Chapter 2. Fundamentals and Clinical Application of the X-ray Diagnostic Method

Chapter 2. Fundamentals and Clinical Application of the X-ray Diagnostic Method

For more than 100 years, the rays of a special kind, which occupy most of the spectrum of electromagnetic waves have been known. On November 8, 1895, Professor of Physics of the Würzburg University Wilhelm Konrad X-ray (1845-1923) drew attention to an amazing phenomenon. Studying in its laboratory, the operation of the electrovacuum (cathode) tube, he noticed that when the high voltage current is supplied to its electrodes, the platinum-sinted barium located near the platoch-sinerodystone began to emit a greenish glow. Such a glow of luminescent substances under the influence of cathode rays emanating from an electrovacuum tube was already known by that time. However, on the X-ray table, the tube during experience was tightly wrapped in black paper and although the platinum-sinoid barium was at a considerable distance from the tube, its glow resumed at each electric current supply to the tube (see Fig. 2.1).

Fig.2.1.Wilhelm Conrad. Fig. 2.2.Radiographic acid

X-ray (1845-1923) of wives in Khthena Berth

X-ray concluded that in the tube there are some non-known science rays that can penetrate the solid bodies and spread in the air at distances measured by meters. The first radiograph in the history of mankind was an X-ray brushes (see Fig. 2.2).

Fig. 2.3.Spectrum of electromagnetic radiation

The first preliminary message of X-ray "On the new form of the rays" was published in January 1896 in the three subsequent public reports in 1896-1897. He formulated all the properties of unknown rays identified by them and pointed to the technique of their appearance.

In the first days after the publication of the opening of the X-ray, his materials were translated into many foreign languages, including Russian. In January 1896, the University of St. Petersburg and the Military Medical Academy already in January 1896, snapshots of human limbs were performed, and later than other bodies. Soon the inventor of Radio A. S. Popov made the first domestic X-ray apparatus, which operated in the Kronstadt hospital.

X-ray among physicists in 1901 for his discovery was awarded the Nobel Prize, which was awarded to him in 1909 by the decision of the I International Congress on X-ray in 1906, X-rays were named X-ray.

For several years, specialists who dedicated themselves radiology appeared in many countries. The hospitals appeared X-ray branches and cabinets, in large cities there were scientific companies of radiologists, the corresponding departments were organized at the medical facultilities of universities.

X-ray rays are one of the types of electromagnetic waves, which in the community spectrum occupy a place between ultraviolet rays and γ-rays. They differ from radio waves, infrared radiation, visible light and ultraviolet radiation of a smaller wavelength (see Fig. 2.3).

The speed of radiation propagation is equal to the speed of light - 300,000 km / s.

Currently known the following the properties of X-rays. X-rays possess penetrating ability.X-ray reported that the ability of rays to penetration through various environments

proportional to the specific weight of these environments. Due to the low wavelength, X-rays can penetrate through objects that are impenetrable for visible light.

X-rays are capable absorbate and dissipate.When absorbing, some X-ray rays with the greatest wavelength disappears, fully transmitting its energy to the substance. When scattered, part of the rays deviates from the initial direction. Scattered X-ray radiation does not bear useful information. Part of the rays completely passes through the object with a change in its characteristics. Thus, an invisible image is formed.

X-rays, passing through some substances, cause them fluorescence (glow).Substances possessing this property are called phosphors and are widely used in radiology (x-ray, fluorography).

X-rays are rendered photochemical action.As well as visible light, falling into a photographic emulsion, they affect the silver nidget, causing a chemical reaction of silver recovery. This is based on the registration of the image on photosensitive materials.

X-rays cause ionization of the substance.

X-rays are rendered biological actionassociated with their ionizing ability.

X-rays spread out straighttherefore, the X-ray image always repeats the form of the object under study.

X-rays are peculiar polarization- distribution in a certain plane.

Diffraction and interferenceinherent in X-rays, as well as other electromagnetic waves. On these properties, X-ray ropes and X-ray structural analysis are based.

X-rays invisible.

The composition of any X-ray diagnostic system includes 3 main components: an X-ray tube, a study object (patient) and a radiation receiver.

X-ray tubeit consists of two electrodes (anode and cathode) and a glass flask (Fig. 2.4).

