An x-ray is a painless test in which an image is created of part of the body by using low doses of electromagnetic radiation that are reflected on film paper or fluorescent screens. X-rays can be used  to help diagnose a wide range of conditions, from a broken arm to abnormal growths. Depending upon a physician’s evaluation, review and interpretation of an x-ray image, further tests may be ordered.

X-ray images are typically taken with no preparation but in some cases, the physician might use a special dye (contrast medium). This dye is helpful in highlighting and identifying certain structures and conditions within the body. If a contrast medium is going to be used, changes may be made in the patient’s diet or medication schedule prior to the test.

In most cases, x-rays are safe, effective diagnostic tools that expose patients to very low levels of radiation. However, women who are or may be pregnant are advised to avoid x-rays or wear a protective lead apron over the abdomen during the test. X-ray radiation in high doses has the potential to harm a fetus if the rays are directed at certain parts of the body, such as the abdomen or lower back. According to the U.S. Food and Drug Administration (FDA), x-ray tests pose very little risk to the expectant mother or unborn child.

An x-ray is a painless test in which an image is created of part of the body by using low doses of radiation reflected on film paper or fluorescent screens. These images, also known as a radiograph or roentgenogram, are used to diagnose and monitor the treatment of various diseases. X-rays are noninvasive, relatively inexpensive and fast.

Radiologists (physicians who specialize in reading x-rays) and other healthcare professionals can use the details gleaned from x-rays to identify abnormalities, including gynecological conditions.

In some cases, standard x-ray procedures may not be sensitive enough to detect very small abnormalities or tumors hidden in the body by other organs. In such situations, an x-ray procedure known as a CAT scan (computed axial tomography) may be helpful. Instead of taking a single x-ray image, a CAT scanner rotates around a patient’s body to capture multiple images. A computer combines these images into detailed “slices” of a person’s internal body system.

X-rays are a valuable, safe diagnostic tool in most circumstances. However, x-rays can raise concerns related to gynecological health, particularly among pregnant women. Though the amount of radiation in x-rays is relatively low, it may present a small danger to a developing fetus. Cells that divide quickly are especially vulnerable to the radiation in x-rays, and the cells of a developing fetus divide rapidly as tissues form in the developing child.

According to the U.S. Food and Drug Administration (FDA):

• X-ray tests pose very little risk to an expectant mother or unborn child.
  
  
• The risk of not having a medically necessary x-ray could far outweigh any risk from radiation.
  
  
• X-rays should be avoided if tests are not necessary.

Imagine that an individual is standing between a wall and a window through which sunlight is streaming. Because sunlight cannot pass through the solid barrier created by the body, it will cast a shadow against the wall. X-rays have been likened to rays of sunlight because they cannot pass through solid barriers such as bones, organs or tumors. As a result, these barriers will appear on the special x-ray film in white, whereas less dense barriers, such as organs, muscle and fat, will appear in varying shades of gray. Bones, which are dense and calcium-rich, will appear the whitest of all internal structures. Any solid objects, such as metal, will appear as bright white.

Additional techniques may be necessary to get a clear view of softer tissues, hollow areas or fluid-filled body parts. For example, a physician may administer a special dye known as a contrast medium to produce sharper contrasts in light and dark areas on the x-ray. These contrasts give the physician a clearer image of areas such as the urinary tract, the spinal cord, blood vessels and the gallbladder.

X-rays were discovered almost by accident in the 1890s by a German scientist named Wilhelm Conrad Roentgen. Because no one understood the rays that were at work in forming these images, the rays were initially called x-rays. Much more is now known about this form of radiation.

Today, the special silver-coated x-ray film is contained in a flat cassette that is placed on the far side of the patient. The area to be examined is placed between the metal film cassette and the x-ray tube, which is surrounded in lead casing except for a small opening through which the rays are beamed. Within the x-ray tube, a beam of electrons is fired into a target made of a chemical element known as tungsten, emitting photons that travel straight and outward from a point on the target to the area being x-rayed. The resulting images are recorded on either film or a fluorescent screen.

Some of these photons pass directly through the body, while tissues in the body absorb the rest. The energy contained in the photons may cause some cell damage. Most of this cell damage is repaired quickly, but some may be permanent. Considering the low doses of radiation in modern x-ray tests, most physicians feel the benefits of x-rays outweigh the very small risk associated with them. However, young children, including developing fetuses, are more sensitive, and women should advise their physicians if they are pregnant.

