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|Becca Bear on Eyes wide open|
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The cat’s pajamas
I am a licensed x-ray technologist and I must say I absolutely LOVE my job; even when I have the worst, uncooperative patients, helping people is really what I enjoy doing!
That being said I get a lot of the same questions to very common exams so this is kind of an informational blog on x-rays and some common facts that were pounded into my head when I went to school. I also believe its important for you to have some basic knowledge of radiation since it seems to be a bigger concern for the general public these days.
First off, there are multiple modalities to a diagnostic imaging department and regular x-rays are the most common diagnosing broken bones, chest (heart and lung) pathologies, and viewing the digestive tract through use of fluoroscopy (study of real time movement through body using some form of contrast medium). Other modalities include CT (Computer Tomography), MRI (Magnetic Resonance Imaging), Nuclear Medicine, Ultrasonography, Mammography, DEXA (Dual-Energy X-ray Absorptiometry ) Scan. My knowledge of the other modalities are fairly limited to the basic, but you’re more than welcome to ask any questions about them I might be able to answer or I can ask the technologist I know who work in that modality.
So questions I get asked all the time:
1. If the right side of my chest hurts, why are you putting my left side against the board?
Well, as most people know the heart is located on the left side. Although you have right chest pain what we are actually trying to visualize on a lateral chest x-ray is the heart and any fluid or nodules seen in the *PA[posterior anterior] (or **AP [anterior posterior]) view. With x-rays the object you are looking to see should be the one closest to the board to decrease the OID (Object to Image Distance). In this instance putting your left side against the board decreases the OID, and therefore decreasing the magnification on the heart so we can make sure your heart is the proper size it should be and checking for any other abnormalities is possible.
2. How much radiation am I getting from this?
The amount of radiation you receive is based off of many factors:
What exam are you getting?
How big are you?
What technique is your technologist setting?
How long are you getting radiated (most important for fluoroscopic cases)?
I cannot tell you how much radiation you are receiving in a number unless I had all of that information, but even if I could it probably wouldn’t mean anything to you. The next question would be “well how much is that?” I can tell you that a simple two view chest x-ray is generally so little radiation that walking outside in the sun will give you more radiation. In fact, if you fly on a plane you are probably receiving more radiation than coming in to have an exam done. Radiation is all around you! Even bananas emit small amounts of radiation.
3. Why do I have to change my clothes?
Trust me when I say us x-ray technologist do not want to see you naked. If you are wearing a thick material, metal, plastic, or something with a very textural design there is a good chance we will see it on our pictures. Underneath that button or those metal clips could be some kind of pathology the radiologist would miss.
4. Do you see anything?
“Well, I see some bones, a heart, maybe some lungs. Pretty much looks like a human chest to me.” My patients probably think I am a sarcastic ass. And they’re right. However, technologist are not allowed to answer this question (and if they do they are putting their jobs on the line). The Radiologist (who must be a certified Doctor) is responsible for reading the pictures the technologist takes. How would you feel if the technologist told you they thought you had lung cancer but when your doctor gets the report it comes back normal? That could get seriously out of hand, very quickly. So please, do not ask. If you would like to see your pictures and the tech you get is nice enough/ able to, feel free to look. Otherwise, try to be patient.
5. How does radiation create a picture of my anatomy?
Through a complicated process, radiation exposes a special plate in an image receptor and that receptor is read using a machine or processing where you have to dip your film in chemicals to get a picture. The specifics really depends on the equipment used and type of x-ray machine. There is the really old school film that requires film, a dark room, and chemicals. This is fairly outdated and only used in private doctors offices; most hospitals in the United States (as far as I’m aware) utilize technology/computers (of course). Basically, there is a plate that is read by a machine. The amount of radiation that hits the plate is based on the density of the object its going through. For example radiation will not go through bone as easily as it would go through muscle, and muscle would be more difficult to go through than fat. The exposed plate will turn various shades of gray and black (black is air), bone will be white with a few grey lines (called trabecular markings). Those varying black, grays, and white create the picture of your anatomy for the Radiologist to read!
Common fact about x-rays:
-Chest and Abdominal x-rays are done erect in order to view air/fluid levels in your body. If you would like a visual of this, go grab a bottle of water and drink about half of it. Set the bottle up against a wall at eye level. You can clearly see the level of fluid and how much is in the bottle. Now, lay the bottle down and standing over it look down. You cannot tell how much water is in it. Since your body is made up mostly of fluid, while a patient is laying down we would not even be able to tell if there is fluid present where it shouldn’t be.-The Gallbladder does not show up on x-rays; gallstones are rarely seen on x-rays because of the material they are made of (mostly cholesterol) is not dense enough to differ from other anatomy.
-There are 206 bones in the body. When you are a child your bones are not fused together; they fuse are you grow.
-There is no such thing as big boned. I’m sorry to inform you, but everyone’s bones are generally the same size (of course our different body types, height, ect do effect the shape and length of the bone). Some people’s bones are denser or a little thicker, but just because your body gets bigger does not mean your bones are! Trust me on this, I see what I like to call “little people trapped in a big body” every day. So, 20 years ago the knees you had when you only weighted 100 pounds are still supporting your now 200+ pound body. Just think about that for a minute.
-If you have any UGI (upper gastrointestinal) studies done and they give you specific instructions to not eat or drink for 6-8 hours prior to your study: We will know if you are lying. Liquid and food will be in your stomach and it shows up on x-rays. Even normal activity such as smoking cigarettes, chewing bubble gum, and taking medication in the morning can skew your results, so make sure you pay attention to your instructions!
-The appendix is best viewed with contrast studies, but most of the time so small it cannot be seen! It is found in an area of the large intestines known as the cecum, or near the ileocecal valve (the junction between the ileum of the small intestine and the cecum of the large intestine).
*The PA [posterior anterior] position is where x-ray beam is traveling through your body from the posterior to the anterior. You are facing the image receptor that is capturing radiation coming from your chest which is what creates your picture.
**The AP [anterior posterior] position is where you are facing the x-ray tube with your back to the image receptor. If this is occurring you are most likely not able to stand and will be done with you laying in a bed sitting up or sitting up in a wheelchair.
It’s amazing how much I information I cannot come up with when I try! In any case, I hope you learned something and if you (or someone you know) have ever had an x-ray this will help clear some things up! Please ask questions if you can come up with any I will try to answer them to the best of my ability!
Reference pictures from webmd.com