When the flow current is supplied to the cathode, its spiral thread is heated strongly (heated). There is a cloud of free electrons around it (the phenomenon of thermoelectronic emission). Once the potential difference arises between the cathode and the anode, the free electrons rush to the anode. The speed of the electron movement is directly proportional to the voltage value. When braking electrons in the substance anode, part of their kinetic energy goes to the formation of X-rays. These rays are freely outside the X-ray tube and distributed in different directions.

X-ray rays depending on the method of occurrence are divided into primary (peeling rays) and secondary (rays characteristic).

Fig. 2.4.Circuit diagram of the X-ray tube: 1 - cathode; 2 - anode; 3 - glass flask; 4 - electron flow; 5 - X-ray bundle

Primary rays.Electrons depending on the direction of the main transformer can be moved to X-ray tubes with different speeds approaching with the highest voltage to the speed of light. When hitting the anode, or, as they say, when braking, the kinetic electron flight energy is converted to a majority in thermal energy, which heats the anode. A smaller part of the kinetic energy is converted to the X-rays of braking. The wavelength of braking radiation depends on the flight speed of the electrons: how it is more, the larger the wave is less. The penetrating ability of the rays depends on the wavelength (than the wave in short, the greater the penetrating ability).

By changing the voltage of the transformer, you can adjust the speed of the electrons and receive either heavily penetrating (the so-called hard), or weakly penetrating (so-called soft) X-rays.

Secondary (characteristic) rays.They arise in the process of braking electrons, but the length of their waves depends solely on the structure of the anode substance atoms.

The fact is that the electron flight energy in the tube can achieve such values \u200b\u200bthat, with shutters of electrons, the anode will be released enough to force the electrons of the internal orbits of the atoms of the anode anode to "leap" to external orbits. In such cases, the atom returns to its state, because with the external orbits there will be an electron transition to free internal orbits with energy release. An excited atom of the anode substance returns to the state of rest. Characteristic radiation occurs as a result of changes in the inner electronic layers of atoms. Layers of electrons in the atom are strictly defined

for each element and depend on its place in the periodic Mendeleev system. Consequently, the secondary rays obtained from this atom will have a waves of a strictly defined length, so these rays are called characteristic.

The formation of an electron cloud on the helix of the cathode, flight of electrons to the anode and the production of X-rays is possible only under vacuum conditions. To create it and serves flask X-ray tubefrom durable glass capable of passing X-rays.

As x-ray receiverscan perform: X-ray film, selenium plate, fluorescent screen, as well as special detectors (with digital methods for obtaining an image).

X-ray research techniques

All numerous radiological research techniques are divided into generaland special.

TO commonmethods intended to study any anatomical areas and performed on general-purpose X-ray devices (X-ray and radiography).

A number of methods under which are also considered to study any anatomical areas, but either special equipment (fluorography, radiography with direct increase in the image), or additional adaptations to conventional X-ray devices (tomography, electric power). Sometimes these techniques are also called private.

TO specialthe methods include those that allow us to obtain an image on special installations intended for the study of certain organs and regions (mammography, orthopantography). Special methods also include a large group of X-ray-traus research, in which images are obtained using artificial contrast (bronchography, angiography, excretory urography, etc.).

General methods of x-ray research

Radioscopy.- The study technique in which the image of the object is obtained on a luminous (fluorescent) screen real-time. Some substances are intensely fluoressed under the influence of X-ray rays. This fluorescence is used in x-ray diagnostics, applying cardboard screens covered with fluorescent substance.

The patient is installed (laid) at a special tripod. X-rays, passing through the body of the patient (the area of \u200b\u200binterest to the researcher), fall on the screen and cause its glow - fluorescence. The fluorescence of the screen is not the same intense - it is brighter, the more x-rays fall into a particular point of the screen. On screen

the less rays falls, the more dense obstacles will be on their way from the tube to the screen (for example, bone tissue), as well as the thicker of the tissue through which the rays pass.

The fluorescent screen glow is very weak, so the x-ray was carried out in the dark. The image on the screen was poorly distinguishable, small parts were not differentiated, and the radiation load with this study was rather high.

As an improved X-ray method, x-ray-disposal translucent using an X-ray amplifier is an electron-optical converter (EEA) and a closed television system. In the eop, the visible image on the fluorescent screen is amplified, converted to an electrical signal and is displayed on the display screen.

X-ray image on display, like the usual television image, can be studied in a lit room. The radiation load on the patient and the staff with the use of EOP is significantly less. TeleSystem allows you to record all the stages of the study, including the movement of the organs. In addition, on the TV channel, the image can be transferred to monitors located in other rooms.

