Ascending part of the aortic arch;

Descending part of the aortic arch;

Conus pulmonary artery;

Left atrial appendage; 6-left ventricle; AB is the axis of symmetry of the radiograph; Z - heart length; Mr - small transverse size; Mi - large transverse size; Gi - angle

inclination of the length of the heart to a horizontal line.

To assess the parameters of the median shadow, the length of the heart is isolated - the line connecting the apex of the atriovasal angle with the outermost point of the apex of the heart. The position of the middle shadow is determined by the angle of inclination of its length to the horizontal line. Normally, this angle is 42 - 56°. The transverse size of the median shadow consists of two parts: Mr and Ml, which are perpendiculars lowered from the most distant points of the right and left contours to the midline. The elements of the transverse size of the heart are related to each other as 1:2.

Descriptions of the median shadow include:

location of the median shadow;

description of the type of shadow;

the severity of the cardiac arches, the clarity of their contours;

assessment of the angle of inclination of the length of the heart to the horizontal line;

the ratio of the transverse dimensions of the heart shadow to each other.

The protocol must make a conclusion about the presence or absence of pathology on the part of the median shadow.

Analysis of the diaphragm and diaphragmatic sinuses

The diaphragm limits the pulmonary field from below with a dome-shaped shadow. In its central part it stands highest; towards the periphery of the pulmonary fields, the shadow of the diaphragm descends steeply downward and forms sharp costophrenic angles.

The position of the diaphragm depends both on the depth of inspiration and on the degree of airiness of the lung parenchyma. Normally, with an average depth of inspiration, the highest point of the dome of the diaphragm is on the right at the level of the fifth intercostal space - VI rib along the midclavicular line, on the left - 1.5 cm lower. The high standing of the domes of the diaphragm at the level of the 4th intercostal space is observed during exhalation or shallow inspiration, in the presence of air in the abdominal cavity and relaxation

diaphragm. Low standing of the domes of the diaphragm is observed with asthenic physique and pulmonary emphysema. The contours of the diaphragm are normally clear and even. The costophrenic and cardiophrenic sinuses are pointed and free.

Description of the shadow of the diaphragm and phrenic sinuses includes an assessment of:

diaphragm shapes;

clarity of its contours;

the location of the right and left domes of the diaphragm relative to each other and in relation to the intercostal spaces;

the magnitude of the sinus angles (cardio-phrenic and costo-diaphragmatic).

After assessing the parameters of the diaphragm and phrenic sinuses, a conclusion is made.

X-ray, unlike fluorography, is characterized by stronger radiation exposure to the patient. Performed for diagnostic purposes. Fluorography is a preventive examination.

Chest X-ray and fluorography: similarities and differences

Classic chest radiography is performed in a posteroanterior projection. The size of an object on an x-ray is determined by the distance between the radiation source and the patient.

X-ray and diagram showing normal anatomical structures in the image

The size of the image of the heart, pulmonary fields, ribs, and collarbones is somewhat distorted during radiography in bedridden patients in intensive care units. The research is carried out using mobile devices that have limited exposure modes.

Factors leading to enlargement of blood vessels and the heart when lying down on radiography: The level of the diaphragm increases;
Redistribution of blood flow in the cardiovascular system enhances the pulmonary pattern and expands the left chambers of the heart;
A short focal length increases the volume of the image in the photo.

What should be described on a chest x-ray

When analyzing a chest X-ray, a radiologist should analyze the following anatomical structures:

1. Caliber of pulmonary vessels;
2. Cardiothoracic index;
3. Aperture location;
4. Condition of the costophrenic sinuses;
5. Pulmonary fields;
6. Osteoarticular system;
7. Surrounding soft tissues.

Physiologically, the blood supply to the vessels is stronger in the lower parts of the lung fields due to the pressure gradient. If you take a picture of a person who is standing on his head, the blood supply to the upper pulmonary lobes on both sides increases.

In patients with venous congestion due to heart failure, the caliber of vessels in the upper pulmonary fields increases. At the same time, an increase in the pulmonary pattern in the roots can be observed.

When describing an X-ray image of the chest cavity, the radiologist must take into account the congestion of the vessels of the upper lobes when exposed in the supine position. When taking a picture while exhaling, the expansion and elevation of the heart shadow can be seen. The diaphragm is slightly raised. The pulmonary pattern of the upper pulmonary fields is enhanced.

To improve the quality of chest radiography in bedridden patients, a screening grid must be installed along with the cassette. The device is able to eliminate the distortion of X-rays, which results from the difficulty of perfectly maintaining the sagittal plane between the surface of the patient's body and the path of the X-rays.

Chest X-ray to verify heart disease

The use of X-rays to study the condition of the heart is losing relevance due to the use of more technological diagnostic solutions. Modern ultrasound machines make it possible to study not only the state of the myocardium, but also the internal structure of the heart cavities. Dopplerography indicates the nature of blood movement.

When describing a chest X-ray, the radiologist first sees the cardiac shadow. The specialist must indicate the presence of pathology in order to diagnose heart disease at an early stage.

The standard for cardiac shadow analysis involves measuring the cardiothoracic index. The indicator evaluates the ratio of the transverse size of the heart (the outermost points are marked on the image) to the length of the anterior aperture of the chest. In adults, the rate normally does not exceed 0.5.

In children, the ratio is slightly higher due to anatomical features. In a child under 1 year of age, the cardiothoracic index should not exceed 0.65.

