Radiography is a method of studying the internal structure of objects using x-rays. Reviews, contraindications
Radiography is a certain type of study of the internal systems and organs of the human body. When it is carried out, a projection of the area under study is created on film or special paper. This is facilitated by X-rays. Based on such a projection, a specialist can draw certain conclusions.
Radiography is the first medical imaging technique. It allows you to obtain images of organs and tissues for their study during the patient’s lifetime.
Radiography is a diagnostic method that was discovered by the German physicist Wilhelm Conrad Roentgen in 1895. He recorded the ability of x-ray radiation to darken a photographic plate.
Description of the diagnostic method
What is radiography based on? This study is made possible thanks to the high penetrating power of X-rays, which are created by a sensor of a special device.
Such radiation passes through the tissues of the human body. At the same time, it not only ionizes cells, but also lingers in them. The volume of such presence of X-rays in tissues varies. This allows a black and white image of the area under study to appear on film. Bone tissue is more radiopaque. That is why in the photographs her image appears in light colors. Dark areas of the film represent soft tissue. These areas absorb X-rays very poorly.
It is clear that radiography is the study of three-dimensional objects. However, on film, all images come out flat. In this regard, photographs are taken in at least 2 projections. This allows you to accurately detect the location of the source of pathology.
Advantages of the technique
What are the positive aspects of organ radiography? They are as follows:
Ease of conducting research;
- wide availability of the method;
- no need (in most cases) for special preparation of patients;
- relatively low cost (except for studies whose results are obtained digitally);
- absence of operator-dependence, which facilitates the consideration of the data obtained by specialists during consultations.
Negative aspects of the technique
Despite the fact that radiographic examinations are widespread in modern medicine, they still have some disadvantages:
The resulting image is “frozen,” which greatly complicates the diagnosis of the functioning of internal organs;
- X-rays have a harmful ionizing effect on the human body;
- the results obtained have low information content when compared with the latest tomographic methods;
- when examining soft tissues, there is a need to use special contrast agents.
Prevalence of the method
Thanks to the discovery of X-ray radiation, medicine was able to make a significant breakthrough in the field of diagnosing a huge number of diseases that, before the discovery of the German physicist, were detected only at a late stage, which made it difficult or impossible to treat the disease.
Today, X-rays can be taken in most clinics and hospitals where special equipment is available. With the help of the study, the diagnosis is clarified in the shortest possible time and the necessary treatment plan is drawn up.
In addition, the doctor sends his patients for x-rays so that they undergo a preventive examination. Sometimes this helps to diagnose serious pathologies at the earliest stages of their development. The most famous and widespread type of such research is fluorography. The purpose of its implementation lies in the possibility of early diagnosis of pulmonary tuberculosis.
Classification
There are various x-ray examination techniques, which differ in the way they record the resulting image. So, they distinguish:
1. Classic radiography. It allows you to obtain an image using direct impact of ionizing rays on the film.
2. Fluorography. When using this type of technique, the image appears on the monitor screen, from which it is printed on small-format film.
3. Digital X-ray. The result of this study is a black and white image. The picture is on digital media.
4. Electroradiography. During this study, the image is captured on special plates and then transferred to paper.
5. Teleradiography. This study uses a special television system that displays images on a television screen.
6. X-ray. With this technique, the desired area can be viewed on a fluorescent screen.
Digital radiography most accurately reflects the picture of the study area. This technique greatly facilitates the diagnosis. And this allows you to more accurately select a treatment regimen.
Object of research
Depending on which organ or system is being diagnosed, the following research options are distinguished:
X-ray of the spinal column and limbs;
- chest;
- teeth (intraoral, extraoral, orthopantomography);
- breast (mammography);
- colon (irrigoscopy);
- duodenum and stomach (gastroduodenography);
- gallbladder and biliary tract (cholecystography and choleography);
- uterus (metrosalpinography).
Indications
The doctor refers his patients to x-rays, as well as to other x-ray examinations. He does this only if there is evidence, of which there is a great variety. The main ones:
Carrying out diagnostics of pathologies of internal organs and skeleton;
- checking the effectiveness of the treatment and determining its negative consequences;
- monitoring of installed tubes and catheters.
Contraindications
Before sending a patient for an x-ray, the doctor must find out whether the patient has serious reasons not to undergo this study. But it cannot be carried out in the following pathologies and conditions:
Active forms of tuberculosis;
- disorders of the thyroid gland;
- general serious condition of the patient;
- pregnancy (for women expecting a child, radiography is performed only if there are vital indications);
- breastfeeding (in cases where it is necessary to administer a contrast agent);
- renal and heart failure (contraindication also applies to contrast);
- bleeding;
- allergies to substances containing iodine (if it is necessary to introduce contrast elements).
Decoding the results
How to correctly read the resulting radiographic projections? This can only be done by a specialist with the necessary qualifications. Such work cannot be performed by a person ignorant in this area.
Those images that are the result of radiography are negatives with light areas of denser structures of the body and dark ones, which indicates the presence of soft tissue in this place. Deciphering each area of the body is done according to certain rules. So, when examining a chest X-ray, a specialist should evaluate the relative position, as well as the structural features of the heart, lungs and mediastinum. In addition, the collarbones and ribs are examined to identify cracks and fractures. All obtained parameters are assessed based on the patient’s age.
In order to make a final diagnosis, a doctor, as a rule, does not have enough of one image. In addition to radiography, the presence of pathology can be determined based on examination data, interviews, as well as the results of various instrumental and laboratory examination methods.
X-ray of the spine
Often the doctor sends his patient for examination of this part of the body in case of injury and to make the necessary diagnosis. X-ray of the spine is considered the most conservative method. To carry it out, no preliminary preparation is required from a person.
X-ray of the spine can give an objective picture only if it is performed in two projections. The first image should be taken with the patient lying on his back. The second one is lateral. This is a photo of the lumbosacral region.
An X-ray of the spine is performed if pain occurs in the back. In case of emergency, such a procedure is carried out at home.
The reason for examining the cervical spine is severe headaches, as well as dizziness with rapid turns of the neck. Such fluoroscopy is performed in two projections. Often, in order to obtain more detailed information, images are taken through the patient's open mouth.
Indications for performing x-rays of the thoracic spine are pain in the chest that occurs when bending or turning. A distinctive feature of such a study is to take pictures in three projections: side, back and front.
In order for a survey radiography of the coccyx and lumbosacral region to be performed, preparatory measures will be required. First of all, this is a diet that must be followed for several days (usually two) preceding the examination. It consists of eliminating from the daily diet those foods that cause gas formation in the intestines. In this case, the patient should not eat cabbage and potatoes, consume rye bread, milk and beans.
The studies themselves are performed only on an empty stomach and with cleansed intestines. If the patient is not properly prepared, accumulations of intestinal gases that do not allow X-rays to pass through can give a unclear picture of the area being examined.