With an x-ray examination, a positive plane black and white comprehensive image is formed real-time. When the patient is moved relative to the X-ray radiator, they say the polyposition, and when the X-ray emitter is moved relative to the patient - about a polyperation study; Both allows you to get more complete information about the pathological process.

However, radioscopy, both with the EUC, and without it, is characterized by a number of disadvantages that narrow the scope of application of the method. First, the radiation load during radioscopy remains relatively high (much higher than when radiography). Secondly, the technique has a low spatial resolution (the ability to consider and evaluate small parts lower than when radiography). In connection with this, the x-ray is advisable to supplement the production of snapshots. It is also necessary to objectify the results of the study and the possibility of their comparison with a dynamic observation of the patient.

Radiography- This is a method of x-ray research in which a static image of an object, recorded on a carrier of information, is obtained. Such carriers can be X-ray film, a film film, a digital detector, etc. On radiographs, you can get an image of any anatomical area. Snapshots of the whole anatomical area (head, chest, stomach) are called overview(Fig. 2.5). Pictures depicting a small part of the anatomical area that most interests the doctor, called victory(Fig. 2.6).

Some organs are well distinguishable in the pictures due to the natural contrast (lungs, bones) (see Fig. 2.7); Other (stomach, intestines) are clearly displayed on radiographs only after artificial contrast (see Fig. 2.8).

Fig. 2.5.Overview radiograph of the lumbar spine in lateral projection. Compression but-OS-ring body fracture L1 vertebra

Fig. 2.6.

Aiming radiograph L1 vertebrae in lateral projection

Passing through the object of the study, X-ray radiation is more or less detained. Where radiation is delayed more, plots are formed shading; where less - enlightenment.

X-ray image can be negativeor positive.So, for example, in the negative image of the bone look light, the air is dark, in a positive image - on the contrary.

X-ray image black and white and plane (suma-manual).

Advantages of radiography before x-ray:

Large resolution;

The possibility of assessing by many researchers and retrospective study of the image;

The possibility of long-term storage and comparison of the image with repeated pictures in the process of dynamic observation of the patient;

Reducing the radiation load on the patient.

The disadvantages of radiography include an increase in material costs in its use (X-ray film, photorectivations, etc.) and receiving the desired image is not immediately, but after a certain time.

The radiography technique is available for all therapeutic institutions and is used everywhere. X-ray devices of various types allow radiography not only in an X-ray Cabinet, but also beyond (in the ward, in the operating system, etc.), as well as in nonstationary conditions.

The development of computer equipment made it possible to develop a digital (digital) method of obtaining an X-ray image (from English. digit.- "Digit"). In digital devices, the X-ray image from the EUP enters a special device - analog-to-digital converter (ADC), in which an electrical signal that brings information about the X-ray image is encoded into a digital form. Entering then into the computer, digital information is processed in it according to predetermined programs, the choice of which depends on the tasks of the study. The transformation of the digital image into the analog, visible occurs in the digital-analog converter (DAC), the function of which is the opposite of the ADC.

The main advantages of digital radiography before the traditional: the speed of obtaining an image, the wide possibilities of its postprocessor processing (the correction of brightness and contrast, noise suppression, the electronic increase in the image of the area of \u200b\u200binterest, the preferential allocation of bone or gentle-bantle structures, etc.), the lack of a photo laboratory process and Electronic image archiving.

In addition, computerization of X-ray equipment allows you to quickly transfer images for considerable distances without loss of quality, including other medical institutions.

Fig. 2.7.Radiographs of the ankle joint in straight and lateral projections

Fig. 2.8.Radiograph of the colon, contrasted by the suspension of the barium sulfate (irrigograph). Norm

Fluorography- Photographing X-ray image from a fluorescent screen on a photographic film of various formats. Such an image is always reduced.

According to informative, fluorography is inferior to radiography, but when using large-frame fluorograms, the difference between these techniques becomes less significant. In this regard, in medical institutions in a number of patients with diseases of the respiratory organs, fluorography can replace radiography, especially with repeated studies. Such fluorography is called diagnostic.

The main purpose of the fluorography associated with the speed of its execution (to perform the fluorogram is spent by about 3 times less time than on the performance of the radiograph), are mass surveys to detect hidden lung diseases (prophylactic,or check, fluorography).

Fluorographic devices are compact, they can be mounted in the car body. This makes it possible to carry out mass examinations in areas where X-ray diagnostic equipment is absent.

