X-ray projections. chest x-ray

Fluorography is done in one projection

Fluorography from the front side or from both sides (from the front and side). That's clearer?

Do the front and then the side. Usually 2 projections are prescribed if some kind of lung disease is suspected. Then the lateral projections allow you to better examine the lungs and not miss the signs of the disease.

In two projections, a full x-ray of the lungs is usually done. And the projections are the same as those of the photographer - full face: in front, and profile: from the side.

X-ray and fluorography: what is the difference, description

In the article, we will consider x-rays and fluorography. What is the difference between them? At present, in our country, everyone must undergo a scheduled fluorographic examination once a year. This procedure is generally accepted and does not cause any doubts among people. However, there are situations when doctors offer the patient to undergo an x-ray instead of fluorography. What is more harmful - X-ray or fluorography?

Basic concepts

Fluorography is a method of X-ray diagnostics, which consists in displaying the shadow of the chest organs on photographic film (an outdated method) or converting it into a digital image. In turn, X-ray of the lungs is a technique by which pathological changes are diagnosed by fixing objects on film. The difference between these types of X-ray studies is significant. Digital fluorography is characterized by a reduced radiation effect on the patient, however, its resolution is lower compared to direct projection of lung radiography.

What is fluorography?

Every year, each person is faced with fluorography, carried out for preventive purposes. This procedure is carried out in medical institutions, since this is a legal method for screening lung pathologies. Doctors without him will not sign the commission. Fluorography has become widespread in our country due to numerous cases of tuberculosis. To prevent mass infection, the Ministry of Health decided to introduce mandatory annual fluorography. A single dose in one study is not more than 0.015 mSv, while a prophylactic dose of 1 mSv is allowed. Taking into account this norm, it can be calculated that in order to exceed the radiation load, it is required to perform a thousand studies during the year. What to choose X-ray and fluorography? What is the difference between them, many are interested.

Types of fluorography

Currently, there are several modern types of fluorography, which are used not only in the diagnosis of tuberculosis, but also in pneumonia.

Digital fluorography is a modern method of X-ray screening of lung diseases. This method assumes that the shadow image is photographed on a computer monitor from a special chip that is installed in the receiver. Reduced radiation exposure to the patient is determined by the principle of operation of the device: the beam passes through the entire area of the study in turn, after which the image is reconstructed in the software. That's what happens in the fluorography room.

An outdated method is traditional fluorography. With this method, the image is displayed on a small photographic film. With this approach, the rooms were provided with high throughput, however, radiation doses were not reduced compared to pulmonary radiography.

A significant disadvantage of the digital view is the high cost of the necessary equipment, and therefore not all medical institutions can currently afford such technologies. So, x-ray and fluorography - what's the difference? To understand this, you need to consider in detail each diagnostic method.

X-ray of the lungs: what is it?

To some extent, lung X-ray is a high-quality alternative to fluorography because of its high resolution. On a pulmonary radiograph, shadows equal to two millimeters are distinguished, while with a fluorographic study, the minimum size is five millimeters. Radiography is performed with suspicion of lung diseases: pneumonia, tuberculosis, cancer, and others. Children fluorography, as a rule, is not prescribed. It is a preventive method.

X-rays are obtained by exposing certain areas of the film as the X-rays pass through the body. How is an x-ray done? More on that below.

Is there a danger?

During the study, a high, but short-term radiation load on a person is formed. Its danger lies in the fact that mutations can occur at the cellular level. That is why, before referring a patient for an x-ray, the attending physician must compare the degree of risk from x-ray exposure with the practical value of the results obtained during the examination. The procedure is assigned when this value is low. X-ray diagnostics is based on the principle: the benefit must exceed the harm.

This must be remembered when an x-ray of a tooth is prescribed during pregnancy. It should be done only in the most extreme cases.

Safety of chest X-ray examination

It must be said that the amount of radiation exposure to a patient during x-rays of the lungs in domestic medical institutions is higher than the dosage in developed countries. This happens because outdated equipment is used. For example, in Europe, during X-ray examination, the average dose per patient per year is not more than 0.6 mSv. In our country, it is twice as high - about 1.5 mSv. For greater safety, it is recommended to make diagnostics on an X-ray machine in modern institutions. Of course, if acute pneumonia is diagnosed, the doctor is limited in time and will not allow the patient to choose a clinic for examination.

In this case, the pathology poses a threat to life, and therefore what is available will be used for analysis. In this situation, an x-ray of the lungs will be taken not only in direct projection, but also in the lateral, and also, possibly, sighting. This is required in order to determine the size, as well as the prevalence of the focus of pathology in the lung tissue. There are such important contraindications to fluorography and x-rays as planning a child and pregnancy. When is a medical x-ray necessary?

X-ray technique and indications

Indications for X-ray of the chest, that is, chest organs, are the doctor's suspicions of lung pathology (cancer, tuberculosis, pneumonia). Special preparation is not required. There is only one condition - to remove foreign objects and expose the chest. Shooting can also be carried out in underwear, if it does not contain metal objects and synthetic fibers that can be reflected on the radiograph. The transparency of the upper parts of the lung fields in women may decrease if they are covered during the procedure with hair. A similar feature is taken into account by the radiologist during the analysis of the image.

There are the following types of pulmonary x-rays:

When conducting a targeted study, the focus is on a specific pathological tissue area. Targeted x-ray images should be taken under control, but there is an increase in radiation exposure to the patient. With a survey technique, it is necessary to take pictures in two projections: lateral and direct. The main reason for the errors that can appear in the picture lies in the dynamic blur, that is, the fuzzy contours of the formations caused by the pulsation of large vessels or breathing. It can be eliminated by setting the exposure time on the device from 0.02 to 0.03 seconds.

That is why experts recommend taking pictures of the lungs at shutter speeds from 0.1 to 0.15 seconds. Of course, in this case, powerful equipment is required. To prevent projection distortion, the distance between the focus and the object should be between one and a half and two meters. What is better - to visit the office of fluorography or X-ray?

Fluorography or X-ray: which is better for pneumonia?

Often, patients are interested in: is it possible to refuse an x-ray of the lungs or fluorography? By law, a person has such a right, but at the same time he is responsible for his own health. If a refusal is written, then you can go through a medical commission, but at the same time, the phthisiatrician may not sign it, since he has every right. If a specialist has suspicions of pneumonia or active tuberculosis, as well as confirmation of these pathologies by other clinical and instrumental methods (an increase in leukocytes, sputum analysis), then the doctor may legally refer the patient to compulsory treatment.

The danger of tuberculosis

Tuberculosis in an open form is dangerous for the surrounding people, and therefore it must be treated in phthisiatric hospitals. Pneumonia, which is clearly manifested on a pulmonary radiograph, also poses a threat to life. There are no other reliable methods for its detection. Fluorography is not carried out for children, they do with x-rays.

