Procedures
RADIOGRAPHY (X-RAY)
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Summary
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Synonyms: X-ray, roentgenography

The X-ray or roentgenography (named after the physicist Wilhelm Conrad Röntgen, 1895) continues to be an examination frequently performed in clinical routine. As the procedure is cost-effective and exhibits low radiation exposure compared to a CT, it is used alongside sonography as a first-line diagnostic procedure for a variety of conditions. Radiography is the process of penetrating an area of the body with X-rays for visualisation on suitable film or electronic sensors.

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Technique
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What it is

X-rays can blacken X-ray film. X-rays are partially attenuated (weakened) when they penetrate the body. This changes the image on the X-ray film. The extent of this attenuation depends on the tissue. Soft tissues such as fat, muscles and skin absorb little radiation. Hard tissue such as bone on the other hand, absorbs a lot of radiation. Therefore, a bone is displayed on an X-ray as a white structure.

In a fluoroscopy, detectors are used to display X-rays leaving the body as a moving picture on a monitor, like a video. In this way, the doctor can continuously watch functional processes within the body on the monitor.

X-ray contrast agents create artificial contrasts in the X-ray image or on the monitor. Thus, hollow organs such as the digestive tract as well as blood vessels are visualised much more clearly and can be examined more easily. A stomach filled with contrast agent for example, appears in white in the X-ray or the monitor, contrasting with the surrounding area. This white contrast results from the contrast agent absorbing the X-rays. However, there are also negative contrast agents that make the filled structures appear dark on the X-ray or the monitor.

Mammography is an X-ray procedure as well.

 

 

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Purpose
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The classic X-ray is a standard procedure in medicine. The most frequent procedures are the following X-rays:

  1. Chest X-ray: This allows for the visualisation of the lungs, heart and skeleton. It can point towards indications of the following conditions: pneumonia, lung cancer, metastases, weak heart, and broken bones, for example...
  2. Abdominal X-ray: This visualises free air as an indication of perforation of a hollow organ, intestinal obstruction, foreign bodies or calcifications.
  3. The X-ray examination of the skeleton is the most common procedure to detect broken bones, tumours, degenerative changes, osteoporosis and changes in the joints.
  4. Fluoroscopy is used to visualise vessels with a contrast agent (angiography) or to examine functions of the digestive tract (X-ray of swallowing centre, stomach, bowels).
  5. The X-ray examination of the skeleton is the most common procedure to detect broken bones, tumours, degenerative changes, osteoporosis and changes in the joints.
  6. Fluoroscopy is used to visualise vessels with a contrast agent (angiography) or to examine functions of the digestive tract (X-ray of swallowing centre, stomach, bowels).

 

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Procedure
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Persons

You are looked after by an experienced team consisting of a medical radiology technician (MRT) and a radiologist.

The procedure itself is performed by the MRTs. The MRT will ask you to briefly hold your breath in order to avoid artefacts (errors) in the image caused by breathing.

The radiologist examines and assesses the images after the procedure. Then a written report is drawn up. This is either given to you or sent to the doctor who referred you.

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Preparation

Special preparation is not necessary since no contrast agent is administered!

You do not have to fast beforehand. The urinary bladder should be emptied before the procedure if possible, and jewellery including piercings within the area to be examined should be removed.

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Precautions

Please also inform the doctor without fail if one of the following applies:

  1. Existing or suspected pregnancy: Due to the radiation exposure of the unborn child, an ultrasound is often conducted as an alternative.
  2. Barium-containing contrast agents or bismuth medication within the four days preceding the examination: Limited possibility for evaluation due to radio-opaque superpositions.

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Duration

The entire procedure including preparations takes approximately 5-30 minutes, depending on the respective procedure. As in any medical facility, the start of your procedure may be delayed if emergency patients have to take precedence. Please always allow enough time.

 

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Process

The procedure is performed on an undressed body part. You may be given a gown to wear. Note that all foreign objects in the area to be examined such as piercings must be removed before the procedure to guarantee optimum image assessment. Metals, for example, make the evaluation of the image harder or even impossible.

The procedure is performed while lying on your back, standing up, or lying on your side. A small lead apron might be placed over the lower pelvis to protect this area from radiation. Sometimes female ovaries cannot be protected as they may be located too close to the abdominal organs being examined. Depending on the diagnostic task, male testicles can be protected by lead aprons.

During imaging, you will receive the command to briefly hold your breath.

The examination is not painful. The X-ray table might be perceived as very hard, and the room temperature may be cool.

When the procedure is over, you can return to the waiting room. It is now evaluated whether the image is technically sound. The written report of the procedure is either given to you or to the doctor who referred you.

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After procedure

You will usually be able to go straight home after the procedure.

 

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Consideration
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Risks

Radiography uses X-ray radiation. Rays are reduced to a minimum to ensure your safety.

There is a low risk of radiation damage to cells and tissue. With the low radiation doses used, however, the damage is very small compared to the benefits of the procedure.

The radiation exposure corresponds to approximately 0.001 mSv to 8 mSv depending on the area under examination; this corresponds to a natural environmental radiation of approximately between 0.5 days and 3 years.

However, since radiation can damage unborn life, the procedure is usually not performed if you are pregnant.

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Alternatives

An ultrasound examination is a simple, cost-effective, alternative procedure to evaluate certain areas of the body. This does not expose the body to X-ray radiation.

Further procedures are e.g. computed tomography or magnetic resonance imaging (cross-sectional images of all organs).

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FAQ

Do I have to be an in-patient in the hospital to have an X-ray?

No, the procedure can be performed if you are an out-patient. You will usually be able to go straight home after the procedure unless there are other medical reasons why you should not do so.

Which patients should not undergo this procedure?

As a general rule, the procedure is suitable for all patients. However, in pregnant patients the examination is performed only in exceptional cases for life-threatening states, provided that an alternative procedure without radiation exposure is not available or not diagnostically conclusive. When contrast agents have been administered shortly beforehand, the examination and/or its diagnostic conclusiveness have to be considered carefully, and steps towards preparation may need to be taken.

How much radiation will I be exposed to?

The radiation exposure corresponds to approximately 0.001 mSv to 8 mSv depending on the area under examination; this corresponds to a natural environmental radiation of approximately between 0.5 days and 3 years.

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Citations
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1   Team General Hospital Vienna
 
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