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Bone Radiography

Bone X-ray

  • An X-ray examination is the key to diagnosing many skeletal abnormalities, such as fractures, dislocations, arthritis, tumors, etc.
  • Bone radiography is a fast, safe, easy, painless, reliable, and economic way to assess abnormalities in bones, joints, and adjacent soft tissue.
  • When a bone X-ray is taken, radiation is momentarily irradiated on the area being examined. X-rays pass through the body to produce an image on film. Structures like bone that are dense and have a high atomic number absorb a lot of X-rays, so less X-rays reach the film and appear white. Muscle, fat, tumor, and fluid absorb less X-ray than bone, and appear darker than bone on film. Air distributed in various pockets within the body (usually due to an abnormity) has a low atomic number and density, and consequently appears black, because most X-rays pass through without being absorbed.
  • In the event of a bone fracture, blood and other cells fill the broken or cracked area, so that a fracture appears as a dark line against white bone.
  • Bone X-rays reveal not only bone abnormality but also the position and alignment of joints, joint fluid, soft tissue swelling, and tumors. Even when the bone X-ray shows normal bone, it can still give a lot of potentially valuable clues to help diagnose a patient's condition.
  • The findings of bone X-rays should be correlated with the clinical history, age, and sex of the patient before making confirmative diagnosis. Sometimes, additional X-ray views of the affected bone are needed for better evaluation.
  • Additional radiological examinations (such as CAT scan, MRI, bone scan, ultrasonography) may be needed to arrive at a final diagnosis.
  • Types of bone radiology --
    1. Joint X-ray:
    - Knee joint X-ray
    - Hip joint X-ray
    - Ankle joint X-ray
    - Shoulder joint X-ray
    - Elbow joint X-ray
    - Wrist X-ray
    2. Spine X-ray:
    - Cervical spine X-ray
    - Thoracic spine X-ray
    - Lumbosacral spine X-ray
    - Coccyx X-ray
    3. Extremity X-ray:
    - Humerus (upper arm)
    - Radius and ulna (forearm)
    - Hand
    - Scapula (shoulder blade)
    - Femur (thigh)
    - Tibia and fibula (leg)
    - Foot
    4. Pelvis X-ray
    5. Rib cage X-ray
    6. Skull X-ray
    7. Facial bone X-ray
    8. Mandible X-ray
    9. Paranasal sinus X-ray

  • Injury. To detect fractures or joint injury from traffic accidents, assault, falling down, gunshot, etc.
  • Arthritic conditions. When there's pain, swelling, or limitation of motion in any joint or in the spine
  • Bone infection. When there's fever and painful swelling of bone and adjacent soft tissue
  • Cancer. When there's swelling of bone, joint, and adjacent soft tissue

  • Fractures of bone -- initial detection of fractures, serial bone X-rays, evaluating the healing process
  • Dislocation of joints -- the displacement of a bone from its normal position in a joint
  • Sports injuries
  • Diseases of the joints:
    1. Degenerative joint diseases (i.e., osteoarthritis)
    2. Degenerative disease of the spine
    3. Infectious arthritis (pyogenic arthritis, tuberculous arthritis)
    4. Infections of the spine
    5. Rheumatoid arthritis
    6. Ankylosing spondylitis
    7. Psoriatic arthritis
    8. Reiter's syndrome
    9. Enteropathic arthropathies
    10. Metabolic arthritis (gouty arthritis, pseudogout)
  • Tumors of bone and soft tissue:
    1. Benign tumors of bone -- such as osteoid osteoma, enchondroma, osteochondroma, multiple osteocartilaginous exostoses, chondromyxoid fibroma, fibrous cortical defect, nonossifying fibroma, benign fibrous histiocytoma, periosteal desmoid, fibrous dysplasia, bone cyst, giant cell tumor, hemangioma
    2. Malignant tumors (cancer) of bone -- osteogenic sarcoma, chondrosarcoma, fibrosarcoma, malignant fibrous histiocytoma, Ewing's sarcoma, lymphoma, multiple myeloma)
    3. Benign soft tissue tumors -- lipoma, fibroma, neurogenic tumor
    4. Malignant soft tissue tumors -- liposarcoma, fibrosarcoma
    5. Metastatic bone tumors -- cancer that spreads to bone from other parts of the body
  • Infections and inflammations of bone -- osteomyelitis (inflammation of bone caused by pathogenic organisms)
  • Congenital and developmental anomalies of the skeleton --
    1. Congenital dislocation of the hip
    2. Legg-Calve-Perthes' disease
    3. Slipped capital femoral epiphysis
    4. Congenital tibia vara
    5. Scoliosis
    6. Achondroplasia Clubfoot
  • Metabolic, endocrine, and related bone diseases:
    1. Osteoporosis
    2. Richets
    3. Osteomalacia
    4. Hyperparathyroidism
    5. Paget's disease
    6. Acromegaly

