How to Read an X-Ray Report: Understanding Radiology Report Terminology

If your medical provider has recommended an X-ray, you may have questions about interpreting your final report. A radiologist will review the images and your doctor will discuss the results with you at your follow-up appointment. However, it can be helpful to understand the medical terminology in advance. This guide will cover the uses of X-rays, explain the different imaging views and define the technical terms you’re likely to see on your report.  

Having access to your results before seeing your doctor empowers you to engage in more informed and meaningful conversations with your physician, making the most of your time together. PocketHealth simplifies this process by providing secure, easy access to your report as soon as it’s available, helping you be better prepared for your follow-up appointment.

What is an X-ray and what is it used to detect?

An X-ray procedure is a painless scan technique that uses a low dose of electromagnetic radiation exposure to create images of the internal structure of your body. As the rays pass through your body, the degree to which they are absorbed depends on the density of the structure they encounter. The non-absorbed ray is captured as visible light on the other side.

 What is an X-ray used for?

X-rays are a reliable, safe and easily accessible method for identifying bone deformities and injuries, as well as viewing soft tissues and organs for potential issues. They are often less expensive for patients compared to other imaging techniques and are quicker to perform. While other modalities may be necessary for a more detailed view of specific health conditions or structures, X-rays are particularly well-suited for bone screenings.

What abnormalities can an X-ray detect?

The type of abnormalities an x-ray will reveal depends on the part of your body being x-rayed.
Generally, an x-ray can detect the following:

• Bone abnormalities (also called osseous lesions)
• Bone or joint fractures
• Chronic conditions like emphysema
• Collapsed lungs
• Infections like pneumonia
• Masses, nodules or tumors, including bone cancer and lung cancer
• Pericardial effusion (the buildup of fluid around the heart)
• Pleural effusion (the buildup of fluid between the lung and the chest wall)

 

Understanding different views on an X-ray

Your X-ray results will likely mention different views taken, often referenced as various abbreviations. Without knowing what these stand for it’s easy to get confused. Read on to learn what each view means and how they differ from each other.

What’s the difference between AP, PA, LAT and oblique views?

An x-ray image of skull showing the difference between AP and LAT views 

The views refer to the manner of projection, meaning the way the X-ray is taken.

• AP: with your back against the X-ray film, the X-ray beam enters from the front (anterior) and travels through to the back (posterior).
• PA: your chest is positioned towards the X-ray film in this view, and the X-ray beam enters from the back (posterior) and travels through to the front (anterior). PA is the standard projection, as these views are generally sharper and more accurately portray the size and margins of organs like the heart.
• LAT: a lateral view is a side view, meaning the X-ray is taken from the side.
• Oblique: an oblique X-ray is taken on an angle, meaning neither from the front/back or from the side. The exact angle will depend on what is being X-rayed, such as a joint like an elbow.

LAT and oblique X-ray views are taken in conjunction with AP and PA views to provide more perspective and can reveal nodules and lesions not seen from the front or back views.

Your X-ray will also likely mention the plane on which it is taken. The term “plane” is used to describe the viewing angle of a patient in an X-ray image. Images are obtained in 1 plane and then reconstructed along 3 different planes to provide the radiologist with a 360° view of your body’s internal structures and organs:

• Coronal, which divides the body into front and back halves.
• Sagittal, which divides the body into left and right halves.
• Axial, which divides the body into top and bottom halves.

What is lucency on an X-ray?

Another common term on X-ray reports is “lucency.” This refers to how easily the X-ray beam passed through the patient’s body to reach the detector on the other side. Less dense areas appear darker on the image and can be described as lucent, having increased lucency or being radiolucent.

 

What’s the difference between density and lucency?

Density and lucency are descriptions of how the soft tissues and structures inside your body absorb X-ray beams.

• Hard tissues like bone are dense. Dense tissues absorb X-rays and appear light or white on X-ray images.
• Fat- or air-filled tissues like lungs are lucent. Lucent tissues don’t absorb X-rays to the same degree and appear darker in X-ray images.

Density is also sometimes described relative to surrounding tissues.

• Hypodense tissue is darker (less dense, more lucent) than other tissues or structures nearby.
• Hyperdense tissue is lighter (more dense, less lucent) than other tissues or structures nearby.

 

Linear, focal, peripheral lucency and more: what do these terms mean?