The result of the x-ray will be an image in which the specialist will be able to see the person’s spinal pathologies. These are osteochondrosis and vertebral hernia, spinal tuberculosis, its curvature, etc.
Joint studies
Often, a doctor needs to make a diagnosis for existing disorders of the osteoarticular system. For this, the patient is prescribed radiography of the joints. Only in the images obtained during such a study can one see the following signs of pathology:
Calcium deposit areas;
- bone growths occurring on the edge of the cartilage;
- violation of the conformity of joint surfaces.
X-rays help the doctor identify existing problems to make an accurate diagnosis, as well as determine the type of treatment and plan it.
The doctor may order x-rays:
Ankle joint;
- knee joint;
- hip joint;
- elbow joint;
- shoulder joint;
- temporomandibular joint.
X-ray of the stomach
This research method allows us to identify numerous diseases of this important digestive organ, as well as the presence of its functional disorders.
X-ray of the stomach helps determine:
Peptic ulcer;
- malignant and benign neoplasms;
- diverticula (protrusion of the wall of this organ in the form of a bag).
X-ray of the stomach helps determine its size and position, the integrity of the wall and many other parameters. In order to examine this hollow organ, a contrast procedure is required. Barium salts suspended in water are used as a substance that does not transmit x-rays. Sometimes gas serves as a contrast.
Lung studies
This diagnostic method, in addition to general indications, is applied to a certain category of the population. These are, for example, people who constantly experience hazardous production conditions: masons and miners, workers in the chemical industry, etc.
X-ray of the lungs reveals:
Pneumonia of the lungs;
- hydrotax (accumulation of fluid in the pulmonary tract due to liver cirrhosis, ascites, heart failure);
- pneumothorax (mechanical damage to lung tissue);
- chronic diseases (atypical pneumonia, silicosis, tuberculosis, lupus erythematosus, etc.).
Only an x-ray will allow you to recognize the onset of the above pathologies in time and select the necessary course of treatment.
Radiography
In 1918, the first X-ray clinic was created in Russia. Radiography is used to diagnose an increasing number of diseases. Lung radiography is actively developing. In 1921, the first X-ray dental office was opened in Petrograd. Research is being actively carried out and X-ray machines are being improved. The Soviet government is allocating funds to launch the production of X-ray equipment in Russia. Radiology and equipment production are reaching a global level.
Currently, radiography remains the main method for diagnosing lesions of the osteoarticular system. Plays an important role in lung examination, especially as a screening method. Contrast radiography methods make it possible to assess the state of the internal relief of hollow organs, the prevalence of fistulous tracts, etc.
Application
In medicine
Radiography is used for diagnosis: X-ray examination (hereinafter referred to as X-ray) of organs allows us to clarify the shape of these organs, their position, tone, peristalsis, and the state of the relief of the mucous membrane.
- RI of the stomach and duodenum (duodenography) is important for recognizing gastritis, ulcerative lesions and tumors.
- RI of the gallbladder (cholecystography) and biliary tract (cholegraphy) is carried out to assess the contours, size, lumen of the intra- and extrahepatic bile ducts, the presence or absence of stones, and clarify the concentration and contractile functions of the gallbladder.
- RI of the colon (irrigoscopy) is used to identify tumors, polyps, diverticula and intestinal obstruction.
- chest radiography - infectious, tumor and other diseases,
- spine - degenerative-dystrophic (osteochondrosis, spondylosis, curvature), infectious and inflammatory (various types of spondylitis), tumor diseases.
- various parts of the peripheral skeleton - for various traumatic (fractures, dislocations), infectious and tumor changes.
- abdominal cavity - organ perforation, kidney function (excretory urography) and other changes.
- Metrosalpingography is a contrast X-ray examination of the uterine cavity and the patency of the fallopian tubes.
- teeth - orthopantomography
Under restoration
Acquiring an image
X-ray recording technique
Obtaining an image is based on the attenuation of X-ray radiation as it passes through various tissues and its subsequent recording on X-ray sensitive film. As a result of passing through formations of different densities and compositions, the radiation beam is scattered and decelerated, and therefore an image of varying degrees of intensity is formed on the film. As a result, the film produces an averaged, summation image of all tissues (shadow). It follows from this that in order to obtain an adequate x-ray, it is necessary to study radiologically heterogeneous formations.
In modern digital devices, the output radiation can be recorded on a special film cassette or on an electronic matrix. Devices with an electronic sensitive matrix are much more expensive than analog devices. In this case, films are printed only when necessary, and the diagnostic image is displayed on the monitor and, in some systems, stored in the database along with other patient data.
Principles of radiography
For diagnostic radiography, it is necessary to take pictures in at least two projections. This is due to the fact that an x-ray is a flat image of a three-dimensional object. And as a consequence, the localization of the detected pathological focus can be established only using 2 projections.
Image acquisition technique
The quality of the resulting x-ray image is determined by 3 main parameters. The voltage supplied to the X-ray tube, the current strength and the operating time of the tube. Depending on the anatomical formations being studied and the weight and dimensions of the patient, these parameters can vary significantly. There are average values for different organs and tissues, but it should be borne in mind that the actual values will differ depending on the apparatus where the examination is performed and the patient for whom radiography is performed. An individual table of values is compiled for each device. These values are not absolute and are adjusted as the study progresses. The quality of the images taken largely depends on the ability of the x-ray technician to adequately adapt the table of average values to a specific patient.
Recording an image
The most common way to record an X-ray image is to record it on X-ray sensitive film and then develop it. Currently, there are also systems that provide digital recording of data. Due to the high cost and complexity of manufacturing, this type of equipment is inferior in prevalence to analog.
Analog
There are the following options for obtaining images using X-ray film.
One of the previously used methods for obtaining usable density images is overexposure followed by underexposure, made during visual inspection. Currently, this method is considered obsolete and is not widely used in the world.
Another way is adequate exposure (which is more difficult) and full development. With the first method, the X-ray load on the patient is overestimated, but with the second, it may become necessary to take repeated photographs. The advent of on-screen preview of a computerized X-ray machine with a digital matrix and automatic developing machines reduces the need and possibility of using the first method.
It should also be noted that the quality of the image is reduced by dynamic blur. That is, the blurring of the image is associated with the movement of the patient during irradiation. Secondary radiation poses a certain problem; it is formed as a result of the reflection of X-ray radiation from various objects. To filter scattered radiation, filtration gratings are used, consisting of alternating strips of X-ray transparent and X-ray opaque material. This filter filters out secondary radiation, but it also weakens the central beam, which requires a large dose of radiation to obtain an adequate image. The question of the need to use filter grids is decided depending on the size of the patient and the organ being x-rayed.
Many modern X-ray films have very low intrinsic X-ray sensitivity and are designed for use with intensifying fluorescent screens that emit blue or green visible light when irradiated with X-rays. Such screens, along with the film, are placed in a cassette, which, after the image is taken, is removed from the X-ray machine and then the film is developed. Film development can be done in several ways.
