Introduction

diagnostics medical examination endoscopic

The last decade of the 20th century is characterized by the rapid development of radiation diagnostics. The main reason for this is the emergence of a whole series of so-called “new technologies”, which have made it possible to dramatically expand the diagnostic potential of “old” traditional radiology. With their help, the concept of so-called white spots in classical radiology was essentially “closed” (for example, the pathology of the entire group of parenchymal organs of the abdominal cavity and retroperitoneal space). For a large group of diseases, the introduction of these technologies has dramatically changed the existing capabilities of their radiological diagnosis.

Largely due to the success of radiation diagnostics in leading clinics in America and Europe, the time for diagnosis does not exceed 40-60 minutes from the moment the patient is admitted to the hospital. Moreover, we are talking, as a rule, about serious urgent situations, where delay often leads to irreversible consequences. Moreover, the hospital bed has become less and less used for diagnostic procedures. All necessary preliminary studies, and primarily radiation, are performed at the prehospital stage.

Radiological procedures have long been second in frequency of use, second only to the most common and mandatory laboratory tests. Summary statistics from the world's major medical centers show that thanks to radiation methods, the number of erroneous diagnoses during a patient's initial visit today does not exceed 4%.

Modern visualization tools meet the following fundamental principles: impeccable image quality, equipment safety for both patients and medical personnel, operational reliability.

Purpose of the work: to gain knowledge about instrumental methods of examining patients during X-ray, endoscopic and ultrasound examinations.

Instrumental methods for X-ray, endoscopic and ultrasound examinations

Methods for studying the structure and functions of human organs using special equipment are called instrumental. They are used for medical diagnostic purposes. The patient must be psychologically and physically prepared for many of them. A nurse must be proficient in the technology of preparing patients for instrumental examinations.

X-ray research methods

X-ray (x-ray) examination is based on the property of x-rays to penetrate body tissue to varying degrees. The degree of absorption of X-ray radiation depends on the thickness, density and physico-chemical composition of human organs and tissues, therefore denser organs and tissues (bones, heart, liver, large vessels) are visualized on the screen (X-ray fluorescent or television) as shadows, and lung tissue due to the large amount of air, it is represented by an area of \u200b\u200bbright glow. Wilhelm Conrad Roentgen (1845-1923) - German experimental physicist, founder of radiology, discovered X-rays (X-rays) in 1895. On X-rays of the intestine with contrast, you can see changes in the lumen of the intestine, an increase in the length of the organ, etc. (Annex 1).

Figure 1. X-ray room.

The following main radiological research methods are distinguished:

1. Fluoroscopy (Greek skopeo - examine, observe) - x-ray examination in real time. A dynamic image appears on the screen, allowing you to study the motor function of organs (for example, vascular pulsation, gastrointestinal motility); the structure of the organs is also visible.

2. Radiography (Greek grapho - to write) - x-ray examination with registration of a still image on a special x-ray film or photographic paper. With digital radiography, the image is recorded in the computer's memory. Five types of radiography are used.

* Full-format radiography.

* Fluorography (small-format radiography) - radiography with a reduced size of the image obtained on a fluorescent screen (Latin fluor - flow, flow); it is used for preventive examinations of the respiratory system.

* Survey radiography - an image of an entire anatomical area.

* Sight radiography - an image of a limited area of the organ being studied.

* Serial radiography - sequential acquisition of several radiographs to study the dynamics of the process being studied.

3. Tomography (Greek tomos - segment, layer, layer) - a layer-by-layer visualization method that provides an image of a layer of tissue of a given thickness using an X-ray tube and a film cassette (X-ray tomography) or with the connection of special counting cameras from which electrical signals are supplied to a computer (computed tomography).

4. Contrast fluoroscopy (or radiography) is an X-ray research method based on the introduction into hollow organs (bronchi, stomach, renal pelvis and ureters, etc.) or vessels (angiography) of special (radiopaque) substances that block X-ray radiation, resulting in A clear image of the organs being studied is obtained on the screen (photo film).

Before conducting an X-ray examination, you should clear the area of the planned examination from clothing, ointment bandages, adhesive plaster stickers, electrodes for ECG monitoring, etc., ask to remove watches, metal jewelry and pendants.

Chest X-ray is an important method for examining patients with respiratory and cardiovascular diseases.

Fluoroscopy and radiography are the most commonly used methods for examining the respiratory system. X-ray examination allows us to assess the condition of the lung tissue, the appearance of areas of compaction and increased airiness in it, the presence of fluid or air in the pleural cavities. No special preparation of the patient is required. The study is carried out with the patient standing or, if the patient’s condition is serious, lying down.

Contrast radiography of the bronchi (bronchography) is used to identify tumor processes in the bronchi, dilatation of the bronchi (bronchiectasis) and cavities in the lung tissue (abscess, cavity). A radiopaque substance is injected into the bronchial cavity.

Preparing a patient for bronchography is carried out in several stages:

1. Conducting a test for individual tolerance to iodine-containing drugs (iodine test): for 2-3 days, as prescribed by the doctor, the patient is asked to drink 1 tbsp. 3% potassium iodide solution. Another option for conducting an iodine test: on the eve of the test, the skin of the inner surface of the patient’s forearm is treated with a 5% alcohol solution of iodine. It is necessary to ask the patient about his tolerance to medications, in particular anesthetics (tetracaine, lidocaine, procaine), and if necessary, conduct intradermal allergy tests. The medical history should reflect the date of the drug tolerance test, a detailed description of the patient’s condition (the presence or absence of signs of hypersensitivity); The signature of the nurse who observed the patient for 12 hours after the test is required.

2. Cleansing the bronchial tree in the presence of purulent sputum: 3-4 days in advance, as prescribed by the doctor, the patient is prescribed bronchial drainage (by the patient adopting the appropriate, optimal position for sputum discharge, position with the foot end of the bed raised), expectorants and bronchodilators.

3. Psychological preparation: the patient should be explained the purpose and necessity of the upcoming study. In some cases, patients may develop insomnia and increase blood pressure before the study. In this case, as prescribed by the doctor, the patient is given sedatives and antihypertensive drugs.

4. Direct preparation of the patient for the study: on the eve of the study, the patient is given a light dinner (milk, cabbage, meat are excluded). It is necessary to warn the patient that the study is carried out on an empty stomach; on the morning of the test, he should also not drink water, take medications or smoke. The patient should be reminded that before the study he must empty his bladder and bowels (naturally).

5. Premedication: 30-60 minutes before the examination, as prescribed by the doctor, the patient is administered special drugs (diazepam, atropine, etc.) in order to create conditions for free access of the bronchoscope. Particular attention should be paid to the patient after the study, as the following complications may develop:

* the appearance or intensification of a cough with the release of sputum with a large amount of radiopaque substance (sometimes the injected substance is released within 1-2 days); in this case, the patient must be provided with a special jar (spittoon) for sputum;

* increased body temperature;

* development of pneumonia (in rare cases with poor contrast agent release).

