Rib X-ray (3 views, both sides)

What it is

Ribs curve from the spine around to the front of the chest, so any one picture flattens them against each other and against the lungs, heart, and spine behind them. A rib study deals with that by taking several exposures with the patient turned, and by setting the machine for bone rather than for air-filled lung, which is how a chest X-ray is exposed. This code describes the bilateral version — three views covering the rib cage on both sides rather than concentrating on one. Even so, rib fractures are notoriously hard to see on plain films, and a normal rib series does not by itself settle the question; that limitation is worth knowing before the result comes back.

Why it is done

• To look for rib fractures after a fall, a blow to the chest, or a compression injury
• To investigate chest wall pain that is reproduced by pressing on a specific spot
• To look at the ribs themselves when a bone lesion is suspected somewhere in the chest wall
• To check both sides at once when the pain is not clearly on one side, or when the injury involved the whole chest

What to expect

Jewelry, necklaces, and any clothing with metal come off, and a gown is worn. The technologist positions the patient upright or lying down, sometimes rotating the torso a quarter turn for one of the views, and asks for a held breath during each exposure. Holding a breath and staying still is the uncomfortable part when ribs are sore. The imaging itself is painless and the visit generally runs about ten to fifteen minutes. A radiologist reads the series and sends a report. A chest X-ray is sometimes done alongside a rib series, because the reason for looking at the ribs often also raises a question about the lung underneath them.

Questions worth asking

• Was a chest X-ray performed at the same visit, and is it billed as a second study on top of this one?
• Would a one-sided rib study have covered the area in question at a lower price than the bilateral code?
• If treatment would be the same whether or not a fracture shows, is the imaging still being ordered, and is that worth discussing before it is billed?
• In an emergency department, is there a facility charge for the visit in addition to the imaging charge?