When you arrive for an X-ray, you will most often be asked to change into a hospital gown, though the specifics depend on which body part is being imaged. For a chest X-ray, you will likely strip from the waist up and put on a thin, open-backed cotton or cotton-blend gown. For an X-ray of your hand or foot, you may not need to change at all. Beyond the gown, you might also be given a lead apron or thyroid shield to protect parts of your body not being imaged. The experience involves more wardrobe decisions than most people expect, and each one exists for a reason that directly affects the quality of the image your doctor sees.
The Hospital Gown and Why It Exists
The standard hospital gown is a loose-fitting garment, usually made of a light cotton or cotton-polyester blend, that ties or snaps at the back or side. Its main job during an X-ray is simple: get everyday clothing out of the way. Street clothes are full of materials that can interfere with the image. Buttons, zippers, underwire bras, metal snaps, belt buckles, and even some decorative prints contain substances dense enough to block X-ray beams. When that happens, those objects show up on the image as bright white spots or lines, potentially obscuring the anatomy your radiologist needs to evaluate.
Most radiology departments stock gowns in a few sizes. You typically change in a private cubicle or behind a curtain, and a technologist will tell you how to orient the opening (front-opening for chest X-rays, back-opening for spine imaging, and so on). The gown is designed to be quickly repositioned so the technologist can access whatever body region the X-ray needs to capture without requiring you to fully undress.
What Creates Artifacts on X-Ray Images
The concern about clothing goes beyond the obvious metal pieces. Research has shown that even non-metallic clothing elements can produce artifacts that mimic real pathology. In one published case, fabric features from a patient’s clothing appeared on a chest X-ray as what looked like multiple lung nodules, prompting unnecessary concern before clinicians realized the “nodules” were just artifacts from the garment.
A phantom study focused on children’s abdominal X-rays found that a surprisingly wide range of common clothing features showed up on the images. Seams, clothing tags, elastic waistbands, sequins, and printed figures were all visible regardless of the X-ray settings used. Diapers were clearly visible too, and different brands produced different artifact patterns. Some diaper waistlines appeared at every energy level tested.1European Society of Radiology. Children’s abdominal plain X-ray examinations: A phantom study of common artifacts
Not everything shows up, though. That same study found that adhesive patches, body glitter, and water-based temporary tattoos were completely invisible on the X-ray images.1European Society of Radiology. Children’s abdominal plain X-ray examinations: A phantom study of common artifacts So the rule is not “remove everything” but rather “remove anything that could cast a shadow,” which is a distinction the technologist makes based on what the item is made of and where on your body it sits relative to the area being imaged.
Even the Gown Itself Can Affect the Image
Here is something most patients would never consider: even the examination gown you change into is not perfectly invisible to X-rays. A study examining how different fabric materials affect computed radiography found that the standard radiographic examination gown produced statistically significant reductions in mean grey values at several measurement points on chest images compared to a bare-skin control. The most pronounced change was about a 4.3% shift at one measurement point.2Asian Journal of Medicine & Health Sciences. Gray Value Variation in Chest Imaging: Effects of Fabric Materials in Computed Radiography In practical terms, that means the gown slightly alters the appearance of the image, though the effect is small enough that radiologists can easily read through it. The point is that gowns are chosen not just for convenience but because their particular fabric has been validated to have minimal impact on diagnostic quality.
What You Typically Need to Remove
The technologist will give you specific instructions, but some general patterns apply across most X-ray exams. For any X-ray, you will be asked to remove jewelry in the area being imaged. This includes necklaces and earrings for head and chest X-rays, watches and bracelets for hand and wrist imaging, and body piercings near the target area. Research on dental and maxillofacial imaging has specifically addressed why insisting on jewelry removal matters: metallic objects near the head and face create artifacts that can obscure important diagnostic detail on the film.3PubMed Central. Why should we insist patients remove all jewellery?
