Frequently Asked Questions about X-Ray Film

To create a radiograph, a patient is positioned so that the part of the body being imaged is located between an x-ray source and an x-ray detector. When the machine is turned on, x-rays travel through the body and are absorbed in different amounts by different tissues, depending on the radiological density of the tissues they pass through. Radiological density is determined by both the density and the atomic number (the number of protons in an atom’s nucleus) of the materials being imaged. For example, structures such as bone contain calcium, which has a higher atomic number than most tissues. Because of this property, bones readily absorb x-rays and, thus, produce high contrast on the x-ray detector. As a result, bony structures appear whiter than other tissues against the black background of a radiograph. Conversely, x-rays travel more easily through less radiologically dense tissues such as fat and muscle, as well as through air-filled cavities such as the lungs. These structures are displayed in shades of gray on a radiograph.

Listed below are examples of examinations and procedures that use x-ray technology to either diagnose or treat disease:

Diagnostic:
X-ray radiography:
Detects bone fractures, certain tumors and other abnormal masses, pneumonia, some types of injuries, calcifications, foreign objects, dental problems, etc.

Mammography:
A radiograph of the breast that is used for cancer detection and diagnosis. Tumors tend to appear as regular or irregular-shaped masses that are somewhat brighter than the background on the radiograph (i.e., whiter on a black background or blacker on a white background). Mammograms can also detect tiny bits of calcium, called microcalcifications, which show up as very bright specks on a mammogram. While usually benign, microcalcifications may occasionally indicate the presence of a specific type of cancer.

CT (computed tomography):
Combines traditional x-ray technology with computer processing to generate a series of cross-sectional images of the body that can later be combined to form a three-dimensional x-ray image. CT images are more detailed than plain radiographs and give doctors the ability to view structures within the body from many different angles.

Fluoroscopy:
Uses x-rays and and a fluorescent screen to obtain real-time images of movement within the body or to view diagnostic processes, such as following the path of an injected or swallowed contrast agent. For example, fluoroscopy is used to view the movement of the beating heart, and, with the aid of radiographic contrast agents, to view blood flow to the heart muscle as well as through blood vessels and organs. This technology is also used with a radiographic contrast agent to guide an internally threaded catheter during cardiac angioplasty, which is a minimally invasive procedure for opening clogged arteries that supply blood to the heart.

Therapeutic:
Radiation therapy in cancer treatment: X-rays and other types of high-energy radiation can be used to destroy cancerous tumors and cells by damaging their DNA. The radiation dose used for treating cancer is much higher than the radiation dose used for diagnostic imaging. Therapeutic radiation can come from a machine outside of the body or from a radioactive material that is placed in the body, inside or near tumor cells, or injected into the blood stream.

Despite the development of newer technologies such as computed tomography (CT), ultrasound imaging and magnetic resonance imaging (MRI), plain film X-rays remain an important tool for the diagnosis of many disorders. In radiography, a beam of X-rays, produced by an X-ray generator, is transmitted through an object, e.g. the part of the body to be scanned. The X-rays are absorbed by the material they pass through in differing amounts depending on the density and composition of the material. X-rays that are not absorbed pass through the object and are recorded on X-ray sensitive film

The basic setup for X-ray imaging. The collimator restricts the beam of X-rays so as to irradiate only the region of interest. The antiscatter grid increases tissue contrast by reducing the number of detected X-rays that have been scattered by tissue.
While bone absorbs X-rays particularly well, soft tissue such as muscle fiber, which has a lower density than bone, absorbs fewer X-rays. This results in the familiar contrast seen in X-ray images, with bones shown as clearly defined white areas and darker areas of tissue (Figure 2) 2. This makes conventional X-rays very suitable for scans of bones and tissue dense in calcium such as in dental images and detection of bone fractures. Other uses of radiography include the study of the organs in the abdomen, such as the liver and bladder; chest radiography for diseases of the lung, such as pneumonia or lung cancer and mammography to screen for breast cancer. X-ray fluoroscopy is used to detect a number of diseases associated with the stomach and intestine, genitals and urinary tract.

A typical X-ray radiograph of the chest, in which the regions of bone appear white.
Traditionally, medical X-ray images were exposed onto photographic film, which require processing before they can be viewed and take up a lot of space in hospitals and doctors’ offices. Digital X-rays, which overcome these problems, have therefore become increasingly popular in radiography. Similar to a digital camera, an electronic detector is used instead of film. This “electronic image” is processed by a computer, enabling it to be stored digitally and viewed on screen immediately without processing.

X-ray imaging provides fast, high-resolution images and is relatively inexpensive. The average examination for most plain film examinations takes no more than 10–15 minutes and requires no special preparation of the patient. The operator, usually the radiographer (also known as a radiologic technologist), selects the amount and type of X-rays to be used according to the patient’s size, the tissue or part of the body being imaged and the amount of image contrast required. Because movement, e.g. of the lungs and diaphragm, blurs the image, patients are usually asked to hold their breath during the exposure. The X-ray picture is stored on a piece of film called a radiograph. These are interpreted by a physician specially trained to interpret them, known as a radiologist.

The ionizing radiation used in the production of X-ray images is carcinogenic and continuous exposure to these rays over time may cause damage to the body and increase the risk of cancer. However, experts consider the benefits of an accurate diagnosis and treatment to far outweigh the comparatively small risk involved in X-ray imaging.

Since the developing embryo is much more sensitive to the effects of ionizing radiation than adult patients, X-rays of any part of the body are not recommended for pregnant women. The risks of X-rays are greater for young children and unborn babies and the doctor will always bear this in mind when deciding on the need for medical imaging.