X-Ray: What to Expect and How to Prepare

X-rays are a form of energy that can pass through the body. Dense structures such as bone absorb a lot of the beam and show up pale; softer tissue absorbs less and shows up darker. The pattern that reaches the detector on the other side is the image. You may hear the test called plain radiography, or simply a plain film.

It is the simplest and most widely available imaging test in Australia. Nothing enters your body, nothing touches you apart from the table or the plate you stand against, and each picture takes a fraction of a second.

X-rays are commonly requested to look at:

• bones and joints, after an injury or where there is ongoing pain
• the chest, including the lungs and the outline of the heart
• the spine
• the abdomen, in certain situations
• the position of a device, implant or fracture after treatment

Because an X-ray is fast and available almost everywhere, it is often the first imaging test done — and sometimes the only one needed. If it does not answer the question, your doctor may then request an ultrasound, CT or MRI. If you are unsure why this test was chosen for you, the doctor who referred you is the person to ask.

Plain X-rays need no fasting and no special preparation. A small number of X-ray examinations that involve swallowing or injecting a contrast medium do have instructions of their own; if yours is one of those, the clinic will tell you when you book.

• Wear something simple without zips, studs, hooks or underwiring over the area being examined — metal shows on the image and can obscure what the radiologist needs to see.
• Leave jewellery at home where you can, rather than bringing it to store in a locker.
• Expect to be given a gown for some examinations, particularly chest and spine images.
• Bring any earlier images of the same problem, if they were taken somewhere else and you have them.

Being asked about the possibility of pregnancy — including the date of your last period — is a normal part of arranging any test that uses X-rays, and it is asked every time rather than assumed from your record. It does not necessarily mean the X-ray cannot go ahead: it may change how the image is taken, whether shielding is used, or whether a different test is better. That decision belongs to your doctor and the radiologist, and they can only make it if they know.

• your referral, if it has not already been sent to the clinic
• your Medicare card, and any concession or DVA card
• private health insurance details, if the imaging is being done as a private patient in hospital
• any previous images or reports for the same problem, if they were done elsewhere
• the name of the doctor who should receive the report

1. You check in at reception and hand over your referral, along with your Medicare card and any concession card.
2. Staff confirm which part of your body is being imaged, and ask about the possibility of pregnancy.
3. You may be asked to change into a gown and to remove jewellery near the area being examined.
4. The radiographer explains what they need you to do, and how many images they expect to take.

The radiographer positions the part of your body being examined against a flat detector, moves the X-ray tube into place, and then steps behind a screen or out of the room to take the image. You may be asked to take a breath in and hold it, which stops movement blurring the picture.

Most body parts are imaged from more than one angle, so you will usually be repositioned between images. Tell the radiographer if a position is painful — there is often another way to get the same view.

Afterwards, the radiographer checks each image is clear enough to be reported on. Occasionally an extra image is needed. This is a quality check, not a finding, and it does not mean something has been seen.

The exposure itself is a fraction of a second. Almost all of the appointment is positioning, checking the images, and changing. How long that takes depends on how many views are needed and how easily you can move.

Examinations covering several body parts, or where someone is in pain and needs help to move, take considerably longer. Many practices accept walk-in X-ray referrals; it is worth asking whether yours does, and how busy the day is.

There is no sensation from the beam at all. If you have a fracture or an acute injury, being moved into position can hurt, so say so before you start: the radiographer can support the limb, take fewer views, or find an alternative position.

Everyone is exposed to ionising radiation continuously from natural sources: the ground, building materials, food and cosmic rays. A plain X-ray adds a small amount to that ongoing background exposure — much less than a CT scan of the same area.

At the doses used in plain radiography, health effects have not been demonstrated in people having these examinations. The generally accepted position is that any increase in long-term risk is very small, and smaller than the risk of a condition going undiagnosed or being treated on incomplete information.

That balance is why an X-ray is requested by a doctor rather than chosen from a menu — each examination is meant to be justified by what it will show. Equipment is checked regularly, and the people operating it are licensed to do so. Once the exposure is over there is no radiation left in the room, and an X-ray does not make you radioactive.

If you would like to understand the balance for your own examination, ask the doctor who referred you. Children are more sensitive to radiation than adults, which is why imaging for children is planned with particular care.

Reports on plain X-rays are often available quickly, sometimes the same day, but it depends on the practice and on how urgent the examination is. Ask when the report is expected to be sent, and book a follow-up with your referring doctor to go through what it means for you.

Many practices can also give you access to your images, or send them to another doctor if you are being referred on. Ask at reception before you leave rather than afterwards.

A plain X-ray has no after-effects. There is nothing in your body afterwards, no recovery time, and no restriction on what you do next.

If you were being imaged because of an injury, follow whatever advice you were given about the injury itself. If you become unwell or your symptoms worsen, contact your doctor. In an emergency, call 000.

In Australia, medical imaging is arranged through a referral (also called a request) from a doctor. You take that referral to an imaging provider, and for most types of imaging you may choose which provider you go to, unless your referral names one.

Whether a Medicare benefit applies to a particular examination, and how much of the fee it covers, depends on the item and on your circumstances. Some providers bulk bill some examinations; others charge a fee, and you pay the difference between that fee and any Medicare benefit.

• Ask the imaging provider what the examination will cost you before you go, and whether they bulk bill it.
• Ask whether a referral expires, if you are not planning to attend immediately.
• Services Australia publishes current information on Medicare and bulk billing, and MBS Online publishes the Medicare Benefits Schedule itself. Both are linked in the sources below.