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 a film or on special paper. This is facilitated by x-rays. Based on such a projection, certain conclusions can be drawn by a specialist.
Radiography is the first method of medical imaging. It allows you to obtain images of organs and tissues for their study during the life of the patient.
Radiography is a diagnostic method that was discovered by the German physicist Wilhelm Conrad Roentgen in 1895. He registered 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 by the high penetrating power of X-rays, which are created by the 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 is different. This allows a black-and-white image of the area under study to appear on the film. Bone tissue is more radiopaque. That is why in the pictures her image appears in bright colors. The dark areas of the film represent soft tissue. These zones absorb x-rays very poorly.
It is clear that radiography is the study of three-dimensional objects. However, on film, all images are flat. In this regard, pictures are taken at least in 2 projections. This allows you to accurately locate the location of the focus of pathology.
Advantages of the technique
What are the benefits of organ radiography? They are as follows:
Ease of conducting research;
- wide availability of the method;
- no need (in most cases) for special training of patients;
- relatively low cost (except for studies, the results of which are obtained in digital form);
- the absence of operator-dependence, which contributes to the consideration of the obtained data by specialists at ongoing consultations.
Negative aspects of the technique
Despite the fact that radiographic studies 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 are of low information content when compared with the latest tomographic methods;
- when examining soft tissues, it becomes necessary to use special contrast agents.
The prevalence of the method
Thanks to the discovery of X-ray radiation, medicine managed 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.
To date, X-rays can be done in most clinics and hospitals, where there is special equipment. 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 in order for them to undergo a preventive examination. Sometimes this contributes to the diagnosis of serious pathologies at the earliest stages of their development. The most famous and common type of such a study is fluorography. The purpose of its implementation lies in the possibility of early diagnosis of pulmonary tuberculosis.
Classification
There are various methods of X-ray examination, which differ from each other in the way of fixing the resulting image. So, allocate:
1. Classical radiography. It allows you to get an image by direct hit of ionizing rays on the film.
2. Fluorography. When applying this type of technique, the image falls on the monitor screen, from which it is printed on a small format film.
3. Digital x-ray. The result of this study is a black and white image. The picture is on a digital medium.
4. Electroroentgenography. In this study, the image falls on special plates, and then transferred to paper.
5. Teleroentgenography. This study involved a special television system that displays the image on the TV screen.
6. Fluoroscopy. With this technique, the desired zone 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 choose a treatment regimen.
Object of research
Depending on which organ or system is to be diagnosed, the following research options are distinguished:
Radiography of the spinal column, as well as limbs;
- chest;
- teeth (intraoral, extraoral, orthopantomography);
- mammary gland (mammography);
- large intestine (irrigoscopy);
- duodenum and stomach (gastroduodenography);
- gallbladder and biliary tract (cholecystography and choleography);
- uterus (metrosalpinography).
Indications
A doctor sends his patients to X-ray, as well as to other X-ray examinations. He does this only if there are indications, of which there are a great many. The main ones are:
Carrying out diagnostics of pathologies of internal organs and skeleton;
- checking the effectiveness of the treatment and determining its negative consequences;
- control of installed tubes and catheters.
Contraindications
Before referring a patient to an x-ray, the doctor must necessarily find out if the patient has serious reasons not to undergo this study. And it can not be carried out with the following pathologies and conditions:
Active forms of tuberculosis;
- dysfunction of the thyroid gland;
- the general serious condition of the patient;
- pregnancy (women who are expecting a baby, x-rays are performed only if there are vital indications);
- breastfeeding (in cases where a contrast agent is required);
- renal and heart failure (a contraindication also applies to contrasting);
- bleeding;
- allergies to substances containing iodine (if necessary, the introduction of contrast elements).
Deciphering the results
How to correctly read the obtained projections of radiography? This can only be done by a specialist with the necessary qualifications. Such work cannot be done by a person ignorant in this area.
Those images that are the result of radiography are negatives with light areas of denser body structures and dark areas, which indicates the presence of soft tissues in this place. Decoding of each area of the body is done according to certain rules. So, when considering 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 clavicles and ribs are examined for cracks and fractures. All obtained parameters are evaluated based on the age of the patient.
In order to make a final diagnosis, the doctor, as a rule, one picture is not enough. It is possible to establish the presence of pathology, in addition to radiography, based on the data of the examination, the survey, as well as the results of various instrumental and laboratory methods of examination.
X-ray of the spine
Often a doctor sends his patient to study this part of the body in case of injuries and to make the necessary diagnosis. Radiography of the spine is considered the most conservative method. It does not require any prior preparation to carry it out.
Radiography of the spine can give an objective picture only if it is performed in two projections. The first x-ray should be taken with the patient in the supine position. The second is lateral. This is a picture of the lumbosacral region.
X-ray of the spine is performed when pain occurs in the back. In case of emergency, such a procedure is carried out at home.
The reason for the study of the cervical spine are severe headaches, as well as dizziness with quick turns of the neck. Perform such fluoroscopy in two projections. Often, in order to obtain more detailed information, pictures are taken through the patient's open mouth.
