X-Ray Exam: Scoliosis

What It Is

A scoliosis X-ray is a relatively safe and painless test that uses a small amount of radiation to create detailed images of the spine. During the examination, an X-ray machine sends a beam of radiation through the back, and an image is recorded on a computer or special film. The scoliosis X-ray includes the thoracic spine (upper back) and the lumbar spine (lower back).

The X-ray image is black and white. Dense body parts that block the passage of the X-ray beam through the body, such as bones, appear white on the X-ray image. Softer body tissues, such as muscles, allow the X-ray beams to pass through them and appear darker.

X-rays are performed by an X-ray technician in the radiology department of a hospital, a freestanding radiology center, or a health care provider's office. Two pictures are usually taken of the spine, one from the back (posteroanterior or PA view) and one from the side (lateral view). Sometimes other views are taken in which the person is bending to the side.

Why It's Done

Children with scoliosis have a spine that curves from side to side, like an S or a C. Although small curves generally don't cause problems, bigger curves can be visible and cause discomfort. A curved spine can cause the body to tilt to the left or right. One shoulder blade may be higher than the other, or the waist may be uneven, with a tendency to lean to one side.

If a curve is severe, it can even affect breathing and heart function and lead to damage in the joints of the spine and pain during adulthood.

Doctors routinely check kids for scoliosis during regular physical exams, and some schools also test for scoliosis. If scoliosis is suspected, the doctor may order X-rays to measure the curvature of the spine. The angle of the curve, measured in degrees on the X-ray, will help the doctor decide whether it needs to be treated and, if so, how.

X-rays also help determine the type of scoliosis and how mature the child's skeleton is, which helps the doctor to predict if the scoliosis may progress. The scoliosis X-ray might be repeated at regular intervals (sometimes every 3-12 months) to check whether the curve is getting bigger or to monitor the effects of treatment.

The doctor might refer your child to a specialist for further evaluation. If a neurological abnormality is suspected, the doctor may order a magnetic resonance imaging (MRI) study to look at the spinal cord.

Preparation

A scoliosis X-ray doesn't require any special preparation. Your child may be asked to remove some clothing and jewelry and change into a hospital gown because buttons, zippers, clasps, or jewelry might interfere with the image.

If your daughter is pregnant, it's important to tell the X-ray technician or her doctor. X-rays are usually avoided during pregnancy because there's a small chance the radiation may harm the developing baby. But if the X-ray is necessary, precautions can be taken to protect the fetus.

Procedure

Although the procedure may take about 15 minutes, actual exposure to radiation is usually less than a few seconds.

Your child will be asked to enter a special room that will most likely contain a table and a large X-ray machine hanging from the ceiling or wall. Parents are usually able to accompany their child to provide reassurance. If you stay in the room while the X-ray is being done, you'll be asked to wear a lead apron to protect certain parts of your body. Your child's reproductive organs will also be protected with a lead shield.

A scoliosis X-ray is usually performed in a standing position, but may be done while the child is sitting or laying down. Sometimes, this will depend on the condition of your child. The technician will position your child, then step behind a wall or into an adjoining room to operate the machine. Two X-rays are usually taken (from the back and from the side), so the technician will return to reposition your child for each X-ray. Sometimes doctors will request additional views.

Older kids will be asked to hold their breath and remain still for 2-3 seconds while each X-ray is taken; infants may require gentle restraint. Keeping still is important to prevent blurring of the X-ray image.

What to Expect

Your child won't feel anything as the X-rays are taken. The X-ray room may feel cool due to air conditioning used to maintain the equipment.

The position required for the X-rays can feel uncomfortable, but they need to be held for only a few seconds. If your child is in pain and can't stay in the required position, the technician might be able to find another position that's more comfortable. Babies often cry in the X-ray room, especially if they're restrained, but this won't interfere with the procedure.

After the X-rays are taken, you and your child will be asked to wait a few minutes while the images are processed. If they are blurred or unclear, the X-rays may need to be redone.

Getting the Results

The X-rays will be looked at by a radiologist (a doctor specially trained in reading and interpreting X-ray images). The radiologist will send a report to your doctor, who will discuss the results with you and explain what they mean.

In an emergency, the results of an X-ray can be available quickly. Otherwise, results are usually ready in 1-2 days. In most cases, results can't be given directly to the patient or family at the time of the test.

Risks

In general, X-rays are very safe. Although any exposure to radiation poses some risk to the body, the amount used in a scoliosis X-ray is small and not considered dangerous. It's important to know that radiologists use the minimum amount of radiation required to get the best results.

Developing babies are more sensitive to radiation and are at more risk for harm, so if your daughter is pregnant, inform her doctor and the X-ray technician.

Helping Your Child

You can help your child prepare for a scoliosis X-ray by explaining the test in simple terms before the procedure. It may help to explain that getting an X-ray is like posing for a picture.

You can describe the room and the equipment that will be used, and reassure your child that you'll be right there for support. For older kids, be sure to explain the importance of keeping still while the X-ray is taken so it won't have to be repeated.

If You Have Questions

If you have questions about why the scoliosis X-ray is needed, speak with your doctor. You can also talk to the X-ray technician before the procedure.