X-rays can be used for a variety of reasons. X-ray tests that may be performed to address gynecological conditions include:

• Standard x-rays. They may be used to diagnose gynecological abnormalities, such as those that affect the uterus, cervix, vagina and ovaries. This is especially true when a physician is looking for signs of reproductive cancers.
  
  
• Mammograms. A specialized x-ray of the breast from various angles that can detect abnormalities that may indicate breast cancer. The American Cancer Society (ACS) recommends that women age 40 and older have a mammogram every year.
  
  
• Bone-density scans. Women who go through menopause find that decreased levels of the hormone estrogen leave them at risk for osteoporosis. The loss of vital minerals from this condition makes bones fragile, thin and weak. Dual energy x-ray absorptiometry (DEXA) is a common method of gauging bone density in patients suspected of osteoporosis. It can measure the density of bones in the spine, hip and wrist, which are the bones most likely to be fractured as a result of osteoporosis.
  
  
• Intravenous pyelogram (IVP). X-ray of the urinary tract that can detect blockages that prevent normal urine flow, including malformations, tumors and kidney or bladder stones. A contrast agent is given to the patient intravenously to help enhance the image.
  
  
• Infertility testing. To check for blockage of a woman’s fallopian tubes, an x-ray may be taken after these structures are injected with contrast dye via the cervix. A man may have an x-ray that looks for blockage or leakage of structures such as the vas deferens, the tubes that transport sperm from the testicles. Nonsteroidal anti-inflammatory drugs (NSAIDs) may be used prior to infertility testing to decrease cramping. In addition, antibiotics may be administered before and after the procedure to reduce the possibility of infection.

In general, no preparation is needed before an x-ray is taken, unless a special dye called a contrast medium is going to be used. X-rays may be taken in a laboratory, physician’s office, clinic or hospital. If a dye will be used, then patients may be asked not to eat or drink after midnight before the test, and adjustments in the patient’s medication schedule may be made. The physician will also ask about the patient’s history of allergies to screen for a potential allergic reaction to the dye.

A radiology technician (radiographer) or specially trained nurse generally takes x-ray films. This person will ask the patient to remove any objects that may show up on the image (e.g., jewelry, wigs, dentures). Patients should inform the examiner if they have had an x-ray using a contrast dye or barium in the past few days. Patient should also make sure the examiner is aware of all medications that have been taken recently, including over-the-counter medications and herbal supplements.

Female patients should be sure to inform the examiner if they are or may be pregnant, or if they currently have an intrauterine device (a form of birth control) implanted. Although today’s modern equipment and technology uses only minimal radiation when taking an x-ray, pregnant women may want to either avoid x-rays or to wear a lead apron over the abdominal area if testing is necessary. X-rays cannot pass through the lead in the apron, offering protection for the fetus. Sometimes women of childbearing age prefer to wear a lead apron even if they are not pregnant to protect their reproductive organs. Male and female examiners may also wear these lead aprons themselves to protect their reproductive organs against any cumulative effects of x-rays.

Depending on the area of the body that needs to be x-rayed, patients will be asked to position the body accordingly. An x-ray of an arm may require only that patients put their arm in a certain position on a table, whereas a chest x-ray will require patients to lie on the table or stand in front of the machine and hold their breath.

The technician (radiographer) who operates the x-ray machine will tell the patient when to move, shift, take a deep breath or perform other actions that may be necessary to take a clear image.

Patients can resume normal activities immediately following the test. The radiologist or the patient’s physician will interpret the findings and review them with the patient either that same day or at a follow-up visit. Depending on the x-ray results, the physician will recommend either additional tests or design a treatment plan for the patient.

Additional tests may be necessary if the x-rays do not provide enough information on the tissues or structures being studied. These tests could include the following:

• CAT scan (computed axial tomography). X-ray procedure that produces detailed, cross-sectional images of the body.
  
  
• MRI (magnetic resonance imaging). An imaging test that uses powerful magnets to produce images of body structures.
  
  
• Biopsy. Removal of a sample of tissue from the body for laboratory testing.
  
  
• Mammogram. X-ray picture of the breast that can detect a tumor before it is large enough to feel.
  
  
• Angiography. X-ray procedure that examines the blood vessels.
  
  
• Radionuclide imaging, such as PET scan (positron emission tomography) or bone scan. Imaging tests that use an injected radioactive substance (tracer) to highlight internal structures.

The levels of radiation used in x-ray procedures are so low that they pose only minimal risk to most patients. However, x-rays do present potential risks to a woman’s gynecological health. At very high doses, radiation can damage a woman’s eggs. As a precaution, some patients may be asked to wear a lead apron to shield sex organs from exposure to radiation.

