Radiologists & information on X-ray diagnostics

X-ray diagnostics refers to X-ray imaging techniques used to diagnose diseases. Various imaging techniques are used for this purpose. X-rays are a medical procedure used to visualize body structures such as bones, tendons, muscles, vessels and internal organs. The technique uses X-rays, which were discovered by Conrad Röntgen in 1895. Since then, X-ray technology has been consistently developed further. Today, it is used in almost all areas of medicine.

What are X-rays?

X-rays can penetrate matter and are weakened during this process. It is precisely this property that makes them useful for creating images. Just like light, X-rays can blacken photographic material (this effect was once responsible for their discovery). However, they also cause changes in living organisms. This undesirable effect makes radiation protection necessary.

What happens during an X-ray examination?

The part of the body to be examined must be unclothed. The patient must also not wear any metal objects on their body, as they will cause interference on the X-ray image. After radiation-sensitive organs have been protected by a lead apron, a member of the practice team places the patient between the X-ray machine and the detector. He takes an image from a separate room, which only takes a fraction of a second. The examination is completely painless. The patient must not move during the examination. Several images are often taken from different angles. The specialist (usually a radiologist) then takes a critical look at the images and searches for conspicuous areas of tissue.

An X-ray examination is an imaging procedure that uses X-rays to create an image of an area of the body @ Gorodenkoff /AdobeStock

Which specialists carry out X-ray diagnostics?

Radiologists specialize in diagnostic imaging and have completed several years of specialist training in addition to their general medical training. He examines patients who have been referred to him by GPs and specialists. His practice is equipped with state-of-the-art MRI and X-ray technology. Radiology practices also carry out screening examinations such as regular breast cancer screening(mammography). If inpatients require an X-ray examination, this is also carried out in the hospital's radiology department.

Mammography is a special X-ray examination of the breast @ RFBSIP /AdobeStock

Which tissues can be visualized using X-rays?

When the body is X-rayed, it is penetrated by electromagnetic waves. This makes it possible for the rays to hit the X-ray film. If the radiation penetrates matter, it loses energy. As a result, structures are displayed in shades ranging from black to white, depending on their composition. Bones have the highest density of all body tissues and therefore attenuate the radiation the most. They are recognizable as white structures on the image. Permeable, soft tissue and air-filled organs such as the lungs and stomach are almost black and difficult to see. X-ray examinations with contrast media are used here.

Which techniques are commonly used for X-rays?

A distinction is made between technical X-rays, computer tomography (CT) and fluoroscopy.

X-rays are the most common conventional diagnostic technique. The resulting image shows dense structures in light colors and less dense structures such as fatty tissue in dark colors.

X-ray fluoroscopy is used for examinations that are intended to show movement sequences. It is commonly used for examinations of the oesophagus and the gastrointestinal tract. Angiography is also one of these examination methods and can also be used for treatment. It is used, for example, to widen a constricted blood vessel.

Angiography is the term used to describe the imaging of blood vessels @ utah51 /AdobeStock

Computed tomography is a cross-sectional imaging procedure. A large number of individual images are taken in order to create sectional images without overlapping. Digital volume tomography (DVT) and tomosynthesis mammography are also cross-sectional imaging procedures that are being used more and more frequently today. DVT is particularly common in dental diagnostics.

Digital X-rays are state of the art today

Digital X-rays differ from analog X-rays both in terms of image generation and presentation. Traditional analog technology poses health risks for staff due to the chemicals required for film development. Furthermore, conventional X-ray archives take up a lot of space. Digital technology allows images to be stored on much smaller media and is more environmentally friendly. Only a PC is required to view the images, and the workflow in the practice is hardly affected. The most decisive advantage of digital X-rays is that patients are exposed to less radiation. Digital X-ray systems are based on existing X-ray systems. They are simply supplemented by an X-ray detector or a CR read-out device. This means that the investment for the doctor remains manageable.

When is X-ray diagnostics useful?

X-ray technology has brought considerable medical progress and the range of applications for X-ray examinations is very wide. Nevertheless, there is still an exposure to radiation. X-ray diagnostics should therefore only be used if the therapeutic benefit justifies the radiation risk.

X-ray examinations are required for

• Detection and therapeutic monitoring of cancers
• Reliable diagnosis of bone fractures and monitoring of the healing process
• Diagnosis of inflammatory/rheumatic diseases of the skeleton and monitoring the success of treatment
• Assessment of head injuries after accidents
• Early diagnosis of vascular diseases
• for the early detection of breast cancer (German Mammography Screening Program)

The hand consists of many bones that are connected to each other via joints @ Mathias Weil /AdobeStock

Many diseases can only be clearly diagnosed with X-rays. In the case of accidents (bone fractures) or suspected cancer, there is no way around such an examination. In some procedures, a water-soluble contrast medium is injected into the bloodstream. Patients should drink a lot after an examination with contrast medium so that it can be flushed out again.

Risks of X-ray examinations

There are risks due to exposure to radiation and the contrast medium. The contrast medium rarely causes allergic reactions. Today's X-ray technology works with a lower radiation dose than 10 years ago, so that the exposure for patients is low. Nevertheless, pregnant women may only undergo X-rays in exceptional cases and with special protection, as the unborn child is particularly susceptible to damage from X-rays. The examining doctors are obliged to ask patients if they are pregnant.

How harmful are X-rays?

X-ray examinations are harmful to everyone. The extent of the damage always depends on the dose. The insidiousness of radiation exposure lies in the fact that it does not cause any acute side effects. Damage caused by radiation often only becomes apparent after years or decades. Since 2007, the number of CT examinations has fallen by 40 %. This has also increased the average radiation exposure of German citizens. The average effective radiation dose per inhabitant due to medical examinations was around 1.6 millisieverts (mSv) in 2015. For all other X-ray procedures, however, the average per capita radiation dose has decreased noticeably. Thanks to the easy-to-use technology, many doctors tend to take more X-rays than necessary. Patients should question X-ray examinations as critically as possible.

It should also be borne in mind that seriously ill patients are very frequently subjected to radiological examinations. However, their risk of dying from cancer is higher than from the late effects of radiation exposure.