The presence of inflammation processes in the lung tissue and the prescription of antibiotics can be based on indirect signs, however, with a full X-ray analysis, it is possible to control the degree, size of the foci, the severity and course of the pathology process. At the same time, the doctor can combine several antibacterial agents and change the treatment regimen during an exacerbation. When requesting a fluorographic coupon at an appointment with a dentist, ophthalmologist or other specialists, the actions of medical workers are unlawful, since internal orders are not able to cancel the constitutional action. You just need to write a refusal in your outpatient card or medical history about the failure to perform such a study. When deciding which is better to do - chest x-ray and fluorography, it is necessary to evaluate the specifics of both methods and their prophylactic benefit in establishing a diagnosis.

The feasibility of performing an X-ray of the lungs or fluorography is actively discussed by researchers, scientists and the media. Each person may have his own opinion, but it is best to choose the method of x-ray examination based on the opinion of a doctor, since it is necessary to take into account the ratio between the practical benefits and harm produced by ionizing radiation.

negative impact

Fluorography and radiography adversely affect the human body. The degree of dose control of X-rays is 1.5 mSv per gram. With film fluorography, this indicator varies from 0.5 to 0.8 mSv, for digital it is 0.04. To undergo an examination of organs located in the chest, it is required to take into account the level of EED. When conducting an examination by means of an X-ray machine, the image appears on a special film. During fluorography, a preliminary image is displayed on the monitor, after which it is photographed. Thanks to this technique, pathology can be diagnosed. X-rays pass through the body, reflecting on the film.

Another technique is characterized by additional transformation of rays into expressed light. The reduced image is then focused on the film. Based on the results, an additional examination is carried out. That is why x-rays or fluorography are prescribed individually in each case. The radiograph of OGK is used for lung and TB screening. For this purpose, stationary and mobile equipment is used. X-ray of the tooth during pregnancy is better not to prescribe.

In medicine, digital technology is currently replacing film technology, since it greatly facilitates image processing. A picture is displayed on the monitor screen, printed and then transmitted over the network, and then loaded into the database. Such an examination is characterized by reduced radiation exposure and low material costs.

Now we know what an x-ray shows and what a fluorography shows.

Main conclusions

We have reviewed various methods of X-ray examination. During radiography, an image appears on a special film, and during fluorography it is reflected on the screen, and from there it is photographed on a digital or conventional camera. With fluorography, the radiation exposure is higher compared to radiography. Most often, fluorography is used to diagnose diseases, and X-rays are used to clarify or monitor pathology in dynamics. The first method has a lower cost.

We reviewed X-ray and fluorography. What is the difference between them, now readers know.

X-ray of the lungs in two projections for accurate diagnosis of diseases

Radiography of the lungs in two projections is performed for diagnostic purposes. When it is necessary to identify pathological changes in the chest (pneumonia, pneumothorax, cancer), there are no more reliable methods than radiation methods.

The study is carried out strictly according to indications, when the benefit from it is greater than the harm. For example, during pregnancy and for children, radiation exposure is dangerous due to the occurrence of genetic mutations. Doctors prescribe radiation exposure to these categories of the population only as a last resort.

Appointment and preparation for radiography in two projections

An X-ray of the lungs is prescribed in the right or left lateral projections in the following cases:

in order to detect heart disease and pathological changes in the lung fields;
monitoring the placement of a catheter in the heart, pulmonary artery, and also for the purpose of evaluating pacemaker electrodes;
in the diagnosis of pneumonia, inflammatory changes in the bronchi, bronchiectasis.

X-ray of the lungs in two projections does not require special preparation, but a person will have to perform some manipulations:

Remove clothing and foreign objects that cover the area of study.
Leave a mobile phone and keys on the table, as well as other items that can accumulate radioactive radiation.

In the process of performing an X-ray of the lungs, it is necessary to follow all the recommendations of the X-ray laboratory assistant. It is important to hold your breath during the shot so that dynamic blur does not form.

Direct (posterior-anterior) projection with x-ray of the lungs

Direct (posterior-anterior) projection with lung x-ray is performed as often as possible if pneumonia or tuberculosis is suspected. In its implementation, there are some technical subtleties:

the ideal focal length between the x-ray tube and the human chest should be on average 2 meters;
when placing the patient on the stand, the X-ray laboratory assistant makes sure that the chin is located on a special holder;
The height of the brace is adjusted so that the cervical spine is straight. During installation, a person leans his hands against the screen, and the chest is projected in the central part of the cassette;
You must hold your breath while exposing the image.

This is how the posterior-anterior (direct) projection is performed in the diagnosis of respiratory diseases.

Lower lobe pneumonia on x-ray of the lungs in direct projection

Anterior-posterior view of the lungs

Anterior-posterior lung X-ray in combination with left or right lateral projections is performed in the supine position. How to take a direct shot:

the patient is laid down on the couch;
the head end rises up;
the cassette is located under the patient's back, and the distance between the x-ray tube and the object of study is selected according to the doctor's instructions. In this case, it should be borne in mind that foreign objects should not be located in the path of penetration of X-rays;
exposure is carried out on a deep breath.

Taking a right and left lateral chest x-ray

To perform lateral images of the lungs (left and right), special styling is required:

hands are placed behind the head;
the left side leans against the cassette;
when exposing, the breath is held or a deep breath is taken.

The patient is positioned against the cassette with the side to be X-rayed.

Lower lobe pneumonia on a lung radiograph in the left lateral view

Precautionary measures

Chest X-ray is contraindicated in pregnant women. The radiation effect on the fetus under the action of ionizing radiation is the appearance of genetic mutations, which can lead to developmental abnormalities.

When performing the study, it is necessary to protect the pelvic area and abdomen of a person with a special lead apron.

On an outpatient basis (in a polyclinic), when a doctor prescribes radiography in two projections, posterior-anterior images should be taken, and not anterior-posterior, due to the greater reliability of the former.

When choosing side images (left or right), you need to focus on the doctor's prescription with a description.

The norm in the pictures in two projections

The norm in the images in two projections is characterized by the following indicators:

the width of the chest on a direct radiograph is twice as large as the transverse size of the heart;
lung fields are symmetrical on both sides;
spinous processes are located evenly in the vertical plane;
intercostal spaces are uniform.

Deviation from the normal values in the lung images in two projections with pneumonia is the presence of additional intense shadows on the direct and lateral radiographs.

Venous stasis in the small circle will be characterized by a special shape of the roots, which in the image resembles “butterfly wings”. With edema in the lung tissue, flaky uneven blackouts will appear.

Cardiac changes on direct and lateral x-rays

Cardiac changes on x-rays of the lungs are combined with an increase in the right or left ventricles and atria. With an increase in size on the left, the roundness of the left border of the cardiac shadow will be visualized on the x-ray.