- Fully automatic when a cassette is inserted into the machine, after which the developing machine removes the film, develops it, dries it and refills a new one.
- Semi-automatically, when the film is removed and loaded manually, and the developing machine only develops and dries the film.
- Completely manually, when development occurs in tanks, the film is removed, refilled, and developed by an X-ray technician.
For X-ray image analysis, an analog X-ray image is recorded on an illuminating device with a bright screen - a negatoscope.
Digital
Resolution
Resolution reaches 0.5 mm (1 pair of lines per millimeter corresponds to 2 pixels/mm).
One of the highest film resolutions is considered to be “26 pairs of lines per mm,” which approximately corresponds to a resolution of 0.02 mm.
Preparing the patient for x-ray examination
Special preparation of patients for x-ray examination is generally not required, however, the following preparation methods are available for examination of the digestive organs:
- Previously, special diets were carried out, foods that contributed to flatulence were excluded from the diet, and a cleansing enema was performed, but now it is generally accepted that RI of the stomach and duodenum of patients with normal intestinal function does not require any preparation. However, in case of severe flatulence and persistent constipation, a cleansing enema is performed 2 hours before the test. If there is a large amount of liquid, mucus, or food debris in the patient’s stomach, gastric lavage is performed 3 hours before the test.
- Before cholecystography, the possibility of flatulence is also excluded and a radiopaque iodine-containing drug is used (cholevid, iopagnost 1 g per 20 kg of live weight). The drug enters the liver and accumulates in the gallbladder. To determine the contractility of the gallbladder, the patient is also given a choleretic agent - 2 raw egg yolks or 20 g of sorbitol.
- Before cholegraphy, the patient is injected intravenously with a contrast agent (bilignost, bilitrast, etc.), which contrasts the bile ducts.
- Before irrigography, it is carried out using a contrast enema (BaSO 4 at the rate of 400 g per 1600 ml of water). On the eve of the study, the patient is given 30 g of castor oil, and in the evening a cleansing enema is given. The patient does not eat dinner, the next day a light breakfast, two cleansing enemas, a contrast enema.
Benefits of radiography
- Wide availability of the method and ease of research.
- Most tests do not require special patient preparation.
- Relatively low cost of research.
- The images can be used for consultation with another specialist or in another institution (unlike ultrasound images, where a repeat examination is necessary, since the resulting images are operator-dependent).
Disadvantages of radiography
- “Frozenness” of the image is the difficulty of assessing organ function.
- The presence of ionizing radiation that can have a harmful effect on the organism under study.
- The information content of classical radiography is significantly lower than such modern medical imaging methods as CT, MRI, etc. Conventional X-ray images reflect the projection layering of complex anatomical structures, that is, their summation X-ray shadow, in contrast to the layer-by-layer series of images obtained by modern tomographic methods.
- Without the use of contrast agents, radiography is practically uninformative for analyzing changes in soft tissues.
see also
Notes
Links
Manufacturers of medical solutions in the field of radiography Practical radiography- Successful intraoral radiography - typical errors, their causes and solutions.
Literature
- Kishkovsky A.N., Tyutin L.A., Esinovskaya G.N. Atlas of placements for X-ray examinations. - Leningrad: Medicine, 1987. - 520 p.
- Lindenbraten L.D. Korolyuk I.P. Medical radiology (basics of radiation diagnostics and radiation therapy). - 2nd revised and expanded. - Moscow: Medicine, 2000. - P. 77-79. - 672 s. - ISBN 5-225-04403-4
| Medical Imaging Techniques | |
|---|---|
| X-ray | Angiography · Computed tomography · CT angiography (CT angiopulmonography, CT coronary angiography) · Contrast radiography · Linear tomography · Myelography · X-ray mammography · Radiography· Tomosynthesis · Fluorography |
| Magnetic resonance | MR imaging (MRI) · Functional MR imaging (fMRI) · MR spectroscopy · MR angiography |
| Radionuclide | |
To diagnose various diseases of the lungs, bones and other organs and tissues of the human body, radiography (or X-ray) has been used in medicine for 120 years - this is a simple and error-free technique that has saved a huge number of lives due to the accuracy of the diagnosis and the safety of the procedure.
X-rays, discovered by the German physicist Wilhelm Roentgen, pass almost unhindered through soft tissue. The bone structures of the body do not allow them to pass through, as a result of which shadows of varying intensity are formed on X-ray photographs, accurately reflecting the condition of the bones and internal organs.
Radiography is one of the most researched and tested diagnostic techniques in clinical practice, the effect of which on the human body has been well studied for more than a century of use in medicine. In Russia (in St. Petersburg and Kyiv), thanks to this technique, already in 1896, a year after the discovery of X-rays, operations using X-ray images on photographic plates were successfully carried out.
Despite the fact that modern X-ray equipment is constantly being improved and represents high-precision medical devices that allow detailed diagnostics, the principle of obtaining an image has remained unchanged. Tissues of the human body, which have different densities, transmit invisible X-rays with varying degrees of intensity: soft, healthy structures practically do not retain them, but bones absorb them. The final images look like a collection of shadow images. The X-ray image is a negative, on which bone structures are indicated in white, soft ones in gray, and air spaces in black. The presence of pathological changes in internal organs, for example, in the lungs, is displayed as a lighter area on the pulmonary pleura or in segments of the lung itself. The description of the x-ray taken is the basis on which doctors can judge the condition of certain objects of study.
If in the 20th century the equipment allowed mainly only the examination of the chest and limbs, then modern fluoroscopy is used for high-precision diagnosis of various organs using a wide range of X-ray equipment.
Types and projections of radiography
Various types of radiography are used in medicine to conduct preventive studies and in-depth diagnostics. X-ray techniques are classified:
- according to form:
- panoramic, allowing you to completely cover different areas of the body;
- targeted, which is usually carried out during in-depth diagnosis of a certain area of an organ using a special attachment on an X-ray machine;
- layer-by-layer, during which parallel sections of the studied area are performed.
- by type of equipment used:
- traditional film;
- digital, which provides the ability to record the resulting image onto removable media;
- three-dimensional. This includes computed tomography, multislice and other types of tomography;
- fluorographic, allowing for safe preventive examination of the lungs;
- special:
- mammography, for examining the breast in women;
- hysterosalpingography, used to examine the uterus and fallopian tubes;
- densitometric, for the diagnosis of osteoporosis and others.
The listing of various techniques shows how in demand and indispensable radiology can be in diagnostics. Modern doctors can use various forms of research to identify pathologies in most organs and vital systems of the human body.
Why are x-rays done?
X-rays in modern medicine are used for preventive examinations and targeted diagnostics. You cannot do without such an examination if:
- bone fractures;
- damage to internal organs as a result of external trauma;
- diagnosis of breast cancer and a number of other oncological diseases;
- examination of the lungs and other organs of the chest;
- dental treatment and prosthetics;
- deep study of brain structures;
- scanning areas of vessels with suspected aneurysm, and so on.