Indications for performing radiography 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 a picture in three projections: from the 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) prior to the examination. It consists in the exclusion from the daily diet of those foods that provoke gas formation in the intestines. The patient in this case should not eat cabbage and potatoes, eat rye bread, milk and beans.
The studies themselves are performed only on an empty stomach and with a cleansed intestine. If the patient is not properly prepared, accumulations of intestinal gases that do not pass X-rays can give a fuzzy picture of the study area.
The result of the transillumination will be a picture in which the specialist will be able to see the pathologies of the spine that a person has. These are osteochondrosis and vertebral hernia, tuberculosis of the spine, its curvature, etc.
Joint research
Often, a doctor needs to make a diagnosis for existing disorders of the osteoarticular apparatus. For this, the patient is prescribed x-ray of the joints. Only in the images obtained in the course of such a study, one can see such signs of pathology:
Calcium deposition zones;
- bone growths that occur at the edge of the cartilage;
- Violations of the conformity of the surfaces of the joints.
X-rays help the doctor identify problems for an accurate diagnosis, as well as determine the type of treatment and plan it.
Your doctor may order an X-ray:
Ankle joint;
- knee joint;
- hip joint;
- elbow joint;
- shoulder joint;
- temporomandibular joint.
X-ray of the stomach
This method of research allows to identify numerous diseases of this important digestive organ, as well as the presence of its functional disorders.
X-ray of the stomach helps to determine:
peptic ulcer;
- malignant and benign neoplasms;
- diverticula (protrusion of the wall of this organ in the form of a bag).
Radiography of the stomach helps to 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 research
This diagnostic method, in addition to general indications, is applied to a certain category of the population. These are, for example, people who are constantly experiencing conditions of harmful production: 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 with cirrhosis of the liver, ascites, heart failure);
- pneumothorax (mechanical damage to lung tissue);
- chronic diseases (atypical pneumonia, silicosis, tuberculosis, lupus erythematosus, etc.).
Only the radiography performed will allow timely recognition of the onset of the above pathologies and the selection of the necessary course of treatment.
Radiography
In 1918, the first X-ray clinic was established in Russia. Radiography is being used to diagnose an increasing number of diseases. The radiography of the lungs 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 allocates funds for the expansion of the production of x-ray equipment in Russia. Radiology and equipment manufacturing are reaching the world level.
Currently, radiography remains the main method for diagnosing lesions of the osteoarticular system. It plays an important role in the examination of the lungs, especially as a screening method. Methods of contrast radiography 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 RI) of organs allows you 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 the recognition of gastritis, ulcerative lesions and tumors.
- RI of the gallbladder (cholecystography) and biliary tract (cholegraphy) is performed to assess the contours, size, lumen of the intra- and extrahepatic bile ducts, the presence or absence of calculi, and clarify the concentration and contractile functions of the gallbladder.
- RI of the colon (irrigoscopy) is used to recognize tumors, polyps, diverticula and intestinal obstruction.
- chest x-ray - 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 - perforation of organs, 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
In restoration
Image Acquisition
X-ray registration technique
Image acquisition is based on the attenuation of X-ray radiation as it passes through various tissues, followed by its registration on an X-ray sensitive film. As a result of passing through formations of different density and composition, the radiation beam is scattered and slowed down, and therefore an image of different intensity is formed on the film. As a result, an average, summation image of all tissues (shadow) is obtained on the film. From this it follows that in order to obtain an adequate x-ray image, it is necessary to conduct a study of radiologically inhomogeneous formations.
In modern digital devices, the output radiation can be registered on a special cassette with film 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 the radiograph is a flat image of a three-dimensional object. And as a result, the localization of the detected pathological focus can be established only with the help of 2 projections.
Imaging technique
The quality of the resulting X-ray image is determined by 3 main parameters. The voltage applied to the X-ray tube, the current strength and the operating time of the tube. Depending on the studied anatomical formations, and the weight and size data 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 \u200b\u200bwill differ depending on the apparatus where the study is performed and the patient who is undergoing x-rays. 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 performed images largely depends on the ability of the X-ray laboratory technician to adequately adapt the table of average values to a particular patient.
Image recording
The most common way to record an X-ray image is to fix it on an X-ray sensitive film and then develop it. Currently, there are also systems that provide digital data recording. Due to the high cost and complexity of manufacturing, this type of equipment is inferior to analog equipment in terms of prevalence.
analog
There are the following options for obtaining an image using X-ray sensitive film.
One of the previously used methods for obtaining shots of usable density is overexposure followed by underexposure made under visual control. 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 method, it may be necessary to re-shoot. The appearance of the possibility of previewing on the screen of a computerized X-ray machine with a digital matrix and automatic processing machines reduces the need and possibilities for 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. A certain problem is the secondary radiation, it is formed as a result of the reflection of X-rays from various objects. To filter the scattered radiation, filtration gratings are used, consisting of alternating bands of X-ray transparent and X-ray opaque material. This filter filters out secondary radiation, but it also weakens the central beam, and therefore a large dose of radiation is required 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 inherent x-ray sensitivity and are designed for use with intensifying fluorescent screens that glow blue or green visible light when irradiated with x-rays. Such screens, together with the film, are placed in a cassette, which, after the picture is taken, is removed from the X-ray machine and then the film is developed. Film development can be done in several ways.