The image with the expansion of the right contours of the heart will be manifested by the expansion of the shadow of the right ventricle. At the same time, an increase in the shadow of the right ventricle is observed on the posterior-anterior radiograph.

What influences the result of the study

When taking x-rays, it is important that the patient learn to hold their breath prior to exposure, which will prevent the need for a repeat x-ray.

Improper centering of the chest on x-ray can interfere with visualization of the costophrenic sinus.

Distortion of the results is also observed in the presence of a lateral curvature of the spinal column in a person.

In two projections, radiography is performed if any disease is suspected, which is accompanied by damage to the chest cavity, and the purpose of performing a lateral image is no different from a direct one.

Particular attention should be paid to the laterogram - a special study that allows you to determine the presence of a fluid level in the costophrenic sinus. When performing a study, a person is laid on his side and a picture is taken with the front direction of the x-rays. In this case, the cassette is installed from the back of the back. In the presence of exudative pleurisy in the lower part of the costal arch, a thin band of blackout can be traced, reflecting the accumulation of fluid in the costophrenic sinus.

X-ray examination of the heart is often supplemented by contrasting the esophagus with barium. This allows you to clearly monitor the pressure of the aorta on the esophagus or identify various deviations of the aortic arch.

Against the background of pathology, an increase in the pulmonary pattern can be observed. In this case, the results have a radial direction, and the veins are located in a horizontal plane.

Thus, in two projections, x-rays are assigned for diagnostic purposes to detect diseases of the cardiovascular and respiratory systems.

What new and safer methods of fluorography does modern science offer

This method of examining the lungs refers to screening and is carried out annually to identify certain diseases in the initial stages of their development.

In contrast to the "large" X-ray study, the radiation dose during fluorography (synonyms "X-ray photography" and "radio photography") is much less, although the principle underlying them is the same.

With a frequency of research once a year, radiation does not cause harm to the body.

How is the procedure carried out

X-rays, which have a high penetrating power, pass through the patient's body during the procedure. Due to the fact that they are absorbed unevenly by tissues of different densities, on the other side of the body the rays come out with different intensities.

Important! Twice a year, only patients with tuberculosis, employees of sanatoriums, maternity hospitals, tuberculosis dispensaries and other institutions and enterprises where there is an increased risk of tuberculosis are examined.

On the fluorescent screen located behind the person, which contains a special film, a reduced image-projection is formed, displaying the state of the organs. The film is subsequently developed and images of the internal organs are obtained on it with all the changes.

Reference. Thus, the bones, mammary glands and chest are examined, revealing pathologies.

Fluorography helps to detect not only ordinary lung diseases, but also malignant tumors; also in the picture you can see various inflammations, seals and much more.

Types of fluorography

To date, there are two types of research of this type: film (obsolete technique) and digital (technology of the XXI century). One or another method of fluorography is used, depending on what equipment is in service with the clinic. The equipment used is produced in three versions:

Stationary option. It is installed in medical institutions for permanent work.

Mobile installation. The design of the apparatus provides for multiple assembly and disassembly. The set necessarily includes a mobile power station.

The disassembled equipment is packed and transported to the desired location in a suitable vehicle. Mobile units are used to work in remote areas, to examine employees in large enterprises or students in educational institutions.

Mobile station. The stationary apparatus is mounted in the passenger compartment of the vehicle. There are also jobs for medical staff and a photo lab for processing images (if the device works with film), a power plant.

It is used in the same situations as the mobile unit, but the equipment does not require assembly / disassembly, so the operation of this option is more efficient.

Traditional film method

The method differs in the duration of obtaining the result, since the image that has fallen on the film needs to be developed, and the result is not always satisfactory. This is influenced by the quality of the film and chemicals, as well as other factors. Although the radiation exposure is lower than in a conventional study on a large viewing apparatus, it is still quite high.

Digital fluorography

The rays that have passed through the patient do not fall on the film, but on a special matrix, approximately the same as in a digital video camera or camera. The advantage of digital fluorography is a lower radiation dose than in the previous case, high image quality, and its independence from the chemical processing of the film.

Photo 1. Digital fluorography allows you to store and use the image for a long time.

Computed fluorography makes it possible to examine not only lung tissue, but also dense structures in the middle sections of the chest.

The resulting image is stored on a digital medium and can be further processed with special programs that allow not to conduct additional studies, without exposing the patient to unnecessary radiation.

A digital image is stored for as long as you like, the archive of the digital X-ray room is located on a computer disk, any image can be printed on a printer or sent by e-mail if necessary.

Fluorography in two projections

If a serious illness is suspected, a lung examination is performed in two projections. Both film and digital equipment is used.

Indications for this technique are cases where the need for a thorough examination of the chest exceeds the harm caused by X-rays.

Pictures are taken in projections directly and sideways with suspicion of the following diseases:

With fluorography in 2 projections, the side view is an addition to the traditional study (direct image). It allows you to view the entire thickness of the chest and examine the nearby parts of the organs with special care.

Peculiarities. A two-projection examination is prescribed if, when examining a direct image, a specialist has a suspicion of tuberculosis or pneumonia, but additional confirmation is needed to make a final diagnosis, even though this is associated with additional exposure.

On a direct picture, you can not see a small focus of infiltration due to the fact that it is hidden by the sternum, and on the side picture, the infiltration will be clearly visible. The same situation occurs with basal pulmonary edema.

Are fluorographic examinations necessary?

Despite the fact that only a reduced image of an organ can be obtained with fluorography, this does not detract from the effectiveness of the technique. The importance of fluorography in the timely detection of tuberculosis is high. This is facilitated by modern digital technologies and chest scanning in two projections.

Photo 2. The doctor examines the picture: fluorography allows you to identify not only tuberculosis, but also other pathologies.

In addition to tuberculosis and oncology, the study makes it possible to identify pathologies of large vessels, the skeleton of the chest, the heart, and the diaphragm. One should not neglect the examination and be afraid of exposure, since it is minimal and during the year all the consequences for the body are leveled.

Useful video

Check out the video, which explains in detail what fluorography is, how it differs from radiography, what are the different types of procedures.

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Alexander - What you need to know about Mantoux in a child at 2 years old: what is the norm? four
Ira Kapitonova - What you need to know about Mantoux in a child at 2 years old: what is the norm? four
Alexander - Dangerous exposure! How often can an adult lung x-ray be done? 6
Bakhytgul - What you need to know about Mantoux in a child at 2 years old: what is the norm? four

An online journal about tuberculosis, lung diseases, tests, diagnostics, medicines and other important information about it.

X-ray of the lungs in two projections or X-ray of the chest

Direct and lateral radiography (2nd projection) is performed for a thorough examination of the chest for suspected pneumonia, tuberculosis and cancerous tumors.