The method of conducting an x-ray examination is chosen by the doctor depending on the patient’s indications and contraindications. Compared to some modern techniques for obtaining volumetric images, traditional x-rays are the safest. But it is not indicated for certain categories of patients.
Contraindications
Despite the safety of diagnosis, patients experience the effects of ionizing radiation, which negatively affects the bone marrow, red blood cells, epithelium, reproductive organs and the retina. Absolute contraindications for x-rays are:
- pregnancy;
- child's age under 14 years;
- serious condition of the patient;
- active form of tuberculosis;
- pneumothorax or bleeding;
- thyroid disease.
For children and pregnant women, such an examination is prescribed only in extreme cases, when the threat to life is greater than the potential harm from the procedure. Whenever possible, we try to resort to alternative methods. So, if a doctor needs to diagnose a tumor in a pregnant woman, then ultrasound is used instead of X-rays.
What do you need for an x-ray as preparation?
No special preparation is needed to examine the condition of the spine, stomach or jaw bones. The patient must remove clothing and metal objects before undergoing such an examination. The absence of foreign objects on the body ensures the accuracy of the x-ray image.
Preparation is required only when using a contrast agent, which is injected for X-rays of certain organs in order to improve the visualization of the results. An injection of a contrast agent is done some time before the procedure or directly during the procedure.
How to do an x-ray
All X-rays are taken in specially equipped rooms where there are protective screens to prevent radiation from reaching non-transparent organs of the body. The research doesn't take much time. Depending on the method used to perform the procedure, radiography is performed in different positions. The patient can stand, lie down or sit.
Is it possible to go at home?
Proper conditions for shooting with an X-ray machine of one modification or another are created in specially equipped rooms where there is protection from ionizing rays. Such equipment is large in size and is used only in stationary conditions, which allows for maximum safety of the procedure.
To conduct preventive examinations of a large number of people in areas remote from large clinics, mobile fluorography rooms can be used, which completely replicate the environment of inpatient medical premises.
How many times can an x-ray be taken?
Transillumination of tissues and organs is carried out as many times as allowed by one or another diagnostic technique. Fluorography and x-rays are considered the safest. The doctor may refer the patient several times for such an examination, depending on the previously obtained results and the goals set. Three-dimensional photographs are taken according to indications.
When ordering radiography, it is important not to exceed the maximum permitted total radiation dose per year, equal to 150 mSv. For information: radiation exposure when performing a chest x-ray in one projection is 0.15-0.4 mSv.
Where can an x-ray be taken and its average cost?
An x-ray can be taken in almost any medical institution: in public clinics, hospitals, private centers. The cost of such an examination depends on the area being examined and the number of images taken. As part of compulsory health insurance or under allocated quotas in public hospitals, organ x-rays can be done free of charge upon referral from a doctor. In private medical institutions, such a service will need to be paid for. The price starts from 1,500 rubles and may vary in different private medical centers.
What does an x-ray show?
What does the x-ray show? The picture taken or the monitor screen shows the condition of a certain organ. The variety of dark and light shades on the resulting negative allows doctors to judge the presence or absence of certain pathological changes in a certain part of the organ being examined.
Decoding the results
Only a qualified doctor who has long-term clinical practice and understands the characteristics of various pathological changes in various organs of the body can read X-rays. Based on what he saw in the image, the doctor makes a description of the resulting x-ray in the patient’s chart. In the absence of atypical light spots or darkening on soft tissues, cracks and fractures in bones, the physician records the healthy state of a particular organ. Only an experienced doctor who is well aware of the human x-ray anatomy and the symptoms of the disease of the organ whose image is being taken can accurately decipher an X-ray image.
What do inflammatory foci in the image indicate?
When soft tissues, joints or bones are examined in the presence of pathological changes, symptoms characteristic of a particular disease appear in them. The area affected by inflammation absorbs x-rays differently than healthy tissue. As a rule, such a zone contains pronounced foci of darkening. An experienced doctor immediately determines the type of disease from the resulting image.
What do diseases look like on an x-ray?
When the image is transferred to film, areas with pathological changes stand out against the background of healthy tissue. When damaged bones are scanned, places of deformation and displacement are clearly visible, which allows the traumatologist to make an accurate prognosis and prescribe the correct treatment. If shadows are detected on the lungs, this may indicate pneumonia, tuberculosis or cancer. A qualified specialist must differentiate the identified deviations. But areas of clearing in this organ often indicate pleurisy. Specific symptoms are characteristic of each type of pathology. To make a correct diagnosis, it is necessary to have a perfect command of the x-ray anatomy of the human body.
The advantages of the technique, and what are the negative effects of x-rays on the body
X-rays obtained as a result of X-ray scanning provide an accurate understanding of the condition of the organ being examined and allow doctors to make an accurate diagnosis. The minimum duration of such an examination and modern equipment significantly reduce the possibility of receiving a dose of ionizing radiation dangerous to human health. A couple of minutes is enough for detailed visualization of the organ. During this time, in the absence of contraindications for the patient, it is impossible to cause irreparable harm to the body.
How to minimize the effects of radiation
All forms of disease diagnosis using X-rays are carried out only for medical reasons. Fluorography is considered the safest, which is recommended to be performed annually for the purpose of early detection and prevention of tuberculosis and lung cancer. All other procedures are prescribed taking into account the intensity of X-ray radiation, and information about the dose received is entered into the patient’s chart. The specialist always takes this indicator into account when selecting diagnostic techniques, which allows not to exceed the norm.
Is it possible to do x-rays for children?
In accordance with international and domestic standards, any research based on the effects of ionizing radiation is permitted to be carried out by persons over 14 years of age. As an exception, a doctor may prescribe an x-ray to a child only if he suspects he has dangerous lung diseases with the consent of the parents. Such an examination is necessary in acute situations that require quick and accurate diagnosis. Before this, the specialist always weighs the risks of the procedure and the threat to the child’s life if it is not carried out.
Is it possible to have an x-ray during pregnancy?
Such an examination is usually not prescribed during pregnancy, especially in the first trimester. If it is so necessary that the lack of timely diagnosis threatens the health and life of the expectant mother, then during it a lead apron is used to protect internal organs from X-rays. Compared to other similar methods, x-rays are the safest, but in most cases doctors prefer not to use them during pregnancy, protecting the fetus from harmful ionizing effects.
Alternative to X-ray
The 120-year practice of using x-rays and similar techniques (fluorography, computer, multispiral, positron emission tomography and others) has shown that today there is no more accurate way to diagnose a number of pathologies. Using X-ray examination, you can quickly identify lung diseases, bone injuries, identify diverticula in older patients, perform high-quality retrograde urethrography, timely detect oncology at the initial stage of development, and much more.
An alternative to such diagnostics in the form of ultrasound can be prescribed only to pregnant women or patients with contraindications to X-rays.