If a patient develops symptoms such as increased body temperature, deterioration in general condition, a sharp increase in cough, or shortness of breath after bronchography, the nurse should immediately inform the doctor about this.

Fluoroscopy and radiography are also often used to study the cardiovascular system (heart, aorta, pulmonary artery). X-ray examination makes it possible to determine the size of the heart and its chambers, large vessels, the presence of displacement of the heart and its mobility during contractions, and the presence of fluid in the pericardial cavity. If necessary, the patient is offered to drink a small amount of a radiopaque substance (a suspension of barium sulfate), which makes it possible to contrast the esophagus and, by the degree of its displacement, judge the degree of enlargement of the left atrium. No special preparation of the patient is required.

Contrast radiography (angiocardiography) is used to determine the condition of large vessels and chambers of the heart. A radiopaque substance is injected into large vessels and cavities of the heart through special probes. This procedure is actually a surgical operation; it is performed in a specially equipped operating room, usually in a cardiac surgery department. On the eve of the study, the patient must undergo tests to determine the tolerance of iodine-containing drugs and anesthetics. The study is carried out on an empty stomach. In addition, the nurse should pay special attention to the patient after the examination, since the introduction of a radiopaque substance into the heart cavity can cause not only early but also late complications. X-ray examination of the digestive organs makes it possible to assess the condition of hollow (esophagus, stomach, intestines, bile ducts) and parenchymal (liver, pancreas) organs. X-ray and fluoroscopy of the digestive organs without radiopaque contrast agent are used to detect intestinal obstruction or perforation of the stomach and intestines. The use of a radiopaque substance (a suspension of barium sulfate) makes it possible to determine the motor function and relief of the mucous membrane of the digestive tract, the presence of ulcers, tumors, areas of narrowing or expansion of various parts of the digestive tract.

Examination of the esophagus. Preparing the patient for x-ray examination of the esophagus depends on the indications.

* No special preparation is required to identify a foreign body in the esophagus.

* To assess the motor function of the esophagus and its contours (identifying areas of narrowing and expansion, tumors, etc.), fluoroscopy and/or serial radiography are performed; in this case, before the study, the patient is given a radiopaque substance to drink (150-200 ml of barium sulfate suspension).

* If it is necessary to carry out a differential diagnosis of organic narrowing and functional damage (spasms of the esophagus), 15 minutes before the study, as prescribed by the doctor, the patient is injected with 1 ml of a 0.1% atropine solution. If there is a pronounced organic narrowing of the esophagus, as prescribed by a doctor, using a thick probe and a rubber bulb, the accumulated fluid is suctioned from the esophagus.

Examination of the stomach and duodenum. Preparing the patient for an x-ray examination involves freeing these parts of the digestive tract from food masses and gases and begins several days before the examination. The stages of preparing the patient are as follows.

1. Prescribe a diet 3 days before the study that excludes foods rich in plant fiber and containing other substances that promote increased gas formation. It is necessary to exclude freshly baked rye bread, potatoes, legumes, milk, vegetables and fruits, and fruit juices from the diet.

2. On the eve of the study, the patient is prescribed a light dinner (no later than 8 pm). Allowed are eggs, cream, caviar, cheese, meat and fish without seasoning, tea or coffee without sugar, porridge cooked in water.

3. The night before and in the morning, 2 hours before the study, the patient is given a cleansing enema.

4. It is necessary to warn the patient that 12 hours before the test he must stop eating, and on the morning of the test he should not drink, take any medications or smoke.

Colon examination. To conduct an X-ray examination of the colon - irrigoscopy (Latin irrigatio - irrigation) - a complete cleansing of the intestines from contents and gases is necessary. A radiopaque substance - up to 1.5 liters of warm (36-37 °C) barium sulfate suspension - is injected into the intestines using an enema directly in the X-ray room. Contraindications to irrigoscopy: diseases of the rectum and its sphincters (inflammation, tumor, fistula, sphincter fissure). Situations are possible when the patient cannot keep the fluid administered to him in the intestines (rectal prolapse, sphincter weakness), which makes this procedure impossible.

Stages of preparing the patient for the study:

1. Prescribe a diet 2-3 days before the study, excluding foods rich in plant fiber and containing other substances that promote increased gas formation. It is necessary to exclude fresh rye bread, potatoes, legumes, fresh milk, fresh vegetables and fruits, and fruit juices from the diet.

2. On the eve of the study, the patient is prescribed a light dinner (no later than 8 pm). Omelette, kefir, caviar, cheese, boiled meat and fish without seasoning, tea or coffee without sugar, semolina porridge cooked in water are allowed.

3. On the eve of the study, before lunch, the patient is given 30 g of castor oil to take orally (contraindication to taking castor oil is intestinal obstruction).

4. The night before (30-40 minutes after dinner), the patient is given cleansing enemas with an interval of 1 hour until “clean” rinsing water is obtained.

5. In the morning, 2 hours before the study, the patient is given a cleansing enema, also until “clean” rinsing water is obtained.

6. The study is carried out on an empty stomach. If necessary, as prescribed by the doctor, the patient is allowed a light protein breakfast in the morning (low-fat cottage cheese, whipped egg white soufflé or protein omelet, boiled fish), which allows for a reflex movement of the contents of the small intestine into the large intestine and prevents the accumulation of gases in the intestines. In this case, a morning cleansing enema is given 20-30 minutes after breakfast.

7. 30 minutes before the study, a gas tube is inserted into the patient.

Another way to cleanse the intestines before x-ray and endoscopic examination is oral lavage. To carry it out, isoosmotic solutions are used, for example fortrans. The Fortrans package, intended for one patient, consists of four packets containing 64 g of polyethylene glycol in combination with 9 g of electrolytes - sodium sulfate, sodium bicarbonate, sodium chloride and potassium chloride. Each packet is dissolved in 1 liter of boiled water. As a rule, the patient is prescribed the first 2 liters of solution in the afternoon on the day preceding the study; a second portion of 1.5-2 liters is given in the morning on the day of the study. The effect of the drug (bowel emptying) is not accompanied by pain and tenesmus, begins 50-80 minutes after starting to take the solution and continues for 2-6 hours. Bowel emptying when Fortrans is re-administered in the morning begins 20-30 minutes after taking the drug. The use of Fortrans is contraindicated if the patient has ulcerative colitis, Crohn's disease, intestinal obstruction, or abdominal pain of unknown etiology.

X-ray examination of the gallbladder (cholecystography) allows us to determine its shape, position and deformations, the presence of stones in it, and the degree of emptying. A radiopaque substance (for example, sodium iopodate - “Bilimin”) is given to the patient to drink; in this case, the concentration of the contrast agent reaches its maximum in the gallbladder 10-15 hours after its administration. If a radiopaque contrast agent is administered intravenously, this study is called intravenous cholegraphy. This method allows contrasting of intrahepatic bile ducts. In this case, after 20-25 minutes you can get an image of the bile ducts, and after 2-2.5 hours of the gallbladder. Preparing the patient for the study depends on the method of administration of the contrast agent.

