Imaging-Guided Respiratory Care: The Role of Chest Radiography, Computed Tomography, and Lung Ultrasound in Respiratory Therapy Practice

Abstract

Imaging is an integral component of contemporary respiratory and critical care, providing structural and increasingly functional information that complements clinical examination, respiratory physiology, and monitoring. Respiratory therapists (RTs) participate in the assessment and management of patients receiving oxygen therapy, noninvasive respiratory support, invasive mechanical ventilation, airway clearance, and weaning. Understanding clinically relevant thoracic imaging can therefore support timely recognition of respiratory deterioration and communication within multidisciplinary teams. This narrative review examines the roles of chest radiography, computed tomography (CT), and lung ultrasound (LUS) in respiratory therapy (RT) practice and considers how imaging can be integrated with bedside physiological assessment. Chest radiography remains important for evaluating pulmonary opacities, atelectasis, pulmonary edema, pneumothorax, pleural abnormalities, and respiratory-device position. CT provides high-resolution
anatomical information and can quantify regional lung aeration and structural disease, particularly in heterogeneous acute respiratory distress syndrome (ARDS). LUS provides radiation-free, repeatable bedside assessment of pleural and peripheral pulmonary abnormalities and has increasing evidence in acute respiratory failure, lung aeration assessment, and weaning. Emerging evidence also supports structured LUS education for RTs, although competency standards and longitudinal outcome data remain limited. Imaging should complement, rather than replace, clinical assessment and respiratory physiology. The most useful model is an integrated pathway in which imaging findings are interpreted alongside gas exchange, respiratory mechanics, ventilator waveforms, work of breathing, and treatment response. Quantitative CT, artificial intelligence, dynamic chest radiography, and electrical impedance tomography may further expand personalised imaging-guided respiratory care. Implementation should occur within local scope-of-practice, credentialing, and multidisciplinary governance frameworks.