Conventional Radiographs

• A CXR is the initial step in imaging acute cardiopulmonary disease.

• A CXR may be performed using a stationary or portable radiography unit.

• Indications for portable CXR include unstable patients in acute distress, intubated patients in ICUs, and intraoperative/recovery room radiographs.

• Optimal CXR includes frontal and lateral projections. It may only be possible to obtain frontal views due to a patient's clinical status, body habitus, or pregnancy. Pregnant patients are required to give verbal consent after discussion of the risks of radiation to the fetus, and these patients are double or triple lead shielded for the study. The risk to the fetus is low, particularly in later pregnancy when the fetus has developed beyond the stage of organogenesis. The patient (mother) is “triple shielded,” meaning that lead aprons are placed over the abdomen and pelvis to protect the fetus from the x-ray beam. The actual scatter radiation from a single x-ray is quite low and typically of no significant risk to the fetus.

• CXR findings often lag behind clinical findings by up to 48 hours.

• In certain disease processes, the CXR may be normal.

• CXR findings may be non-specific and can be seen in a variety of diseases; for example, it may not be possible to differentiate pulmonary edema from multilobar pneumonia. The clinical history is often key to interpreting radiographic findings.