X-ray of the lungs in two projections - indications and contraindications

In two projections, an x-ray of the lungs is performed according to absolute indications when the benefits of an x-ray study outweigh the harm. With inflammation of the lung parenchyma, life-threatening conditions are formed that will lead to respiratory failure.

X-ray of the lungs in two positions involves taking pictures in a direct and lateral position.

X-ray of the chest in 2 projections - indications:

1. Inflammation of the alveoli of the lungs (pneumonia);

2. Tuberculosis of the lung fields;

3. Peripheral and central cancer;

4. Diseases of the pleural cavity (pleurisy);

5. Cysts and abscesses;

6. Determining the size of the heart;

7. Evaluation of airiness;

8. Identification of pneumothorax (air of the pleural cavity).

The list goes on longer, but the diseases described above are studied with the help of x-rays as often as possible.

Radiography in frontal and lateral projections

A chest x-ray in two projections consists of direct and lateral images. A direct radiograph is also called anteroposterior, since x-rays pass through the object under study (the chest cavity of the patient) in the anteroposterior direction.

For any examination of the lungs, a frontal radiograph is always performed. The image in the lateral position is performed at the request of the radiologist.

What shadows does a direct x-ray of the chest organs show:

- Increased airiness of the lung fields with emphysema;

– Intense darkening with pneumonia or tuberculosis;

- Violation of the innervation of the diaphragm (relaxation of the dome);

- Deformation, strengthening or thickening of the lung pattern;

- Fall of lung tissue - atelectasis;

– Pathology of bone and soft tissue.

The list of radiological syndromes in the disease is more extensive. A qualified radiologist knows about them. The authors described the most common symptoms of pulmonary pathology.

X-ray image in lateral projection

A lateral view x-ray is optional. It complements the diagnostic list of clinical studies. On the lateral radiograph, the entire thickness of the chest is traced, but nearby parts of the organs are viewed as clearly as possible.

In case of pneumonia, radiology is prescribed radiography in 2 (two) projections to assess the volume and localization of the lesion. The structural element of the lung tissue is a segment. Inflammation of the lungs occurs in one or more segments. A lateral x-ray helps to establish the exact localization of the pathology.

Examination for tuberculosis is indispensable. When there are no infiltrative shadows of the upper lobe on the direct radiograph, infiltrative shadows can be seen on the lateral image. If they are accompanied by paths to the roots, the likelihood of respiratory tuberculosis is high.

X-ray of the lungs of a child in two projections - safety issues

An x-ray of the lungs of a child must be carried out very carefully. X-ray examination is not safe. It provokes mutations in cells that divide rapidly. To prevent negative consequences from radiography, we recommend that you consider safety issues regarding examinations in children more carefully.

The lower the radiation dose, the less harm.

Preventive fluorography for a child under 14 years of age is prohibited, although it is characterized by a lower level of radiation than chest x-ray. What is the reason for such an approach?

Obviously, the “stick” has a low resolution, so it can only reveal pathology, but it cannot be reliably confirmed. If the radiologist detects pathological x-ray syndromes on the fluorogram, he sends the child for a direct x-ray. If it is enough to establish a diagnosis of pneumonia or tuberculosis, a side picture is not taken. Examination in 2 projections is carried out when previous images are not enough to make a diagnosis.

Note that up to 14 years of age, radiography in two positions is rarely performed. So doctors take care of the health of a growing organism.

X-ray examination of the lungs of adults - when to make two projections

Two projections during an x-ray examination of the lungs of adults should be done when a radiologist sees suspicion of pneumonia or tuberculosis in a direct picture. The procedure is also performed when, according to clinical data, the patient has a suspicion of these diseases. Then the study is carried out in two positions (anteroposterior and lateral).

This approach is used in order not to miss a small focus of infiltration. It can not be seen on a direct roentgenogram, and on the lateral infiltrate it is well traced, since it is not hidden behind the sternum. A similar situation is observed in the presence of basal edema near the roots of the lungs.

In adults, cells do not grow, so the risk of mutations under the action of chronic doses of ionizing radiation is minimal. Because of this, radiography is used as much as possible for timely diagnosis. Diseases of the chest organs are insidious and can be fatal if detected late.

Description of the radiograph of the lungs in frontal and lateral projection

We give an example of a description of a radiograph in pneumonia in two projections by a radiologist.

On the presented X-ray of the chest organs in the direct and lateral projection, a mid-focal infiltrative shadow (up to 0.6 cm) is visualized in the region of the apex of the right lung. A path departs from it to the right root (due to lymphangitis). In the picture in the right lateral projection, additional small-focal shadows are traced in S1 and S2. The contours of the diaphragm and sinuses without pathological changes. Heart shadow of the usual configuration.

Conclusion: x-ray signs of infiltrative tuberculosis S1-S2 of the right lung. A consultation with a phthisiatrician is recommended.

Disease history. Patient Zh. turned to the therapist with complaints of a hacking cough that does not go away after taking expectorants (bromhexine, ambroxol). The secretion of sputum is accompanied by streaks of blood.

Auscultatory: rales in the upper and lower lobe of the right lung. General blood test is normal. Biochemical study - an increase in the level of liver enzymes (AlAt, AsAt).

The deciphering of the radiograph (described above) indicated tuberculosis. The diagnosis was confirmed by a phthisiatrician - infiltrative tuberculosis of the upper lobe of the right lung.

Any opinion of our doctors is not a call to action before consulting a personal doctor!

Radiography, unlike fluorography, is characterized by a stronger exposure of the patient. Performed for diagnostic purposes. Fluorography is a preventive examination.

Chest x-ray and fluorography: similarities and differences

Classical chest x-ray is performed in the posterior-anterior projection. The size of an object on an x-ray is determined by the distance between the radiation source and the patient.

X-ray and scheme for displaying normal anatomical structures in the picture

The size of the image of the heart, lung fields, ribs, clavicles in the radiography of bedridden patients in intensive care units is somewhat distorted. The study is carried out by mobile devices, which have limited exposure modes.

Factors leading to an increase in blood vessels, the heart when lying down: The level of the diaphragm rises;
The redistribution of blood flow in the cardiovascular system contributes to the strengthening of the pulmonary pattern, the expansion of the left heart;
A short focal length increases the volume of the image in the picture.

What should be described on a chest x-ray

When analyzing a radiograph of the lungs, the radiologist should analyze the following anatomical structures:

1. Caliber of pulmonary vessels;
2. Cardio-thoracic index;
3. Diaphragm location;
4. The state of the costophrenic sinuses;
5. Lung fields;
6. Osteo-articular system;
7. Surrounding soft tissues.

Physiologically, the blood filling of the vessels is stronger in the lower parts of the lung fields due to the pressure gradient. If you take a picture of a person who is standing on his head, the blood supply to the upper pulmonary lobes increases on both sides.

In patients with venous plethora in heart failure, the caliber of the vessels in the upper lung fields increases. At the same time, there is an increase in the lung pattern in the roots.