The stages of preparing a patient for cholecystography are as follows:

2. On the eve of the study, after a light dinner (with the exception of fats), the patient is given a cleansing enema.

3. 12 hours before the study, the patient takes a radiopaque substance (for example, 3 g of Bilimin), washed down with warm tea. If the patient is obese, the patient is given to drink "Bilimin" twice - 3 g at 20 o'clock and at 22 o'clock.

4. The patient must be warned that the study is being performed on an empty stomach. Directly in the X-ray room, the patient receives a choleretic breakfast (100 g of sour cream or 20 g of butter on a thin piece of white bread).

With intravenous cholegraphy, the stages of preparing the patient for the study include the mandatory testing of individual tolerance to the drug (several days before the study), the prescription of a diet with the exclusion of foods that contribute to increased gas formation, and the administration of cleansing enemas the night before and in the morning on the day of the study. Intravenous cholegraphy is also performed on an empty stomach. Before the study, a radiopaque contrast agent heated to human body temperature is injected intravenously slowly (over 4-5 minutes).

Survey radiography of the kidneys and urinary tract makes it possible to determine the shape and position of the renal pelvis and ureters, and in some cases, to assess the presence of stones (calculi).

Contrast radiography. Depending on the method of administration of the radiocontrast agent, two types of contrast radiography of the kidneys and urinary tract are distinguished.

* Retrograde urography is a research method when a radiopaque substance is injected through a urinary catheter under the control of a cystoscope into the desired ureter. No special preparation of the patient is required.

* For excretory urography, a radiopaque substance is administered intravenously. This research method allows you to identify the presence of stones, anomalies, cicatricial narrowings, and tumor formations in the kidneys and urinary tract. The rate of release of the radiopaque substance characterizes the functional capacity of the kidneys.

The stages of preparing a patient for x-ray examination of the kidneys and urinary tract are as follows:

2. Conducting a test to determine individual tolerance to a radiocontrast agent 12-24 hours before the study.

3. Limiting the patient’s fluid intake 12-18 hours before the test.

4. Administration of a cleansing enema (before receiving “clean” rinsing water) the night before and in the morning 2 hours before the study. The study is carried out strictly on an empty stomach.

The radiopaque contrast agent is administered to the patient directly in the X-ray room.

Physical foundations and methods of X-ray research

1. X-ray sources

X-rays were discovered by the German physicist Roentgen in 1895. Roentgen himself called them X-rays. It occurs when fast electrons are slowed down by matter. X-ray radiation is obtained using special electron-vacuum devices - X-ray tubes.

In a glass flask, the pressure in which is 10 -6 mmHg, there is an anode and a cathode. The anode is made of copper with a tungsten tip. The anode voltage of X-ray tubes is 80 – 120 kV. Electrons emitted from the cathode are accelerated by the electric field and decelerated by the tungsten anode nozzle, which has a bevel at an angle of 11–15 O . X-ray radiation exits the flask through a special quartz window.

The most important parameters of X-ray radiation are wavelength and intensity. If we assume that the deceleration of an electron at the anode occurs instantaneously, then all its kinetic energy eU a goes into radiation:

. (1)

In reality, electron deceleration takes a finite time, and the radiation frequency, determined from equation (1), is the maximum possible:

. (2)

Taking into account (c – speed of light), we find the minimum wavelength

. (3)

Substituting valuesh, c, einto formula (3) and expressing the anode voltage in kilovolts, we obtain the wavelength in nanometers:

=. (4)

For example, at an anode voltage of 100 kV, the x-ray wavelength will be equal to 0.012 nm, i.e. approximately 40,000 times shorter than the average wavelength of the optical range.

The theoretical frequency distribution of bremsstrahlung energy was derived by Cramer and experimentally obtained by Kulenkampf. Spectral DensityI  continuous s clear X-ray spectrum at anode currenti a canode, the substance of which has a serial numberZ, is expressed by the relation

Component BZdoes not depend on frequency and is not called characteristic radiation. Usually its share is negligible, so we will assume

. (5)

The distribution of intensities over wavelengths can be obtained from the equality

Where .

Using formula (5), taking into account and we find

. (6)

We find the intensity of bremsstrahlung using formula (5)

or, taking into account relation (2),

Where . (7)

Thus, the intensity of X-ray radiation is proportional to the anode current, the square of the anode voltage and the atomic number of the anode substance.

The place where electrons fall on the anode is called the focus. Its diameter is several millimeters, and the temperature in it reaches 1900 O C. Hence the choice of tungsten as a material for the nozzle is clear: it has a high atomic number (74) and a high melting point (3400 O WITH). Recall that the atomic number of copper is 29, and the melting point is “only” 1700 about S.

From formula (7) it follows that the intensity of X-ray radiation can be adjusted by changing the anode current (cathode heating current) and the anode voltage. However, in the second case, in addition to the intensity of the radiation, its spectral composition will also change. Formula (6) shows that spectral intensity is a complex function of wavelength. It starts from zero at , reaches a maximum at 1.5 and then asymptotically tends to zero. Components of X-ray radiation with wavelengths close to are called hard radiation, and those with wavelengths much longer are called soft radiation.

The anode of the simplest X-ray tube is cooled by convection, and therefore such tubes have low power. To increase it, active cooling with oil is used. The anode of the tube is made hollow and oil is fed into it under a pressure of 3 - 4 atm. This cooling method is not very convenient, as it requires additional bulky equipment: pump, hoses, etc.

For high tube powers, the most effective cooling method is to use a rotating anode. The anode is made in the form of a truncated cone, the generatrix of which makes an angle of 11–15 with the base O . The side surface of the anode is reinforced with tungsten. The anode rotates on a rod connected to a metal cup, to which

anode voltage is applied. A three-phase winding, which is a stator, is put on the flask. The stator winding is powered by industrial or high frequency current, for example 150 Hz. The stator creates a rotating magnetic field, which drags the rotor along with it. The anode rotation speed reaches 9000 rpm. When the anode rotates, the focus moves along its surface. Due to thermal inertia, the heat transfer area increases many times compared to a stationary anode. It is equal to 2r  D f, where D f is the diameter of the focal spot, and r is its radius of rotation. Tubes with a rotating anode can withstand very heavy loads. Modern tubes usually have two focal points and, accordingly, two filament coils.

In table 1 shows the parameters of some medical X-ray tubes.

Table 1. X-ray tube parameters

Tube type	Anode voltage, kV	Rated power for 1 s, kW
With fixed anode
0.2BD-7–50 50 0.2 5D1 3BD-2–100 100 3.0 RUM
With rotating anode
10 BD-1–110 110 10.0 Fl 11F1 8–16 BD-2–145 145 8.0; 16.0 RUM-10 14–30 BD-9–150 150 14.0; 30.0 RUM-20

2. Types of X-ray examinations

Most x-ray studies are based on the conversion of x-rays passed through human tissue. When X-rays pass through a substance, part of the radiant energy is retained in it. In this case, not only a quantitative change occurs - a weakening of the intensity, but also a qualitative change - a change in the spectral composition: softer rays are delayed more strongly and the output radiation becomes generally harder.