Currently, film fluorography is increasingly displaced digital. The term "digital fluorographs" is to a certain extent conditional, since these devices do not photograph X-ray image on a film, that is, the fluo-rograms are not performed in the usual sense of the word. In essence, these fluorographs are digital radiographic devices intended mainly (but not exclusively) to study the organs of the chest cavity. Digital fluorography has all the advantages inherent in digital radiography in general.

Radiography with direct zoom imageit can only be used in the presence of special X-ray tubes, in which the focal spot (the area with which X-rays comes from the emitter) has very small dimensions (0.1-0.3 mm 2). The enlarged image is obtained by bringing the studied object to the X-ray tube without changing the focal length. As a result, smaller parts are visible on radiographs, indistinguishable on ordinary pictures. The technique is used in the study of peripheral bone structures (brushes, foot, etc.).

Electrodentygenography- The technique at which the diagnostic image is obtained not on the X-ray film, but on the surface of the Selena plate with the transfer on paper. Uniformly charged with static electricity, the plate is used instead of a tape with a film and, depending on the different number of ionizing radiation, which has fallen into different points of its surface, is discharged differently. A fine coal powder is sprayed on the surface of the plate, which, according to the laws of electrostatic attraction, is distributed over the surface of the plate unevenly. The plate is imposed on the papers of paper papers, and the image is translated into paper as a result of coal adhesion

powder. Selena plate, in contrast to the film, can be used repeatedly. The technique is characterized by speed, efficiency, does not require a darkened room. In addition, selenium plates in an unchargeable state are indifferent to the effects of ionizing radiation and can be used when operating under conditions of an increased radiation background (X-ray film under these conditions will be unusable).

In general, the electric agent in its informativeness is only slightly inferior to film radiography, surpassing it in the study of the bones (Fig. 2.9).

Linear tomography- Methods of layered x-ray research.

Fig. 2.9.Electric agent of ankle joint in direct projection. Fracture of Malobersian Bone

As already mentioned, an adequate image of the entire thickness of the body under study is seen on the radiograph. Tomography is used to obtain an isolated image of structures located in one plane, as it were, as it were, the calculation of the amount-§ image into separate layers.

The effect of tomography is achieved due to the continuous movement during the shooting of two or three components of the X-ray system: the X-ray tube (emitter) is the patient - the image receiver. Most often, the emitter and the image receiver are moved, and the patient is fixed. The emitter and the image receiver move along an arc, a straight line or a more complex trajectory, but necessarily in opposite directions. With this movement, the image of most parts on the tomogram turns out to be folded, vague, fuzzy, and the formation at the level of the system of rotation of the system emitter - receiver, are displayed most clearly (Fig. 2.10).

Special advantage over radiography Linear tomography acquires

when the organs are investigated with dense pathological zones formed in them, fully shadowing certain sections of the image. In some cases, it helps to determine the nature of the pathological process, clarify its localization and prevalence, identify small pathological foci and cavity (see Fig. 2.11).

Constructive tomographs are performed in the form of an additional tripod, which can automatically move the X-ray tube on the arc. When changing the level of the center of rotation, the emitter - the receiver will change the depth of the resulting cut. The thickness of the studied layer is less than the greater the amplitude of the movement mentioned above. If you choose very

small movement angle (3-5 °), then the image of a thick layer is obtained. This kind of linear tomography was named - sonography.

Linear tomography is used quite wide, especially in medical institutions that do not have computer tomographs. Most often, the indication for the performance of tomography is the disease of the lungs and mediastinum.

Special techniques

X-ray

Research

Orthopantomography- This is an embodiment of zo-niography, allowing you to obtain a disconnected plane image of the jaws (see Fig. 2.12). A separate image of each tooth is achieved by their sequential shooting by a narrow beam

Fig. 2.10.The scheme of obtaining a tomographic image: A - the object under study; b - tomographic layer; 1-3 - sequential positions of the X-ray tube and radiation receiver in the process of research

com x-rays on separate sections of the film. Conditions for this are created by synchronous circular motion around the patient's head of the X-ray tube and the image receiver installed at the opposite ends of the rotary tripod of the device. The technique allows you to explore other facial skeleton departments (otolonic sinuses, sockets).