- Fully automatically, when a cassette is loaded into the machine, after which the processor removes the film, develops, dries and refills a new one.
- Semi-automatic, when the film is removed and loaded by hand, and the processor only develops and dries the film.
- Completely manually, when developing takes place in tanks, the film is removed, loaded, developed by an X-ray laboratory assistant.
For x-ray analysis of the image, an analog x-ray image is fixed on an illuminating device with a bright screen - a negatoscope.
Digital
Resolution
The 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 line pairs per mm", which roughly 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 methods of preparation are available for examination of the digestive organs:
- Previously, special diets were used, foods that promote flatulence were excluded from the diet, a cleansing enema was performed, but it is now generally accepted that no preparations are required for RI of the stomach and duodenum of patients with normal bowel function. However, with a sharp pronounced flatulence and persistent constipation, a cleansing enema is performed 2 hours before the study. If there is a large amount of liquid, mucus, food debris in the patient's stomach, gastric lavage is performed 3 hours before the study.
- Before cholecystography, the possibility of flatulence is also excluded and a radiopaque iodine-containing preparation (cholevid, iopagnost 1 g per 20 kg of live weight) is used. 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, in the evening they put a cleansing enema. The patient does not have 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 studies 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 second examination is necessary, since the images obtained are operator-dependent).
Disadvantages of radiography
- "Freezing" of the image - the complexity of assessing the function of the body.
- The presence of ionizing radiation that can have a harmful effect on the organism under study.
- The information content of classical radiography is much lower than such modern methods of medical imaging as CT, MRI, etc. Ordinary x-ray images reflect the projection layering of complex anatomical structures, that is, their summation x-ray shadow, in contrast to the layered series of images obtained by modern tomographic methods.
- Without the use of contrast agents, radiography is practically uninformative for the analysis of changes in soft tissues.
see also
Notes
Links
Radiography Medical Solutions Manufacturers Practical Radiography- Successful intraoral radiography - typical errors, their causes and solutions.
Literature
- Kishkovsky A.N., Tyutin L.A., Esinovskaya G.N. Atlas of laying in X-ray studies. - Leningrad: Medicine, 1987. - 520 p.
- Lindenbraten L.D. Korolyuk I.P. Medical radiology (basics of radiation diagnostics and radiation therapy). - 2nd revised and supplemented. - Moscow: Medicine, 2000. - S. 77-79. - 672 p. - ISBN 5-225-04403-4
| Medical Imaging Methods | |
|---|---|
| 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 | |
For the diagnosis of 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 tissues. The bone structures of the body do not let them through, as a result of which shadows of different intensity are formed on x-rays, accurately reflecting the state of the bones and internal organs.
Radiography is one of the most researched and proven diagnostic techniques in clinical practice, the effect of which on the human body has been perfectly 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 were successfully performed using X-ray images on photographic plates.
Despite the fact that modern X-ray equipment is constantly being improved and is a high-precision medical device that allows for detailed diagnostics, the principle of obtaining a picture has remained unchanged. The tissues of the human body, which have different densities, transmit invisible X-rays with varying degrees of intensity: soft, healthy structures practically do not delay them, while bones absorb them. The resulting images look like a collection of shadow images. An x-ray image is a negative, on which bone structures are indicated in white, soft in gray, and air spaces in black. The presence of pathological changes in the internal organs, for example, in the lungs, is displayed as a lighter spot on the pulmonary pleura or in the segments of the lung itself. The description of the radiograph made is the basis on which doctors can judge the state of certain research objects.
If in the 20th century the equipment made it possible to conduct, basically, only the examination of the chest and limbs, then modern fluoroscopy is used for high-precision diagnostics of various organs using a wide range of X-ray equipment.
Types and projections of radiography
Various types of radiography are used to conduct preventive studies and in-depth diagnostics in medicine. X-ray techniques are classified:
- in the form:
- overview, allowing you to completely cover various areas of the body;
- sighting, which is usually carried out with a deep diagnosis of a certain area of an organ using a special nozzle on an x-ray machine;
- layer-by-layer, during which parallel sections of the studied zone are performed.
- by type of equipment used:
- traditional film;
- digital, which provides the ability to record the resulting image on removable media;
- three-dimensional. This includes computed, multispiral and other types of tomography;
- fluorographic, which allows for a safe preventive examination of the lungs;
- special:
- mammographic, for examining the breast in women;
- hysterosalpingographic, used to examine the uterus and fallopian tubes;
- densitometric, for the diagnosis of osteoporosis and others.
The enumeration of various methods shows how in demand and indispensable in the diagnosis is radiology. Modern doctors can use various forms of research to detect pathologies in most organs and vital systems of the human body.
