Chest X-ray

Methods and Conditions

The chest (mainly lungs, heart, aorta, spine, etc.) is imaged using X-rays.
Members of the University of Tokyo (all faculty, staff, and students) are required to undergo  Chest X-ray once a year as part of their regular health check-ups.

Meaning of Chest X-ray

A chest X-ray may detect abnormalities such as tuberculosis, pneumonia, pneumothorax, pleural effusion, lung cancer, cardiac enlargement, aortic aneurysm, scoliosis, and bone fractures. In particular, tuberculosis is a disease that needs early detection because it can spread in group life and requires isolation. However, it can be treated with oral medicines without isolation and spreading to others, if it is diagnosed before the bacteria appear in sputum. It is important to detect chest abnormalities including tuberculosis early by receiving annual chest X-ray examinations.
On the other hand, radiographs are unidirectional images and are evaluated in overlapping normal structures such as ribs and blood vessels, so one image may not be enough to distinguish between normal and abnormal. Therefore,  those who have been evaluated as "require a detailed examination" include those who have obvious abnormal findings which requires treatment by refferring to  the specialist, those who have possible abnormal findings which requires one more chest X-ray to confirm, and those who need detailed examinations such as a CT scan.  It is important to follow the instructions on the result of your health check-up,.

If there is an instruction to see a doctor as a result

If your chest X-ray results indicate that you should consult a medical institution or that you should consult an internal medicine department at the Health Center, please follow the instructions below. You can visit any medical institution at your own discretion. Please bring the results of your health checkup, visit a medical institution, and report the results to the Health Center Health Management Office. (Please use the reply slip.)
A refference letter can be obtained from the Health Center Health Management Office. It costs 300 yen. A CD contining the chest X-ray can be obtained also. It costs 500 yen. Please call us in advance to reduce the waiting time.

If you want to consult a doctor at the Health Center, it is recommended to call to the internal medicine department of the health center and check the availability of respirologists and the chest X-ray machine. Faculty and staff will be charged 100 yen as a consultation fee. Students are free of the consultation fee. Additional chest X-ray costs 300 yen.

*Chest X-ray examination cannot be performed at the Kashiwa Health Center. Please visit the Health Center in Hongo or Komaba. We can also show you some clinics and hospitals nearby at Kashiwa Health Center.

Explanation of findings and doctor's evaluation / diagnosis

Evaluation code
A normal no remarkable findings
B minor findings Findings that do not require further detailed examination or treatment are detected which inculede scars of past inflammation of lung or old bone fractures.
C observation Annual followup is recommended. Be sure to undergo annual check-up next year.
D detailed examinations / treatment needed

Detailed examinations or treatment is needed. Follow the instruction. This does not necessarily mean that you are in severe conditions. The ability of the diagnosis with chest X-ray only is limited. The University Health Service Center may contact you depending on the type of the findings.

Some reports include the following codes:

#1: Recommendation to visit Hongo or Komaba University Health Service Center for additional chest X-ray. Contact us in advance for the availability of respirologist and X-ray machine.

#2: Recommendation to  see a pulmonologist outside for detailed examinations. Contact us for the referral letter and X-ray data as well as information about where to go.

#3: Recommendation to see a cardiologist outside for detailed examinations. Contact us for the referral letter and X-ray data as well as information about where to go.

A referral letter costs 300 JPY, and  a CD with chest X-ray data costs 500 JPY.

(blank) follow your attending doctor's instruction The findings may be related to your conditions / diseases under treatment by your doctor. Discuss the results of this health check-up with your doctor. If needed, a CD with chest X-ray data is available on request.



<Findings> The findings mean only how they appear.
Consulation to a doctor is needed for their interpretation.


Pleural thickening/pleural adhesion

Most are caused by old inflammation.

Pleura is a membrane surrounding  chest cavities. Its thickening  causes shadows on chest X-rays.



Visceral pleura. a membrane surrounding the lung, has ruptured and air is in the chest cavity by leaking from the lung. The lungs appears deflated and smaller while low density area appears in the chest cavity. Excessive pneumothorax is life threating and requires emergent surgery, while small air leak can be cured by itself. In most of the cases, a follow-up chest X-ray is needed.


Granular shadows, nodular shadows, mass shadows

These refer to a shadow with almost circular shape with its density nearly the same. Smaller shadows are called granular shadows, larger ones are called mass shadows. Granular shadows can be inflammation including tuberculosis. Nodular and mass shadows may indicate tumors. Sometimes nipples can be seen on the film and regarded as a nodular shadows. In that case, another chest X-ray may be needed to confirm it benign.


Infiltrative shadow

This refers to a shadow with an unclear boundary and an unclear interior compared to a nodule shadow. Shapes vary.

線状影, 索状影

linear shadow.

cord-like shadow

Linear shadow refers to linear shadows less than 2mm wide. If the width is thick or multiple intersecting linear shadows are sometimes expressed as cord-like shadows. Lines that follow the tumor may appear linear on X-rays, so a detailed examination may be needed for linear shadows unless these can be explained by normal structures.


____ (like) shadows

These ares verbal descriptions of what an X-ray looks like, not a direct description of the disease. There is a wide range of evaluation depending on the appearance of the shadow from "no abnormality" to "more detailed examination required".


Pleural effusion

Fluid builds up in the thoracic cavity, mainly outside the lungs. It may be seen in inflammation of the lungs and surrounding pleura, and in cases of decreased heart function.


Enlarged mediastinum

Mediastinum is an area between both sides of the chest cavities. Heart, bllood vessels, esophagus, thymus and lymph nodes are located in Mediastinum. Enlarged mediastinum is a sign of the width of the mediastinum is more than normal. This can be caused by tumors, swelling of lymph nodes, but this can also be caused by oblique position.



Veertebras (back bones) are curved abnormally. Mild curve is often observed.


heart enlargement

The shadow of the heart is enlarged on the film. This may be caused by low heart function. In some cases, the heart may appear larger when the inhalation is not full. 


Aortic tortuosity/Aortic calcification shadow

A curved thoracic aorta is called aortic tortuosity, and calcification found in the aortic wall is called aortic calcification. Both of them often suggest atherosclerotic changes.


old shadows

Shadows that look old or that are explainable by the past medical history.


foreign body

A foreign body is defined as any object other than those associated with surgical procedures. Most of them are derived from external objects such as clothing and ornaments, but it is sometimes difficult to determine the origin.



Findings that cannot be classified using typical categories. If you would like to hear a detailed explanation, call us at Health Center Internal Medicine Department in advance to check the availability of a respirologist.

There are various other findings, and the same expression may not necessarily result in the same evauation. Two or more doctors including a respirologist check the X-rays and evaluate findings, so please take measures according to the evaluation.

If you have questions about your result, call us at Health Center Internal Medicine Department in advance to check the availability of a respirologist and come to the center by yourself. We cannot talk about the result unless we can verify the identity, which is difficult over the phone or email.