Beyond jewelry, what you need to take off depends on the body part:
- Chest X-ray: Remove all clothing from the waist up, including bras (especially underwire), undershirts, and any necklaces or chains. You will wear a gown.
- Abdominal X-ray: Remove clothing with metal fasteners, belts, and waistbands. The gown covers you from roughly the shoulders down.
- Extremity X-ray: If you are having your hand, wrist, foot, ankle, knee, or elbow imaged, you often only need to roll up a sleeve or pant leg and remove watches, rings, or ankle bracelets. No gown may be needed at all.
- Spine or pelvis: Full gown, with most clothing removed depending on whether the target is your upper or lower spine.
- Dental X-ray: Usually no gown, but you will remove earrings, facial piercings, glasses, and sometimes dentures or retainers.
If you are unsure, wear simple clothing without metal when you know you have an X-ray appointment. A plain T-shirt and elastic-waist pants with no zippers or metal hardware can sometimes eliminate the need to change entirely for certain exams, though the technologist always has the final say.
Lead Aprons and Thyroid Shields
In addition to a gown, you may be given a heavy lead apron or a thyroid collar during your X-ray. These are radiation-shielding garments designed to protect organs not being imaged from unnecessary exposure. A thyroid shield, for instance, is a small collar-like device that wraps around your neck to cover the thyroid gland. It is used as a precautionary measure against radiation exposure and is designed to fit flexibly and comfortably.4PubMed Central. Effectiveness of protective thyroid shield in chest X-ray imaging
Lead aprons, which cover the torso, are sometimes draped over patients during X-rays of extremities or during dental imaging. They contain lead or lead-equivalent material and feel noticeably heavy. Whether you actually receive one depends on the facility’s protocol, the type of exam, and your age and sex. Children and people of reproductive age are more likely to be offered shielding for exams near the pelvis or abdomen.
It is worth noting that shielding practices have been evolving. Some professional radiology organizations have moved away from routine patient shielding for certain exams, arguing that modern X-ray equipment delivers such low doses that the shield provides minimal additional benefit and can sometimes interfere with the image if it drifts into the field of view. Other organizations and individual facilities still follow traditional shielding protocols. If shielding matters to you, it is reasonable to ask your technologist about their facility’s policy before the exam begins.
Special Considerations for Children
Getting an X-ray with a young child adds layers of complexity. Infants and toddlers cannot undress themselves or hold still on command, and their clothing tends to feature exactly the kinds of decorative elements that create imaging artifacts. The phantom study mentioned earlier found that sequins, printed designs, elastic waistbands, and clothing tags all showed up clearly on pediatric abdominal X-rays.1European Society of Radiology. Children’s abdominal plain X-ray examinations: A phantom study of common artifacts Even the diaper was a consistent source of artifacts, with different brands producing distinctly different patterns on the image.
For parents, the practical advice is to dress your child in plain, soft clothing without decorations if you know an X-ray is coming. A simple onesie or cotton shirt with no screen-printed graphics and no sequins will make the process faster. If the abdomen or pelvis is being imaged, the technologist may ask you to remove the diaper entirely. For chest X-rays, the child will usually need to have their upper body bare except for a gown, and a parent may be asked to hold the child in position while wearing a lead apron themselves.
Why the Gown Experience Bothers Patients
For something so routine from the clinical side, the hospital gown generates a remarkable amount of distress from the patient side. A study investigating the psychological impact of hospital gowns found that gowns are frequently used even when there is no strict medical necessity, and the experience often leaves patients feeling exposed, self-conscious, vulnerable, uncomfortable, cold, and disempowered. These negative effects were more pronounced in women and in people living with long-term health conditions.5PubMed. Baring all: The impact of the hospital gown on patient well-being
The finding that gowns are sometimes used when not medically required is worth sitting with. For an extremity X-ray where only your forearm is being imaged, there is usually no imaging reason to have you in a gown at all. If you are asked to change and it is not obvious why, asking the technologist “Is the gown necessary for this particular X-ray?” is a perfectly reasonable question. Many technologists appreciate it because it signals that you are engaged and gives them an opportunity to explain or skip an unnecessary step.
