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Although everyone understands what one means when it is said to “get an x-ray”, or refers to the imageon film as “an x-ray”, the proper term for an image on x-ray film is a radiograph.There are four densities on a radiograph. They are from black to white: gas, fat, water and mineral.Gas, of course, is self-explanatory and includes air in the lungs and upper airway, gas in the intestines,and gas such as nitrogen in so called vacuum spaces. It becomes black on a radiograph because there arefew molecules to stop or attenuate the x-ray beam as it passes through the body to darken the film. Itwon’t take the student or practitioner long to recognize normal gas patterns on a radiograph, and as westart to program the computer that we call a brain between his or her ears, the student will begin to usepattern recognition as a means to correct interpretation.Fat, on the other hand, is just a shade or two lighter than gas, a dark gray, and becomes important inspecific locations, as we’ll see later. Water density tissue makes up the majority of body parts andincludes muscle and organs. Since we’ve all been made aware that the body is made up of 70+% water,it is no surprise to find it usually comprises most of the volume seen on a radiograph of, for instance, theabdomen in a healthy individual. Although water density tissue varies in its density even on Plain filmradiographs, it has a uniform appearance when compared to the other three densities of gas, fat andmineral. It is a lighter shade of gray than fat, but not as white as the mineral seen in bone or the reallywhite appearance of metal, such as seen in an ingested foreign body like a coin. Now that you have thebasics of the four densities down, let’s review them on an actual radiograph. In figure # 1 we haveappropriately labeled the four densities on a plain film of the abdomen.

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