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X-ray diagnostic method. Types of X-ray examination of bones
X-ray of bones is one of the most common studies conducted in modern medical practice. Most people are familiar with this procedure, since the possibilities for using this method are very extensive. List of indications for x-ray bone disease includes a large number of diseases. Injuries and fractures of the limbs alone require repeated x-rays. X-rays of bones are performed using various equipment, and there are also a variety of methods for this study. The use of the type of x-ray examination depends on the specific clinical situation, the age of the patient, the underlying disease and associated factors. Radiation diagnostic methods are indispensable in the diagnosis of diseases of the skeletal system and play a major role in making a diagnosis.
There are the following types of x-ray examination of bones:
- film radiography;
- digital radiography;
- X-ray densitometry;
- x-ray of bones using contrast agents and some other methods.
What is an X-ray?
X-ray is a type of electromagnetic radiation. This type of electromagnetic energy was discovered in 1895. Electromagnetic radiation also includes sunlight, as well as light from any artificial lighting. X-rays are used not only in medicine, but are also found in ordinary nature. About 1% of the Sun's radiation reaches the Earth in the form of X-rays, which forms the natural background radiation.The artificial production of X-rays became possible thanks to Wilhelm Conrad Roentgen, after whom they are named. He was also the first to discover the possibility of using them in medicine to “transilluminate” internal organs, primarily bones. Subsequently, this technology developed, new ways of using X-ray radiation appeared, and the radiation dose was reduced.
One of the negative properties of X-ray radiation is its ability to cause ionization in the substances through which it passes. Because of this, X-ray radiation is called ionizing radiation. In large doses, x-rays can lead to radiation sickness. For the first decades after the discovery of X-rays, this feature was unknown, which led to illness for both doctors and patients. However, today the dose of X-ray radiation is carefully controlled and we can say with confidence that the harm from X-ray radiation can be neglected.
The principle of obtaining an x-ray
Three components are required to produce an x-ray. The first of these is an X-ray source. The source of X-ray radiation is an X-ray tube. In it, under the influence of an electric current, certain substances interact and energy is released, most of which is released in the form of heat, and a small part in the form of x-rays. X-ray tubes are part of all X-ray machines and require significant cooling.The second component for obtaining an image is the object under study. Depending on its density, partial absorption of X-rays occurs. Due to the difference in the tissues of the human body, X-ray radiation of varying power penetrates outside the body, which leaves different spots on the image. Where the X-ray radiation was absorbed to a greater extent, shadows remain, and where it passed almost unchanged, clearings are formed.
The third component for obtaining an x-ray is the x-ray receiver. It can be film or digital ( X-ray sensor). The most commonly used receiver today is X-ray film. It is treated with a special emulsion containing silver, which changes when X-rays hit it. The highlight areas in the image have a dark tint, and the shadows have a white tint. Healthy bones have high density and leave a uniform shadow on the image.
Digital and film X-ray of bones
The first X-ray research techniques involved the use of a photosensitive screen or film as a receiving element. Today, X-ray film is the most commonly used X-ray detector. However, in the coming decades, digital radiography will completely replace film radiography, as it has a number of undeniable advantages. In digital radiography, the receiving element is sensors that are sensitive to x-ray radiation.Digital radiography has the following advantages over film radiography:
- the ability to reduce the radiation dose due to the higher sensitivity of digital sensors;
- increasing the accuracy and resolution of the image;
- simplicity and speed of taking an image, no need to process photosensitive film;
- ease of storing and processing information;
- the ability to quickly transfer information.
X-ray of bones with contrast agent
X-rays of the limb bones can be performed using contrast agents. Unlike other body tissues, bones have a high natural contrast. Therefore, contrast agents are used to clarify formations adjacent to bones - soft tissues, joints, blood vessels. These X-ray techniques are not used very often, but in some clinical situations they are irreplaceable.There are the following radiopaque techniques for examining bones:
- Fistulography. This technique involves filling the fistula tracts with contrast agents ( iodolipol, barium sulfate). Fistulas form in bones due to inflammatory diseases such as osteomyelitis. After the study, the substance is removed from the fistula tract using a syringe.
- Pneumography. This study involves the introduction of gas ( air, oxygen, nitrous oxide) with a volume of about 300 cubic centimeters into soft tissue. Pneumography is performed, as a rule, for traumatic injuries combined with crushing of soft tissues and comminuted fractures.
- Arthrography. This method involves filling the joint cavity with a liquid X-ray contrast agent. The volume of contrast agent depends on the volume of the joint cavity. Arthrography is most often performed on the knee joint. This technique allows you to assess the condition of the articular surfaces of the bones included in the joint.
- Angiography of bones. This type of study involves the introduction of a contrast agent into the vascular bed. The study of bone vessels is used for tumor formations, to clarify the characteristics of its growth and blood supply. In malignant tumors, the diameter and arrangement of blood vessels are uneven, and the number of vessels is usually greater than in healthy tissues.
X-ray and computed tomography ( CT) bones
Computed tomography is an x-ray method that has increased accuracy and information content. Today, computed tomography is the best method for studying the skeletal system. With the help of CT, you can obtain a three-dimensional image of any bone in the body or sections through any bone in all possible projections. The method is accurate, but at the same time it creates a high radiation dose.The advantages of CT over standard radiography are:
- high resolution and accuracy of the method;
- the ability to obtain any projection, while x-rays are usually performed in no more than 2 - 3 projections;
- the possibility of three-dimensional reconstruction of the body part being studied;
- absence of distortion, correspondence of linear dimensions;
- possibility of simultaneous examination of bones, soft tissues and blood vessels;
- the ability to conduct surveys in real time.
X-ray of bones and magnetic resonance imaging ( MRI)
Magnetic resonance imaging ( MRI) is a relatively new diagnostic method. MRI allows you to obtain an accurate image of the internal structures of the body in all possible planes. Using computer modeling tools, MRI makes it possible to perform three-dimensional reconstruction of human organs and tissues. The main advantage of MRI is the complete absence of radiation exposure.The operating principle of a magnetic resonance imaging scanner is to impart a magnetic impulse to the atoms that make up the human body. After this, the energy released by the atoms when returning to their original state is read out. One of the limitations of this method is the impossibility of use if there are metal implants or pacemakers in the body.
When performing an MRI, the energy of hydrogen atoms is usually measured. Hydrogen in the human body is most often found in water compounds. Bones contain much less water than other tissues of the body, so when examining bones, MRI provides less accurate results than when examining other areas of the body. In this respect, MRI is inferior to CT, but still exceeds conventional radiography in accuracy.
MRI is the best method for diagnosing bone tumors, as well as metastases of bone tumors in distant areas. One of the serious disadvantages of this method is the high cost and time-consuming research ( 30 minutes or more). All this time, the patient must remain stationary in the magnetic resonance imaging scanner. This device looks like a tunnel of a closed structure, which is why some people experience discomfort.