The attenuation of X-ray radiation occurs due to absorption and scattering. When absorbed, X-ray quanta knock out electrons from the atoms of the substance, i.e. ionize it, which is where the harmful effects of X-ray radiation on living tissues manifest themselves. The spectral absorption coefficient is proportional to . Thus, soft rays are absorbed much more strongly than hard ones (and, strange as it may seem at first glance, do more harm). Attenuation due to scattering mainly affects very short wavelengths, which are not used in medical radiology.

It has been established that if the relative absorption coefficient of X-ray radiation of water (for radiation of medium hardness) is taken equal to unity, then for air it will be 0.01; for adipose tissue – 0.5; calcium carbonate – 15.0; calcium phosphate – 22.0. In other words, X-rays are absorbed to the greatest extent by bones, to a much lesser extent by soft tissues, and least by tissues containing air.

X-ray converters usually have a large active area, the points of which are affected by individual rays passing in certain directions through the object. At the same time, they experience different attenuation, depending on the properties of tissues and media encountered in the direction of the beam. The most important parameter for X-ray imaging is the linear attenuation coefficient . It shows how many times the intensity of x-ray radiation decreases over a very small segment of the beam path, over which the tissue or medium can be considered homogeneous.

I B = I 0 exp(-).

The linear attenuation coefficient  varies along the beam path and the total attenuation is determined by the absorption of all tissues encountered along it.

The energy dependence of the X-ray attenuation coefficient - it decreases with increasing energy - also leads to its dependence on the distance traveled by the beam. Indeed, as the beam moves, its softer components are eliminated and increasingly hard ones remain, which are absorbed less. This specific feature does not pose any problems for conventional X-ray examinations, but is of great importance in X-ray computed tomography.

Due to changes in the spectral composition of X-ray radiation transmitted through the substance, the dependence of the intensity I P of the transmitted radiation on the anode voltage becomes more complicated

where n = 2–6.

One of the most common types of x-ray examinations is still radiography - taking x-ray images on a special x-ray film.

Radiation from an X-ray source first passes through a filter - a thin sheet of aluminum or copper, which filters out soft components. They are not of great importance for diagnosis, but they incur additional radiation exposure for the patient and can cause an X-ray burn. After passing through the object, the X-ray radiation hits the receiver, which looks like a cassette. It contains X-ray film and an intensifying screen. The screen is a thick sheet of cardboard. Its side facing the film is coated with a luminescent layer, for example, calcium tungstate CaWO 4 or ZnS  CdS  Ag, capable of glowing under the influence of X-rays. Optical radiation illuminates the emulsion layer of the X-ray film and causes a reaction in the silver compounds. Proportionality is maintained between the intensities of both types of radiation, so areas of the object corresponding to stronger absorption of X-ray radiation (for example, bone tissue) appear lighter in the image.

At the early stage of development of X-ray technology, direct filming was used - without an intensifying screen. However, due to the small thickness of the emulsion layer, a very small part of the total radiation energy was retained in it, and to obtain a high-quality image it was necessary to use a long shooting time. This resulted in significant radiation exposure to patients and staff. Roentgen himself was the first to feel the results of this influence.

A distinction is made between emitted and absorbed doses of X-ray radiation. Both of these can be expressed in roentgens. In medical radiology, a special unit is used to estimate the absorbed dose - Sievert (Sv): 13 V is equivalent to approximately 84 R. Unlike the radiated dose, the absorbed dose cannot be measured accurately. It is determined by calculation or using models (phantoms). The absorbed dose characterizes the degree of radiation exposure to a person and, consequently, the harmful effects on the body. During one x-ray, the patient receives from 0.5 to 5 mR.

The quality of the image (contrast) depends on shutter speed and exposure. Exposure is the product of radiation intensity and shutter speed: H = It. A picture of the same quality can be obtained with the same exposure, i.e. at high intensity and short shutter speed or at low intensity and long shutter speed. Since exposure is energy, it also determines the absorbed dose of radiation.

One of the significant disadvantages of radiography has already been noted above - the high consumption of silver (5–10 g per 1 m 2 of film). Therefore, intensive development of methods and tools for “filmless” X-ray studies is underway. One such way is electroradiography. X-ray examination is carried out in the same way as for radiography, only instead of a cassette with film and an intensifying screen, a cassette with a semiconductor (selenium) plate is used. The plate is pre-charged in a special device with a uniform electric field. Under the influence of X-ray irradiation, the resistance of the semiconductor layer decreases, and the plate partially loses its charge. A latent electrostatic image is created on the plate, reflecting the structure of the object being photographed. Subsequently, this image is transferred to thick paper using graphite powder and fixed. The plate is cleaned of powder residues and reused. The electroradiography method is characterized by its simplicity and low cost of materials, but it is 1.5–2 times less sensitive than conventional radiography. Therefore, the main area of its application is urgent research - traumatology of the limbs, pelvis and other bone formations.

Another important branch of X-ray diagnostics is rapidly developing - radiography. Until relatively recently (the 60s of the twentieth century), direct fluoroscopy was used. X-ray radiation passing through the object fell on a luminescent screen - a metal sheet coated with a layer of ZnS or CdS. The physician positioned himself behind the screen and observed the optical image. To obtain an image of sufficient brightness, it was necessary to increase the radiation intensity. In this case, both the patient and the doctor (despite protective measures) were exposed to severe radiation. Still, the brightness of the image remained low, and observation had to be carried out in a darkened room. Subsequently, fluoroscopy from its original form branched into two directions - fluorography and X-ray television systems.

Fluorography is the most common x-ray examination and is intended primarily for mass diagnosis of tuberculosis.

X-ray radiation passing through an object hits a luminescent screen, on which an optical image appears. The light radiation is focused and concentrated by the optical system and illuminates the roll film, on which images of size 100100 or 7070 are obtained. The quality of fluorographic images is somewhat worse than radiographic ones, and the radiation dose received during this study reaches 5 mR. Tens of millions of meters of film are spent annually on fluorograms.

The use of X-ray to optical converters - X-ray electron-optical converters (X-ray electron-optical converters) (X-ray electron-optical converters), the design and principle of operation of which will be discussed in the section “X-ray television systems,” can significantly reduce the radiation dose to the patient and improve the quality of the image.

In order to obtain a differentiated image of tissues that absorb radiation approximately equally, artificial contrast is used. For this purpose, substances are introduced into the body that absorb X-ray radiation more strongly or, conversely, weaker than soft tissues, and thereby create sufficient contrast in relation to the organs being studied. Iodine or barium are used as substances that block x-ray radiation more strongly than soft tissue (to obtain x-rays of the digestive tract). Artificial contrast is also used in angiography - radiography of blood and lymphatic vessels. All manipulations during angiography are carried out under X-ray television control.

