X-ray

An X-ray or radiograph is a type of radiological imaging. In many ways, it is similar to having your picture taken in a photography studio. A radiologic technologist (RT) uses nonvisible X-rays (short wavelength) to create an image of internal structures and organs of your body. X-rays reveal body structures proportional with their density. The denser the tissue, (such as bone, compared to fat), the fewer X-rays passes through it. This difference in body tissue density is why:

• bone – with a high density – appears white on a radiograph
• fat – with a low body tissue density – appears gray
• air – with no density – appears black

Frequently asked questions about X-rays

• Why did my doctor order an X-ray?
• Who performs and interprets my X-ray?
• How is an X-ray performed?
• What is special about the conventional X-ray examination at HSS?
• What should I do to prepare for the examination?
• What are the risks of an X-ray?
• What are the alternatives?
• What can I expect after the examination?
• What happens with the results?
• Will other tests be ordered?

Why did my doctor order an X-ray?

A radiograph is a reliable and accurate means of obtaining information to help doctors diagnosis the cause of pain. An X-ray  is commonly used to determine the presence or absence of disease, a bone fracture, joint malalignment, arthritis, or cause of other painful conditions.

Who performs and interprets my X-ray?

Radiologists specialize in the imaging and diagnosis of disease. Interpretation of a radiograph, MRI, CT, EOS or ultrasound examination requires expertise in pattern recognition and in the identification of artifacts or findings that could be mistaken for pathology. Radiologists are trained in the variable sensitivity and specificity of each imaging technique, and in the potential for hazards related to the examination that could cause harm and must be avoided. All the radiologists at Hospital for Special Surgery are board certified by the American Board of Radiology, have years of experience in the imaging of musculoskeletal disorders, and the majority have additional formal fellowship training beyond residency in musculoskeletal or body imaging.

How is an X-ray performed?

After changing into an examination gown, if necessary the radiologic technologist (RT) will instruct you to remove specific articles of your clothing that may interfere with the radiograph to ensure that the radiograph is free of artifacts (e.g. material from your clothing, snaps, buttons, clips, etc...). You will be taken into an e-ray room and instructed to lie, sit or be positioned on X-ray table. Just as a photographer has special equipment in the portrait studio to achieve the best portrait, the radiologic technologist (RT) uses special equipment such as an X-ray source (camera), positioning blocks and sponges to achieve an optimal image.

What is special about the conventional X-ray examination at HSS?

HSS uses the most advanced state-of-the-art X-ray technologies and our technologists and radiologists focus solely on musculoskeletal imaging. There are may other benefits, including:

• At HSS weight bearing X-rays of your feet, ankles, knees and spine are routine positions in order to optimally determine the extent of your condition.
• Varied beam angulations customized to optimally visualize specific osseous or joint structures are performed as routine, not the exception.
• Stress views of the joints are performed to evaluate degree of instability.
• Stress views/bending films of the spine to evaluate the flexibility of a scoliosis curve to adjust for deformity are normally performed.
• There is a dedicated pediatric suite and trained technologists.
• Special equipment, techniques and positions are used to obtain specific information:
  • Club foot boards for pediatric studies of the foot/ankle
  • Merchant boards to evaluate patellofemoral joints (knee caps)
  • Stitching software to create a continuous long image used to evaluate scoliosis, or lower leg examination including the hips to the ankles
  • Pre/Post-op limb-lengthening protocol includes various height blocks to equalize the leg length discrepancy and verify alignment
  • Boomerang and gentle slope filters to enhance image quality are used for shoulder and other sort of examinations
  • Gradient filters are used for foot examinations that optimally visualize the toes and the heel
  • Anteversion boot/board combination to evaluate the version (rotation) of the hip joint with and without a total hip joint (arthroplasty)
  • Magnification markers are used for custom joint replacement planning
  • Cine/video available to allow motion studies analysis
• Highly skilled technologists with years of experience perform the prescribed musculoskeletal studies. Our department's repeat rate (the amount of times a film has to be re-done) averages 3.5% compared to the national repeat rate of 8%.
• An Orthopedics' Guide to Plain Film Imaging, published by Thieme New York, co-authored by Dr. Helene Pavlov, The Radiologist-in Chief, Ed White, R.T., AVP et al. Also, a textbook on image acquisition was published by our team.

What should I do to prepare for the examination?

No preparation is required for a routine X-ray examination. If you are pregnant or think you may be pregnant, be sure to inform your physician, and the technologist prior to the start of the X-ray examination. Most examinations using X-ray will not be performed on pregnant women unless the benefits of the examination outweigh the risks of radiation exposure to the fetus. Extremity examinations can safely be performed with appropriate lead shielding.

What are the risks of an X-ray?

X-ray uses ionizing radiation. The technologists are experts in utilizing the minimal dose to achieve optimal results. Lead aprons and shields are used, and the equipment is routinely inspected by state and local inspectors for safety and adequate shielding. All examinations are well within permissible levels of diagnostic radiation dosage.

What are the alternatives?

Low-dose radiation EOS imaging is a useful alternative for spinal and hip conditions. Other alternative diagnostic imaging tests, such as MRI and ultrasound, are radiation-free. Their use, however, is dependent on your condition and the diagnostic information your doctor requires.

What can I expect after the examination?

After the technologist has completed taking your X-rays, you will be asked to wait in the X-ray room while your images are reviewed for diagnostic quality. Additional images are occasionally required to ensure the examination completely demonstrates the area in clinical questions. The radiographic examination will be interpreted by a radiologist. Your HSS physician will be able to view the images immediately. If your referring physician is not at HSS, your images will be shared either with a CD or cloud technology.

What happens with the results?

The radiologist generates a written report which will be sent to the physician who referred you for the examination. The radiograph and the report become part of your medical record. Copies of the report can be obtained through your referring physician's office. Your physician can call the file room at 212.606.1015 and a copy of the report can be faxed or mailed free of charge to their office. The images are the property of the institution as are biopsy slides or blood samples. Copies of the images can be obtained by contacting the file room. There is a charge for copies.

Will other tests be ordered?

Depending on the findings on the X-ray, additional tests may be ordered including, other X-ray exams utilizing different views/positions, a CT examination, bone scan, MR, ultrasound, or special interventional procedures that utilize imaging guidance.