What should I do if I have concerns about my X-ray (X-ray) picture?

What to Do If You Have Concerns About Your X-ray Picture

If you have concerns about your X-ray results, you should directly discuss them with the physician who ordered the imaging, as they can interpret the findings in the context of your complete clinical picture and guide appropriate next steps. 1, 2

Understanding Your Right to Information

• Most patients (89.5%) desire access to their radiology images and reports, and this access helps them better understand their medical conditions and feel more in control of their care. 3
• You have the right to request a copy of your imaging and radiology report from the facility where the X-ray was performed, typically through patient portals or medical records departments. 3
• The interpreting radiologist should include clear conclusions in the report, stating whether findings are present or absent, and should communicate any uncertainty in interpretation to help your referring physician understand the results. 1

Who Should Explain Your Results

• Your ordering physician (the doctor who requested the X-ray) is the primary person to discuss results with you, as they understand your complete clinical context and can integrate imaging findings with your symptoms, physical examination, and other test results. 3
• 65.7% of patients prefer discussing results with their ordering clinician, while 29.5% also value discussion with the interpreting radiologist. 3
• If imaging suggests a new diagnosis (such as axial spondyloarthritis on spine imaging), the radiologist should recommend referral to the appropriate specialist for further assessment and treatment initiation. 1

When Additional Imaging May Be Needed

• If your X-ray findings are negative but clinical suspicion remains high for certain conditions, your physician may recommend advanced imaging such as MRI or CT based on your specific symptoms. 1
• For suspected fractures with negative initial X-rays, MRI is the most sensitive next step (near 100% sensitivity for occult fractures), particularly for stress fractures, hip fractures, or bone injuries not visible on plain films. 1, 4
• The radiologist may suggest further imaging in their report if findings are inconclusive, and this recommendation should guide your physician's decision-making. 1

Common Concerns and How to Address Them

Radiation Exposure Concerns

• Medical X-rays present a small, insignificant addition to background radiation exposure that is not likely to cause harm, and low-dose diagnostic radiation does not cause cancer at the exposure levels used in medical imaging. 5, 6
• Current imaging practices are safe, as exposures are orders of magnitude below threshold levels shown to be harmful, and the decision to image should rely on medical necessity rather than radiophobia. 5, 6

Understanding Confusing Results

• The biggest patient concern (23.8%) is that images may be confusing, which is why radiology reports should always accompany images when viewed online. 3
• If findings are equivocal or uncertain, the radiologist should communicate this clearly along with differential diagnoses and their relative probabilities. 1
• Non-spondyloarthritis-related findings that contribute to your symptoms should also be listed in the report, even if another diagnosis is supported. 1

Practical Steps to Take

1. Request a copy of both your images and the complete radiology report through your patient portal or medical records department. 3

2. Schedule a follow-up appointment with your ordering physician to review the results in detail and discuss their clinical significance. 3

3. Prepare specific questions about your concerns before the appointment, including questions about:

   • What the findings mean for your diagnosis
   • Whether additional imaging or testing is needed
   • What treatment options are available
   • Whether specialist referral is warranted 1, 2

4. If your physician ordered the X-ray to address your concerns rather than for clear medical indication (which occurs due to patient pressure in some cases), discuss whether the imaging was truly necessary and what the results actually show. 1

5. If findings suggest a condition requiring specialist care, request appropriate referral to ensure timely diagnosis and treatment initiation. 1

Critical Pitfalls to Avoid

• Do not rely solely on viewing images without the accompanying radiology report, as images alone can be confusing without expert interpretation. 3
• Do not delay discussing concerning findings with your physician, as early diagnosis and treatment initiation is advantageous for many conditions. 1
• Do not assume negative X-rays exclude all pathology, particularly for conditions like stress fractures, early infections, or soft tissue injuries that may require MRI for detection. 1
• Do not share medical imaging on social media without considering privacy implications, though some patients (3.8%) express interest in doing so. 3