The most important method for diagnosing tuberculosis at different stages of its formation is the x-ray method. Over time, it became clear that with this infectious disease there is no “classical”, that is, constant X-ray picture. Any pulmonary disease may appear similar to tuberculosis on imaging. And vice versa - a tuberculosis infection may look similar on X-rays to many pulmonary diseases. It is clear that this fact makes differential diagnosis difficult. In this case, specialists resort to other, no less informative methods for diagnosing tuberculosis.

Although x-rays have disadvantages, this method sometimes plays a key role in diagnosing not only tuberculosis infection, but also other diseases of the chest organs. It helps to accurately determine the location and extent of the pathology. Therefore, the described method most often becomes the correct basis for making an accurate diagnosis of tuberculosis. Due to its simplicity and information content, X-ray examination of the chest organs is mandatory for the adult population in Russia.

How are X-rays obtained?

The organs of our body have a different structure - bones and cartilage are dense formations, compared to parenchymal or cavitary organs. It is on the difference in the density of organs and structures that X-ray images are based. Rays that pass through anatomical structures are absorbed differently. This directly depends on the chemical composition of the organs and the volume of tissue studied. Strong absorption of X-ray radiation by the organ gives a shadow in the resulting image if it is transferred to film or on a screen.

Sometimes it is necessary to additionally “note” some structures that require more careful study. In this case, they resort to contrasting. In this case, special substances are used that can absorb rays in a larger or smaller volume.

The algorithm for obtaining an image can be represented by the following points:

The radiation source is an X-ray tube.
The object of the study is the patient, and the purpose of the study can be both diagnostic and preventive.
The emitter receiver is a film cassette (for radiography), fluoroscopic screens (for fluoroscopy).
A radiologist - who studies the image in detail and gives his opinion. It becomes the basis for making a diagnosis.

Is x-ray dangerous for humans?

It has been proven that even tiny doses of x-rays can be dangerous to living organisms. Studies conducted on laboratory animals show that X-ray radiation caused disturbances in the structure of their germ cell chromosomes. This phenomenon negatively affects the next generation. The cubs of irradiated animals had congenital anomalies, extremely low resistance and other irreversible abnormalities.

An X-ray examination, which is carried out in full accordance with the rules of its technique, is absolutely safe for the patient.

It is important to know! In the case of using faulty X-ray equipment or gross violation of the imaging algorithm, as well as the lack of personal protective equipment, harm to the body is possible.

Each x-ray examination involves the absorption of microdoses. Therefore, healthcare has provided a special resolution that medical personnel are obliged to comply with when taking images. Among them:

The study is carried out according to strict indications for the patient.
Pregnant women and pediatric patients are checked with extreme caution.
The use of the latest equipment, which minimizes radiation exposure to the patient’s body.
PPE for the X-ray room – protective clothing, protectors.
Reduced exposure time – which is important for both the patient and the medical staff.
Control of doses received by medical personnel.

The most common methods in x-ray diagnostics of tuberculosis

For the chest organs, the following methods are most often used:

Fluoroscopy - the use of this method involves x-ray examination. This is the most affordable and popular x-ray examination. The essence of his work is to irradiate the chest area with X-rays, the image of which is projected on a screen and then examined by a radiologist. The method has disadvantages - the resulting image is not printed. Therefore, in fact, it can be studied only once, which makes it difficult to diagnose small lesions in tuberculosis and other diseases of the chest organs. The method is most often used to make a preliminary diagnosis;
Radiography is an image that, unlike fluoroscopy, remains on film, therefore it is mandatory in the diagnosis of tuberculosis. The picture is taken in a frontal projection, if necessary - in a lateral one. The rays that have previously passed through the body are projected onto the film, which is capable of changing its properties thanks to the silver bromide included in its composition - dark areas indicate that the silver on them has been restored to a greater extent than on transparent ones. That is, the former display the “air” space of the chest or other anatomical area, and the latter – bones and cartilage, tumors, accumulated fluid;
Tomography – allows specialists to obtain a layer-by-layer image. In addition to the X-ray machine, special devices are used that are capable of recording images of organs in their different parts without overlapping each other. The method is highly informative in determining the location and size of a tuberculosis focus;
Fluorography - an image is obtained by photographing an image from a fluorescent screen. It can be large- or small-frame, electronic. It is used for mass preventive examinations for the presence of tuberculosis and lung cancer.

Other X-ray examination methods and preparation for them

Some patient conditions require imaging of other anatomical areas. In addition to the lungs, you can take an x-ray of the kidneys and gallbladder, the gastrointestinal tract or the stomach itself, blood vessels and other organs:

X-ray of the stomach - which will allow you to diagnose ulcers or neoplasms, developmental abnormalities. It should be noted that the procedure has contraindications in the form of bleeding and other acute conditions. Before the procedure, it is necessary to follow a diet three days before the procedure and a cleansing enema. The manipulation is carried out using barium sulfate, which fills the stomach cavity.
X-ray examination of the bladder - or cystography - is a method that is widely used in urology and surgery to identify kidney pathology. Since it can show stones, tumors, inflammations and other pathologies with a high degree of accuracy. In this case, contrast is administered through a catheter previously installed in the patient's urethra. For children, the manipulation is performed under anesthesia.
X-ray of the gallbladder - cholecystography - which is also performed using a contrast agent - bilitrast. Preparation for the study - a diet with a minimum fat content, taking iopanoic acid before bed, before the procedure itself, it is recommended to conduct a test for sensitivity to contrast and a cleansing enema.

X-ray examination in children

Even young patients can be referred for X-rays – and even the neonatal period is not a contraindication for this. An important point for taking an image is the medical justification, which must be documented either in the child’s card or in his medical history.

For older children - after 12 years - the X-ray examination is no different from an adult. Young children and newborns are examined using x-rays using special techniques. Children's healthcare facilities have specialized X-ray rooms where even premature babies can be examined. In addition, in such offices the technique of taking photographs is strictly observed. Any manipulations there are carried out strictly observing the rules of asepsis and antiseptics.

In the case where an image needs to be taken on a child under 14 years of age, three persons are involved - a radiologist, an x-ray technician and a nurse accompanying the small patient. The latter is needed to help secure the child and to provide care and observation before and after the procedure.

For children in X-ray rooms, special fixing devices are used and, of course, radiation protection devices in the form of diaphragms or tubes are used. Particular attention is paid to the child’s gonads. In this case, electron-optical amplifiers are used and radiation exposure is reduced to a minimum.

It is important to know! Most often, radiography is used for pediatric patients due to its low ionizing load compared to other X-ray methods.

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An important part of the functional analysis of teeth, jaws and TMJ is radiography. Radiological research methods include intraoral dental radiography, as well as a number of extraoral radiography methods: panoramic radiography, orthopantomography, TMJ tomography and teleradiography.

A panoramic radiograph shows an image of one jaw, and an orthopantomogram shows both jaws.

Teleradiography (radiography at a distance) is used to study the structure of the facial skeleton. When radiography of the TMJ, the Parma, Schüller methods, as well as tomography are used. Survey radiographs are of little use for functional analysis: they do not show the entire joint space, there are projection distortions, and overlaps of surrounding bone tissue.

