The X-Ray Process
X-ray images are used by doctors to see bones, organs, and other objects inside of the body. A x-ray is made by placing the patient or other object between a photographic plate and a machine which emits a stream of x-rays. The x-rays pass through body and either directly exposes the film, or it passes through a special screen which converts the radiation to visible light which exposes the film. New technology allows a digital reader to detect the x-rays, which directly creates a digital image, by-passing the film altogether. The x-ray radiation passes through the different substances of the body at different rates, which creates the image. Hard tissues like bone obstruct the x-rays more, so those areas remain unexposed, while soft tissues like organs and skin allow the x-rays to pass through easily, exposing those areas. This creates a negative image that, when held up to the light, shows the bones in white and the other areas as dark or black. The x-ray is then viewed by being held up against a lighted background.
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Curiosity.com from Discovery. How does an X-ray machine work? http://curiosity.discovery.com/question/how-xrays-machine-work
Format, Size, and Preservation
X-rays as physical objects have many similarities to other photo types. Like an ambrotype, an x-ray image is a unique, direct image. No prints are made of the image, and it is properly viewed as originally created. But x-rays most resemble film negatives. X-rays were first made using nitrate film, from the 1910s to the 1930s, on acetate safety film, from the 1920s to the mid-1960s, and then on polyester film from the mid-1950s onward. All of the regular preservation problems apply to x-rays as to any other film, such as exploding nitrate and acetate’s vinegar syndrome. The same storage conditions also apply to x-rays as to any other film. For short term storage, temperatures less than 70 F and relative humidity around 50% will suffice. For long term storage, cool storage between 35 and 40 F and relative humidity between 20 and 50% is recommended. This can extend the life of the film to about 100 years. Archives should also be aware of any special storage conditions required by law for nitrate storage.
X-rays, however, do pose a few special concerns. First is that x-rays are very likely to be intermixed with paper documents, since they often accompany patient or research files. Separating the x-rays from the papers requires proper documentation so that intellectual control can be maintained. Often, x-rays will simply be left intermixed with the papers. Whether they are removed or not, the x-rays should be stored individually in lignin-free, buffered paper envelopes so that the film can breath. These envelopes should be stored vertically, to avoid damaging the film.
X-rays, unlike most film, are single sheets, and they come in a wide range of sizes due to the requirement that the image be life-size. This can make both storage and handling difficult. The large single sheets mean that film can break easily if not handled properly. Physical handling should be avoided if possible, and white cotton lint-free gloves should be used. The larger sizes are especially fragile. X-rays can come in sizes ranging from 8” x 10” to very large, measuring more than 17” on a side. These large x-rays will not fit in a normal records box, and special containers would have to be made or ordered. The smaller sizes are often still larger than the paper documents surrounding them. As with photographs, if x-rays are removed, they should be arranged by size to equalize stress on the film and to make storage easier.
If x-rays are deteriorating and the archives fears losing the images, a print can be made using the x-ray as a negative, or it can be scanned to create a digital copy.
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National Archives. Managing X-ray Films as Federal Records. http://www.archives.gov/records-mgmt/publications/managing-xray-films.html
Privacy and Access
When photographs and negatives enter a collection, preservation action is often taken immediately to insure speedy access to the material. X-rays and other medical records, however, cannot by law be accessed for some time if there is any personal information attached.
In 1996, the U. S. Department of Health and Human Services passed the Health Insurance Portability and Accountability Act (HIPAA) and the corresponding Privacy Rule. This Privacy Rule deals with an individual’s “protected health information,” which includes “names; postal address other than town, city, state, or zip code; telephone numbers; fax numbers; email addresses; Social Security numbers; medical record numbers; health plan beneficiary numbers; account numbers; certificate or license numbers; vehicle identifiers and serial numbers; device identifiers and serial numbers; uniform resource locators (URLs); Internet protocol (IP) addresses; biometric identifiers, such as fingerprints; and full-face photographic images and other similar images” (Wiener and Gilliland, 2011). Any records that do not contain this information, “de-identified health information,” is freely available. This information used to be permanently inaccessible without permission or a million legal hoops for authorized access, due to possible repercussions of the revelation of genetic diseases of descendents. However, in January 2013, an amendment was passed with makes protected health information available 50 years after the death of the subject.
This creates several problems for archives with medical material. Papers must be sorted carefully to determine which folders have personally identifiable information. These papers must then be restricted for a period of time. For medical records of research patients, it is not always clear when an individual died, so calculating 50 years from the death of the subject is difficult if not impossible. Therefore, restrictions must be extended so that the archive can be sure of complying with the law.
These lengthy restrictions impede access by the researcher, but they also create huge preservation problems for x-rays. Without proper long-term storage, many x-rays will be dust or goo before the 50-80 years are up. Archives must fight to get these items properly conserved, stored, or reproduced when the collection is first processed so that access can be assured when the time limit is finally up.
Luckily, the vast majority of x-rays in the last 30 years have been on polyester film, which is likely to last until the information can be made public. Also, not all organizations and archives must comply with the HIPAA laws. Archives should check their HIPAA designation with their legal team. Also, all x-rays that are de-identified can be freely accessed at any time.
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United States Department of Health and Human Services, Office for Civil Rights. Summary of the HIPAA Privacy Rule. http://www.hhs.gov/ocr/privacy/hipaa/understanding/summary/privacysummary.pdf
Wiener, Judith A. and Anne T. Gilliland. “Balancing between two goods: Health Insurance Portability and Accountability Act and ethical compliancy considerations for privacy-sensitive materials in health sciences archival and historical special collections.” Journal of the Medical Library Association. 2011 January; 99(1): 15-22. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3016646/#!po=11.9048
Society of American Archivists Science, Technology and Health Care Roundtable, and Archivists and Librarians in the HIstory of the Health Sciences. HIPAA Resource Page. http://www.library.vcu.edu/tml/speccoll/hipaa.html
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