In some cases, it may be necessary to x-ray the pelvis itself. This should produce no lasting damage to the reproductive organs. All available data suggest that any damage caused by x-rays is repaired within several weeks. Women who wish to become pregnant after an abdominal or pelvic x-ray should consult their physician about any necessary precautions. Most experts agree that these x-rays should not influence a woman’s timetable for pregnancy. However, some women may be more comfortable waiting three months to one year after an abdominal or pelvic x-ray before trying to conceive.

Women who are or may be pregnant should inform their physician or x-ray technologist of their condition. It may be necessary to take certain precautions to protect the fetus from exposure to potentially harmful radiation. Cells that divide quickly are especially vulnerable to damage caused by radiation in x-rays. A fetus has a high number of cells that rapidly divide to create tissues in the developing child. A fetus exposed to high levels of radiation could suffer from birth defects or diseases such as leukemia (cancer of the blood and bone marrow) later in life. Factors that affect the level of potential risk to the fetus include:

• Stage of fetal development. A fetus is most sensitive to radiation in the first 12 weeks of development. After 20 weeks, the fetus is relatively insensitive to such exposure.
  
  
• Magnitude of radiation dose.
  
  
• Length of time of total exposure to radiation.
  
  
• Area to be x-rayed. It is possible that a fetus may be exposed to radiation during an x-ray of the following:
  
  
• Pelvis
• Abdomen
• Stomach
• Lower back
• Kidneys
  
  
X-rays affect only tissues that come into direct contact with the beam. Therefore, x-rays of body areas away from the fetus will not have a negative impact on the developing child.

In most cases, the doses of radiation used in x-rays are not sufficient to cause damage to a fetus, and the Food and Drug Administration (FDA) advises that these tests involve very little risk. However, some experts recommend that pregnant women avoid x-ray procedures and use an alternative imaging system, such as ultrasound or magnetic resonance imaging (MRI), whenever possible. If a woman has an x-ray and later discovers that she was pregnant during the x-ray, she should immediately inform her physician. A consultation with a medical physicist or health physicist can help determine the level of radiation exposure to the fetus as a result of the x-ray.

In addition, women should inform their physician or healthcare professional if they are nursing. Some contrast dyes and other medications used in x-ray procedures are known to pass into the breast milk. For this reason, women may be asked not to breastfeed their child for a period of 24 hours or more. Usually, the patient is also asked to pump their breasts during this interim period and to discard any milk that has been collected.

Some precautions that can be taken in an x-ray procedure include:

• Ask the physician how an x-ray will help. Patients have a right to understand why a physician believes an x-ray is necessary. If it is medically necessary, it should not be refused, as the small risk of radiation is much lower than the risk of not having a condition diagnosed. Patients should not insist on having an x-ray if it is not medically necessary.
  
  
• Keep current on mammography developments. New information is constantly being learned about the proper role of a mammography in preventing and detecting breast cancer. At present, women over the age of 40 years should have a mammogram every year. Women who are at higher risk (i.e., family history of breast cancer) may be advised to receive mammograms at an earlier age or more frequently.
  
  
• Ask for gonad shields for x-rays of the lower back, abdomen or area near the sex organs. These lead shields can protect a woman’s ovaries (or a man’s testicles) from radiation. A gonad shield should be considered for any patient who may have children in the future. In some cases – such as in x-rays of the gonads – these shields are not an option.
  
  
• Keep track of x-rays with an x-ray record card. Patients who have x-rays taken should record the date, type of exam and where the x-ray is kept. In some cases, these old x-rays can be used instead of taking new x-rays. Each family member should have an x-ray card.
  
  
• Some x-ray procedures require the patient to swallow a contrast medium, many of which contain iodine. In rare cases, patients experience an allergic reaction to this dye because of the iodine. Patients with a history of such reactions should inform their physician or x-ray technologist. Alternative contrasts may be used during many x-ray procedures.

In addition, there are potential risks if a contrast medium is used but the side effects are uncommon and usually minor. These possibilities include allergic reaction to the dye, infection at the injection site and damage to surrounding tissues.

Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions about x-ray tests:

1. What is the reason for my x-ray?
2. What area will be x-rayed?
3. What are the risks involved?
4. Will I need a contrast medium?
5. Do I need to follow any special preparations?
6. When and from whom will I receive the results?
7. Will I need any additional tests?
8. How often can I have x-rays?
9. If I’m pregnant, can I still have an x-ray? Should I take any precautions?
   
   
10. If I do not want an x-ray, is there an alternative test?