Radiography (X-Rays)

Chest X-rays remain the cornerstone of thoracic imaging, valued for their accessibility, speed, and low cost. They provide critical first-line insights into lung and mediastinal anatomy, enabling detection of pneumonia, pleural effusions, lung masses, and cardiomegaly, and often guide management before advanced imaging is pursued. While limited in sensitivity for subtle disease, they remain indispensable in acute care and for longitudinal monitoring, offering meaningful diagnostic information with far less radiation exposure than CT.

Approach to Chest Radiography

Computed Tomography (CT Chest)

CT scanning of the chest provides detailed cross-sectional imaging that far surpasses the capabilities of conventional radiography. It offers exceptional visualization of lung parenchyma, airways, vessels, mediastinum, pleura, and chest wall structures. Modern multidetector CT scanners can acquire submillimeter images of the entire chest in a single breath-hold, allowing for multiplanar and 3D reconstructions that enhance diagnostic accuracy.

Key applications of chest CT include:

• Lung nodule evaluation: Detection, characterization, and follow-up of pulmonary nodules with high sensitivity, particularly important in lung cancer screening and management.
• Interstitial lung disease: Detailed assessment of parenchymal patterns crucial for diagnosis and monitoring of diffuse lung diseases like idiopathic pulmonary fibrosis, sarcoidosis, and hypersensitivity pneumonitis.
• Pulmonary embolism: CT pulmonary angiography (CTPA) has become the gold standard for diagnosing acute pulmonary embolism with high sensitivity and specificity.
• Thoracic malignancies: Evaluation of primary and metastatic lesions including precise staging and treatment planning.
• Trauma assessment: Rapid evaluation of thoracic injuries including aortic injury, pulmonary contusion, and rib fractures.
• Airway disease: Visualization of bronchiectasis, tracheal abnormalities, and air trapping in conditions like COPD and asthma.

Specialized CT techniques include high-resolution CT (HRCT) for detailed assessment of lung parenchyma, CT angiography for vascular evaluation, and dual-energy CT which can provide additional functional information. While CT delivers significantly higher radiation doses than conventional radiography, dose reduction techniques continue to evolve, including iterative reconstruction algorithms and low-dose protocols for specific indications like lung cancer screening.

CT Chest

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