Why do x-rays
X-rays in modern medicine are used for preventive examinations and directed diagnostics. Without such an examination, you can not do with:
- 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;
- treatment and prosthetics of teeth;
- deep study of brain structures;
- scanning of sections of vessels with suspicion of an aneurysm, and so on.
The method of conducting an x-ray examination is chosen by the doctor, depending on the presence of indications and contraindications for it in the patient. Compared to some modern volumetric imaging techniques, traditional x-rays are the safest. But it is not indicated for certain categories of patients.
Contraindications
Despite the safety of diagnostics, patients experience the effects of ionizing radiation, which adversely affects the bone marrow, red blood cells, epithelium, reproductive organs and the retina. Absolute contraindications for x-rays are:
- pregnancy;
- the age of the child is up to 14 years;
- severe 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, 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 an x-ray.
What is needed for x-ray preparation
To examine the condition of the spine, stomach or jaw bones, special preparation is not needed. The patient must take off his clothes and metal objects before undergoing such an examination. The absence of foreign objects on the body ensures the accuracy of the x-ray.
Preparation is required only when using a contrast agent, which is introduced to x-ray certain organs in order to increase the visualization of the results. An injection of a contrast agent is done some time before the procedure or directly in the process.
How an x-ray is done
All x-rays are taken in specially equipped rooms, where there are protective screens that prevent radiation from reaching non-translucent organs of the body. The study does not take long. Depending on the technique used for 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 has large dimensions and is used only in stationary conditions, which makes it possible to achieve 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 repeat the situation of stationary medical facilities.
How many times can x-rays be taken
Translucence of tissues and organs is carried out as many times as this or that diagnostic technique allows. The safest are fluorography and x-rays. The doctor may refer the patient several times for such an examination, depending on the results obtained earlier and the goals set. Volumetric pictures are taken according to indications.
When prescribing radiography, it is important not to exceed the maximum permitted total radiation dose per year, which is 150 mSv. For information: exposure when performing a chest x-ray in one projection is 0.15-0.4 mSv.
Where can I get an x-ray, and its average cost
An X-ray can be done in almost any medical institution: in public clinics, hospitals, private centers. The cost of such an examination depends on the area under study and the number of images taken. As part of compulsory health insurance or according to allocated quotas in public hospitals, organ scans can be done free of charge with a referral from a doctor. In private medical institutions, such a service will need to be paid. The price starts from 1500 rubles and may vary in different private medical centers.
What does an x-ray show
What does the x-ray show? The state of a certain organ can be seen on the picture taken or on the monitor screen. A variety of dark and light shades on the resulting negative allows doctors to judge the presence or absence of certain pathological changes in a particular section of the organ under study.
Deciphering the results
Only a qualified doctor who has a long clinical practice and understands the features of various pathological changes in certain organs of the body can read x-rays. Based on what he saw in the picture, the doctor makes a description of the received radiograph in the patient's chart. In the absence of atypical light spots or blackouts on soft tissues, cracks and fractures on the bones, the doctor fixes the healthy state of a particular organ. Only an experienced doctor who knows the X-ray anatomy of a person and the symptoms of the disease of the organ whose image is being taken can accurately decipher an x-ray.
What do the inflammatory foci in the picture indicate
When transilluminating soft tissues, joints or bones 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 tissues. As a rule, such a zone contains pronounced foci of darkening. An experienced doctor immediately determines the type of disease from the resulting image in the picture.
What do diseases look like on x-rays?
When transferring the image to the film, places with pathological changes stand out against the background of healthy tissue. When the damaged bones are translucent, the places of deformations and displacements are clearly visible, which allows the traumatologist to make an accurate prognosis and prescribe the correct treatment. If shadows are found on the lungs, this may indicate pneumonia, tuberculosis, or cancer. A qualified specialist must differentiate the identified deviations. But areas of enlightenment in this organ often indicate pleurisy. Specific symptoms are characteristic for each type of pathology. To make a correct diagnosis, it is necessary to perfectly master the X-ray anatomy of the human body.
The advantages of the technique, and what is the negative effect of x-rays on the body
X-ray images obtained as a result of X-ray transmission give an accurate understanding of the state of the organ under study 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 a detailed visualization of the organ. During this time, in the absence of contraindications in the patient, it is impossible to cause irreparable harm to the body.
How to minimize the effects of exposure
All forms of diagnostics of diseases 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, while information about the dose received is entered into the patient's card. The specialist always takes this indicator into account when selecting diagnostic methods, which allows not to exceed the norm.
Is it possible to do x-rays for children
According to international and domestic regulations, any research based on exposure to ionizing radiation is allowed 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 is suspected of having dangerous lung diseases with the consent of the parents. Such an examination is necessary in acute situations requiring a quick and accurate diagnosis. Before this, the specialist always correlates the risks of the procedure and the threat to the life of the child if it is not performed.
