X-ray

X-ray is a safe and painless procedure often used to produce images of the inside of the body.

Information written and reviewed by Certified Doctors.

Contents

Introduction

X-ray is a safe and painless procedure often used to produce images of the inside of the body.

It is a very effective way of looking at fractured bones, such as a broken arm or wrist.

An X-ray can also be used to examine organs and identify problems. For example, an X-ray will show up an infection in your lungs, such as pneumonia.

X-rays are also often used during therapeutic procedures, such as a coronary angioplasty, to help the surgeon guide equipment to the area being treated.

Read more about when X-ray is used.

How X-rays work

X-rays are a type of radiation. Light and X-rays are similar sources of energy. However, light has a much lower frequency than X-rays and is absorbed by your skin. X-rays have a higher frequency and pass through the human body.

As X-rays pass through the body, energy particles in them (called photons) are absorbed at different rates. This pattern shows up on the X-ray images.

The parts of your body that are made up of dense material, such as your bones, show up as clear white areas on an X-ray image.

The parts of your body that are made of softer material, such as your heart and lungs, show up as darker areas.

Having an X-ray

X-rays are carried out by radiographers who are healthcare professionals trained to use imaging technology, including X-ray machines, computerised tomography (CT) scanners and ultrasound scanners.

During an X-ray you will be asked to lie on a table or stand against a flat surface so that the part of your body being examined is positioned between the X-ray machine and a photographic plate.

The X-ray will last for a fraction of a second. As the X-rays hit the photographic plate, the plate captures a snapshot of the image.

The resulting image will be transferred to a computer so it can be studied on a screen and printed out if necessary.

Read more about how an X-ray is taken.

Safety

Exposure to high levels of radiation can be very harmful. However, the X-rays used for medical purposes are safe because the dose of radiation is very small.

The strength of radiation in relation to long-term risk is measured using units called millisieverts (mSv). Some examples of typical exposures are:

  • chest X-ray: 0.02 mSv
  • a year’s worth of medical tests: 0.4 mSv
  • average annual exposure to natural radiation: 2.2 mSv

Read more about the risks of X-rays.

Risks

People are often concerned about being exposed to radiation during an X-ray. However, everyone is exposed to sources of natural radiation throughout their life.

Natural radiation is sometimes known as background radiation. Sources of background radiation include:

  • radon: a naturally occurring radioactive gas that is found in low levels in the atmosphere
  • cosmic rays: a type of radiation that originates from space (from the sun and stars)
  • the earth: soil and rocks contain various radioactive materials that have been present since the earth was formed; these contribute to our exposure, as do building materials that are made from soil, rocks and stones
  • food and water: for example, nuts, bananas, red meat and potatoes all contain tiny traces of radiation

Read more about radiation.

Cancer risk

Being exposed to X-rays does carry a theoretical risk of triggering cancer at a later date (as does exposure to background radiation). However, this risk is extremely low.

For example, the Health Protection Agency (HPA) has calculated that:

  • an X-ray of your chest, teeth, arms or feet is the equivalent of a few days' worth of background radiation and has a less than 1 in 1,000,000 chance of causing cancer
  • an X-ray of your skull or neck is the equivalent of a few weeks' worth of background radiation and has 1 in 100,000 to 1,000,000 chance of causing cancer
  • an X-ray of your breasts (mammogram), hip, spine, abdomen or pelvis is the equivalent of a few months' to a year’s worth of background radiation and has a 1 in 10,000 to 100,000 chance of causing cancer
  • an X-ray that uses a contrast fluid, such as a barium meal, is the equivalent of a few years' worth of background radiation and has a 1 in 1,000 to 10,000 chance of causing cancer

It is important to put the risk of developing cancer from X-rays into perspective.

Your risk of developing cancer depends on many factors, including your age, lifestyle and genetic make-up.

X-rays and pregnancy

The doses of radiation that are used during an X-ray are not thought to pose a risk to an unborn baby. However, as a precaution, X-rays that directly target the womb (abdominal X-rays) are not usually recommended unless there is a clear clinical need.

In some cases, an alternative method that does not involve radiation, such as an ultrasound scan, may be recommended.

Also as a precaution, before having an X-ray you may be asked the date of your last period. This is to check whether there is a chance that you could be pregnant.

Do not panic if you have an X-ray and later discover that you are pregnant. Even the most powerful types of X-rays, such as a barium enema, are not thought to have any adverse effects on the outcome of pregnancy.

How is it performed

During an X-ray, you will be asked to lie on a table or stand against a flat surface. This is so the part of your body being examined can be positioned between the X-ray machine and photographic plate.