The need to describe the heart by radiologists is justified by the possibility of early verification of pathology. Every adult must undergo fluorography once a year according to the law. Every year, a radiologist examines almost all patients assigned to a medical institution. The specialist has the ability to establish an early diagnosis. Of course, the purpose of an X-ray fluorographic examination is somewhat different, but we should not forget about the cardiothoracic index.

Information for radiology doctors

When a cardiac shadow is detected in the middle part of the right lung, it becomes necessary to establish the localization of infiltration. The issue can be resolved by performing radiography in the right lateral projection, but there is a simpler practical observation. If, against the background of infiltrative darkening, the right contour of the heart can be traced, pathology in the upper segments of the right lower lobe is easy. If the darkening and the contour of the cardiac shadow merge, the middle lobe is affected.

Fluorography - what is it?

Fluorographic is a preventive x-ray examination, intended primarily for the early detection of tuberculosis. Of course, during screening studies, other nosological forms are visualized in the images - pneumonia, cancer.

The main purpose of fluorography is to detect tuberculosis. It was for these purposes that a mass annual screening examination of all people once a year was legally introduced, except for children.

Patients ask “is it possible to do an X-ray of the lungs instead of fluorography?” The answer is ambiguous. Fluorographic examination using modern digital equipment leads to a reduction in the patient’s radiation exposure 100 times less than with classic chest radiography. This effect is achieved by the unique technology of digital fluorographs. To scan the lungs, such devices use a thin beam of X-rays that linearly passes through the entire chest cavity of the patient.

In traditional radiography, images on film are obtained after the X-ray tube emits a large quantum of ionizing radiation. If suspicious shadows are detected on the fluorogram, the patient is sent for an X-ray of the lungs in two projections. Fluorography is characterized by a lower resolution compared to conventional x-ray examination. The rationality of the type of examination in both cases is determined by the attending physician.

Normal X-ray of the lungs - what does it show?

When describing a normal X-ray of the lungs, doctors do not pay attention to changes in the pleura, although in some tumors the pleural layers are affected first.

A photograph of the lungs in a lateral projection and a diagram showing the anatomical structures in the image

The thickness of the pleural pulmonary sheet is 0.2-04.0 mm, which does not allow it to be visualized on an x-ray. Normally, the pleural layers appear as a thin strip only in those places where the X-ray rays pass tangentially. In the image, you can sometimes trace a linear shadow in the upper lobes formed by the pleural layers.

Anatomically, in some people, the pleural layers are mistaken for a pathological thickening, which is clearly visible in the posteroanterior projection. The wavy contour of the formation is due to the intercostal spaces. Such changes should be considered a normal x-ray picture. Accompanying stripes are observed along the ribs. A thin line above the collarbone is formed by a fold of the skin of the organ.

A separate shadow in the image is formed by the sternocleidomastoid muscle. The radiologist must clearly distinguish these formations from pathological shadows.

Pathological thickening of the pleura when radiography of the pleural layers is classified as widespread or focal. Causes of the condition:

Traumatic;
Inflammatory;
Malignant.

Areas of thickening are clearly visible in the posteroanterior projection due to the tangential direction of the beam.

Calcifications of the pleural layers are localized on the anterior or posterior wall. They should not be mistaken for intrapulmonary formations. For differential diagnosis and localization, radiography should be performed in two projections.

You should be wary if there is a limited shadow more than 1 cm in diameter. To differentiate the affected leaf, a fluoroscopic examination should be performed. If the formation is located on the visceral pleura, it moves after the lungs. When the shadow is localized on the parietal pleura, a shift of the darkening can be seen following the ribs.

Computed tomography is prescribed when the pleura thickens more than 3 mm. Fibrous changes often affect the visceral layer. Primary fibrosis (proliferation of granulation tissue) does not pose a threat to human life and health.

There are primary tumors of the pleura, but more often secondary tumors are detected - metastases from ovarian, breast, colon, and kidney cancer. When it grows into the pleural cavity, fluid may accumulate in the pleural cavity.

Pleural mesothelioma is a primary malignant tumor that occurs against the background of asbestosis lesions of the pleural layer. On an x-ray, the formation can be seen in the form of nodular thickenings localized along the edge of the mediastinum or lungs. The tumor may come into contact with the diaphragm or be localized. In advanced cases, a malignant neoplasm can damage the pericardium. In pathology, pronounced thickening of the pleura and effusion in the costophrenic sinus can be observed.

Densitometry is used for differential diagnosis between fibrous changes in the pleura and mesotheliomas. The method allows you to determine the density of the fabric. With a tumor, the density of the pleural layers increases to 80 HU (with fibrosis - 40 HU).

When analyzing a normal radiograph of the lungs, in addition to the pleura, it is necessary to analyze the symmetry of the pulmonary fields. Changes in transparency, abnormal darkening are a sign of pathology.

Unilateral increased transparency occurs after mastectomy, excision of cervical lymph nodes, hematoma of the chest wall, unilateral muscle atrophy.

Accumulation of air in the soft tissues of the chest is a sign of rupture of the lung or soft tissues after injury. Pneumothorax is clearly visible on direct radiographs.

An x-ray should carefully examine the bone structures for metastases. Enlarged bone contour with external periostitis requires additional diagnosis using CT.

X-ray and diagram showing the anatomical structures of the cardiovascular system