When describing an x-ray image of the chest cavity, the radiologist should take into account the plethora of the vessels of the upper lobes when exposed in the supine position. When taking a picture on exhalation, an expansion, an elevation of the shadow of the heart is traced. The diaphragm is slightly raised. Enhanced pulmonary pattern of the upper lung fields.

To improve the quality of chest x-rays in bedridden patients, a screening grid should be installed together with the cassette. The device is able to eliminate the distortion of x-rays, which is obtained due to the difficulty of perfectly maintaining the sagittal plane between the surface of the patient's body and the path of the x-rays.

Chest x-ray for verification of heart disease

The use of X-ray to study the state of the heart is losing relevance due to the use of more technological diagnostic solutions. Modern ultrasound devices make it possible to study not only the state of the myocardium, but also the internal structure of the heart cavities. Dopplerography indicates the nature of the movement of blood.

When describing an x-ray of the lungs, the radiologist first sees the heart shadow. The specialist must indicate the presence of pathology in order to diagnose heart disease at an early stage.

The standard for cardiac shadow analysis involves the measurement of the cardio-thoracic index. The indicator evaluates the ratio of the transverse size of the heart (the most extreme points are marked in the image) to the length of the anterior chest aperture. In adults, the normal value does not exceed 0.5.

In children, the ratio is slightly higher due to anatomical features. In a child under 1 year old, the cardio-thoracic index should not exceed 0.65.

The need to describe the heart by radiologists justifies the possibility of early verification of the pathology. Fluorography should be carried out by every adult 1 time per year according to the law. Every year, a radiologist examines almost all patients assigned to a medical institution. The specialist has the ability to establish an early diagnosis. Of course, the purpose of an x-ray examination is somewhat different, but one should not forget about the cardio-thoracic index.

Information for radiologists

When a cardiac shadow is detected in the middle part of the right lung, it becomes necessary to establish the localization of infiltration. The question can be solved by performing an x-ray in the right lateral projection, but there is a simpler practical observation. If, against the background of infiltrative darkening, the right contour of the heart is traced, the pathology in the upper segments of the lower lobe of the right is easy. If the darkening and the contour of the heart shadow merge, the middle lobe is affected.

Fluorography - what is it

Fluorographic is a preventive X-ray examination, intended primarily for the early detection of tuberculosis. Of course, during screening studies, other nosological forms are visualized in the pictures - pneumonia, cancer.

The main purpose of fluorography is the detection of tuberculosis. It was for these purposes that a mass annual screening examination of all people was introduced once a year, except for children.

Patients ask - "is it possible to do an x-ray of the lungs instead of fluorography." The answer is ambiguous. A fluorographic examination using modern digital equipment leads to a decrease in the patient's radiation exposure by 100 times less than with classical radiography of the chest organs. This effect is achieved by the unique technology of digital fluorographs. To scan the lungs, such devices use a thin beam of x-rays that linearly pass through the entire chest cavity of the patient.

In traditional radiography, the image on the film is obtained after the X-ray tube emits a large quantum of ionizing radiation. If suspicious shadows are detected on the fluorogram, the patient is sent for an x-ray of the lungs in two projections. Fluorography is characterized by a lower resolution compared to conventional X-ray examination. The rationality of the type of examination in both cases is determined by the attending physician.

Normal X-ray of the lungs - what shows

When describing a normal x-ray of the lungs, doctors do not pay attention to changes in the pleura, although in some tumors the pleural sheets are affected in the first place.

A photograph of the lungs in a lateral projection and a diagram showing the anatomical structures in the picture

The thickness of the pleural lung sheet is 0.2-04 mm, which makes it impossible to visualize it on an x-ray. Normally, pleural sheets are displayed as a thin strip only in those places where x-rays pass tangentially. In the picture, you can sometimes trace a linear shadow in the upper lobes, formed by pleural sheets.

Anatomically, in some people, pleural sheets are mistaken for pathological thickening, which can be clearly seen in the posterior-anterior projection. The wavy contour of the formation is due to the intercostal spaces. Such changes should be considered a normal X-ray picture. Accompanying stripes are observed along the ribs. A thin line above the clavicle is formed by a fold of the skin of the organ.

A separate shadow in the picture is formed by the sternocleidomastoid muscle. These formations must be clearly distinguished by the radiologist from pathological opacities.

Pathological thickening of the pleura on radiography of the pleural sheets is classified into widespread or focal. Causes of the condition:

traumatic;
Inflammatory;
Malignant.

Areas of thickening are well seen in the posteroanterior projection due to the tangential direction of the beam.

Calcifications of pleural sheets are localized on the anterior or posterior wall. They cannot be mistaken for intrapulmonary formations. For differential diagnosis and localization, radiography should be performed in two projections.

You should be wary if there is a limited shadow of more than 1 cm in diameter. To differentiate the affected leaf, a fluoroscopic examination should be performed. If the formation is located on the visceral pleura, it moves after the lungs. When the shadow is localized on the parietal pleura, there is a shift of darkening after the ribs.

Computed tomography is prescribed for thickening of the pleura more than 3 mm. Fibrous changes often affect the visceral layer. Primary fibrosis (proliferation of granulation tissue) does not pose a threat to human life and health.

There are primary tumors of the pleura, but more often secondary neoplasms are detected - metastases in cancer of the ovaries, breast, colon, kidneys. When sprouting into the pleural cavity, accumulation of fluid in the pleural cavity is possible.

Pleural mesothelioma is a primary malignant tumor that occurs against the background of asbestosis lesions of the pleural sheet. On the radiograph, the formation can be traced in the form of nodular thickenings, localized along the edge of the mediastinum or lungs. The tumor can come in contact with the diaphragm or be localized. In advanced cases, malignancy can damage the pericardium. In pathology, there is a pronounced thickening of the pleura, effusion in the costophrenic sinus.

For differential diagnosis between fibrous changes in the pleura and mesothelioma, densitometry is used. The method allows you to determine the density of the tissue. With a tumor, the density of pleural sheets increases to 80 HU (with fibrosis - 40 HU).

When analyzing a normal radiograph of the lungs, in addition to the pleura, it is necessary to analyze the symmetry of the lung fields. Changes in transparency, abnormal darkening are a sign of pathology.

Unilateral enhancement of transparency occurs after mastectomy, excision of the cervical lymph nodes, chest wall hematoma, unilateral muscle atrophy.

The accumulation of air in the soft tissues of the chest is a sign of a rupture of the lung or soft tissues after an injury. Pneumothorax is well seen on a direct roentgenogram.

With an x-ray, bone structures should be carefully examined for metastases. An increase in the contour of the bone with external periostitis requires additional diagnosis using CT.

X-ray and diagram showing the anatomical structures of the cardiovascular system

This information cannot be used for self-treatment!
Be sure to consult with a specialist!