X-rays are usually carried out by radiographers who are healthcare professionals trained in using imaging technology, such as X-ray machines, computerised tomography (CT) scanners and ultrasound scanners.

The X-ray machine

An X-ray machine consists of several parts, including an X-ray tube, a photographic plate and lead shielding.

The X-ray tube is like a giant light bulb that uses high-voltage electricity to generate X-rays. The lead shielding directs the X-rays towards the part of your body being examined and prevents them escaping in all directions. The photographic plate captures the image produced by the X-rays as they pass through your body.

In the past, the photographic plate used the same type of film as a traditional camera. However, nowadays the plate in most X-ray machines is connected to a computer so that a digital image can be taken.

The X-ray procedure

When you have an X-ray, the part of your body being examined will be exposed to X-rays for a fraction of a second. It is a safe and painless procedure.

As the X-rays hit the photographic plate, the plate will capture a snapshot of the image. The image will be transferred directly from the photographic plate to a computer so that it can be studied on a screen. If necessary, the image can be also be printed out.

While the X-ray is being taken, you will need to keep still so that the image produced is not blurred. More than one X-ray may be taken from different angles to provide as much information as possible. For example, if your lungs are being examined, X-rays of both the front and side of your body will be taken.

A radiologist will study your X-ray images. Radiologists are doctors who are specially trained to carry out examinations and interpret medical images, such as X-rays and CT scans.

The radiologist may discuss their findings with you on the day of your X-ray or they may send a report to your doctor.

What is it used for

Bone is a very hard and dense tissue that shows up clearly on X-rays. X-rays are therefore very useful for diagnosing bone-related problems.

For example, X-rays can be used to help identify:

  • fractures and breaks
  • problems with teeth, such as tooth decay
  • thinning and weakening of the bones (osteoporosis)
  • bone infection (osteomyelitis)
  • an abnormal curvature of the spine (scoliosis)
  • bone cancers, such as osteosarcoma and Ewing’s sarcoma

X-rays are also sometimes used during investigative or therapeutic procedures to help the surgeon guide equipment to the area being examined or treated.

For example, X-rays are often used during a coronary angioplasty, where a catheter (a long, thin, flexible tube) is inserted into a blood vessel either in your groin or arm.

X-rays are used to guide the tip of the catheter to the heart or the arteries that supply your heart. A special fluid that shows up clearly on X-rays (contrast medium) is injected through the catheter. The images that are produced (angiograms) are able to highlight whether a blood vessel is blocked.

Chest examination

Although major organs and blood vessels do not show up as clearly on X-rays as bones, they are visible. A chest X-ray is therefore a good way of identifying changes or abnormalities in your heart, lungs and major arteries.

In particular, chest X-rays can help diagnose:

Contrast medium

Contrast medium is liquid that contains dye. It is sometimes swallowed or injected before an X-ray is taken and shows up clearly in white, helping to distinguish between different structures in the body.

Contrast medium is usually harmless and passes out of the body in your urine. However, in rare cases it can cause an allergic reaction. Make sure that you tell the radiologist if you have had an allergic reaction to iodine or contrast medium in the past or if you have any other allergies.

Types of X-ray

There are various ways that X-rays can be used to investigate different parts of the body, as described below.

Barium swallow

Barium is a type of contrast medium that you may be given in a solution to drink. After the barium has moved down into your upper digestive system, a series of X-rays will be taken.

A barium swallow can be used to diagnose problems with the upper digestive system, such as swallowing problems (dysphagia) and persistent symptoms of abdominal pain.

Barium enema

A barium enema involves barium solution being pumped through your anus (back passage) and into your bowel.

Barium enemas can be used to diagnose bowel problems, such as persistent constipation and blood in your faeces (stools).

Angiography

Angiography is a type of X-ray used to examine blood vessels. The images created during angiography are called angiograms.

As blood vessels do not show up clearly on ordinary X-rays, contrast medium is injected into the area being examined. The dye highlights the blood vessels as it moves through them and shows up in white on the angiogram.

Studying the movement of the fluid through a blood vessel can often highlight problems, such as blockages.

Less commonly, angiographies are also carried out using magnetic resonance imaging (MRI) and computerised tomography (CT) techniques.

Intravenous urogram (IVU)

During an intravenous urogram (IVU), contrast medium is injected into your veins.

Iodine solution is usually used, which moves into your kidneys and bladder. X-rays of your kidneys and bladder will then be taken. IVU is often used to diagnose urinary system problems.

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