X-Rays: An Inside Look at Bones and Organs

Radiography -- or an X-ray, as it is most commonly known -- is the oldest and most frequently used form of medical imaging. Discovered more than a century ago, X-rays can produce diagnostic images of the human body on film or digitally on a computer screen. X-ray imaging is extremely fast and provides a rapid method of evaluating the entire body -- especially the joints, bones and chest cavity.

Radiography involves exposing a part of the body to a small dose of invisible, electromagnetic radiation to produce an image of the internal organs. Typical radiography equipment consists of a large, flat table with a drawer that holds a tray into which an x-ray film cassette is placed. Suspended above the table is the apparatus that holds the x-ray tube that can be moved over the body to direct the x-ray. When X-rays penetrate the body, they are absorbed in varying amounts by different tissues and then exposed on the film where an image is recorded.

Conventional X-Rays use film similar to photographic film that must be “developed” in a laboratory. Modern imaging is shifting towards computed radiography (CR) and digital radiography (DR), which result in a digital image that can be processed and made available for viewing in a fraction of the time of traditional X-Rays. These techniques have the added benefit that there is less chance of error and re-takes. The images may be placed on film or may be stored electronically.

An experienced Main Line Health Imaging radiologist will analyze your X-ray images and send a report to your primary care or referring physician, who will inform you on your test results. New technology also allows for distribution of diagnostic reports and referral images over the Internet at many facilities.

Fluoroscopy: Viewing Live X-Ray Images
Typical X-ray images are still pictures. A similar imaging method, fluoroscopy, uses X-rays to capture an image of an organ while it is functioning. Unlike a conventional X-ray, which shows a detailed yet static image, fluoroscopy allows a physician to see a “live” image of the body's internal organs on a TV monitor in order to observe their size, shape and movement.

Fluoroscopy uses a continuous beam of X-rays to evaluate structures and movement within the body, such as blood through an artery, lung expansion and contraction, or food moving through the digestive tract. It also can be used to help a physician locate a foreign object in the body, position a catheter or needle for a procedure, or realign a broken bone.

Applications for X-Ray Imaging and Fluoroscopy

• Bone X-rays: Probably the most common use of X-ray imaging is to assist the physician in identifying and treating bone fractures including the arms, legs, knees, wrists, shoulders, spine and skull. Images of the injury can show even very fine hairline fractures or bone chips, while images produced after treatment ensure that a fracture has been properly aligned and stabilized for healing. X-ray images can also be used to diagnose and monitor the progression of degenerative diseases such as arthritis.

• Chest X-rays: A chest x-ray is usually done for the evaluation of lungs, heart and chest wall. Pneumonia, heart failure, emphysema, lung cancer and other medical conditions can be accurately diagnosed or suspected through a chest x-ray.

• X-ray Guided Breast Biopsy: A mammography may reveal a breast abnormality, but in many cases it is not possible to tell whether a growth is benign or cancerous. To make this determination it is necessary to obtain a tissue sample for examination. As an alternative to open surgical biopsy, which removes an entire breast lump for microscopic analysis, a hollow needle may be passed through the skin into the suspicious lesion with the help of special breast X-rays. The small sample of breast tissue obtained in this way can show whether the lesion is malignant or benign. This much less invasive than the surgical approach and is particularly for pinpointing suspicious masses that cannot be felt on breast examination.

• Upper/Lower Gastrointestinal (GI) Series: An Upper Gastrointestinal (GI) Series is an X-ray or fluoroscopic examination of the esophagus, stomach and first part of the small intestine (the duodenum). In order for these organs to show up on radiographic images, patients are usually asked to swallow either a solution of baking soda crystals or a barium contrast liquid.

  A Lower Gastrointestinal (GI) Series is an X-ray or fluoroscopic evaluation of the large intestine (colon) and the rectum. To aid in this examination, patients are given an enema of liquid barium contrast solution. The barium coats the inside of the rectum and colon, producing a sharp, well-defined image.

  Both GI examinations are useful for looking for ulcers, benign tumors (polyps, for example), cancer, or signs of certain other intestinal illnesses such as Crohn's disease and ulcerative colitis.

• Useful for diagnosing common bone injury and disease (such as fractures, bone infections, and arthritis) as well as common conditions of the lung and chest such as infection, emphysema, and fluid accumulation.
• Fast and easy to perform; particularly useful in emergency diagnosis and treatment
• Inexpensive and widely available
• Most procedures can be performed on an outpatient basis

The chest X-ray is a very useful examination, but has limitations. Some conditions of the chest will not show up on the image. There are some cancers that are too small or are difficult to visualize and may not be identified. Blood clots to the lungs (pulmonary embolism) cannot be seen on chest X-rays and require additional study.

For more complex conditions, other imaging modalities -- such as PET, PET/CT, DEXA or CT scanning -- may be more effective in making accurate identifications and diagnoses.

How Should I Prepare for an X-ray?
Most procedure require no special preparation. Once you arrive, you may be asked to change into a gown before your examination. You will also be asked to remove jewelry, eyeglasses and any metal objects that could show up on the images and overlap important findings. If you are going for an Upper or Lower GI Tract X-ray, you will be asked to avoid eating before your procedure and only to drink clear liquids, as not to interfere with the image quality. Women should always inform their doctor or x-ray technologist if there is any possibility that they are pregnant.

Are X-rays Safe?
X-rays are a type of invisible electromagnetic radiation and create no sensation when they pass through the body. Modern X-ray techniques use only a fraction of the X-ray dose that was required in the early days of radiology. During a single X-ray exposure, a patient is exposed to approximately 20 milliroentgens of radiation. To put this into perspective, we are all exposed to approximately 100 milliroentgens of radiation each year from sources like the ultraviolet rays of the sun and small traces of radioactive isotopes, such as uranium found in soil.

Special care is taken during x-ray examinations to ensure maximum safety for the patient by paying attention to correct x-ray beam energies. Body parts not being examined are shielded with a lead apron helps reduce unnecessary radiation to the abdomen and pelvis. Modern X-ray systems use tightly controlled x-ray beams with significant filtration to minimize scatter of stray radiation. And today’s high-speed X-ray films require less amounts of radiation than ever before in order to produce an optimal image. (Fluoroscopy can deliver more radiation than conventional X-rays, however).

X-ray imaging itself is painless. For most procedures, patients must remove their clothing and wear a loose-fitting gown. Patients will also be asked to remove jewelry and metal as it may interfere with the image quality. Some discomfort may result from lying on the table, which may feel quite hard and cold. Sometimes, to get a clear image of an injury such as a possible fracture, you may be asked to hold still an uncomfortable position for a short time.  Patients receiving chest X-rays may be asked to hold their breath while the imaging is taking place. The radiologist may also need to take additional views from different angles to make a proper diagnosis.

If you are going for an Upper GI Tract, the barium solution you will be asked to swallow may taste chalky. If you are going for a Lower GI Tract X-ray, you will be asked to undergo a barium enema which may produce some discomfort as the barium fills your colon, including abdominal pressure or minor cramping.

Women should always inform their physician or X-ray technologist if there is any possibility that they are pregnant.

Where Can I Go for an X-Ray?
Conventional X-Ray imaging is performed at all Main Line Health Imaging sites; fluoroscopy is offered at Lankenau, Bryn Mawr and Paoli Hospitals. View Locations and Hours.