What is the essence of fluorography?

Fluorography is one of the methods for diagnosing the pathology of the chest organs, based on the use of x-rays passing through the human body. Due to their uneven absorption by various tissue structures, an image appears on the screen, which is transferred to a small-sized photographic film. Today, in clinical practice, specialists use two types of fluorography: digital and film. Recently, the digital method has been used much more often, since it can significantly reduce the radiation load on the human body and simplify image decoding.

In most cases, fluorography is prescribed as a preventive measure to detect lung diseases in the early stages. Fluorography allows you to see the presence or absence of signs of such dangerous diseases as sarcoidosis, tuberculosis, malignant tumors. If during the procedure the doctor sees pathological changes in the tissues of the lungs during the procedure, he will definitely prescribe an additional X-ray examination to the patient to clarify the diagnosis.

Indications for chest x-ray

Fluorography together with chest X-ray is prescribed in the following cases: to identify the causes of cough and shortness of breath, to diagnose lung diseases (tuberculosis, cancer, pneumothorax, cystic fibrosis, pulmonary edema, chronic obstructive disease). Doctors of various specialties use the results of fluorography to diagnose heart diseases, to assess the consequences of chest injuries and detect rib fractures, to visualize foreign bodies in the trachea, bronchi, esophagus and stomach, to assess the correct location of the tubes for intubation in the airways.

How is the research done?

Fluorography of the chest organs is an absolutely painless procedure that does not require any preliminary preparation. The only contraindication in this case is pregnancy. In some cases, the study is not carried out due to the presence of concomitant serious diseases in the patient. Do not prescribe this study to children under 14 years of age.

Chest x-ray is performed on a special apparatus with the patient in a standing position. Before the procedure, all metal objects must be removed from the neck and chest. To obtain a clear image, the doctor will ask you to hold your breath for a few seconds.

What does the study show?

After the examination, the specialist deciphers the obtained images. On them, you can see blackouts in the lungs, indicating inflammation, tumor development, the presence of a tuberculous focus.

Fluorography of the chest organs makes it possible to see and evaluate the structure and size of the heart. The expansion of its boundaries may indicate, for example, the presence of hypertension, as a result of which, due to prolonged overloads, the myocardium has increased in volume.

Radiography or fluorography - which is better?

Both of these methods are considered to be of sufficient quality to detect the pathology of the chest organs. They differ in the dose of radiation and the resolution of the obtained images.

During fluorography, the radiation exposure is low, but the image is not of sufficient quality for accurate diagnosis. According to the fluorogram, the presence of a pathology can be assumed, which then will need to be confirmed or excluded using an x-ray examination.

Due to the rather high radiation load, radiography cannot be used for preventive examinations of the entire population. Therefore, if you do not have diseases of the chest organs, it is better to undergo a fluorography. If you suspect the presence of a pathology, it would be more rational to perform an x-ray.

In two projections, it is carried out for suspected diseases. There are 2 types of X-ray examinations - diagnostic and preventive. The second option is fluorography. It is carried out for a mass examination of the population in order to identify diseases.
Direct and lateral radiography (2nd projection) is performed for a thorough examination of the chest for suspected pneumonia, tuberculosis and cancerous tumors.

X-ray of the lungs in two projections - indications and contraindications

X-ray of the chest in 2 projections - indications:
1. Inflammation of the alveoli of the lungs (pneumonia);
2. Tuberculosis of the lung fields;
3. Peripheral and central cancer;
4. Diseases of the pleural cavity (pleurisy);
5. Cysts and abscesses;
6. Determining the size of the heart;
7. Evaluation of airiness;
8. Identification of pneumothorax (air of the pleural cavity).

The list goes on longer, but the diseases described above are studied with the help of x-rays as often as possible.

Radiography in frontal and lateral projections

For any examination of the lungs, a frontal radiograph is always performed. The image in the lateral position is performed at the request of the radiologist.

What shadows does a direct x-ray of the chest organs show:

Increased airiness of the lung fields with emphysema;
- Intense darkening with pneumonia or tuberculosis;
- Violation of the innervation of the diaphragm (relaxation of the dome);
- Deformation, strengthening or thickening of the lung pattern;
- Expansion of the heart;
- Fall of lung tissue - atelectasis;
- Pathology of bone and soft tissue.

In the region of the pulmonary lobes, ring-shaped cavity formations are noted.

White stripes in the lower pleural region.

Differences between fluorography and radiography

Fluorography is useful in detecting abnormal changes in the lungs at an early stage. After it, if a disease is suspected, an x-ray of the lungs is prescribed in two projections: direct and lateral. The main difference between these methods is that radiography gives a brighter and clearer picture of what is happening in the chest.

Why, then, use fluorography, if the x-ray shows the results more accurately? Firstly, a fluorographic examination has a lower exposure coefficient. Secondly, it is less costly for the budget of hospitals.

Features of fluorography

With frequent x-rays, the body runs the risk of earning an overload of harmful radiation. Fluorography is a diagnostic method for monitoring the health of the lungs, which is shown to every person. These measures are relevant for countries where the number of patients with tuberculosis and oncological diseases is higher. The Commonwealth of Independent States is first on this list. With the same fluorography, more accurate research methods, such as MRI, CT and digital radiography, have long been replaced.

There is a difference between fluorography and preventive chest x-ray:

- On fluorographic images, only the outlines of the shadows of anomalous formations are visible.
X-rays are obtained in the best resolution.
With x-rays, the patient is irradiated 10 times stronger than with fluorography.
Fluorography is not done to children under 16 years of age.
During x-rays, radiation is received not only by the lungs, but also by the nearest organs.

To whom are x-rays and fluorography contraindicated? Since the principle underlying the acquisition of a picture is the same for both procedures, the same categories of people fall under contraindications. First of all, these are pregnant women, children under 16 years of age, patients with cancer in the last stage, who have earned radiation sickness, and people with low immunity.

Which of the procedures is preferable?

There is no definite answer to this question. The procedures complement each other. For example, suspicious blackouts were detected during fluorography, but it is impossible to say exactly why they appeared due to a blurry image. In such cases, to confirm the diagnosis, an x-ray is performed, which allows you to get clear pictures with a detailed image of the pathology.

How often can I have x-rays and x-rays?

Undoubtedly, radiography involves some radiation exposure to the body, so it is prescribed only in cases of urgent need. There are situations when the patient is obliged to constantly take pictures for the purpose of diagnosis. At the same time, doctors are guided by the following rule: the benefits obtained from x-rays should be higher than the risks and consequences.

Fluorography is carried out only once a year for the purpose of preventive examination. Sometimes it is prescribed for a preview of the lungs, with suspicion of pneumonia or other inflammatory processes.

Radiography, unlike fluorography, is characterized by a stronger exposure of the patient. Performed for diagnostic purposes. Fluorography is a preventive examination.