Mammography- Radiographic study of the breast. It is performed to study the structure of the breast when seals are found in it, as well as with a prophylactic target. Dairy jelly

because is a soft body, therefore, to study its structure, it is necessary to use very small values \u200b\u200bof anodic voltage. There are special X-ray devices - mammographers, where X-ray tubes are installed with a focal spot size in a fraction of a millimeter. They are equipped with special tripods for laying breasts with a device for its compression. This allows you to reduce the thickness of the tissue of the gland during the study, thereby increasing the quality of the mammograms (see Fig. 2.13).

Methods with artificial contrasting

In order to be invisible in conventional images, the organs are displayed on radiographs, resort to the method of artificial contrast. The technique is to introduce substances into the body,

Fig. 2.11.Linear tomogram of the right lung. In the top of the lung, a large air cavity with thick walls is determined

which absorb (or, on the contrary, they pass) the radiation is much stronger (or weaker) than the organ under study.

Fig. 2.12.Ortopantomogram

As contrasting substances, substances are used or low relative density (air, oxygen, carbon dioxide, nitrogen rushing), or with a large atomic mass (suspension or solutions of heavy metal salts and halides). The first absorb X-ray to a lesser extent than the anatomical structures (negative),second - in the greater (positive).If, for example, enter the air into the abdominal cavity (artificial pneumoperitoneum), then on its background, the outlines of the liver, spleen, gallbladder, stomach are clearly distinguished.

Fig. 2.13.Radiographs of the breast in Kraniocaudal (A) and oblique (b) projections

For the study of organ cavities, high-teaching contrast agents are usually used, most often aqueous suspension of sulfate barium and iodine connections. These substances, largely delaying X-ray radiation, give an intense shadow in the pictures, according to which it is possible to judge the position of the organ, form and the magnitude of its cavity, the outlines of its inner surface.

There are two ways of artificial contrasts with high-neutheom substances. The first is to directly introduce a contrast agent into the cavity of the organ - esophagus, stomach, intestines, bronchi, blood circulatory or lymphatic vessels, urinary tract, strength kidney systems, uterus, salivary ducts, fistula strokes, face-or-spinal cord spaces, etc. d.

The second method is based on the specific ability of individual organs to concentrate those or other contrast agents. For example, liver, gallbladder and kidneys concentrate and highlight some iodine connections entered into the body. After the patient is administered to such substances in the pictures at a certain time, bile ducts differ, gallbladder, stripe kidney systems, ureterals, bladder.

The technique of artificial contrastment is currently leading with the X-ray study of most internal organs.

In X-ray practices, 3 types of radiopatrum (RCS) are used: iodine-containing soluble, gaseous, aqueous suspension of barium sulfate. The main means for the study of the gastrointestinal tract is the water suspension of barium sulfate. To study the blood vessels, the cavities of the heart, urinary tract use water-soluble iodine-containing substances that are introduced either intras and tried or in the organ cavity. Gases as contrasting agents are currently almost not used.

When choosing contrast agents for conducting research of the RCC, it is necessary to evaluate from the position of the severity of the contrasting effect and harmlessness.

The harmlessness of the RCC in addition to mandatory biological and chemical inertia depends on their physical characteristics, of which osmolarity and electrical activity are the most significant. Os-molar is determined by the number of ions or RCS molecules in the solution. Regarding blood plasma, the osmolarity of which is 280 moss / kg H 2 O, the contrast agents can be highly graded (more than 1200 mosm / kg H 2 O), low-grain (less than 1200 mos / kg H 2 o) or isosmolar (by osmolarity equal blood) .

High osmolarity adversely affects endotheliums, erythrocytes, cell membranes, proteins, so it is necessary to give preference to low-grained RCS. Optimal RCS, isosmolar with blood. It should be remembered that the osmolarity of the RCS both below and above the osmolarity of the blood makes these means adversely affecting blood cells.

In terms of electrical activity, X-ray-contrast drugs are divided into: ionic, disintegrating in water on electrically charged particles, and non-ionic, electrically neutral. Osmolarity of ionic solutions due to the greater particles in them twice as much as non-ionic.

Non-ionic contrasting substances compared to ion have a number of advantages: significantly less (3-5 times) with general toxicity, give a significantly less pronounced vasodilation effect, determine

smaller deformation of the erythrocytes and much less release the GIS-Tamin, activate the complement system, inhibit the activity of holi-nonserase, which reduces the risk of negative side effects.

Thus, non-ionic RCCs give the greatest guarantees for both the safety and quality of contrast.

The wide introduction of contrasting of various organs with these drugs led to the emergence of numerous methods of x-ray examination, significantly improving the diagnostic capabilities of the X-ray method.