Is X-ray possible during pregnancy
Such an examination is usually not prescribed during the period of gestation, especially in the first trimester. If it is so necessary that the lack of timely diagnosis threatens the health and life of the future mother, then during it a lead apron is used to protect the internal organs from X-rays. Against the background of other similar methods, X-rays are the safest, but doctors in most cases prefer not to carry them out during pregnancy, protecting the fetus from harmful ionizing effects.
Alternative to x-ray
The 120-year practice of using X-ray and similar techniques (fluorography, computed, multislice, positron emission tomography, and others) has shown that today there is no more accurate way to diagnose a number of pathologies. With the help of x-rays, you can quickly identify lung diseases, bone injuries, identify diverticula in aged patients, make high-quality retrograde urethrography, timely detect oncology at an early stage of development, and much more.
An alternative to such a diagnosis in the form of ultrasound can only be prescribed 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 research conducted in modern medical practice. Most people are familiar with this procedure because the possibilities for applying this method are very extensive. List of indications for x-ray bones includes a large number of diseases. Only injuries and fractures of the limbs require repeated X-ray examinations. X-ray of the bones is carried out using various equipment, there is 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 concomitant factors. Radiation diagnostic methods are indispensable in the diagnosis of diseases of the skeletal system and play a major role in the 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 one of the types 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 a natural radiation background.The artificial production of X-rays was made possible by Wilhelm Conrad Roentgen, after whom they are named. He was also the first to discover the possibility of their use in medicine for "transillumination" of internal organs, primarily bones. Subsequently, this technology developed, new ways of using X-ray radiation appeared, and the radiation dose decreased.
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-rays are called ionizing radiation. In high 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 diseases in both doctors and patients. However, today the dose of X-ray radiation is carefully controlled and it is safe to say that the harm from X-ray radiation can be neglected.
The principle of obtaining an x-ray
Three components are needed to take an x-ray. The first one is an X-ray source. The source of X-rays is an X-ray tube. In it, under the influence of an electric current, certain substances interact and release energy, from which most of it 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 a snapshot 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 different power penetrates outside the body, which leaves various spots on the picture. Where the X-ray radiation was absorbed to a greater extent, shadows remain, and where it passed almost unchanged, enlightenments form.
The third component for taking an x-ray is the x-ray receiver. It can be film or digital ( X-ray sensitive 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 areas of enlightenment in the picture have a dark tint, and the shadows have a white tint. Healthy bones have a high density and leave a uniform shadow on the image.
Digital and film x-ray of bones
The first methods of X-ray research implied 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, sensors that are sensitive to x-rays are the receiving element.Digital radiography has the following advantages over film radiography:
- the ability to reduce the radiation dose due to the higher sensitivity of digital sensors;
- increase the accuracy and resolution of the image;
- simplicity and speed of obtaining a picture, no need to process a photosensitive film;
- ease of storage and processing of information;
- the ability to quickly transfer information.
X-ray of bones with contrast agent
Radiography of the bones of the extremities can be performed using contrast agents. Unlike other body tissues, bones have a high natural contrast. Therefore, contrast agents are used to clarify the formations adjacent to the bones - soft tissues, joints, blood vessels. These x-ray techniques are not used so often, but in some clinical situations they are indispensable.There are the following radiopaque techniques for examining bones:
- Fistulography. This technique involves filling the fistulous passages with contrast agents ( iodolipol, barium sulfate). Fistulas form in the bones in inflammatory conditions such as osteomyelitis. After the study, the substance is removed from the fistula with a syringe.
- Pneumography. This study involves the introduction of gas ( air, oxygen, nitrous oxide) with a volume of about 300 cubic centimeters into soft tissues. Pneumography is performed, as a rule, with traumatic injuries combined with crushing of soft tissues, comminuted fractures.
- Arthrography. This method involves filling the joint cavity with a liquid radiopaque preparation. The amount of contrast agent depends on the volume of the joint cavity. Most often, arthrography is performed on the knee joint. This technique allows you to assess the state of the articular surfaces of the bones included in the joint.
- Bone angiography. This type of study involves the introduction of a contrast agent into the vascular bed. The study of bone vessels is used in tumor formations, to clarify the features of its growth and blood supply. In malignant tumors, the diameter and location of the vessels are uneven, 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. To date, computed tomography is the best method for examining the skeletal system. With CT, you can get 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 creates a high radiation load.The advantages of CT over standard radiography are:
- high resolution and accuracy of the method;
- the possibility of obtaining any projection, while X-rays are usually carried out in no more than 2 - 3 projections;
- the possibility of three-dimensional reconstruction of the studied part of the body;
- lack of distortion, compliance with linear dimensions;
- the possibility of simultaneous examination of bones, soft tissues and blood vessels;
- Possibility of real-time survey.
X-ray of bones and magnetic resonance imaging ( MRI)
Magnetic resonance imaging ( MRI) is a relatively new diagnostic method. MRI allows you to get an accurate image of the internal structures of the body in all possible planes. With the help of computer simulation tools, MRI makes it possible to perform a three-dimensional reconstruction of human organs and tissues. The main advantage of MRI is the complete absence of radiation exposure.The principle of operation of a magnetic resonance tomograph is to impart a magnetic impulse to the atoms that make up the human body. After that, the energy released by the atoms when returning to their original state is read. One of the limitations of this method is the impossibility of using in the presence of metal implants, pacemakers in the body.
