Competent radiographs of the lungs can be used to identify not only the subtleties of pathological processes in the chest, but also to study the effect of the disease on the surrounding tissues (within the cutting capacity of the method).
When analyzing the X-ray image, it is necessary to understand that the image is formed by diverging beams of x-rays, therefore, the resulting sizes of objects do not correspond to the real ones. As a result, radiation diagnostics experts analyze an extensive list of blackouts, lightening, and other x-ray symptoms before issuing a conclusion.
How to decipher the X-ray of the lungs
To decipher the X-ray of the lungs to get the right, you need to create an analysis algorithm.
In classic cases, experts study the following features of the image:
- performance quality;
- shadow picture of the chest organs (pulmonary fields, soft tissues, bone system, the location of the diaphragm, mediastinal organs).
Quality assessment involves the identification of features of the installation and mode that may affect the interpretation of the x-ray picture:
- Asymmetrical body position. It is estimated by the location of the sternoclavicular joints. If you do not take it into account, you can identify the rotation of the vertebrae of the thoracic, but this will be wrong.
- Stiffness or softness of the image.
- Additional shadows (artifacts).
- The presence of concomitant diseases affecting the chest.
- Completeness of coverage (a normal snapshot of the lungs should include the tops of the pulmonary fields above and the costal-diaphragmatic sinuses below).
- On the right snapshot of the lung, the scapula must lie outward from the chest, otherwise they will create distortions when assessing the intensity of radiological symptoms (enlightenment and darkening).
- Clarity is determined by the presence of single-circuit images of the front segments of the ribs. If there is a dynamic blur of their contours, it is obvious that the patient breathed during the exposure.
- The contrast of radiographs is determined by the presence of color shades of black and white. That is, when deciphering, it is necessary to compare the intensity of the anatomical structures that give darkening, with those that create enlightenment (pulmonary fields). The difference between the shades indicates the level of contrast.
It is also necessary to take into account possible distortion of the image when examining a person under different directions of x-rays (see the figure).
Figure: distorted image of the ball in the study of the direct beam (a) and with an oblique arrangement of the receiver (b)
Protocol for the description of radiographs of the lungs by a doctor
The protocol for deciphering a snapshot of the organs of the chest with the description begins: “on the presented radiograph of OGK in a direct projection.” A straight (anterior-anterior or anterior-posterior) projection involves performing an X-ray pattern when the patient is standing face or back to the ray tube with a central course of rays.
We continue the description further: “in the lungs without visible focal and infiltrative shadows”. This standard phrase indicates the absence of additional shadows caused by pathological conditions. Focal shadows occur when:
- occupational diseases (silicosis, talcosis, asbestosis).
Infiltrative darkening indicate diseases involving inflammatory changes in the lungs. These include:
Pulmonary pattern is not deformed, clear – this phrase indicates the absence of violations of the blood supply, as well as the pathogenetic mechanisms causing the deformation of the vessels:
- circulatory disorders in small and large circles;
- cavitary and cystic X-ray negative formations;
The roots of the lungs are structural, not expanded – this description of the OGK image suggests that in the area of the roots, the radiologist does not see additional shadows that can change the course of the pulmonary artery, enlarge the mediastinal lymph nodes.
Low structure and deformation of the roots of the lungs is observed when:
- swollen lymph nodes;
- mediastinal tumors;
- stagnation in the pulmonary circulation.
If the shadow of the mediastinum is unremarkable, it means that the doctor did not reveal any additional formations emerging due to the sternum.
The absence of “plus shadows” on a direct x-ray of the lungs does not mean the absence of tumors. It should be understood that the X-ray image is summing and is formed on the basis of the intensity of many anatomical structures that overlap each other. If the tumor is small and not from the bone structure, it is blocked not only by the sternum, but also by the heart. In such a situation, it cannot be identified even in the side picture.
The diaphragm is not changed, costal-phrenic sinuses are free – the final stage of the descriptive part of decoding the x-ray image of the lungs.
There is only a conclusion: “in the lungs without visible pathology.”
Above, we gave a detailed description of the radiographs of the lungs are normal, so that readers have an idea of what the doctor sees in the picture and what the protocol for its conclusion is based on.
Below is an example of decoding if a patient has a lung tumor.
Description of the X-ray of the lungs in a tumor
On the review p-gram of the chest organs, a nodular formation in the upper lobe of the left lung (segment S3) is visualized against the background of a deformed pulmonary pattern about 3 cm in diameter of a polygonal shape with wavy clear contours. From the node there is a path to the left root and cords to the interlobar pleura. The structure of education is heterogeneous, due to the presence of foci of decay. The roots are structural, the right one is somewhat dilated, probably due to enlarged lymph nodes. Heart shadow without features. Sines are free, the diaphragm is not changed.
Conclusion: X-ray picture of peripheral cancer in S3 of the left lung.
Thus, in order to decipher a chest radiograph, the radiologist has to analyze a multitude of symptoms and reunite them into a single picture, which leads to the formation of a final conclusion.
Features of the analysis of pulmonary fields
Correct analysis of the lung fields creates opportunities to detect many pathological changes. The absence of blackouts and enlightenment still does not exclude lung diseases. However, to properly interpret a snapshot of the organs of the chest (OGK), the doctor must know the numerous anatomical components of the x-ray symptom “pulmonary field”.
Features of the analysis of the pulmonary fields on radiographs:
- the right margin is wide and short, the left is long and narrow;
- the median shadow is physiologically extended to the left at the expense of the heart;
- for a correct description of the pulmonary fields are divided into 3 zones: lower, middle and upper. Similarly, we can distinguish 3 zones: the inner, middle and outer;
- the degree of transparency is determined by air and blood filling, as well as the volume of lung parenchymal tissue;
- intensity is affected by the imposition of soft tissue structures;
- in women, the image may overlap with the mammary glands;
- The individuality and complexity of the course of the pulmonary pattern requires a highly skilled doctor;
- normal pulmonary pleura is not visible. Its thickening occurs with inflammation or tumor growth. More clearly, pleural sheets are visualized on the lateral radiograph;
- each share consists of segments. They are distinguished on the basis of the special structure of the bronchovascular bundle, which branches in each lobe separately. In the right lung – 10 segments, in the left – 9.
Thus, decoding the x-ray of the lungs is a difficult task, requiring extensive knowledge and long practical experience. If you have a radiograph that needs to be described, contact our radiologist. We will be happy to help!