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Background/Purpose

Patients with the following conditions should be evaluated with a chest X-ray:

Fever (>37.8° C / 100° F)
Tachypnea (> 20 breaths/min)
Tachycardia (> 100 bpm)
Decreased breath sounds and crackles in the physical exam
Findings
Chest x-rays can reveal areas of opacity (seen as white) which represent consolidation. Pneumonia is not always seen on x-rays, either because the disease is only in its initial stages, or because it involves a part of the lung not easily seen by x-ray.
A normal chest x-ray makes community-acquired pneumonia (CAP) less likely; however, CAP is sometimes not seen on x-rays because the disease is either in its initial stages or involves a part of the lung not easily seen by x-ray.
X-rays can be misleading, because other problems, like lung scarring and congestive heart failure, can mimic pneumonia on x-ray. Chest x-rays are also used to evaluate for complications of pneumonia.
Chest x-ray findings are usually nonspecific in viral pneumonia.
Computed tomography is used in situations when the diagnosis is not clear with a chest x-ray

Procedure

Patient position
patient is erect facing the upright image receptor, the superior aspect of the receptor is 5 cm above the shoulder joints
the chin is raised as to be out of the image field
shoulders are rotated anteriorly to allow the scapulae to move laterally off the lung fields, and this can be achieved by either:
hands placed on the posterior aspect of the hips, elbows partially flexed rolling anterior or
hands are placed around the image receptor in a hugging motion with a focus on the lateral movement of the scapulae
shoulders are depressed to move the clavicles below the lung apices
Technical factors
posteroanterior projection
suspended inspiration
centering point
the level of the 7th thoracic vertebra, approximately the inferior angle of the scapulae
collimation:
superiorly 5 cm above the shoulder joint to allow proper visualization of the upper airways
inferior to the inferior border of the 12th rib
lateral to the level of the acromioclavicular joints
orientation : portrait or landscape
detector size: 35 cm x 43 cm or 43 cm x 35 cm
exposure: 100-110 kVp, 4-8 mAs
SID: 180 cm
grid: yes

Remember to explain to your patient what you are about to do; that is ask them to take a breath in and hold it. Many times this gives the patient time to prepare and results in a better breath hold and therefore a higher quality radiograph.

Always remember to tell your patient to breathe again!
Performed: Bilaterally

Dialog

Chest radiograph to evaluate for lung consolidation.

Criteria

• Normal density within the lungs
• No sign of consolidation
• Midline trachea

Measurement

LOINC Code

42272-5

Scale/Grading

selection range; grade - LOINC ID
Option - Value option selection range; grade - LOINC IDPass ; Pass - Fail ; Fail -