X-Rays (Radiographs)

X-ray technology is one of the fundamental types of diagnostic imaging used by different spine specialists. It is truly the workhorse of imaging in most areas of medicine. An x-ray—also called a radiograph or radiography—is painless, noninvasive, convenient, and fast.
X-ray room in a hospital ER with a ceiling-mounted x-ray system.Radiographs are taken in many different types of medical settings, including hospital emergency departments and freestanding radiology centers. Photo Source: 123RF.com.Your radiologist is a medical doctor who specializes in imaging. The radiology technician works with the radiologist to obtain the images ordered by your physician. The test involves directing small short doses of radiation to a specific area of the spinal column. The amount of radiation is small and the x-ray beam is very precise.

The type(s) of x-ray images your neurosurgeon, orthopaedic spine surgeon, or other spine specialists may request includes:

  • Cervical (neck), Thoracic (mid back), Lumbar (low back), and/or Sacral (back of the pelvis)
  • Front to back: called anteroposterior (AP)
  • Back to front: called posteroanterior (PA)
  • Side view: called lateral (LAT, left or right)
  • Flexion: bending forward
  • Extension: bending backward
  • Bending sideways to left and/or right
  • Full standing view in any of the above directions

Radiographs are taken in many different types of medical settings, including hospital emergency departments, physician's offices, urgent care clinics, and freestanding radiology centers. Some facilities allow walk-in service, whereas others work by appointment only. The images can be printed on film and/or made available in a digital format (available on CD).

Tell Your Physician and Radiologist If:

  • There is a chance you are or could be pregnant.
  • You are breastfeeding
  • Have difficulty lying still

And, if your test includes contrast:

  • If you are allergic to contrast medium or had a previous reaction to IV dye.
  • If you are allergic to latex.

Preparing for X-ray

Typically, undergoing x-ray involves no special preparation. You can drive yourself to and from the testing facility. Always follow the instructions provided by your physician and/or radiologist.

How X-ray Produces Images

An x-ray machine is equipped with a tube through which a small amount of radiation is precisely directed at the target area of the spine. As the x-ray beam passes through your body, the amount of radiation absorbed depends on the density of tissue being examined. Bone, being a dense tissue absorbs more radiation than soft tissue, such as the intervertebral discs. Therefore, bones appear whiter on an x-ray image compared to soft tissue. Images are rendered in gradient scales of blacks, grays and whites.

What to Expect during an X-ray Test

If your clothing has metal snaps, buttons, or a zipper that could obstruct the area of the spine being imaged, you may be asked to change into a gown.

  • Depending on the part of the spine and the view(s) requested by your ordering physician, you may be asked to stand during the test and/or be positioned on the x-ray table by the radiology technician.
  • One or more x-ray-friendly objects (eg, pillow) may be placed about your body (or a part of your body) for support during the test.
  • The technician may cover an area(s) of your body with a lead apron to protect it (eg, thyroid gland, breasts) from radiation exposure.
  • You may hear the technician place and replace image recording device(s) into a tray beneath the table or within the x-ray equipment.
  • At certain times during the test, the radiologist/technician will ask you to lie very still, and you may need to hold your breath for a few seconds.

X-ray with Contrast Medium

Your x-ray testing may be performed with contrast—a material that is injected through an intravenous line (IV) in your hand or arm. Contrast can help to highlight image detail. When the test is ordered with contrast, the test is performed in two steps.

  • Step 1: Without the contrast medium
  • Step 2: After the contrast medium is injected, the next set of images are obtained.

After X-ray Testing

  • You may be asked to wait a brief time to make sure no additional images are needed.
  • Radiation from the x-rays does not stay in your body, and seldom are there any side or after effects.
  • The radiologist reads and interprets your x-rays and sends the ordering physician a written report.
Updated on: 08/06/19
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