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X-rays are a form of electromagnetic radiation with a very short wavelength and high energy. They are produced when fast-moving electrons are decelerated or interact with the target material inside an X-ray tube.

X-rays are differentially absorbed by body tissues. Dense structures such as bone absorb more X-rays and appear white on the image. Air-filled structures absorb very little and appear dark. Soft tissues appear as varying shades of grey.

The diagnostic radiographer is an autonomous healthcare professional registered with the Health and Care Professions Council (HCPC). Their role extends far beyond operating equipment — it combines clinical reasoning, patient care, image evaluation and professional accountability.

• Patient identification, consent and communication
• Assessing the clinical indication and adapting the examination accordingly
• Selecting appropriate projections and technique
• Positioning the patient safely and effectively
• Optimising exposure factors and image quality
• Evaluating images and recognising when a repeat is clinically justified
• Applying radiation protection principles at all times
• Escalating clinical concerns appropriately
• Accurate documentation and record keeping

Radiography requires clinical judgement throughout every examination. The radiographer must understand why the examination has been requested, what anatomy is relevant, how the image should be acquired and optimised, and what the image shows — including when findings require escalation.

Correct patient identification is non-negotiable and must occur before any examination begins. Errors in patient identification can lead to wrong-patient or wrong-examination incidents with serious clinical consequences.

Understanding the clinical indication guides the entire examination. The radiographer should know why the patient is being examined, what the clinical question is, and any relevant history that may affect the technique — including recent surgery, trauma, implants or patient cooperation.

Clear communication with the patient before, during and after the examination reduces anxiety, improves cooperation, enables informed consent and maintains patient dignity. The radiographer must adapt their communication style to the individual patient's needs.

Radiation protection is a fundamental responsibility of every radiographer. X-rays are a form of ionising radiation and can cause biological effects. Safe practice requires application of the core principles at all times.

• IR(ME)R — Ionising Radiation (Medical Exposure) Regulations: governs medical exposures to patients
• IRR17 — Ionising Radiations Regulations 2017: governs occupational and public exposure
• Local rules, controlled areas and personal monitoring requirements apply in all radiography departments

• Accurate collimation to the area of interest
• Appropriate exposure factors — avoid unnecessary repeats
• Use of gonadal shielding where appropriate per local protocol
• Maintaining distance from the primary beam during exposure
• Pregnancy — always consider and ask before exposure
• Children — special consideration for dose optimisation in paediatric patients

Accurate positioning is essential for producing a diagnostically useful image. Poor positioning can obscure pathology, distort anatomy or necessitate a repeat examination — increasing patient dose and wasting clinical time.

The textbook position may not always be achievable. In trauma and emergency radiography, the radiographer must adapt technique to the patient's condition — always prioritising patient safety while obtaining the required diagnostic information. A technically imperfect image obtained safely is preferable to an ideal image obtained at the expense of patient safety.

Every radiographer must be able to evaluate the technical quality of their images. This is not simply a matter of aesthetics — poor image quality can hide pathology, lead to unnecessary repeat examinations or result in clinical errors.

Repeating an image exposes the patient to additional radiation dose. The decision to repeat must be clinically justified — the repeat should only be performed if the technical error genuinely compromises the diagnostic value of the image. Radiographers must apply their clinical judgement rather than repeating for purely aesthetic reasons.

A thorough understanding of anatomy is essential for positioning, image evaluation and recognising normal from abnormal appearances. The radiographer must know what they are looking at before they can assess whether it looks right.

Radiographers are required by HCPC standards to understand disease and trauma processes and their appearances on imaging. This module introduces the concept of pathology recognition — it does not train learners to independently report or diagnose radiographs.

• Fractures — cortical break, angulation, displacement, impaction
• Dislocations — loss of normal joint alignment
• Osteoarthritis — joint space narrowing, osteophytes, subchondral sclerosis
• Bone lesions — lytic or sclerotic changes in bone structure

• Pneumonia — consolidation, opacification, air bronchograms
• Pneumothorax — absent lung markings, visible pleural edge
• Pleural effusion — blunting of costophrenic angle, meniscus sign
• Pulmonary oedema — bilateral shadowing, Kerley B lines, cardiomegaly

• Bowel obstruction — dilated loops, air-fluid levels
• Free gas — air under the diaphragm on erect film
• Abnormal calcification — renal calculi, vascular calcification

Much of general radiography takes place outside the X-ray room. Mobile imaging on wards, ICU, theatre and the emergency department requires additional skills, clinical awareness and radiation protection considerations.

• Mobile X-ray equipment — safe use, infection prevention, equipment checks
• Bedside positioning — adapting technique to the patient's environment
• ICU imaging — ventilated patients, lines and tubes, limited patient cooperation
• Theatre radiography — working within the sterile field, communication with the surgical team
• Radiation protection — protecting other staff and patients in the environment

In trauma, the radiographer must be able to adapt standard projections to the patient's condition. The priority is always patient safety — obtaining the required diagnostic information in the safest possible way, even when standard positioning is not achievable.

• Maintain patient dignity and privacy at all times
• Adapt communication to the individual patient — including children, elderly patients, those with learning disabilities, language barriers or anxiety
• Obtain appropriate consent before every examination
• Consider chaperoning requirements
• Respond appropriately to patient pain, distress or deterioration

Radiographers work closely with radiologists, nurses, doctors, porters, healthcare assistants and administrative teams. Effective communication, professional behaviour and teamworking are as important as technical skill.

• Work within your scope of practice and recognise your limitations
• Escalate concerns appropriately and promptly
• Maintain accurate documentation and records
• Engage in reflective practice and continuing professional development
• Follow HCPC standards of conduct, performance and ethics

General radiography is both a career in itself and a gateway to many specialist and advanced practice pathways. Understanding the career landscape from the outset helps practitioners make informed decisions about their development.

General radiography also provides the foundation for progression into CT, MRI, fluoroscopy, mammography, interventional radiology, and reporting — as well as education, management and research roles. The College of Radiographers' Education and Career Framework recognises progression through practitioner, enhanced practitioner, advanced practitioner and consultant practitioner levels.