The general definition of lucency has been explained; however, there are multiple descriptors you may find in your X-ray report that further describe the radiological image. Here are the differences in the terminology:

• Linear lucency: This refers to a thin, transparent area or dark line on the X-ray. It can imply a bone fracture or foreign body in the patient, but it can also be found in tissues, organs and other areas.
• Subtle lucency: This refers to a faint or slightly increased area of radiolucency (appearing darker on an X-ray) within a tissue or structure. It specifically suggests that this area is not very pronounced and may be more difficult to detect, requiring careful observation by the radiologist. It could indicate conditions such as a small fracture, a lesion, or early signs of disease, where the changes are not yet prominent or are borderline in appearance.
• Focal lucency: This refers to areas that are less dense than the tissues around them, showing up darker in appearance. They help diagnose conditions such as infections, cancers, cysts and lesions. Additional testing is usually done to confirm the cause.
• Peripheral lucency: This refers to when the darker area of the X-ray is positioned near the edges of a lesion or internal structure. Examples include bone lesions, bone tumors, bone cysts and other places where lucency and bones meet.
• Periapical lucency: This refers to a dark circular area found on dental X-rays, often indicating a hole in the jaw bone. This is frequently due to dental issues, infections, or conditions necessitating root canals.
• Cortical lucency: This refers to an area of decreased bone density within the cortex of a bone, making it appear darker on X-rays. This can indicate conditions such as fractures, bone lesions, infections or osteoporosis.

 

Does lucency mean cancer?

Lucency on an X-ray can sometimes point to tumors and other cancerous conditions, but there are several other possible causes besides cancer. Some examples include fractures, benign tumors or cysts, infections and inflammatory disorders such as rheumatoid arthritis. If your physician is unsure of the cause of any lucency, further testing is likely to be performed.

Report Reader helps you decode X-ray report terminology

Certain medical terms in X-ray reports can be challenging to understand without prior familiarity with their meanings. Report Reader offers easy-to-understand definitions of the medical terminology within your report, helping you better comprehend your results. This allows you to be more informed when your provider discusses them with you.

What is an acute osseous abnormality?

This means the X-ray did find a bone-related abnormality. The term ‘acute’ suggests it is a more recent development, as opposed to a chronic condition that developed over a long period of time. There is a wide variety of conditions that could be categorized as osseous abnormalities. Some examples include arthritis, bone cysts, fractures and injuries, bone deformities or lesions. If the report does indicate an abnormality, your doctor will likely discuss next steps or further testing, if necessary.

What does NF stand for?

NF is an acronym for ‘not found’. It means a specific abnormality or finding was not present in your image. This is a good result if your X-ray was ordered to investigate a specific issue. You may also encounter the term negative to describe the same thing.

No acute osseous findings is another common term that may show up in your report. It means your X-ray specifically showed no bone abnormalities.

What is undulation?

Undulation is an uneven or wavy spot in an X-ray image. Undulation can be caused by several factors, including air or fluid in the body or the way you’re positioned when the X-ray is taken.

What does unremarkable mean? Is it good or bad?

When it comes to medical terminology the term “unremarkable” is actually a good thing! It means your X-ray report has revealed no significant abnormal findings.

How to access your X-ray results using PocketHealth

The technician who takes your X-rays will send them to the hospital imaging department or clinic radiologist who interprets them to create a radiology report. The report and images are released to your referring physician, who then sets up a follow-up appointment with you to discuss the results. The process can take 2-5 business days.

With PocketHealth, you can have early access to your images and radiology report as soon as they’re released, often before your follow-up appointment. PocketHealth allows you can see, share and store all your medical images in one secure, easy-to-use location.

For Norm, using PocketHealth to access his previous X-ray records uncovered an old, undisclosed diagnosis of a hiatal hernia—a condition where the stomach pushes through an opening in the chest cavity, causing digestive issues. Although his doctors hadn’t mentioned it since treatment wasn’t required, Norm gained crucial insight into his health, empowering him with the knowledge to monitor his condition more proactively.

For those looking to further understand their results, Report Reader can help you better understand your medical X-ray report by providing definitions for complex medical terms. In addition, MyCare Navigator highlights personalized insights, including follow-up recommendations your report contains and questions to ask your doctor. If you’re concerned about your risk for osteoporosis, it also provides access to preventative bone health screening tools.

 

The importance of advocating for your health

An X-ray is a painless, low-risk diagnostic imaging test that provides your healthcare team with valuable information about the condition of your inner structures and tissues. When you have secure access to your X-ray images and radiology reports, you can be confident and fully informed, armed with the information you need to take the next steps in your health journey. Learn how to use PocketHealth to access, read and share your X-ray results.