Bone X Rays

Definition
Purpose
Description
Preparation
Aftercare
Risks
Normal results

Definition

Bone X rays are a diagnostic imaging test in which ionizing radiation passing through the bones enables an image to be produced on film. An x ray (radiograph) can produce an image of a bone from various and multiple angles. A physician may view an x-ray film to help diagnose fractures in patients and then consider treatment options based on the findings. An x ray may be taken of many bones in the body including the hand, foot, wrist, spine, rib cage, spine, and ankle.

Purpose

Bone x rays are ordered to detect bone disease or injury, such as in the case of broken bones, tumors, and other problems. They can determine bone density, texture, erosion, and changes in bone relationships. Bone x rays also evaluate the joints for such diseases as arthritis. In addition, x rays may be taken to see if a joint has been dislocated, to guide a surgeon during an orthopedic surgical procedure such as a total joint replacement operation, to visualize foreign objects, or to check bone alignment before and after cast application or repair via screw and plate orthopedic procedures.

Description

X rays are the result of the collision between electrons and a protons. German physicist Wilhelm Conrad Röntgen (1845–1923), discovered what he called X-radiation, in 1895. This form of radiation was noted to have properties allowing transparency and fluorescence that absorbed visible light and contrasting shadows. Experiments with this new form of radiation revealed the distinction between bone and soft tissues in the body, such as in the hand. Rontgen’s first x ray was of his wife’s hand, which showed bones, soft tissue, and metal from the ring she was wearing. His discovery of x rays heralded a significant and valuable diagnostic tool used in the field of medicine. Röntgen was awarded the Nobel Prize for Physics in 1901 for his discovery. He was the first recipient to be honored in this category. This Nobel Laureate was honored “in recognition of the extraordinary services he has rendered by the discovery of the remarkable rays subsequently named after him.”

X rays are a common diagnostic test in which a form of energy called x ray radiation penetrates the patient’s body. In bone x rays, electrical current passes through an x-ray tube and produces a beam of ionizing radiation that passes through the bone(s) being examined. This produces a picture of the inside of the body on film. The doctor reads the developed x ray on a wall-mounted light box or on a computer monitor.

Digital x rays are a new type of exam in which conventional equipment is used to take the x-ray picture, but the image is produced via computer. In a digital x ray, the image is created on a reusable plate. After being read by a laser reader, the information is sent in digital form to a storage unit that is connected to a computer network. The radiologist reads the x ray from there. An electronic report can then be sent to the patient’s doctor. Electronic reports can also be generated with non-digital x-ray exams.

X rays can detect problems with bones that result from injury or disease caused by malfunction in the patient’s bone chemistry. Bone injuries, especially broken bones (fractures), are common and can be accurately diagnosed by evaluation of bone x rays. X rays are especially helpful in diagnosing simple and incomplete fractures, which cannot be detected during a physical examination. X rays can also be used to check for bone position and alignment in a fracture. Some bone diseases can be definitively diagnosed with bone x rays, while others require additional, more sophisticated imaging tests.

Osteoporosis, a common bone disease, can be detected in bone x rays, but other tests, such as bone densitometry, may need to be ordered to determine the extent of the disease. In some cases, a bone biopsy (microscopic analysis of a small amount of tissue) is also done. For arthritis, a common ailment, x rays of the bone are occasionally used in conjunction with blood tests. In bone tumors, bone x rays can be helpful, but they may not be definitive when used alone.

Bone x rays are taken by a technologist or radiologist and interpreted by a radiologist. They are taken in a doctor’s office, in a hospital, or in an outpatient clinic. Bone x rays generally take less than 10 minutes to complete. There is no pain or discomfort associated with the test, but some people find it difficult to remain still throughout the procedure.

During the test, the patient lies on a table. The technician taking the x ray checks the patient’s position and places the x-ray machine over the part of the body being scanned. After asking the patient to remain still, the technician steps out of the area and presses a button to take the picture.

Preparation

The patient is asked to remove clothing, jewelry, and any other metal objects from the part of the body being x rayed. If appropriate, a lead shield is placed over another part of the body to minimize exposure to the radiation that is being used.

Aftercare

The patient can immediately resume normal activities once the technician has checked that the x rays have processed well and that none need to be repeated. This takes just a few minutes.

Risks

The human body contains some natural radiation and is also exposed to radiation in the environment. There is a slight risk from exposure to radiation during bone x rays; however, the amount of radiation is small and the risk of harm is very low. If reproductive organs are to be exposed to large amounts of radiation, genetic alterations could occur in a developing fetus. Excessive or repeated doses of radiation can cause changes in other types of body tissue. No radiation remains in the body after the x ray.

KEY TERMS

Arthritis— A disease of the joints that arises from wear and tear, age, and, less often, from inflammation.

Bone densitometry— A test to measure bone density.

Ionizing radiation— Energy from radio, ultraviolet, or x rays, that produces charged particles in the recipient matter.

Osteoporosis— A disease which occurs primarily in postmenopausal women in which the amount of bone is reduced or skeletal tissue wastes away.

Normal results

Normal bones show no fractures, dislocations, or other abnormalities.

Results that indicate the presence of bone injury or disease differ in appearance, according to the nature of he injury or disease. For example, fractures show up as clear breaks in the bones, while osteoporotic bone has the same shape as normal bone on an x ray, but s less dense.

Resources

BOOKS

Dutton, Mark. Orthopaedic Examination, Evaluation, and Intervention. New York: McGraw-Hill, 2004.

Fishback, Francis Talaska, ed. A Manual of Laboratory and Diagnostic Tests. 5th ed. Philadelphia: Lippincott, 2003.

Perry, Clayton R., and John Elstrom. The Handbook of Fractures, 2nd ed. New York: McGraw-Hill, 1999.

Skinner, Harry. Current Diagnosis & Treatment in Orthopedics. New York: McGraw-Hill, 2006.

Tierney, Lawrence M., Jr., Stephen J. McPhee, Maxine A. Papadakis. “Tumors and Tumor-Like Lesions of the Bone: Current Medical Diagnosis and Treatment.” In Current Medical Diagnosis & Treatment, 36th ed. Stamford, CT: Appleton & Lange, 1996.

OTHER

RadiologyInfo. http://www.radiologyinfo.org.

ORGANIZATIONS

Radiological Society of North America, 820 Jorie Blvd., Oak Brook, IL, 60523-2251, (630) 571-2670, http://www.rsna.org.

Lori De Milto

Lee A. Shratter, M.D.

Laura Jean Cataldo, R.N., Ed.D.