X-rays are widely used for screening of populations at risk of particular disease. This means that the patient is not necessarily sick, but because of a combination of factors, such as age and gender, they may be more likely to develop a particular disease. If that disease can be detected in its early stages by x-ray, and if early treatment is likely to improve the outcome, then it is worth performing x-rays in these people. A good example is the use of chest x-rays to detect tuberculosis in pre- employment examinations, or the use of mammography to screen for breast cancer in older women.

X-rays are also routinely used for the diagnosis of diseases effecting the bones and joints. Dislocations and fractures are usually easily seen on x- rays. Also, changes in bone tissue, as with osteoporosis or more serious diseases, can often be seen with x-rays. x-rays are also useful for the diagnosis of disease effecting soft tissues. However, for such purposes, it is also common to use more advanced technologies, such as MRI (magnetic resonance imaging).

It is important to realize that taking an x-ray does pose a risk to the patient. Radiation does cause cancer. However, with modern equipment and good procedures, the dose of radiation to the patient is very low. The very low risk to the patient posed by the x-ray must be judged against the risk to the patient of making an incorrect diagnosis due to the lack of an x-ray.

Another risk to the patient is that any diagnostic test, including an x- ray, may give a false-positive result: there may seem to be disease where none exists. This creates unnecessary stress for the patient, and could lead to treatment which is unnecessary or even dangerous.

Because of the risk to patients, and the costs of the procedures, you will find that in many countries there are practice guidelines to advise doctors when they should or shouldn't take x-rays. For example, in many places, doctors are discouraged from taking x-rays for problems such as low-back pain or mild whiplash injuries.

Situation 1: An x-ray technician is preparing to take examinations of a patient's chest.

Technician: (Reading the x-ray requisition). All right Mr. Walters, your doctor has sent you for chest x-rays. Are you having any particular problems.

Mr. Walters: No, this is just a routine check-up for me. Will this take long?

Technician: This will only take a minute. Can you stand with your chest right against this screen, and put your chin on top of the screen. Good.

Mr. Walters: Wow, this thing is cold. (Referring to the metallic film holder.)

Technician: We will be done in a minute. Can you place your hands on your hips and bring your elbows forward, please. That's good. Now I want you to take a deep breath and hold it. (The technician takes the first film). Okay, you can relax.

Mr. Walters: Is that it? Am I done?

Technician: We will take one more picture. Can I get you to turn sideways and bring the side of your chest against the screen. Good. Now, I will get you to put your arms out in front of you like this. (The technician demonstrates, holding his arms forward.)

Mr. Walters: Like this?

Technician: That's right. Now, I will get you to take a deep breath and hold it. (The technician exposes the second film.) Good. All finished.

Mr. Walters: That was fast. I think I am supposed to wait for the films.

Technician: It will just take a few minutes to develop the films. If you wait in the reception room, we will bring the films to you.

(a few minutes later in waiting room)Technician: Mr. Walters, here are your films. Please take these back to your doctor.

Mr. Walters: That didn't take long. Thanks very much.

Patterns:

Will this take long
* That didn't take long
* That was fast

* This will only take a minute
* We will be done in a minute

* Is that it
* Am I done
* All finished

* Put your chin on top of the screen
* Bring your elbows forward, please
* Bring the side of your chest against the screen

* Can you
...stand with your chest right against this screen
... place your hands on your hips
* Can I get you to turn sideways

* I want you to take a deep breath and hold it
* I will get you to
... put your arms out in front of you
... take a deep breath and hold it

* Please take these back to your doctor

* Good
* That's good
* That's right

Situation 2: A senior x-ray technician is assisting a student who is learning how to take x-rays of the neck.

Technician: The next patient is having pain radiating from the neck into the right arm. What views do you think the physician ordered?

Student: AP, lateral and obliques, I suppose.

Technician: That`s right. And an AP open mouth. Here is the requisition. What size film do you think you should use?

Student: Eight by ten?

Technician: Good. And do you remember what the kVp is for the neck?

Student: 70 kVp, but I will have to measure the patient, I guess.

Technician: That`s right. And do you remember the focal-film distance?

Student: Seventy-two inches for the lateral and oblique views, and 40 inches for the AP views.

Technician: Okay. Now, why don`t you set up for the lateral view, and then we will go and get the patient.

Student: Did reception look after the consent form?

Technician: No, that`s your responsibility. You are taking the pictures.

Student: This patient is a young woman. I suppose I will have to ask about birth control and that sort of thing.

Technician: Not for a cervical series, but you will have to think about shielding. Also, you have to collimate as tightly as you can on any patient.

Student: But there`s no real danger, I guess.

Technician: The rules are there for a reason. It`s your responsibility to protect the patient and yourself. Now, why don`t we go and get the patient.

Patterns:

* ... I suppose ...
* ... I guess ...

* What views ... do you think the physician ordered
* What size film ... do you think you should use

* Do you remember
... what the kVp is for the neck
... the focal-film distance

* I will have to/ You will have to
... measure the patient
... ask about birth control and that sort of thing
... think about shielding
... collimate as tightly as you can

* Why don`t you/ Why don't we
... set up for the lateral view
... go and get the patient

* That`s your responsibility / It`s your responsibility
...to protect the patient and yourself

Discussion:

1. How would you make sure that a patient was in exactly the right position for an x-ray if they could not understand your language at all?

2. What would you say to a patient who was concerned about the dangers of x-rays?

3. Sometimes you may have to re-take an x-ray because the patient moved, or was in the wrong position. What do you think the patient thinks if you have to re-take an x-ray?

4. In the second situation, the student uses the expressions "I suppose" and "I guess". What is the purpose of these expressions?

5. Even though x-rays are considered quite safe, the patient still has to sign a consent form. What is the reason for this?