Tomography of the temporomandibular joint

Tomography (sagittal, frontal and axial projections) has undoubted advantages over the above methods, allowing one to see the joint space and the shape of the articular surfaces. However, tomography is a slice in one plane and with this study it is impossible to assess the overall position and shape of the outer and inner poles of the TMJ heads.

The blurriness of the articular surfaces on tomograms is due to the presence of a shadow of the smear layers. In the area of the lateral pole it is the massif of the zygomatic arch, in the area of the medial pole it is the petrous part of the temporal bone. The tomogram is clearer if there is a section in the middle of the head, and the greatest changes in pathology are observed at the poles of the heads.
On tomograms in the sagittal projection we see a combination of displacement of the heads in the vertical, horizontal and sagittal planes. For example, a narrowing of the joint space detected on a sagittal tomogram may be a result of displacement of the head outward, and not upward, as is commonly believed; expansion of the joint space - displacement of the head inward (medially), and not just downward (Fig. 3.29, a).

Rice. 3.29. Sagittal tomograms of the TMJ and a scheme for their evaluation. A - topography of the elements of the TMJ on the right (a) and left (b) when the jaws are closed in the position of central (1), right lateral (2) occlusion and with the mouth open (3) is normal. A gap is visible between the bone elements of the joint - a place for the articular disc; B - diagram for analyzing sagittal tomograms: a - angle of inclination of the posterior slope of the articular tubercle to the main line; 1 - anterior articular gap; 2 - superior joint space; 3 - posterior joint gap; 4 - height of the articular tubercle.

The expansion of the joint space on one side and its narrowing on the other is considered a sign of displacement of the lower jaw to the side where the joint space is narrower.

The internal and external parts of the joint are determined on frontal tomograms. Due to the asymmetry of the location of the TMJ in the space of the facial skull on the right and left, it is not always possible to obtain an image of the joint on both sides on one frontal tomogram. Tomograms in axial projection are rarely used due to the difficult positioning of the patient. Depending on the objectives of the study, tomography of the elements of the TMJ in lateral projections is used in the following positions of the lower jaw: with maximum closure of the jaws; with maximum mouth opening; in the position of physiological rest of the lower jaw; in "habitual occlusion".

When performing tomography in a lateral projection on a Neodiagno-max tomograph, the patient is placed on the imaging table on his stomach, the head is turned in profile so that the joint being examined is adjacent to the film cassette. The sagittal plane of the skull should be parallel to the plane of the table. In this case, a cutting depth of 2.5 cm is most often used.

On tomograms of the TMJ in the sagittal projection, when the jaws are closed in the position of central occlusion, the articular heads normally occupy a centric position in the articular fossae. The contours of the articular surfaces are not changed. The articular gap in the anterior, superior and posterior sections is symmetrical on the right and left.

Average dimensions of the joint space (mm):

In the anterior section - 2.2±0.5;
in the upper section - 3.5±0.4;
in the posterior section - 3.7+0.3.

On tomograms of the TMJ in the sagittal projection with the mouth open, the articular heads are located against the lower third of the articular fossae or against the tops of the articular tuberosities.

A craniostat is used to create parallelism between the sagittal plane of the head and the plane of the tomograph table, immobility of the head during tomography, and maintain the same position during repeated studies.

On tomograms in the lateral projection, the width of individual sections of the joint space is measured according to the method of I.I. Uzhumetskene (Fig. 3.29, b): assess the size and symmetry of the articular heads, the height and inclination of the posterior slope of the articular tubercles, the amplitude of displacement of the articular heads during the transition from the position of central occlusion to the open mouth position.
Of particular interest is the method of X-ray cinematography of the TMJ. Using this method, it is possible to study the movement of the articular heads in dynamics [Petrosov Yu.A., 1982].

CT scan

Computed tomography (CT) allows one to obtain intravital images of tissue structures based on studying the degree of X-ray absorption in the area under study. The principle of the method is that the object under study is illuminated layer by layer with an X-ray beam in different directions as the X-ray tube moves around it. The unabsorbed part of the radiation is recorded using special detectors, the signals from which are sent to a computer system (computer). After mathematical processing of the received signals on a computer, an image of the layer under study (“slice”) is constructed on the matrix.

The high sensitivity of the CT method to changes in the X-ray density of the tissues being studied is due to the fact that the resulting image, unlike a conventional X-ray image, is not distorted by the superposition of images of other structures through which the X-ray beam passes. At the same time, the radiation dose to the patient during a CT examination of the TMJ does not exceed that during conventional radiography. According to the literature, the use of CT and its combination with other additional methods make it possible to carry out the most precise diagnosis, reduce radiation exposure and solve those issues that are difficult to resolve or cannot be resolved at all using layer-by-layer radiography.

The degree of radiation absorption (X-ray density of tissues) is assessed using the relative scale of absorption coefficients (AC) of X-ray radiation. In this scale for 0 units. H (H - Hounsfield unit) absorption in water is taken as 1000 units. N. - in the air. Modern tomographs make it possible to detect density differences of 4-5 units. N. On computed tomograms, denser areas with high CP values appear light, and less dense areas, with low CP values, appear dark.

With the help of modern computer tomographs of the III and IV generations, it is possible to identify layers 1.5 mm thick with instant image reproduction in black and white or color, as well as obtain a three-dimensional reconstructed image of the area under study. The method allows you to save the obtained tomograms on magnetic media indefinitely for a long time and repeat their analysis at any time using traditional programs embedded in the computer of the computed tomograph.

Advantages of CT in diagnosing TMJ pathology:

Complete reconstruction of the shape of the bone articular surfaces in all planes based on axial projections (reconstructive image);
ensuring identical shooting of the TMJ on the right and left;
absence of overlaps and projection distortions;
the ability to study the articular disc and masticatory muscles;
image reproduction at any time;
the ability to measure the thickness of joint tissues and muscles and evaluate it from both sides.

The use of CT for studying the TMJ and masticatory muscles was first developed in 1981 by A. Hiils in his dissertation on clinical and radiological studies in functional disorders of the dentofacial system.

The main indications for the use of CT are: fractures of the articular process, craniofacial congenital anomalies, lateral displacements of the lower jaw, degenerative and inflammatory diseases of the TMJ, tumors of the TMJ, persistent joint pain of unknown origin, refractory to conservative therapy.

CT allows you to completely recreate the shape of bone articular surfaces in all planes, does not cause overlapping images of other structures and projection distortions [Khvatova V.A., Kornienko V.I., 1991; Pautov I.Yu., 1995; Khvatova V.A., 1996; Vyazmin A.Ya., 1999; Westesson P., Brooks S., 1992, etc.]. The use of this method is effective both for diagnosis and differential diagnosis of organic changes in the TMJ that are not clinically diagnosed. Of decisive importance in this case is the ability to evaluate the articular head in several projections (direct and reconstructive sections).

In case of TMJ dysfunction, CT examination in the axial projection provides additional information about the condition of bone tissue, the position of the longitudinal axes of the articular heads, and reveals hypertrophy of the masticatory muscles (Fig. 3.30).

