X-rays, also known as X-radiations, are a form of ionizing electromagnetic radiation discovered in 1895 by Wilhelm Röntgen. They have wavelengths between 0.01 to 10 nanometers. X-rays are used widely in medical diagnostics to image bone fractures and other injuries or medical conditions. However, they also carry risks of causing cell damage and cancer due to their ionizing properties. Proper techniques and limited exposure are important to minimize these risks.

1. -Aurodeep Dasgupta
B.P.T. 4th Year
B.I.M.L.S.
Burdwan

2.  X-radiations (or x-rays) is a form of electromagnetic radiations.
Most x-rays have a wavelength of 0.01-10 nanometeres,
corresponding frequencies in the range of 30 petahertz(3X10¹⁶
Hz) to 30 exahertz(3*X10¹⁹Hz) and energies in the range of
100eV to 100 keV.
 It was invented by a German physicist Wilhelm Röntgen in
1895. He named it X-Radiations to signify an unknown type of
radiation.
 It is an important diagnostic tool for medical conditions like bone
fractures, pulmonary tuberculosis, etc.

4. The first x-ray image obtained was of the hands of
Wilhelm Rontgen’s wife, taken on 22nd December,1895.

5.  X-Ray photons carry enough energy to ionize
atoms and disrupt the molecular bonds. This
makes it a type of ionizing radiation.
 This ionizing property is used to kill the
malignant cells by radiotherapy.
 It is absorbed by solid/radio-opaque
substances like bones & metals.

7.  X-rays interact with matter in three main ways,
through photo-absorption, Compton scattering,
and Rayleigh scattering. The strength of these
interactions depend on the energy of the X-Rays
and the elemental composition of the material, but
not much on chemical properties since the X-Ray
photon energy is much higher than chemical
binding energies. Photo-absorption or
photoelectric absorption is the dominant
interaction mechanism in the soft X-ray regime
and for the lower hard X-ray energies. At higher
energies, Compton scattering dominates.

8.  Based on the energy of the radiations, x-rays
have wide range of uses like in the medical
field, industrial work places, security purposes
etc.
 Used in X-Ray scanners.
 X-Ray crystallography.
 Industrial radiography and CT scanning.
 X-Rays has an immense role in the medical
field – diagnostic as well as therapeutic.

9.  Diagnostic Uses-
X-ray is the most preferred tool for detecting
any bone related problem, such as fracture,
tumor, degenerations. It is also used detect
other cases like pulmonary tuberculosis, lung
abcess, etc.
 Therapeutic Uses-
It is used in cancer treatment to kill malignant
cells.

14.  It is a device that let us have an eye on the
amount of exposure of X-radiations to the
technician, thus enabling us to reduce the
hazardous effect of the radiation on the human
tissues.

15.  Helps confirm the clinical diagnosis.
 Helps study the fracture anatomy.
 Helps study the fracture displacement.
 Helps to detect crack and stress fractures.
 Helps to plan the treatment.
 Helps to detect fracture dislocation
combination, e.g. Monteggia fracture.
 Helps to ascertain post-reduction status of
fractures.
 Helps in medico legal studies.

16.  Before asking for an x-ray, the following points
should be kept in mind-
 Both, AP and lateral views should be taken in most
of the cases.
 Special views in some cases show the fracture better.
 X-ray requisition must specify the area of
suspension.
 X-ray of the pelvis with both hips should be asked
for in all cases of suspected pelvic injury.
 For an x-ray evaluation of the hands and feet, antero-
lateral and oblique views (not lateral) are required.

17.  Better no X-Ray than one view X-Ray.
 X-Ray is a shadow, it conceals and distorts. Hence
interpret X-Ray with caution.
 A joint above and joint below should be included with
the fracture under study.
 The fracture should in the middle of the film.
 Exposure should be adequate and the soft tissue
shadow be delineated properly.
 X-Ray should be read by holding the film in an
anatomical position.
 Avoid unnecessary X-Rays.
 Check X-Rays are to be taken without disturbing the
plaster cast.

18.  Most of the time, the body part that is to be
seen under X-Ray is to be exposed properly, i.e.
the cloth over it should be removed.
 Any accessory or jewellery on the focused part
should be removed.
 Patient needs to be calm and maintain the
posture which is instructed to him/her.
 Patient needs to follow the given instructions
strictly.

19.  Antero-posterior view: The X-Ray beam is
exposed from the anterior side of the body
part. The beam casts a shadow on the X-Ray
plate that is kept behind the body part.

20.  Lateral view: The X-Ray beam is exposed from
the lateral aspect of the body part.

21.  Oblique View: In this view, the X-Ray beam is
exposed from a plane which is oblique to the
body part on which the X-Ray beam is focused.

23.  Oblique view wrist is done to detect Scaphoid
fracture. The X-Ray beam is given in a plain
perpendicular to a plain which is slightly
slanting.

24.  Judet view to detect Acetabular fracture. It is a
modification of oblique view of the hip. Here
the patient’s trunk is rotated to contra-lateral
side in relation to the hip whose image is being
taken.

25.  Merchant view is done for patello-femoral
joint. It is taken is such a way that only the
image of the patella is obtained. The procedure
is given the pictures below.

26.  Skyline view for Calcaneum fracture. It is
taken by the same principle as the Merchant
view of patella. The X-Ray beam is directed
obliquely , so that it only casts a shadow of
calcaneum on the film.

27.  ‘Y’ view for scapula. It is taken
perpendicularly to scapular plain from the
lateral aspect. The X-Ray image looks like the
one given below.

28.  Dunn view is an antero-posterior view of the
hip with the patient supine and the hips and
knees flexed at 90˚, the legs abducted 15˚ -20˚,
and the femur in the neutral rotation.

29.  Modified Dunn view is the slight modification
of the Dunn view, where the hip is flexed to
45˚.
 Dunn view and modified Dunn view is mainly
to see the asphericity of the femoral head,
which is the cause of premature arthritis.

30.  Cross table lateral view is the lateral projection
radiography of a supine subject using a
horizontal X-Ray beam.
 Mainly used to detect neonatal pneumo-thorax,
hair-line fracture in the neck of the femur.

31.  An x-ray view box should be used in all cases. If a
fracture is obvious, one must make note of the
following points-
 Which bone is affected?
 Which part of the bone is affected? E.g., shaft etc.
 At what level is the fracture? i.e., whether the fracture
is in the upper, middle, or lower third.
 What is the pattern of the fracture?
 Is the fracture displaced?
 Is the fracture extended to nearby joints?
 Does the underlying bone appear pathological? E.g., a
cyst, abnormal texture of the whole bone, etc.
 Is it a fresh or an old fracture?

32. Shaft ulna fracture

33. Osteo-arthritis knee

34. Crush injury of left
foot

35. Scoliosis

36. Thoracic kyphosis

37. Postero-lateral subluxation of knee

38. Lobectomy

39. Callous formed at fracture site

40. Fracture both bone of forearm

41.  Diagnostic X-Rays increase the risk of
developmental problems and cancer in those
exposed cells. X-Rays are classified as a carcinogen
by both World Health Organisation’s International
Agency for Research on Cancer and the U.S.
government.
 It is estimated that 0.4% of current cancer cases in
the United States are due to diagnostic X-Rays and
CT Scans.
 That’s why when it comes to perform an X-Ray on
a pregnant woman, proper assessment of benefit
versus risk is done.

42.  Essential Orthopaedics
 wikipedia
 wikiRadiography