X-ray and bone densitometry
The study of the structure of bone tissue is carried out in a number of diseases, as well as during the aging of the body. Most often, a study of bone structure is carried out for a disease such as osteoporosis. A decrease in the mineral content of bones leads to their fragility, the risk of fractures, deformations and damage to neighboring structures.An X-ray allows you to evaluate the structure of the bones only subjectively. Densitometry is used to determine quantitative parameters of bone density and mineral content. The procedure is quick and painless. While the patient lies motionless on the couch, the doctor examines certain areas of the skeleton using a special sensor. The most important are densitometry data of the femoral head and vertebrae.
There are the following types of bone densitometry:
- quantitative ultrasound densitometry;
- X-ray absorptiometry;
- quantitative magnetic resonance imaging;
- quantitative computed tomography.
Densitometry is indicated in the following cases:
- osteoporosis;
- mature age ( over 40 – 50 years old);
- menopause in women;
- frequent bone fractures;
- diseases of the spine ( osteochondrosis, scoliosis);
- any bone damage;
- sedentary lifestyle ( physical inactivity).
Indications and contraindications for x-rays of skeletal bones
X-ray of skeletal bones has an extensive list of indications. Different diseases may be specific to different ages, but bone injuries or tumors can occur at any age. For diagnosing diseases of the skeletal system, x-rays are the most informative method. The X-ray method also has some contraindications, which, however, are relative. However, be aware that bone x-rays can be dangerous and harmful if used too frequently. Indications for bone x-ray
X-ray examination is an extremely common and informative examination of skeletal bones. Bones are not available for direct examination, but X-rays can provide almost all the necessary information about the condition of the bones, their shape, size and structure. However, due to the release of ionizing radiation, x-rays of bones cannot be performed too often and for any reason. The indications for bone x-rays are determined quite accurately and are based on the complaints and symptoms of the patients’ diseases.X-ray of bones is indicated in the following cases:
- traumatic bone injuries with severe pain, deformation of soft tissues and bones;
- dislocations and other joint injuries;
- abnormalities of bone development in children;
- children's growth retardation;
- limited mobility in joints;
- pain at rest or with movement of any part of the body;
- an increase in bone volume, if a tumor is suspected;
- preparation for surgical treatment;
- assessment of the quality of treatment provided ( fractures, transplantations, etc.).
X-ray of bones in most cases makes it possible to differentiate between the listed diseases, due to the fact that each of them has reliable radiological signs. In difficult cases, especially before surgery, the use of computed tomography is indicated. Doctors prefer to use this study because it is the most informative and has the least amount of distortion compared to the anatomical dimensions of the bones.
Contraindications for X-ray examination
Contraindications to x-ray examination are associated with the presence of the ionizing effect of x-ray radiation. However, all contraindications to the study are relative, since they can be neglected in emergency cases, such as skeletal bone fractures. However, if possible, you should limit the number of x-ray examinations and not carry them out unnecessarily.Relative contraindications for x-ray examination include:
- the presence of metal implants in the body;
- acute or chronic mental illness;
- serious condition of the patient ( massive blood loss, unconsciousness, pneumothorax);
- first trimester of pregnancy;
- childhood ( up to 18 years old).
- allergic reactions to components of contrast agents;
- endocrine disorders ( thyroid diseases);
- severe liver and kidney diseases;
Radiation doses for various x-ray examination methods
Modern radiation diagnostics adheres to strict safety standards. X-ray radiation is measured using special dosimeters, and X-ray installations undergo special certification for compliance with radiological exposure standards. Radiation doses are not the same for different research methods, as well as for different anatomical areas. The unit of measurement for radiation dose is milliSievert ( mSv).Radiation doses for various bone x-ray methods
As can be seen from the above data, computed tomography carries the greatest x-ray load. At the same time, computed tomography is the most informative method for studying bones today. We can also conclude that digital radiography has a great advantage over film radiography, since the x-ray load is reduced by 5 to 10 times.
How often can an x-ray be taken?
X-ray radiation poses a certain danger to the human body. It is for this reason that all radiation that was received for medical purposes must be reflected in the patient’s medical record. Such records must be maintained in order to comply with annual standards limiting the possible number of x-ray examinations. Thanks to the use of digital radiography, their quantity is sufficient to solve almost any medical problem.The annual ionizing radiation that the human body receives from the environment ( natural background), ranges from 1 to 2 mSv. The maximum permissible dose of X-ray radiation is 5 mSv per year or 1 mSv for each of 5 years. In most cases, these values are not exceeded, since the radiation dose for a single examination is several times less.
The number of X-ray examinations that can be performed in a year depends on the type of examination and the anatomical area. On average, 1 computed tomography scan or 10 to 20 digital x-rays are allowed. However, there is no reliable data on the impact of radiation doses of 10–20 mSv annually. All we can say with certainty is that to some extent they increase the risk of certain mutations and cellular disorders.
What organs and tissues suffer from ionizing radiation from X-ray machines?
The ability to cause ionization is one of the properties of X-ray radiation. Ionizing radiation can lead to spontaneous decay of atoms, cellular mutations, and failure of cell reproduction. That is why x-ray examination, which is a source of ionizing radiation, requires normalization and establishment of threshold values of radiation doses.Ionizing radiation has the greatest impact on the following organs and tissues:
- bone marrow, hematopoietic organs;
- lens of the eye;
- endocrine glands;
- genitals;
- skin and mucous membranes;
- fetus of a pregnant woman;
- all organs of the child's body.
Is it possible to do bone x-rays for pregnant and breastfeeding mothers?
Any X-ray examination is not recommended for pregnant women. According to the World Health Organization, a dose of 100 mSv almost inevitably causes fetal developmental disorders or mutations leading to cancer. The first trimester of pregnancy is of greatest importance, since during this period the most active development of fetal tissue and organ formation occurs. If necessary, all X-ray examinations are transferred to the second and third trimester of pregnancy. Studies conducted on humans have shown that x-rays taken after 25 weeks of pregnancy do not lead to abnormalities in the baby.For nursing mothers, there are no restrictions in taking x-rays, since the ionizing effect does not affect the composition of breast milk. Complete research in this area has not been conducted, so in any case, doctors recommend that nursing mothers express the first portion of milk while breastfeeding. This will help you be on the safe side and maintain confidence in your child’s health.
X-ray examination of bones for children
X-ray examination for children is considered undesirable, since it is in childhood that the body is most susceptible to the negative effects of ionizing radiation. It should be noted that it is in childhood that the largest number of injuries occur, which lead to the need to perform an x-ray examination. This is why children are given x-rays, but various protective devices are used to protect developing organs from radiation.X-ray examination is also required in case of growth retardation in children. In this case, x-rays are taken as many times as required, since the treatment plan includes x-ray examinations after a certain period of time ( usually 6 months). Rickets, congenital skeletal anomalies, tumors and tumor-like diseases - all of these diseases require radiation diagnosis and cannot be replaced by other methods.