CT in the sagittal projection makes it possible to differentiate TMJ dysfunction from other joint lesions: injuries, neoplasms, inflammatory disorders [Pertes R., Gross Sh., 1995, etc.].

In Fig. 3.31 shows CT scans of the TMJ in the sagittal projection on the right and left and diagrams for them. The normal position of the articular discs is visualized.

Here is an example of using CT to diagnose TMJ disease.

Patient M., 22 years old, complained of pain and joint clicks on the right when chewing for 6 years. During the examination, it was revealed: when opening the mouth, the lower jaw moves to the right, and then zigzag with a click to the left, painful palpation of the external pterygoid muscle on the left. The bite is orthognathic with a small incisal overlap, intact dentition, chewing teeth on the right are worn out more than on the left; right-sided type of chewing. When analyzing functional occlusion in the oral cavity and on models of jaws installed in an articulator, a balancing supercontact was revealed on the distal slopes of the palatal tubercle of the upper first molar (delayed wear) and the buccal tubercle of the second lower molar on the right. The tomogram showed no changes in the sagittal projection. On a CT scan of the TMJ in the same projection in the position of central occlusion, there is a posterior displacement of the right articular head, narrowing of the posterior articular space, forward displacement and deformation of the articular disc (Fig. 3.32, a). On a CT scan of the TMJ in the axial projection, the thickness of the external pterygoid muscle on the right is 13.8 mm, on the left - 16.4 mm (Fig. 3.32, b).

Diagnosis: balancing supercontact of the palatine tubercle 16 and the buccal tubercle in the left lateral occlusion, right-sided type of chewing, hypertrophy of the external pterygoid muscle on the left, asymmetry in the size and position of the articular heads, muscle-articular dysfunction, anterior dislocation of the TMJ disc on the right, posterior displacement of the articular head.

Teleradiography

The use of teleradiography in dentistry has made it possible to obtain images with clear contours of the soft and hard structures of the facial skeleton, to carry out their metric analysis and thereby clarify the diagnosis [Uzhumetskene I.I., 1970; Trezubov V.N., Fadeev R.A., 1999, etc.].

The principle of the method is to obtain an X-ray image at a large focal length (1.5 m). When receiving an image from such a distance, on the one hand, the radiation exposure to the patient is reduced, and on the other, the distortion of facial structures is reduced. The use of cephalostat ensures that identical images are obtained during repeated studies.

A teleroentgenogram (TRG) in a direct projection makes it possible to diagnose anomalies of the dentoalveolar system in the transversal direction, and in a lateral projection - in the sagittal direction. The TRG displays the bones of the facial and cerebral skull, and the contours of soft tissues, which makes it possible to study their correspondence. TRG is used as an important diagnostic method in orthodontics, prosthetic dentistry, maxillofacial orthopedics, and orthognathic surgery. The use of TRG allows:
diagnose various diseases, including anomalies and deformations of the facial skeleton;
plan treatment for these diseases;
predict expected treatment results;
monitor the progress of treatment;
objectively evaluate long-term results.

Thus, when making prosthetics for patients with deformations of the occlusal surface of the dentition, the use of TRG in the lateral projection makes it possible to determine the desired prosthetic plane, and, consequently, to resolve the issue of the degree of grinding of hard dental tissues and the need for their devitalization.

If there is a complete absence of teeth on a teleroentgenogram, it is possible to check the correct location of the occlusal surface at the stage of setting the teeth.

X-ray cephalometric analysis of the face in patients with increased tooth wear makes it possible to more accurately differentiate the form of this disease and choose the optimal tactics for orthopedic treatment. In addition, by assessing the TRG, one can also obtain information about the degree of atrophy of the alveolar parts of the upper and lower jaws and determine the design of the prosthesis.
To decipher the TRG, the image is fixed on the screen of a negatoscope, tracing paper is attached to it, onto which the image is transferred.

There are many methods for analyzing TRG in lateral projections. One of them is the Schwartz method, which is based on using the plane of the base of the skull as a reference point. In this case, you can determine:

The location of the jaws in relation to the plane of the anterior part of the base of the skull;
the location of the TMJ in relation to this plane;
the length of the anterior base is
turnip hole.

TRG analysis is an important method for diagnosing dentofacial anomalies, allowing one to identify the causes of their formation.

With the help of computer tools, it is possible not only to increase the accuracy of TRG analysis, save time on their decoding, but also to predict the expected results of treatment.

V.A. Khvatova
Clinical gnathology

Radiography is one of the research methods based on obtaining something fixed on a specific medium, most often X-ray film plays this role.

The latest digital devices can also capture such an image on paper or on a display screen.

Radiography of organs is based on the passage of rays through the anatomical structures of the body, as a result of which a projection image is obtained. Most often, x-rays are used as a diagnostic method. For greater information content, it is better to take x-rays in two projections. This will allow you to more accurately determine the location of the organ under study and the presence of pathology, if any.

The chest is most often examined using this method, but x-rays of other internal organs can also be done. There is an X-ray room in almost every clinic, so undergoing such an examination will not be difficult.

What is the purpose of radiography?

This type of study is carried out in order to diagnose specific lesions of internal organs in infectious diseases:

Pneumonia.
Myocarditis.
Arthritis.

It is also possible to detect diseases of the respiratory system and heart using x-rays. In some cases, if there are individual indications, radiography is necessary to examine the skull, spinal column, joints, and digestive tract organs.

Indications for use

If X-ray is an additional research method for diagnosing certain diseases, then in some cases it is prescribed as mandatory. This usually happens if:

There is confirmed damage to the lungs, heart or other internal organs.
It is necessary to monitor the effectiveness of therapy.
There is a need to check the correct installation of the catheter and

Radiography is a research method that is used everywhere; it is not particularly difficult for both medical staff and the patient. The image is the same medical document as other research findings, and therefore can be presented to different specialists to clarify or confirm the diagnosis.

Most often, each of us undergoes a chest x-ray. The main indicators for its implementation are:

Prolonged cough accompanied by chest pain.
Detection of tuberculosis, lung tumors, pneumonia or pleurisy.
Suspicion of pulmonary embolism.
There are signs of heart failure.
Traumatic lung injury, rib fractures.
Entry of foreign bodies into the esophagus, stomach, trachea or bronchi.
Preventative examination.

Quite often, when a full examination is required, radiography is prescribed among other methods.

Benefits of X-ray

Despite the fact that many patients are afraid to undergo additional X-rays, this method has many advantages compared to other studies:

It is not only the most accessible, but also quite informative.
Quite high spatial resolution.
No special preparation is required to complete this study.
X-ray images can be stored for a long time to monitor the progress of treatment and identify complications.
Not only radiologists, but also other specialists can evaluate the image.
It is possible to perform radiography even on bedridden patients using a mobile device.
This method is also considered one of the cheapest.

So, if you undergo such a study at least once a year, you will not cause harm to the body, but it is quite possible to identify serious diseases at the initial stage of development.