  • Two views are usually taken to evaluate the body part of interest: PA (posterior-anterior) view and lateral view. An oblique view is taken when needed.
  • Before the procedure, remove all clothing and accessories and change in to a hospital gown when needed. The X-ray tube on top of the examination table emits the X-rays. The film where X-rays are detected and made into an image is underneath the table. Place the area being examined between the X-ray tube and film, according to the X-ray technologist's directions.
  • For the picture to be clear without blurring, do not move until the X-ray is taken, and hold your breath as needed.
  • Exposed film is developed, washed, and dried. Then a radiologist (a physician experienced in X-ray and other radiology examinations) places the X-ray film over an illumination box and interprets it. When necessary it is interpreted in comparison to past film.

  • No special preparation is need.
  • Remove clothes if necessary and change in to an X-ray gown. Jewelry, eyeglasses, and other metallic objects can cover an X-ray image, and should be removed as needed.
  • When taking the X-ray, assume the position instructed by the technologist. Do not move until the X-ray is taken and if necessary hold your breath.
  • Women should inform their doctor or X-ray technologist if they are pregnant or suspect pregnancy. Special care will be taken during X-ray exams.

  • A radiologist (a physician specialist trained to interpret X-ray images or other radiology exams, such as CAT scans, MRI, mammography, etc.) reviews the bone X-ray and reports the results to your personal doctor.
  • The attending doctor's office informs patients when the results are in, and their contents. The office uses the results as a reference in evaluating and treating patients.

  • Bone radiography uses X-ray, which is a type of ionizing radiation that can potentially change chemical and genetic structures in the human body.
  • Patients are exposed to far less radiation now than they were in the past, because X-rays are collimated so that there is almost no X-ray exposure outside the intended area, X-rays pass through a filter before being irradiated on the body, and high-speed film is used.
  • For the safety of patients, radiology technologists and radiologists conduct X-ray exams under guidelines set by national and international radiology protection councils.
  • To minimize radiation exposure to reproductive organs, a lead apron/shield can be placed over the patient's testicles (in females, over the pelvic region).
  • A patient is exposed to 20 miliroentgens of radiation during a regular X-ray exam. But considering that one is exposed to 100 miliroentgens a year from ultraviolet rays and small traces of uranium in the soil, radiation exposure from examinations amounts to very little.
  • Women should inform their doctor or X-ray technologist if they are pregnant or suspect pregnancy. Special care will be taken during X-ray exams.

  • In cases of stress fracture (a fine hairline fracture that appears without injury, caused by repetitive microtrauma, as with running, aerobic dancing, marching, etc.) and minor bone injury, the initial X-ray can be normal even when there is pain or swelling. A serial X-ray taken 2-4 weeks after the symptoms presented should reveal any fracture. However, if the symptoms (pain, swelling) continue even after an X-ray was diagnosed normal, serial X-rays and bone scans may succeed in finding the fracture. A bone scan can detect fractures 2-3 weeks earlier than an X-ray at the beginning of symptoms.
  • Even when a bone X-ray taken because of pain after an injury turns out to be normal, there can be soft tissue abnormalities. Joint structure, ligament, tendon, nerve, and muscle show up darker than bone on an X-ray and can't be distinguished. Often, in the case of a meniscus tear or ligament tear in a knee joint, or an Achilles tendon tear, X-rays will appear normal. In these cases, a MRI, CAT scan, or ultrasonography may be needed.
  • When disc diseases are suspected in the lumbar or cervical spine, a normal spine X-ray mean that there appears to be no significant bone anomaly, abnormality in alignment, or other bone changes; but it does not exclude the possibility of disc hernia. If necessary, a CAT scan or MRI can be used to fully evaluate disc herniation and set a treatment plan.
  • If there is soft tissue mass/abnormalities, an X-ray examination may be used to see if there is secondary bone change, calcification, or a large amount of fat in the area. Using X-rays to evaluate soft tissue mass is severely limited, and often an ultrasonography, CAT scan, or MRI may be required to make a proper diagnosis.

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