Chest X-ray (single view)

What it is

A single-view chest X-ray is one picture, almost always taken front to back or back to front. The chest is three-dimensional, so a single flat image stacks the heart, the spine, the diaphragm and both lungs on top of one another — which is exactly the limitation that a second, side-on view exists to solve. A single view is nonetheless the right study in a lot of situations, because plenty of questions are answered by it: a collapsed lung, a large area of pneumonia, fluid filling a chest, or the position of a breathing tube, feeding tube or central line. It is also the only practical option when a patient cannot stand, since portable machines are wheeled to the bedside and the image is taken lying down.

Why it is done

• To check the position of a tube, line, or pacemaker lead after it has been placed or moved
• To take a quick look at the lungs in someone too ill or too immobile to stand for a two-view study
• To screen for obvious lung or heart findings in an urgent care or pre-operative setting
• To follow up a known finding where a repeat comparison image is all that is needed

What to expect

Preparation amounts to removing jewelry, anything metal above the waist, and often clothing from the chest up in favor of a gown. For a standing study the patient presses against the imaging plate, holds still, takes a breath in, and holds it while the exposure is made — a matter of seconds. At the bedside the plate is slid behind the back instead and the machine is positioned over the chest. Nothing hurts, and the radiation dose is small. Anyone who is or might be pregnant should mention it beforehand. A radiologist reads the image and issues a report separately from the visit.

Questions worth asking

• Was one view ordered or two? Two views is a different code and a higher price, and a quoted price for one does not cover the other.
• If this was a portable film taken at the bedside, is there an extra portable or transport charge on top of the image itself?
• If the single view is inconclusive and a two-view study is repeated the same day, will both be billed?
• What is the self-pay or cash price at an urgent care or freestanding imaging center compared with the hospital radiology department for the same single view?