MRI usually measures the energy of hydrogen atoms. Hydrogen in the human body is found most often in the composition of water compounds. Bone contains much less water than other tissues in the body, so MRI is less accurate when examining bones than it is when examining other areas of the body. In this, 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 spent on research ( 30 minutes or more). All this time, the patient must take a stationary position in the magnetic resonance tomograph. This device looks like a tunnel of a closed structure, which causes discomfort for some people.
X-ray and bone densitometry
The study of the structure of bone tissue is carried out in a number of diseases, as well as in the aging of the body. Most often, the study of bone structure is carried out with a disease such as osteoporosis. A decrease in the mineral content of the bones leads to their fragility, the risk of fractures, deformations and damage to neighboring structures.An X-ray image allows you to evaluate the structure of the bones only subjectively. To determine the quantitative parameters of bone density, the content of minerals in it, densitometry is used. The procedure is fast and painless. While the patient lies motionless on the couch, the doctor examines certain parts of the skeleton using a special sensor. The most important are the data of densitometry 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 ( hypodynamia).
Indications and contraindications for X-ray of the bones of the skeleton
X-ray of the bones of the skeleton has an extensive list of indications. Different diseases can be characteristic of different ages, but injuries or tumors of the bones can occur at any age. For the diagnosis of diseases of the skeletal system, X-ray is 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 study for the bones of the skeleton. Bones are not available for direct examination, but an x-ray 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, an X-ray of the bones cannot be performed too often and for any reason. Indications for bone x-rays are determined quite accurately and are based on the complaints and symptoms of patients' diseases.X-ray of bones is indicated in the following cases:
- traumatic injuries of bones with severe pain syndrome, deformation of soft tissues and bones;
- dislocations and other damage to the joints;
- anomalies in the development of bones in children;
- growth lag in children;
- limited mobility in the 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 the treatment ( fractures, transplants, etc.).
X-ray of the bones in most cases allows differentiation between the listed diseases, due to the fact that each of them has reliable radiological signs. In difficult cases, especially before surgical operations, the use of computed tomography is indicated. Doctors prefer to use this study, as 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 an ionizing effect in X-rays. At the same time, all contraindications to the study are relative, since they can be neglected in emergency cases, such as fractures of the bones of the skeleton. However, if possible, the number of X-ray studies should be limited and not carried out unnecessarily.Relative contraindications for X-ray examination include:
- the presence of metal implants in the body;
- acute or chronic mental illness;
- severe condition of the patient massive blood loss, unconsciousness, pneumothorax);
- first trimester of pregnancy;
- childhood ( under 18).
- allergic reactions to components of contrast agents;
- endocrine disorders ( thyroid disease);
- severe liver and kidney disease;
Irradiation doses for various methods of X-ray examination
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. Irradiation doses are not the same for different research methods, as well as for different anatomical regions. The unit of radiation dose is milliSievert ( mSv).Irradiation doses for various bone x-ray methods
As can be seen from the data presented, computed tomography bears the greatest X-ray load. At the same time, computed tomography is the most informative method of examining bones today. It can also be concluded 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 carries a certain danger to the human body. It is for this reason that all radiation that was received for medical purposes should be reflected in the patient's medical record. Such records should be maintained in order to comply with annual norms that limit the possible number of X-ray examinations. Thanks to the use of digital radiography, their number 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 allowable 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 in a single study is several times less.
The number of X-ray examinations that can be performed during the year depends on the type of examination and the anatomical area. On average, 1 CT scan or 10 to 20 digital radiographs is allowed. However, there are no reliable data on the impact of radiation doses of 10-20 mSv annually. We can only say with certainty 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-rays. Ionizing radiation can lead to spontaneous decay of atoms, cellular mutations, failure in cell reproduction. That is why X-ray examination, which is a source of ionizing radiation, requires the regulation and establishment of threshold values of radiation doses.Ionizing radiation has the greatest effect on the following organs and tissues:
- bone marrow, hematopoietic organs;
- lens of the eye;
- endocrine glands;
- genitals;
- skin and mucous membranes;
- the fetus of a pregnant woman;
- all organs of the child's body.
Is it possible to do bone x-rays for pregnant and lactating 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 abnormalities or mutations leading to cancer. The first trimester of pregnancy is of the greatest importance, since during this period the most active development of fetal tissues and the formation of organs occurs. If necessary, all x-ray studies are transferred to the second and third trimester of pregnancy. Human studies have shown that x-rays taken after the 25th week of pregnancy do not lead to abnormalities in the baby.For nursing mothers, there are no restrictions in performing x-rays, since the ionizing effect does not affect the composition of breast milk. Full-fledged studies in this area have not been conducted, therefore, in any case, doctors recommend that nursing mothers express the first portion of milk while breastfeeding. This will help to play it safe and maintain confidence in the health of the child.