Preparing for a bone x-ray
Research preparation is at the core of any successful research. Both the quality of diagnosis and the result of treatment depend on this. Preparing for an x-ray examination is a fairly simple undertaking and usually does not pose any difficulties. Only in some cases, such as x-rays of the pelvis or spine, does the x-ray require special preparation. There are some features of preparing for x-rays of children. Parents should help doctors and properly psychologically prepare their children for the study. It is difficult for children to remain motionless for a long time; they are also often afraid of doctors, people “in white coats.” Thanks to cooperation between parents and doctors, good diagnosis and quality treatment of childhood diseases can be achieved.
How to get a referral for a bone x-ray? Where is X-ray examination performed?
Bone x-rays can be performed today in almost any center that provides medical care. Although X-ray equipment is widely available today, X-ray examinations are performed only on the direction of a physician. This is due to the fact that x-rays are harmful to human health to a certain extent and have some contraindications.Bone x-rays are performed at the direction of doctors of various specialties. Most often it is performed urgently when providing first aid in trauma departments and emergency hospitals. In this case, the referral is issued by the on-duty traumatologist, orthopedist or surgeon. Bone x-rays can also be performed on the direction of family doctors, dentists, endocrinologists, oncologists and other doctors.
X-rays of bones are performed in various medical centers, clinics, and hospitals. For this purpose, they are equipped with special X-ray rooms, which have everything necessary for this type of research. X-ray diagnostics are carried out by radiologists with special knowledge in this field.
What does an X-ray room look like? What's in it?
An X-ray room is a place where X-rays of various parts of the human body are taken. The X-ray room must meet high standards of radiation protection. In the decoration of walls, windows and doors, special materials are used that have a lead equivalent, which characterizes their ability to block ionizing radiation. In addition, it contains dosimeters-radiometers and personal protective equipment against radiation, such as aprons, collars, gloves, skirts and other elements.The X-ray room must have good lighting, primarily artificial, since the windows are small and natural light is not enough for high-quality work. The main equipment of the office is an X-ray unit. X-ray machines come in different forms as they are designed for different purposes. Large medical centers have all types of X-ray machines, but the simultaneous operation of several of them is prohibited.
A modern X-ray room contains the following types of X-ray units:
- stationary x-ray machine ( allows you to perform radiography, fluoroscopy, linear tomography);
- ward mobile X-ray unit;
- orthopantomograph ( installation for performing x-rays of jaws and teeth);
- digital radiovisiograph.
Additional equipment for X-ray rooms includes:
- computer for processing and storing digital images;
- equipment for developing film photographs;
- film drying cabinets;
- Consumables ( film, photo reagents);
- negatoscopes ( bright screens for viewing pictures);
- tables and chairs;
- cabinets for storing documentation;
- bactericidal lamps ( quartz) for disinfection of premises.
Preparing for a bone x-ray
Tissues of the human body, differing in different densities and chemical compositions, absorb x-ray radiation differently and, as a result, have a characteristic x-ray image. Bones have a high density and very good natural contrast, so X-rays of most bones can be performed without special preparation.If a person needs an x-ray examination of most of the bones, then it is enough to come to the x-ray room on time. There are no restrictions on food intake, liquids, or smoking before the X-ray examination. It is recommended not to take any metal items with you, especially jewelry, as they will need to be removed before performing the test. Any metal objects interfere with the X-ray image.
The process of obtaining an x-ray does not take much time. However, in order for the image to be of high quality, it is very important for the patient to remain still while it is being taken. This is especially true for young children who can be restless. X-rays are performed for children in the presence of parents. For children less than 2 years old, x-rays are performed in a lying position; it is possible to use a special fixation that secures the child’s position on the x-ray table.
One of the serious advantages of x-rays is the ability to use them in emergency situations ( injuries, falls, traffic accidents) without any preparation. There is no loss in image quality. If the patient is not transportable or is in serious condition, then it is possible to perform an x-ray directly in the room where the patient is located.
Preparation for x-rays of the pelvic bones, lumbar and sacral spine
X-ray of the pelvic bones, lumbar and sacral spine is one of the few types of x-rays that requires special preparation. It is explained by its anatomical proximity to the intestines. Intestinal gases reduce the sharpness and contrast of an x-ray image, which is why special preparation is carried out to cleanse the intestines before this procedure.Preparation for x-rays of the pelvic bones and lumbar spine includes the following basic elements:
- cleansing the intestines with laxatives and enemas;
- following a diet that reduces the formation of gases in the intestines;
- conducting the study on an empty stomach.
Bone x-ray techniques
X-ray examination is designed to examine all the bones of the skeleton. Naturally, for the study of most bones there are special methods for obtaining x-rays. The principle of obtaining images remains the same in all cases. It involves placing the body part being examined between the X-ray tube and the radiation receiver, so that the X-ray beams pass at right angles to the bone being examined and to the cassette of X-ray film or sensors. The positions that the components of an X-ray installation occupy relative to the human body are called placements. Over the years of practice, a large number of X-ray installations have been developed. The quality of X-ray images depends on the accuracy of their observance. Sometimes the patient has to take a forced position to carry out these instructions, but the x-ray examination is performed very quickly.
Styling usually involves taking pictures in two mutually perpendicular projections - frontal and lateral. Sometimes the study is supplemented with an oblique projection, which helps to get rid of the overlap of some parts of the skeleton with each other. In case of severe injury, some styling may become impossible. In this case, an x-ray is performed in the position that causes the least discomfort to the patient and which will not lead to displacement of the fragments and aggravation of the injury.
Methodology for studying the bones of the extremities ( arms and legs)
X-ray examination of the tubular bones of the skeleton is the most common x-ray examination. These bones make up the bulk of the bones; the skeleton of the arms and legs is made entirely of tubular bones. The X-ray technique should be familiar to anyone who has suffered injuries to their arms or legs at least once in their life. The examination takes no more than 10 minutes and does not cause pain or discomfort.Tubular bones can be examined in two perpendicular projections. The main principle of any X-ray image is the location of the object under study between the emitter and the X-ray sensitive film. The only condition for a high-quality image is that the patient remains motionless during the examination.
Before the examination, the limb section is exposed, all metal objects are removed from it, and the examination area is located in the center of the cassette with X-ray film. The limb should “lie” freely on the film cassette. The X-ray beam is directed to the center of the cassette perpendicular to its plane. The image is taken in such a way that adjacent joints are also included in the x-ray. Otherwise, it is difficult to distinguish between the upper and lower ends of the tubular bone. In addition, the large coverage area helps prevent damage to joints or adjacent bones.
Typically, each bone is examined in frontal and lateral projections. Sometimes images are taken in conjunction with functional tests. They involve flexion and extension of a joint or loading a limb. Sometimes, due to injury or the inability to change the position of a limb, special projections have to be used. The main condition is to maintain the perpendicularity of the cassette and the X-ray emitter.
