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 Radiographic Exam
Below is a list of some frequently asked questions, but please feel free to contact us if you need additional information. We are always pleased to assist you.
What is an X-ray?
An x-ray or radiograph is similar to having a photograph taken in a portrait studio. A Radiologic Technologist (RT) uses non-visible x-rays (shorter wavelength) to expose film similar to a photographer using visible light to expose film. The exposed radiographic film demonstrates the body structures and is called a radiograph. X-rays, demonstrate body structures proportionally with their density. The denser the tissue, (bone versus fat) less x-ray reaches the film. This difference in body tissue density is why bone (high body tissue density) is white on a radiograph, as compared to fat (low body tissue density) which is gray or air (no density) which is black.
Why did my doctor order an X-ray?
Radiographs are a reliable and accurate means of obtaining information to help your physician diagnosis the cause of your pain. An x-rays examination is commonly used to determine the presence or absence of disease, a bony fracture, joint malalignment, arthritis, or source of other painful conditions.
Who performs and interprets my radiograph?
Your examination will be performed by a qualified Radiologic Technologist (RT) licensed by New York State. Your examination will be interpreted by a Radiologist. A radiologist is a doctor specializing in radiology including the other imaging modalities of MRI, ultrasound, nuclear medicine and CT. Radiologists specialize in the imaging and diagnosis of disease. Interpretation of a radiograph, MRI, CT, ultrasound, or nuclear medicine examination requires expertise in pattern recognition and in the identification of potential artifacts that may otherwise 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?
The Radiologic Technologist (RT) will escort you to a dressing room where you will be given an examination gown if necessary and instructed 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 lie, sit or be positioned on an 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 tube (camera), cassettes (film) and positioning blocks and sponges to achieve an optimal image.
What is special about the conventional X-ray examination at HSS?
- Weight bearing x-rays of your feet, ankles, knees and spine are performed as the routine, not the exception
- Varied beam angulations customized to optimally visualize specific osseous structures are performed as routine, not the exception
- Stress views of the extremities are performed to evaluate varus/ valgus measurements
- Stress views / bending films of the spine to evaluate the flexibility of a scoliosis curve to adjust for correction
- There is a dedicated Pediatric Suite
- Special equipment is used to obtain specific information:
- Club foot boards to obtain pediatric studies of the foot/ ankle
- Merchant boards to evaluate patellofemoral joints (knee caps)
- 14 x36 inch cassette/ film combinations to evaluate scoliosis
- 14 x51 inch cassette/ film combinations to evaluate continuous lower leg from the hips to the ankles
- Pre / Post-op limb-lengthening protocol includes various height blocks to equalize the leg length discrepancy and verify alignment of the crests of the pelvis
- Boomerang and gentle slope filters to enhance image quality are used for shoulder examinations
- Gradient fractures are used for foot examinations to visualize optimally the toes to the heal
- Anterversion boot / board combination used to evaluate the version (rotation) of the hip joint with and without a total hip joint (arthroplasty)
- Scanogram equipment used to accurately evaluate leg lengths
- Bell Thompson Ruler used for specific measurement determination
- Magnification markers are used for custom joint replacements
- Tomography equipment and expertise available to optimize visualization of specific osseous (bony) findings otherwise obscured by overlying bone
- Cine/ Video films available to allow motion studies analysis
- Highly skilled technologists with years of experience performing the prescribed Musculoskeletal studies. Our Department's Repeat Rate (the amount of times a film has to be re-done) averages 2.5% 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., Administrative Director, Kathleen Seager, R.T., B.S., Assistant Director, Michelle Burke, R.T., the former CT Supervisor of HSS' Department of Radiology and Imaging and Mary Giesa, R.T., Practice Administrator of the Belaire Radiology, PC.
What should I do to prepare for the examination?
For a routine x-ray examination, no preparation is required. 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.
What are the risks?
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 both New York City and New York State, for safety and adequate shielding. All examinations are well within permissible levels of diagnostic radiation dosage.
What are the alternatives?
Alternate diagnostic tests such as MR or ultrasound may be performed without utilizing ionizing radiation, however their use is dependent on your condition and the information your doctor requires.
What can I expect after the examination?
After the Radiological Technologist has completed taking your x-rays, you will be asked to wait in the x-ray room while your films are developed and reviewed for diagnostic quality. After reviewing your films, it may be necessary to take additional pictures to ensure the examination completely demonstrates the area in clinical questions. The radiographic examination will be interpreted by a Radiologist. If you are seeing your physician on the day of your examination you may be given the films to take to your physician.
What happens with the results?
The Radiologist will generate 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 radiographs are the property of the institution as are biopsy slides or blood samples. Copies of the radiographs can be obtained by contacting the file room. There is a charge for obtaining film copies and mailing them to your physician.
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 procedure that utilize imaging guidance.
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