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 greatest number of injuries occur, which lead to the need to perform an X-ray examination. That is why X-rays are performed for children, but various protective devices are used to protect developing organs from radiation.An X-ray examination is also required for growth retardation in children. In this case, x-rays are taken as many times as required, since the treatment plan includes x-rays after a certain period of time ( usually 6 months). Rickets, congenital skeletal anomalies, tumors and tumor-like diseases - all these diseases require radiation diagnostics and cannot be replaced by other methods.
Preparing for a bone x-ray
Study preparation is at the heart of any successful study. Both the quality of diagnosis and the result of treatment depend on this. Preparing for an x-ray examination is a fairly simple event and usually does not create difficulties. Only in some cases, such as x-rays of the pelvis or spine, do x-rays require special preparation. There are some features of preparing children for x-rays. Parents should help doctors and properly psychologically prepare 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 the cooperation between parents and doctors, it is possible to achieve good diagnosis and high-quality treatment of childhood diseases.
How to get a referral for a bone x-ray? Where is X-ray performed?
Bone X-rays can be performed today at almost any center that provides medical care. Despite the fact that today X-ray equipment is widely available, X-ray examinations are performed only with the direction of a doctor. This is due to the fact that x-rays to a certain extent harm human health and have some contraindications.X-ray of the bones is performed in the direction of doctors of different specialties. Most often, it is performed urgently when providing first aid in trauma departments, emergency hospitals. In this case, the referral is issued by the on-duty traumatologist, orthopedist or surgeon. X-rays of bones may also be performed at the direction of family physicians, dentists, endocrinologists, oncologists, and other physicians.
An x-ray of the bones is performed in various medical centers, clinics, and hospitals. To do this, they are equipped with special X-ray rooms, which have everything necessary for this kind 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 is 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 trap ionizing radiation. In addition, it has dosimeters-radiometers and personal radiation protection equipment, such as aprons, collars, gloves, skirts and other items.The X-ray room should 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 a variety of forms as they are designed for different purposes. All types of X-ray units are present in large medical centers, but the simultaneous operation of several of them is prohibited.
In a modern X-ray room there are 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 ( X-ray machine for jaws and teeth);
- digital radiovisiograph.
Additional equipment for X-ray rooms includes:
- a computer for processing and storing digital images;
- film processing equipment;
- film drying cabinets;
- Consumables ( film, photoreagents);
- negatoscopes ( bright screens for viewing pictures);
- tables and chairs;
- filing cabinets;
- bactericidal lamps ( quartz) for disinfection of premises.
Preparing for a bone x-ray
The tissues of the human body, which differ in different density and chemical composition, absorb X-rays in different ways and, due to this, have a characteristic X-ray image. The bones have a high density and very good natural contrast, so most bones can be x-rayed without much preparation.If a person is to have an x-ray examination of most of the bones, then it is enough to come to the x-ray room on time. At the same time, there are no restrictions on food intake, liquids, smoking before an X-ray examination. It is recommended that you do not bring any metal items with you, especially jewelry, as these will need to be removed prior to the examination. Any metallic objects interfere with the x-ray.
The process of obtaining an X-ray image does not take much time. However, in order for the picture to turn out to be of high quality, it is very important for the patient to remain still during its execution. This is especially true for young children who are restless. X-rays for children are carried out in the presence of parents. For children less than 2 years old, X-rays are performed in the prone position, it is possible to use special fixation, which fixes the position of the child on the X-ray table.
One of the serious advantages of x-rays is the possibility of its use in emergency cases ( 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 ward where the patient is located.
Preparation for X-ray of the pelvic bones, lumbar and sacral spine
An 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 anatomical proximity with the intestines. Intestinal gases reduce the sharpness and contrast of the x-ray, which is why special preparations are made to cleanse the intestines before this procedure.Preparation for x-ray of the pelvis and lumbar spine includes the following main elements:
- bowel cleansing with laxatives and enemas;
- following a diet that reduces the formation of gases in the intestines;
- conducting research 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 taking pictures in all cases remains the same. It involves placing the part of the body to be examined between the X-ray tube and the radiation receiver, so that the X-rays pass at right angles to the bone under examination and to the cassette with X-ray film or sensors. The positions occupied by the components of the x-ray machine relative to the human body are called stacking. Over the years of practice, a large number of x-ray stacks have been developed. The quality of x-rays depends on the accuracy of their observance. Sometimes, in order to comply with these prescriptions, the patient has to take a forced position, but the X-ray examination is performed very quickly.
Laying usually involves taking pictures in two mutually perpendicular projections - front and side. Sometimes the study is supplemented by an oblique projection, which helps to get rid of the overlap of some parts of the skeleton on each other. In the event of a severe injury, some styling becomes 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.
Method for examining the bones of the limbs ( hands and feet)
X-ray examination of the tubular bones of the skeleton is the most frequent X-ray examination. These bones make up the bulk of the bones, the skeleton of the arms and legs is completely made up of tubular bones. The X-ray technique should be familiar to anyone who has received injuries to their arms or legs at least once in their lives. The study takes no more than 10 minutes, it 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 the immobility of the patient during the study.
