The standard chest x-ray (cxr) has been used for decades and is the initial standard radiographic technique to use when first evaluating a patient.  Recently, I was presented with a patient whose cxr was normal, not just by my interpretation, but by the radiologists as well.  A CT scan of the chest, however, revealed multiple nodules, which may very well be the result of spreading cancer. 

I decided to go back and look at some of the statistics regarding cxr’s accuracy in any number of lung diseases.  It turns out that current data says the cxr can be normal in 60% of the patients with emphysema and 3o % of those with bronchiectasis.  10-15% of patients with so-called infiltrative lung diseases may have a normal cxr.  Why then do we continue to use the standard chest x-ray technique?

The standard chest-xray is relatively easy and inexpensive to perform and, although it has its limitations, it remains a helpful tool when first evaluating patients with lung disease. If there is any suspicion that more exacting information is needed, a CT scan of the chest is then usually performed.

Standard CT scans of the chest are more exacting, but even the standard scanning technique is not enough and something called a high resolution CT scan needs to be employed.  The high resolution scan helps better define the lung tissue and is helpful in many instances, including scarring diseases of the lung generally referred to as interstitial fibrosis.