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X-ray

Radiography, or as it is most commonly known, an x-ray, is the oldest and most frequently used form of medical imaging. Discovered more than a century ago, x-rays can produce diagnostic images of the human body on film or digitally on a computer screen.

X-ray imaging is the fastest and easiest way for a physician to view and assess broken bones, joint or spine injuries. At least two images (from different angles) are taken and often three images are needed if the problem is around a joint (knee, elbow or wrist). X-rays also play a key role in guiding orthopedic surgery and in the treatment of sports-related injuries. X-ray may uncover more advanced forms of cancer in bones although early screening for cancer findings requires other methods.

To this end radiologists have developed alternative imaging methods that do not rely on radiation, such as ultrasound and magnetic resonance imaging (MRI). However, because x-ray was the first imaging modality, many people (and medical imaging professionals) continue to use the term "radiology" to include all types of imaging. Strictly speaking, though, radiology refers to the use of x-rays.

Probably the most common use of bone radiographs is to assist the physician in identifying and treating fractures. X-ray images of the skull, spine, joints and extremities are performed every minute of every day in hospital emergency rooms, sports medicine centers, orthopedic clinics and physician offices. Images of the injury can show even very fine hairline fractures or bone chips, while images produced after treatment ensure that a fracture has been properly aligned and stabilized for healing. Bone x-rays are essential tools in orthopedic surgery, such as spinal repair, joint replacements or fracture reductions.

X-ray images can be used to diagnose and monitor the progression of degenerative diseases such as arthritis. They also play an important role in the detection and diagnosis of cancer, although usually computed tomography (CT) or MRI is better at defining the extent and the nature of a suspected cancer. Severe osteoporosis can be visible on regular x-rays, but bone density determination for early loss of bone mineral is usually done on specialized, more sensitive equipment.

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Arthrography

Arthrography is the radiographic examination of a joint after the injection of a dye-like contrast material and/or air to outline the soft tissue and joint structures on the images.

Arthrography is done most often to identify abnormalities associated with the shoulder, wrist, hip, knee and ankle. Patients who undergo this procedure usually have complained of persistent, unexplained joint pain or discomfort. Arthrographic images may allow identification of problems with a joint's function or indicate a need for a joint replacement.

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Hysterosalpingography

Hysterosalpingography, also called uterosalpingography, is radiography (or x-ray) of the uterus and fallopian tubes performed after the injection of radiopaque contrast material (for this examination iodine is used mixed with water or oil). X-ray images are still pictures of the body’s interior structures acquired by using small, highly controlled amounts of radiation that are passed through the body and recorded on film. Certain anatomic structures allow more radiation to pass through them than others, creating varying shades of lightness and darkness on an x-ray image. In hysterosalpingography, a particular type of radiography, called fluoroscopy, is used. The contrast material used for this procedure can be water-soluble. It is administered to the cervix through a small catheter to help the radiologist view the internal uterine structures.

Hysterosalpingography is primarily used to examine women who have trouble becoming pregnant. It is able to show the shape and structure of the uterus, the patency (openness) of the Fallopian tubes, and any adhesions (scarring inside the body from prior surgery or infections) that may be present within the peritoneal cavity. The procedure can be used to investigate repeated miscarriages that can result from congenital abnormalities of the uterus. It can also be used to monitor the effects of tubal surgery—that is, the closure of the fallopian tubes in a sterilization procedure (tubal ligation), or the re-opening of the fallopian tubes after a sterilization reversal.

Hysterosalpingography is able to depict congenital abnormalities of the uterine cavity. It can also be useful to monitor a patient who has undergone surgery to re-open the fallopian tubes from a disease-related obstruction. If the uterus is positioned incorrectly as a result of tumor masses or adhesions, or if uterine fibroids are present in the uterine cavity, hysterosalpingography can be used to determine the presence and severity of these abnormalities.

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Intravenous Pyelogram (IVP)

An Intravenous Pyelogram (IVP) is an x-ray examination of the kidneys, ureters and urinary bladder. Most people are familiar with x-ray images, which produce a still picture of the body's interior by passing small, highly controlled amounts of radiation through the body and capturing the resulting shadows and reflections on film. An IVP study uses a contrast material (iodine) to enhance the x-ray images. The contrast material is injected into the patient's system and its progress through the urinary tract is then recorded on a series of quickly captured images. The exam enables the radiologist to review the anatomy and the function of the kidneys and urinary tract.   

A radiologist can use an IVP study to find the cause of a wide variety of disorders, including frequent urination, blood in the urine, or pain in the side or lower back. The IVP exam can enable the radiologist to detect problems within your urinary tract resulting from kidney stones; enlarged prostate; tumors in the kidney, ureters or urinary bladder; and other changes.

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Myelography

Myelography is an x-ray examination of the spinal cord and the space surrounding it, called the subarachnoid space. The x-ray film, or myelogram, is taken after injecting a radiopaque contrast material through a needle placed in this space. Myelography can demonstrate distortions of the spinal cord, the spinal canal within which it lies, and the spinal nerve roots connected to it. It is an effective means of identifying spinal lesions caused by disease or trauma. This exam, done about 350,000 times a year in the United States, is relatively safe and painless.

A myelogram is done to provide a very detailed picture of the spinal cord and spinal column, and of any abnormalities that may be present. Often myelography is performed when other tests—such as computed tomography (CT) scans or magnetic resonance imaging (MRI) have not provided adequate information. For patients who cannot have an MRI exam for any reason, myelography may be performed, followed by a CT scan.