Before the study, the limb section is exposed, all metal objects are removed from it, the study area is placed 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 picture 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 end of the tubular bone. In addition, the large coverage of the area helps to eliminate damage to the joints or adjacent bones.
Usually, each bone is examined in direct and lateral projection. Sometimes pictures are performed in conjunction with functional tests. They consist in flexion and extension of the joint or load on the limb. Sometimes, due to injury or the inability to change the position of the limb, it is necessary to use special projections. The main condition is to maintain the perpendicularity of the cassette and the X-ray emitter.
The technique of X-ray examination of the bones of the skull
X-ray examination of the skull is usually performed in two mutually perpendicular projections - lateral ( in profile) and direct ( full face). An x-ray of the skull bones is prescribed for head injuries, with endocrine disorders, for diagnosing deviations from indicators of age-related bone development in children.X-ray of the bones of the skull in 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. Usually the patient lies on the X-ray table on the stomach, a roller is placed under the forehead. The patient remains motionless for several minutes while the X-ray tube is directed to the occipital region and the picture is taken.
X-ray of the bones of the skull 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, the film cassette is placed on the left or right side of the patient's head parallel to the body axis. The X-ray tube is directed perpendicular to the cassette from the opposite side, 1 cm above the ear-pupillary line.
Sometimes doctors use an x-ray of the bones of the skull in the so-called axial projection. It corresponds to the vertical axis of the human body. This styling has a parietal and chin direction, depending on which side the X-ray tube is located on. It is informative for the study of the base of the skull, as well as some bones of the facial skeleton. Its advantage is that it avoids the many overlaps of bones that are characteristic of direct projection.
X-ray of the skull in axial projection consists of the following steps:
- the patient takes off metal objects, outerwear;
- 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 as much as possible forward, and only the chin and the front surface of the neck touch the table;
- under the chin is a cassette with x-ray film;
- the x-ray tube is directed perpendicular to the plane of the table, to the region of the crown, the distance between the cassette and the tube should be 100 cm;
- after that, 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 top of the 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 anterior surface of the neck, the distance between the cassette and the x-ray tube is also 1 meter.
Methods of X-ray of the temporal bone according to Stanvers, according to Schüller, according to Mayer
The temporal bone is one of the main bones that form the skull. In the temporal bone there are a large number of formations to which muscles are attached, as well as holes and channels through which nerves pass. Due to the abundance of bone formations in the facial region, X-ray examination of the temporal bone is difficult. That is why a variety of styling has been proposed to obtain special X-ray images of the temporal bone.Currently, three projections of X-ray examination of the temporal bone are used:
- Mayer technique ( axial projection). It is used to study the state of the middle ear, the pyramid of the temporal bone and the mastoid process. Mayer X-ray is performed in the supine position. The head is turned at an angle of 45 degrees to the horizontal plane, a cassette with x-ray film is placed under the ear under study. The X-ray tube is directed through the frontal bone of the opposite side, it should be directed exactly to the center of the external auditory opening of the side under study.
- Method according to Schüller ( oblique projection). With this projection, the state of the temporomandibular joint, mastoid process, as well as the pyramid of the temporal bone is assessed. X-ray is 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 examined side 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 examined side.
- Method according to Stanvers ( transverse projection). A picture 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, the beam is directed to the center of the cassette. For all three techniques, an X-ray tube in a narrow tube is used.
X-ray laying of the zygomatic bones in a 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 styling is used to identify fractures of the zygomatic bone, the outer edge of the orbit, 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 the 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 located strictly vertically, however, due to the tilt of the head, x-rays pass tangentially to the surface of the zygomatic bone;
- during the study, 2-3 shots are taken with slight turns of the head.
Method of X-ray examination of the pelvic bones. Projections in which an x-ray of the pelvic bones is performed
X-ray of the pelvis is the main study for injuries, tumors, and other diseases of the bones of 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. The most common 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 roller is placed under the knees;
- the legs should be slightly apart, the feet fixed in the established position with tape or sandbags;
- the cassette with a film measuring 35 x 43 cm is located transversely;
- the x-ray emitter is directed perpendicular to the cassette, between the upper anterior iliac crest and the pubic symphysis;
- the minimum distance between the emitter and the film is one meter.
To study the sacroiliac joint, a posterior oblique projection is used. It is performed when the examined side is raised by 25 - 30 degrees. In this case, the cassette must be located 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 ilium.
Determining the age of the skeleton by X-ray 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 the bones ( synostoses). On the basis of bone age, it is possible to accurately determine the final growth of children, to establish a lag or advance in development. Bone age is determined by radiographs. After the radiographs were made in this way, the results obtained are compared with the standards according to special tables.The most indicative in determining the age of the skeleton is the x-ray of the hand. The convenience of this anatomical region 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 is mainly used to diagnose endocrine disorders such as growth hormone deficiency ( growth hormone).
Comparison of the age of the child and the appearance of ossification points on the x-ray of the hand
Ossification points |