Technique for X-ray examination of skull bones
X-ray examination of the skull is usually performed in two mutually perpendicular projections - lateral ( in profile) and straight ( in frontal view). X-rays of the skull bones are prescribed for head injuries, endocrine disorders, and to diagnose deviations from indicators of age-related bone development in children.X-ray of the skull bones in a direct anterior projection provides general information about the condition of the bones and the connections between them. It can be performed in a standing or lying position. Typically, the patient lies on the X-ray table on his stomach, with a cushion placed under his forehead. The patient remains motionless for several minutes while the X-ray tube is aimed at the back of the head and the image is taken.
X-ray of the skull bones in a lateral projection is used to study the bones of the base of the skull, the bones of the nose, but is less informative for other bones of the facial skeleton. To perform an x-ray in a lateral projection, the patient is placed on the x-ray table on his back, a cassette with film is placed on the left or right side of the patient’s head parallel to the axis of the body. The X-ray tube is directed perpendicular to the cassette on the opposite side, 1 cm above the ear-pupillary line.
Sometimes doctors use x-rays of the skull bones in the so-called axial projection. It corresponds to the vertical axis of the human body. This placement has a parietal and chin direction, depending on which side the X-ray tube is located on. It is informative for studying the base of the skull, as well as some bones of the facial skeleton. Its advantage is that it avoids much of the overlap of bones on each other that is characteristic of the direct projection.
X-ray of the skull in axial projection consists of the following steps:
- the patient takes off metal objects and outer clothing;
- the patient takes a horizontal position on the X-ray table, lying on his stomach;
- the head is positioned in such a way that the chin protrudes forward as much as possible, and only the chin and the front surface of the neck touch the table;
- There is a cassette with X-ray film under the chin;
- the x-ray tube is directed perpendicular to the plane of the table, towards the crown area, the distance between the cassette and the tube should be 100 cm;
- after this, a picture is taken with the chin direction of the X-ray tube in a standing position;
- the patient throws his head back so that the crown of his head touches the support platform, ( raised x-ray table), and the chin was as high as possible;
- The X-ray tube is directed perpendicular to the front surface of the neck, the distance between the cassette and the X-ray tube is also 1 meter.
X-ray techniques of the temporal bone according to Stenvers, according to Schuller, according to Mayer
The temporal bone is one of the main bones that forms the skull. The temporal bone contains a large number of formations to which muscles are attached, as well as holes and canals through which nerves pass. Due to the abundance of bone formations in the facial area, X-ray examination of the temporal bone is difficult. That is why various positions have been proposed for obtaining special X-ray images of the temporal bone.Currently, three projections of x-ray examination of the temporal bone are used:
- Mayer's technique ( axial projection). Used to study the condition of the middle ear, pyramid of the temporal bone and mastoid process. Mayer's X-ray is performed in the supine position. The head is turned at an angle of 45 degrees to the horizontal plane, and a cassette with X-ray film is placed under the ear being examined. The X-ray tube is directed through the frontal bone of the opposite side, it should be aimed exactly at the center of the external auditory opening of the side being examined.
- Method according to Schuller ( oblique projection). With this projection, the condition of the temporomandibular joint, mastoid process, and the pyramid of the temporal bone is assessed. X-rays are performed lying on your side. The patient's head is turned to the side, and a cassette with X-ray film is placed between the ear of the side being examined and the couch. The X-ray tube is located at a slight angle to the vertical and directed towards the foot end of the table. The X-ray tube is centered on the auricle of the side being examined.
- Stenvers method ( transverse projection). An image in a transverse projection allows you to assess the condition of the inner ear, as well as the pyramid of the temporal bone. The patient lies on his stomach, his head is turned at an angle of 45 degrees to the line of symmetry of the body. The cassette is placed in a transverse position, the X-ray tube is beveled at an angle to the head end of the table, and the beam is directed to the center of the cassette. All three techniques use an X-ray tube in a narrow tube.
X-ray placement of zygomatic bones in tangential projection
To examine the zygomatic bone, the so-called tangential projection is used. It is characterized by the fact that X-rays propagate tangentially ( tangentially) in relation to the edge of the zygomatic bone. This placement is used to identify fractures of the zygomatic bone, the outer edge of the orbit, and the maxillary sinus.The X-ray technique of the zygomatic bone includes the following steps:
- the patient takes off his outer clothing, jewelry, metal prostheses;
- the patient takes a horizontal position on his stomach on the X-ray table;
- the patient's head is rotated at an angle of 60 degrees and placed on a cassette containing X-ray film measuring 13 x 18 cm;
- the side of the face being examined is on top, the X-ray tube is positioned strictly vertically, however, due to the tilt of the head, the X-ray rays pass tangentially to the surface of the zygomatic bone;
- During the study, 2–3 photographs are taken with slight turns of the head.
Technique for x-ray examination of the pelvic bones. Projections in which x-rays of the pelvic bones are performed
X-ray of the pelvis is the main examination for injuries, tumors, and other diseases of the bones in this area. An X-ray of the pelvic bones takes no more than 10 minutes, but there is a wide variety of methods for this study. Most often, a survey x-ray of the pelvic bones is performed in the posterior projection.The sequence of performing a survey x-ray of the pelvic bones in the posterior projection includes the following steps:
- the patient enters the X-ray room, removes metal jewelry and clothing, except for underwear;
- the patient lies on the X-ray table on his back and maintains this position throughout the procedure;
- arms should be crossed on the chest, and a cushion should be placed under the knees;
- the legs should be slightly spread, the feet should be fixed in the established position using tape or sandbags;
- a film cassette measuring 35 x 43 cm is located transversely;
- the X-ray emitter is directed perpendicular to the cassette, between the superior anterior iliac crest and the symphysis pubis;
- The minimum distance between the emitter and the film is one meter.
The posterior oblique view is used to examine the sacroiliac joint. It is performed by raising the side being examined by 25 - 30 degrees. In this case, the cassette must be positioned strictly horizontally. The X-ray beam is directed perpendicular to the cassette, the distance from the beam to the anterior iliac spine is about 3 centimeters. When the patient is positioned in this way, the x-ray image clearly shows the connection between the sacrum and the iliac bones.
Determining the age of the skeleton using X-rays of the hand in children
Bone age accurately indicates the biological maturity of the body. Indicators of bone age are the points of ossification and fusion of individual parts of bones ( synostoses). Based on bone age, it is possible to accurately determine the final height of children and determine whether they are behind or ahead in development. Bone age is determined by radiographs. After radiographs have been taken, the results obtained are compared with the standards using special tables.The most revealing way to determine the age of the skeleton is an x-ray of the hand. The convenience of this anatomical area is explained by the fact that ossification points appear in the hand with a fairly high frequency, which allows regular examination and monitoring of growth rates. Bone age determination is mainly used to diagnose endocrine disorders such as growth hormone deficiency ( somatotropin).
Comparison of the child’s age and the appearance of ossification points on an x-ray of the hand
Ossification points |