Radiography methods

Currently, there are two ways to take x-rays:

Analog.
Digital.

The first of them is older, time-tested, but requires some time to develop the photograph and see the result on it. The digital method is considered new and is now gradually replacing the analog one. The result is displayed immediately on the screen, and you can print it, more than once.

Digital radiography has its advantages:

The quality of the images, and therefore the information content, increases significantly.
Ease of research.
Possibility of getting instant results.
The computer has the ability to process the result with changes in brightness and contrast, which allows for more accurate quantitative measurements.
The results can be stored for a long time in electronic archives, and they can even be transmitted over distances via the Internet.
Economic efficiency.

Disadvantages of radiography

Despite its many advantages, the radiography method also has its disadvantages:

The image in the image turns out to be static, which makes it impossible to assess the functionality of the organ.
When examining small lesions, the information content is insufficient.
Changes in soft tissues are poorly detected.
And, of course, one cannot help but mention the negative impact of ionizing radiation on the body.

But be that as it may, radiography is a method that continues to be the most common for identifying pathologies of the lungs and heart. It is this that makes it possible to detect tuberculosis at an early stage and save millions of lives.

Preparing for an x-ray

This research method is distinguished by the fact that it does not require special preparatory measures. You only need to come to the x-ray room at the appointed time and take an x-ray.

If such a study is prescribed for the purpose of examining the digestive tract, then the following preparation methods will be required:

If there are no deviations in the functioning of the gastrointestinal tract, then no special measures should be taken. In case of excessive flatulence or constipation, it is recommended to give a cleansing enema 2 hours before the test.
If there is a large amount of food (liquid) in the stomach, lavage should be done.
Before cholecystography, a radiopaque contrast agent is used, which penetrates the liver and accumulates in the gallbladder. To determine the contractility of the gallbladder, the patient is given a choleretic agent.
To make cholegraphy more informative, a contrast agent, for example “Bilignost”, “Bilitrast”, is administered intravenously before it is performed.
Irrigography is preceded by a contrast enema with barium sulfate. Before this, the patient should drink 30 g of castor oil, do a cleansing enema in the evening, and not have dinner.

Research technique

Nowadays, almost everyone knows where to get an x-ray and what this study is. The methodology for carrying it out is as follows:

The patient is placed in front; if required, the examination is carried out in a sitting or lying position on a special table.
If there are inserted tubes or hoses, you must ensure that they have not become dislodged during preparation.
Until the end of the study, the patient is prohibited from making any movements.
The medical worker leaves the room before starting the X-ray; if his presence is required, he puts on a lead apron.
Pictures are most often taken in several projections for greater information content.
After developing the images, their quality is checked; if necessary, repeated examination may be required.
To reduce projection distortion, it is necessary to place part of the body as close to the cassette as possible.

If radiography is performed on a digital device, the image is displayed on the screen, and the doctor can immediately see deviations from the norm. The results are stored in a database and can be stored for a long time; if necessary, they can be printed on paper.

How are radiographic results interpreted?

After radiography is performed, it is necessary to correctly interpret its results. To do this, the doctor evaluates:

Location of internal organs.
Integrity of bone structures.
The location of the roots of the lungs and their contrast.
How different are the main and small bronchi?
Transparency of the lung tissue, presence of shadows.

If carried out, it is necessary to identify:

Presence of fractures.
Pronounced with enlargement of the brain.
Pathology of the “sella turcica”, which appears as a result of increased intracranial pressure.
Presence of brain tumors.

To make a correct diagnosis, the results of an X-ray examination must be compared with other tests and functional tests.

Contraindications for radiography

Everyone knows that the radiation loads that the body experiences during such research can lead to radiation mutations, despite the fact that they are very insignificant. To minimize the risk, it is necessary to take x-rays only strictly as prescribed by the doctor and in compliance with all safety rules.

It is necessary to distinguish between diagnostic and preventive radiography. The first has practically no absolute contraindications, but it must be remembered that it is also not recommended for everyone to do it. Such research should be justified; you should not prescribe it to yourself.

Even during pregnancy, if other methods fail to make a correct diagnosis, it is not prohibited to resort to radiography. The risk for the patient is always less than the harm that an undetected disease can bring.

For preventive purposes, X-rays should not be taken on pregnant women and children under 14 years of age.

X-ray examination of the spine

X-rays of the spine are carried out quite often; the indications for this are:

Pain in the back or limbs, a feeling of numbness.
Detection of degenerative changes in intervertebral discs.
The need to identify spinal injuries.
Diagnosis of inflammatory diseases of the spinal column.
Detection of spinal curvatures.
If there is a need to recognize congenital anomalies of the spine.
Diagnosis of changes after surgery.

An X-ray procedure of the spine is performed in a lying position; first you need to remove all jewelry and undress to the waist.

The doctor usually warns that you should not move during the examination so that the pictures do not turn out blurred. The procedure does not take more than 15 minutes and does not cause any inconvenience to the patient.

There are contraindications for radiography of the spine:

Pregnancy.
If an X-ray using a barium compound was taken within the last 4 hours. In this case, the pictures will not be of high quality.
Obesity also makes it difficult to obtain informative images.

In all other cases, this research method has no contraindications.

X-ray of joints

Such diagnostics is one of the main methods for studying the osteoarticular apparatus. X-rays of the joints may show:

Disturbances in the structure of articular surfaces.
The presence of bone growths along the edge of the cartilaginous tissue.
Areas of calcium deposition.
Development of flat feet.
Arthritis, arthrosis.
Congenital pathologies of bone structures.

Such a study helps not only to identify disorders and deviations, but also to recognize complications, as well as determine treatment tactics.

Indications for radiography of joints may include:

Joint pain.
Changing its shape.
Pain during movements.
Limited mobility in the joint.
Received injury.

If there is a need to undergo such a study, then it is better to ask your doctor where to get an X-ray of the joints in order to get the most reliable result.

Requirements for conducting radiation examination

In order for an X-ray examination to give the most effective result, it must be carried out in compliance with certain requirements:

The area of interest should be located in the center of the image.
If there is damage to the tubular bones, then one of the adjacent joints must be visible on the image.
If one of the bones of the leg or forearm is fractured, both joints must be recorded in the image.
It is advisable to take radiography in different planes.
If there are pathological changes in the joints or bones, then it is necessary to take a picture of a symmetrically located healthy area so that the changes can be compared and assessed.
To make a correct diagnosis, the quality of the images must be high, otherwise a repeat procedure will be required.

How often can you have x-rays?

The effect of radiation on the body depends not only on the duration, but also on the intensity of exposure. The dose also directly depends on the equipment on which the research is carried out; the newer and more modern it is, the lower it is.

It is also worth considering that different areas of the body have their own radiation exposure rates, since all organs and tissues have different sensitivity.

Carrying out radiography on digital devices reduces the dose several times, so it can be done more often. It is clear that any dose is harmful to the body, but it is also worth understanding that radiography is a study that can detect dangerous diseases, the harm from which to humans is much greater.