Chest x-ray and fluorography: similarities and differences

Classical chest x-ray is performed in the posterior-anterior projection. The size of an object on an x-ray is determined by the distance between the radiation source and the patient.

X-ray and scheme for displaying normal anatomical structures in the picture

What should be described on a chest x-ray

When analyzing a radiograph of the lungs, the radiologist should analyze the following anatomical structures:

1. Caliber of pulmonary vessels;
2. Cardio-thoracic index;
3. Diaphragm location;
4. The state of the costophrenic sinuses;
5. Lung fields;
6. Osteo-articular system;
7. Surrounding soft tissues.

In patients with venous plethora in heart failure, the caliber of the vessels in the upper lung fields increases. At the same time, there is an increase in the lung pattern in the roots.

Chest x-ray for verification of heart disease

When describing an x-ray of the lungs, the radiologist first sees the heart shadow. The specialist must indicate the presence of pathology in order to diagnose heart disease at an early stage.

In children, the ratio is somewhat larger due to anatomical features. In a child under 1 year old, the cardio-thoracic index should not exceed 0.65.

Information for radiologists

Fluorography - what is it

The main purpose of fluorography is the detection of tuberculosis. It was for these purposes that a mass annual screening examination of all people was introduced once a year, except for children.

Normal X-ray of the lungs - what shows

When describing a normal x-ray of the lungs, doctors do not pay attention to changes in the pleura, although in some tumors the pleural sheets are affected in the first place.

A photograph of the lungs in a lateral projection and a diagram showing the anatomical structures in the picture

A separate shadow in the picture is formed by the sternocleidomastoid muscle. These formations must be clearly distinguished by the radiologist from pathological opacities.

Pathological thickening of the pleura on radiography of the pleural sheets is classified into widespread or focal. Causes of the condition:

traumatic;
Inflammatory;
Malignant.

Areas of thickening are well seen in the posteroanterior projection due to the tangential direction of the beam.

Pleural mesothelioma is a primary malignant tumor that occurs against the background of asbestos lesions of the pleural sheet. On the radiograph, the formation can be traced in the form of nodular thickenings, localized along the edge of the mediastinum or lungs. The tumor can come in contact with the diaphragm or be localized. In advanced cases, malignancy can damage the pericardium. In pathology, there is a pronounced thickening of the pleura, effusion in the costophrenic sinus.

Unilateral enhancement of transparency occurs after mastectomy, excision of the cervical lymph nodes, chest wall hematoma, unilateral muscle atrophy.

The accumulation of air in the soft tissues of the chest is a sign of a rupture of the lung or soft tissues after an injury. Pneumothorax is well seen on a direct roentgenogram.

With an x-ray, bone structures should be carefully examined for metastases. An increase in the contour of the bone with external periostitis requires additional diagnosis using CT.

X-ray and diagram showing the anatomical structures of the cardiovascular system

An x-ray of the lungs in two projections is performed if a disease is suspected. There are 2 types of X-ray examinations - diagnostic and preventive. The second option is fluorography. It is carried out for a mass examination of the population in order to identify diseases.
Direct and lateral radiography (2nd projection) is performed for a thorough examination of the chest for suspected pneumonia, tuberculosis and cancerous tumors.

X-ray of the lungs in two projections - indications and contraindications

The list goes on longer, but the diseases described above are studied with the help of x-rays as often as possible.

Radiography in frontal and lateral projections

For any examination of the lungs, a frontal radiograph is always performed. The image in the lateral position is performed at the request of the radiologist.

Planar images of radiologically examined objects, obtained by X-ray or fluoroscopy, depend on the direction of the main, or central, beam of X-rays to one or another plane of the object of study.

In X-ray diagnostics, as in anatomy, there are three main, or main, planes of study in relation to a person who is in a vertical position: sagittal, frontal and horizontal.

The sagittal plane, passing from front to back, is called the median, or median. It divides the human body into two symmetrical mirror-opposite halves. All other sagittal planes are parallel to the median and pass to the right or left of it. The frontal planes are parallel to the plane of the forehead and perpendicular to the median plane. They divide the human body into two parts - anterior and posterior. Thus, both planes - sagittal and frontal - are vertical and perpendicular to one another. The horizontal plane is perpendicular to both vertical planes.

In relation to the head - one of the most difficult objects of X-ray examination - it is customary to draw the sagittal plane along the swept (sagittal) suture; frontal - anterior to the external auditory canals through the base of the zygomatic arches and horizontal - through the lower edges of the orbits and external auditory canals.

With the sagittal direction of the rays perpendicular to the surface of the body, a frontal projection is obtained. Depending on which surface of the object under study is adjacent to the film or screen, a frontal frontal projection (when the front surface of the object under study is adjacent to the film) and a rear frontal projection (in which the rear surface of the object is adjacent to the film) are distinguished.

When the rays pass in the frontal plane, a sagittal projection is obtained - right or left, also depending on the position of one or another side of the object in relation to the film. Frontal projections are usually called direct (anterior or posterior), and sagittal - lateral (right or left).

Obtaining horizontal projections requires directing the central beam of rays along the long axis of the body. Such projections are also called axial.

In addition to direct projections formed when the central beam of rays is perpendicular to the body of the subject, there are oblique projections obtained by tilting the x-ray tube to the right or left side of the body, as well as in the cranial or caudal directions. Oblique projections can also be obtained with an appropriate rotation or tilt of the subject.

The correct choice of one or another projection in X-ray diagnostics serves to obtain the most complete picture of the organ or anatomical formation under study. Naturally, the most complete representation is created when examining an object in three main mutually perpendicular projections: frontal, sagittal, and horizontal. However, due to the topographic and anatomical features of most internal organs (stomach, liver, heart and large vessels), some large joints (knee, hip), dentoalveolar apparatus and intracranial anatomical formations (for example, optic nerve canals), obtaining an x-ray image in all major projections of the study is often impossible . In these cases, a three-dimensional representation of the organ under study (for example, internal) is facilitated by multi-projection transillumination, carried out by slowly rotating the object under study around its axis in front of the X-ray screen.

The greatest difficulties arise when it is necessary to obtain horizontal projections. In these cases, you can resort to transverse tomography. In those cases when the study in standard projections is not feasible or does not provide the necessary diagnostic data, resort to additional, or so-called atypical, projections, with the aim of obtaining missing data by identifying the corresponding anatomical structures as a result of the use of various, sometimes complex styling or installations. of the object under study in relation to the X-ray tube and film (for example, the so-called tangential projections with the direction of the central beam tangential to the object being filmed, used in the study of flat bones of the skull and soft tissues of the head, in the study of the interscapular region and in a number of other cases). Sometimes it is useful to take pictures in tangential projections after preliminary installation of the object under study under the control of a translucent screen. Often, only a tangential projection can establish the localization of the pathological substrate, as well as the intra- or extracranial, intra- or extrathoracic, intra- or extracardiac location of the foreign body. In atypical projections, aimed shots are usually also produced.

