Plain Radiography/X-rays

Mr Ben O’Sullivan*
                            Prof Stacy Goergen *

What are the prerequisites for having plain radiography/X-rays done?

A signed request from a referring clinician with appropriate and relevant clinical details.

What are the absolute contraindications for plain radiography/X-rays?

None. A plain X-ray is a low dose examination that is cheap and readily available. The small risk must be weighed up against the benefit.

What are the relative contraindications for plain radiography/X-rays?

Pregnancy or weight of patient (X-ray tables have weight limits).

What are the adverse effects of plain radiography/X-rays?

No short term effects. Generally speaking, the benefit of the X-ray procedure is far more important than the small estimated risk (see Radiation risk of medical imaging for adults and children). At the dose levels that are utilised in diagnostic radiography there is little or no evidence of health effects (ARPANSA 2008).

According to ARPANSA (2008) “There is good epidemiological evidence – especially from studies of the survivors of the atomic bombings – that, for several types of cancer, the risk increases roughly linearly with dose”. At low dose levels (like that in diagnostic radiography), the risk is cancer or heritable mutations and no such risk has yet been demonstrated in Japanese bomb survivors who received radiation doses comparable to those delivered by plain X-rays or radiographs. There have been no large scale longitudinal studies of people exposed to diagnostic X-rays that would allow an accurate assessment of risk to be made.

For most plain radiographs/X-rays, the radiation dose is no more than the ionising radiation from normal environmental background over a period of one year. The dose is considerably higher for CT scanning, angiography, and some fluoroscopy procedures. However, the minimal risk of exposure to any type of medical ionising radiation needs to be weighed against the potential gain from the diagnostic information provided by the X-ray.

Are there alternative imaging tests, interventions or surgical procedures to plain radiography/X-rays?

Yes. Ultrasound and MRI don’t utilise radiation and therefore may be an alternative. Alternatives to exposure to ionising radiation may be available but are not always appropriate. Radiologists have expert knowledge of which imaging test is best suited to answer a clinical question and if there is any doubt, a radiologist should be consulted. For example, an ultrasound may be a better test than an X-ray or plain radiograph to locate a non-metallic foreign body in the foot, even though the technology is fundamentally different and ultrasound does not use ionising radiation at all.

Further information about plain radiography/X-rays:

A radiologist should be consulted for more information.

References and useful websites about plain radiography/X-rays:

The following websites are helpful sources of information:

  1. Radiation and health fact sheets (ARPANSA)
  2. International Commission on Radiological Protection
  3. Australian Society of Medical Imaging and Radiation Therapy


  1. ARPANSA 2008, Radiation Protection, viewed 25 September 2008,
*The author has no conflict of interest with this topic.

Page last modified on 21/7/2017.

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