• Myelography can identify a herniated or ruptured intervertebral disk. Slipped disk is a common term for this problem. The disks are pads of rubbery tissue that lie between the vertebrae, the bones that make up the spine. Disks act to cushion the vertebrae when the backbone comes under pressure, whether from heavy lifting, sudden strain, change in position, or injury. There may be sudden severe back pain if the disk ruptures, or pain may develop gradually with advancing age as the disks degenerate. The lower part of the back is most often affected. A myelogram can accurately locate the disk or disks involved, and show whether disk tissue is pressing on nerves connected to the spinal cord. This information is especially important when surgical treatment is a possibility.
• People with spinal arthritis sometimes develop sharp outgrowths of vertebral bone called bone spurs; these may press on spinal nerves and cause pain. Here again, a myelogram can indicate whether surgery might help. The exam also can identify a condition called spinal stenosis where the entire spinal canal is narrowed.
• Tumors may develop within the spinal cord or surrounding tissues. In addition, cancer from elsewhere in the body may spread to the spine. A myelogram will accurately locate a tumor mass in this region and may suggest the most effective treatment.
• Other conditions that may be shown by a myelogram include infection, inflammation of the arachnoid membrane that covers the spinal cord, abnormalities of blood vessels that supply the spinal cord, and traumatic injuries.

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Pediatric Voiding Cystourethrogram

A voiding cystourethrogram (VCUG) is an x-ray examination of the bladder and lower urinary tract. A catheter is inserted through the urethra, the urinary bladder is filled with a water-soluble contrast material, and the catheter is withdrawn. Several x-ray images of the bladder and urethra are captured as the patient empties the bladder. These images allow radiologists to diagnose any abnormalities in the flow of urine through the body.

In children, a voiding cystourethrogram is often recommended after a urinary tract infection to check for a condition known as vesicoureteral (VU) reflux.

Urine is produced in the kidneys and flows through the ureters into the bladder. A valve mechanism prevents urine from backing up into the kidneys as the bladder gets full. Urine leaves the bladder through the urethra and is eliminated from the body during urination.

In some children an abnormality in the valve or the ureters allows urine to flow backwards into the ureters, referred to as VU reflux. In mild cases urine backs up into the lower ureter. In severe cases it can back up into a swollen kidney.

Usually children with this condition are born with it. Other causes can include blockage to the bladder, abnormal urination with very high pressure within the bladder, incomplete emptying of the bladder, or urinary tract infections. Reflux is commonly associated with urinary tract infections, occurring in about 40 percent of newborns and infants, and 25 percent of older children. Urinary tract infection may be the only symptom of the problem.

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Chest X-ray

The chest x-ray is the most commonly performed diagnostic x-ray examination. Approximately half of all x-rays performed in medical institutions are chest x-rays. A chest x-ray is usually done for the evaluation of lungs, heart and chest wall. Pneumonia, heart failure, emphysema, lung cancer and other medical conditions can be diagnosed or suspected on a chest x-ray. Traditionally, chest x-rays have been performed prior to employment, prior to surgery or during immigration. The use of "routine" chest x-rays is being reevaluated because there is a lack of evidence for their usefulness, and many insurance companies no longer pay for these "routine" x-rays performed in the absence of specific signs, symptoms or medical conditions.

A chest x-ray is typically performed as the first imaging test for symptoms of shortness of breath, a bad or persistent cough, chest pain, chest injury or fever. Individuals with known or suspected medical conditions such as congestive heart failure or cancer may undergo chest x-rays to follow their response to treatment, or to determine changes that would require a change in their medical management.

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Lower Gastrointestinal (GI) Tract X-ray

This is an x-ray evaluation of the large intestine, also known as the colon. This includes the right or ascending colon, the transverse colon, the left or descending colon and the rectum. The appendix may be seen if it is present and a portion of the small intestine may be visualized as well. Radiological images are created by passing small, highly controlled amounts of radiation through the body and capturing the resulting shadows and reflections on film. Most people are familiar with x-ray images, which produce a still picture of the body's internal organs. A similar imaging method, fluoroscopy, uses x-rays to capture an image of an organ while it is functioning. Though still x-ray images can be useful in examining the colon and rectum, dynamic fluoroscopy is often the most effective way to view abnormal or blocked movement of waste through the body's lower gastrointestinal (GI) tract.

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Upper Gastrointestinal (GI) Tract X-ray

Also called an "upper gastrointestinal (GI) series" or simply an "upper GI," upper gastrointestinal tract radiography is an x-ray examination of the esophagus, stomach and first part of the small intestine (also known as the duodenum). However, in order for the anatomy to show up on radiographic images the upper gastrointestinal tract must be coated or filled with a contrast material called barium, an element that appears bright white on radiographs. The barium is given to the patient to drink. This procedure is called "upper gastrointestinal tract radiography" when the esophagus, stomach and duodenum are evaluated or a "barium swallow" when only the pharynx and esophagus are evaluated. Additionally, some patients are asked to swallow baking-soda crystals to create gas and further improve the images; this procedure has the modified name of "air-contrast" or "double-contrast upper GI."

An upper GI procedure is done to observe digestive function or to detect abnormalities such as ulcers, tumors or inflammation of the esophagus, stomach and duodenum. Patients who undergo this procedure are usually those who have difficulty swallowing, are complaining of chest and abdominal pain or reflux (a backward flow of partially digested food and digestive juices), or have unexplained vomiting, severe indigestion or blood in the stool (indicating internal GI bleeding).

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