In general, the division of projections into standard and atypical is very conditional and is used only according to the established tradition. Considering the breadth and completeness of x-ray information, oblique projections for examining the organs of the chest cavity can rightfully be classified as standard projections, the use of which is mandatory, as well as the use of anterior, posterior and lateral ones. For the same reasons, many special projections proposed by various authors for the study of complex objects can be considered standard, for example, images of the tops of the lungs according to Prozorov, the study of the interlobar space according to Fleischner, images of the optic nerve canals according to Reza, images of the temporal bones according to Schüller, Stenvers, Mayer and others

The essential difference between standard (generally accepted) projections and atypical (special) ones, in particular those used for aimed images, is that certain technical requirements are imposed on standard projections, according to which they can be performed by radiologist assistants.

Special projections are used during the implementation of an individual patient examination plan, depending on the clinical data reported to the radiologist by the attending physician, or on the need to obtain additional data or clarify specific issues that arise as a result of research in standard projections. In these cases, the choice of the necessary special projection is determined by the radiologist and is carried out personally by him or by assistants on his instructions and under his control.

The different nature of the absorption of X-rays by different tissues located in certain (same) anatomical areas requires the need to individualize the technical conditions for imaging, depending on which organs or tissues are to be examined. So, for example, under the same projection conditions for studying the organs of the chest cavity and the skeleton of the chest in the anterior position, to reveal the structure of the skeleton, the exposure should be increased by about 4 times compared to the exposure required for a picture of the lungs or heart. Approximately the same exposure ratios are formed with radiography of the neck in a lateral projection, depending on whether the larynx and trachea or the cervical spine are being examined.

The best projection of the study in each individual case should be considered the one that provides the most convincing and complete data necessary for X-ray diagnostics.

Hence, for the radiologist and his assistants, it becomes necessary to study projections during X-ray examination in order to learn how to accurately reproduce them during repeated examination in the process of dynamic observation or, if necessary, a comparative assessment of the affected and unaffected organ or anatomical formation.

Often, only the same and, moreover, generally accepted projection image on an x-ray image, for example, both temporal bones, both canals of the optic nerves, or a number of other paired anatomical structures, can provide a basis for establishing the presence or absence of a lesion, if we are talking about a unilateral pathological process. .

Planar x-ray images, even in standard projections, although they create a familiar idea of the anatomical substrate of the objects under study, however, due to the summation effect due to the superimposition of shadows of some anatomical structures on others and projection distortions, depending on one or another degree of removal of the object from the focus of the tube and from the film, create an x-ray picture that is only approximate, but far from identical to the natural anatomical picture. This applies even more to many atypical projections.

The systematic study of anatomical regions, organs and formations in their x-ray images under various projection conditions of the study and the comparison of x-ray pictures with natural anatomical ones contribute to the development of spatial representations that provide unmistakable recognition of the projection conditions of the study, and the ability to translate shadow x-ray pictures into the language of normal and pathological generally accepted by doctors. anatomy. Knowledge of the projections used in X-ray diagnostics, the ability to accurately reproduce them and correctly analyze X-ray data presented depending on one or another projection of the study, characterize the high qualification of the radiologist and provide maximum diagnostic results with a minimum number of studies. The latter, along with careful observance of radiation protection measures (reasonable limitation of the irradiation field and the use of protective equipment), helps to reduce the harmful effects of unused X-ray radiation on patients and staff.

For the convenience and speed of installing the tube in a certain position, the stands of modern x-ray machines are equipped with appropriate linear measuring scales and goniometers, as well as devices for fixing patients.

On fig. 1-57 shows a schematic representation of the laying and installation of the subject, used to obtain the most common projections in the areas of the body.

Projections of the head (fig. 1-14): fig. 1 - straight back; rice. 2 - straight front; rice. 3 - right side; rice. 4 and 5 - chin; rice. 6 - axial chin; rice. 7 - axial parietal; rice. 8 - right lateral for nasal bones; rice. 9 - right side for the lower jaw; rice. 10 - aimed at the chin area, lower jaw and teeth; rice. 11 - comparative for jaw joints; rice. 12 - special for the optic nerve canal (according to Reza); rice. 13 - right side for the nasopharynx; rice. 14 - axial for the teeth of the lower jaw and for the sublingual salivary gland. Projections of the neck (Fig. 15-18): fig. 15 - posterior straight line for the lower cervical vertebrae; rice. 16 - posterior straight line for the upper cervical vertebrae; rice. 17 - right side for the cervical vertebrae; rice. 18 - right side for the larynx and trachea.

Projections of the chest (Fig. 19-23): fig. 19 - straight front for the chest; rice. 20 - left side for the chest and spine; rice. 21 - right side for the heart, esophagus, sternum and spine; rice. 22 - right oblique for the heart, esophagus, sternum and spine (I oblique position); rice. 23 - right side for the sternum. Projections of the abdomen (Fig. 24-29): fig. 24 - straight back for the kidneys and ureters; rice. 25 - anterior for the gallbladder; rice. 26 - front for the stomach and intestines; rice. 27 - right side for the stomach and spine; rice. 28 - straight back for the spine; rice. 29 - left side for the spine.

Projections of the shoulder girdle and upper limb (Fig. 30-39); rice. 30 - straight back for the right shoulder girdle (shoulder joint, collarbone and shoulder blade); rice. 31 - axial for the right shoulder joint; rice. 32 - tangential (oblique) for the left shoulder blade; rice. 33 - straight back for the humerus; 34 - straight back for the elbow joint; rice. 35 - lateral for the humerus and elbow joint; rice. 36 - back for the forearm; rice. 37 - lateral for the forearm; rice. 38 - direct palmar for the wrist joint and hand; rice. 39 - lateral for the wrist joint and hand.

Projections of the pelvic girdle and lower limb (Fig. 40-57): fig. 40 - straight back for the pelvis; rice. 41 - axial for the small pelvis; rice. 42 - straight anterior for the pubic bones and pubic articulation; rice. 43 - straight back for the sacrum and coccyx; rice. 44 - left side for the sacrum and coccyx; rice. 45 - straight back for the right hip joint; rice. 46 and 49 - lateral for the right thigh; rice. 47 - lateral for the left thigh; rice. 48 - straight back for the right thigh; rice. 50 - straight back for the knee joint; rice. 51 - lateral external for the knee joint; rice. 52 - straight back for the right lower leg; rice. 53 - lateral outer for the right lower leg; rice. 54 - straight back for the right ankle joint; rice. 55 - direct plantar for the right foot; rice. 56 - lateral outer for the right foot; rice. 57 - axial for the calcaneus.