Research into better gown designs has explored alternatives to the traditional tie-back model. One qualitative study involving patients and designers examined features like magnetic closures with fabric loops that allow easier grasping, aimed at people with limited hand dexterity.6PubMed Central. Comprehensive design considerations for a new hospital gown: a patient-oriented qualitative study These designs try to balance clinical accessibility with the dignity issue, letting technologists reach the body area they need without leaving the patient feeling like the back of their gown is permanently open to a busy hallway.
Disposable Versus Reusable Gowns
Depending on the facility, you may get either a reusable cloth gown that gets laundered between patients or a disposable single-use gown made of a nonwoven synthetic material. The two feel quite different. Reusable gowns are heavier and more fabric-like but often trap heat and feel less breathable. Research comparing the two types found that comfort, or lack of it, is a common complaint about reusable gowns specifically because of poor breathability. Disposable gowns tend to be more breathable and are often preferred by healthcare workers for that reason, though they offer lower levels of physical protection against fluid exposure.7PubMed Central. Disposable versus reusable medical gowns: A performance comparison
For an X-ray, fluid protection is not the concern, so the choice between disposable and reusable comes down to the facility’s supply chain and environmental preferences. If you find reusable gowns uncomfortably warm, or disposable gowns too flimsy, there is not much you can do in the moment, but knowing the difference can set your expectations. Some outpatient imaging centers have moved toward offering patients two-piece gown sets (a separate top and bottom), which partly addresses the coverage and dignity concerns while still keeping the imaging area accessible.
Modesty, Culture, and Practical Tips
For patients whose cultural or religious practices involve specific clothing requirements, the X-ray experience can be more fraught than for others. Head coverings, for instance, generally do not need to be removed unless the head or neck is being imaged. Long skirts or loose clothing may be acceptable for lower-extremity imaging as long as there are no metal components. If you have concerns about modesty, calling the imaging facility ahead of your appointment can save you anxiety. Most departments can accommodate same-sex technologists upon request, though availability varies.
A few practical tips that experienced radiology patients learn the hard way:
- Skip the sports bra: Many sports bras have metal hooks, wires, or dense elastics that show up on chest and spine X-rays. A simple cotton bralette or no bra at all saves time.
- Leave jewelry at home: Rather than removing rings, necklaces, and earrings at the facility and worrying about losing them, leave them at home or in the car.
- Avoid clothing with metallic prints: Some screen-printed designs use metallic inks that are invisible to the eye but visible to an X-ray beam. Plain, unprinted fabric is safest.
- Wear slip-on shoes: If you are having a foot or ankle X-ray, you will need your shoes off. Lace-up boots slow the process.
- Bring a hoodie or sweater: X-ray rooms are kept cool for the equipment. After your exam, you may want a warm layer while you wait for results, especially if you have been in a thin gown.
When You Wear Nothing at All
Some X-ray exams require you to be completely bare in the area being imaged, with no gown at all. Mammography is the most common example: the breast tissue needs to be compressed directly against the imaging plate with no fabric in between. Similarly, some orthopedic X-rays of the shoulder or hip require the skin to be fully exposed so the technologist can position you precisely against the image receptor. In these situations, the technologist will typically provide draping or a blanket for areas not being imaged, but the experience can feel more exposing than a standard gown-and-X-ray setup.
At the other end of the spectrum, some facilities now allow patients to remain in their own clothing for certain exams after a quick check for metal. A technologist might run a hand-held metal detector over your clothing, or simply ask you to confirm there are no metal components. This approach is becoming more common for straightforward extremity X-rays and for follow-up imaging where the technologist already knows what to expect. The trend reflects a broader push in radiology to reduce unnecessary steps that add patient discomfort without improving diagnostic quality.