Diagnostic pneumothorax- X-ray study of respiratory organs after the administration of gas into the pleural cavity. It is performed in order to clarify the localization of pathological formations located on the border of the lung with neighboring organs. With the advent of the CT method, it is rarely applied.

Pneumomediastinography- X-ray studies of the mediance after the introduction of gas into its fiber. It is performed in order to clarify the localization of pathological formations identified in the pictures (tumors, cyst) and their distribution to neighboring organs. With the appearance of the CT method, it is practically no applied.

Diagnostic pneumoperitoneum- X-ray study of the diaphragms and abdominal organs after the administration of gas into the cavity of the peritoneum. It is performed in order to clarify the localization of pathological formations identified in the pictures on the background of the diaphragm.

Pneummatoreritoneum- Methods of X-ray study of organs located in the retroperitoneal tissue, by introducing into the older gas fiberglass in order to better visualize their contours. With the introduction of ultrasound, CT and MRI in clinical practice is practically no applied.

Pneummatory- X-ray study of the kidney and a nearby adrenal gland after the administration of gas into the oilopochetics. Currently, it is extremely rare.

Pneumopelography- Study of the curious kidney system after filling it with gas through the ureter catheter. Currently used mainly in specialized hospitals to identify intra-catering tumors.

Pneumomyelography- X-ray examination of the spinal spinal cord space after it contrasts the gas. Used to diagnose pathological processes in the spinal channel area, causing a narrowing of its lumen (hernia of intervertebral disks, tumors). It is rarely applied.

Pneumoencephalography- X-ray study of the cerebral spaces after their contrasts gas. After introducing into clinical practice, CT and MRI is rarely carried out.

PneumoartRography- X-ray study of large joints after administration to their gas cavity. Allows you to study the articular cavity, reveal intra-articular bodies in it, detect signs of damage to the knee menisters. Sometimes it is complemented by the introduction of the joint

water soluble RCS. It is widely used in medical institutions with the impossibility of implementing MRI.

Bronchography- Methods of X-ray study of the bronchi after their artificial contrasts of the RCC. Allows you to identify various pathological changes in bronchi. Widely used in medical institutions with unavailability of CT.

Pureurograph- X-ray study of the pleural cavity after it is partially filling with a contrast drug in order to clarify the shape and sizes of pleural amazing.

Synology- X-ray study of the separation sinuses after filling in the RCC. It is used when it is difficult to interpret the cause of the shading of the sinuses on radiographs.

Dacryocystyography- X-ray study of the tear paths after filling in the RCC. It is used to study the morphological state of the lacrimal bag and the pavement of the tear-axis channel.

Syalography- X-ray study of the ducts of the salivary glands after filling in the RCC. It is used to estimate the state of the ducts of the salivary glands.

Radioscopy of the esophagus, stomach and duodenum- It is carried out after their gradual filling of the suspension of the barium sulfate, and if necessary, and air. It necessarily includes polyposition x-ray and performing overview and targeted radiographs. It is widely used in therapeutic institutions to identify various diseases of the esophagus, stomach and duodenum (inflammatory-destructive changes, tumors, etc.) (see Fig. 2.14).

Enterography- X-ray study of the small intestine after filling its loops by the suspension of the barium sulfate. Allows you to obtain information about the morphological and functional state of the small intestine (see Fig. 2.15).

Irrigoscopy.- X-ray examination of the colon after retrograde contrasting its lumen by the suspension of the barium sulfate and air. It is widely used to diagnose many colon diseases (tumors, chronic colitis, etc.) (see Fig. 2.16).

Cholecystography- X-ray examination of the gallbladder after accumulating in it a contrast agent adopted inside and highlighted with bile.

Selective chopper- X-ray study of the biliary tract contrasted with the help of iodine-containing drugs administered intravenously and allocated with bile.

Cholangiography- X-ray study of bile ducts after the introduction of the RCS in their lumen. It is widely used to clarify the morphological state of the bile ducts and identifying the concrections. It can be performed during operational intervention (in-tractoral cholangiography) and in the postoperative period (through a drainage tube) (see Fig. 2.17).

Retrograde cholangiopancatikography- X-ray study of bile ducts and pancreatic duct after administration

in their lumen of a contrast preparation under X-ray endoscopic control (see Fig. 2.18).

Fig. 2.14.Radiograph of the stomach contrasted by the suspension of the barium sulfate. Norm

Fig. 2.16.Irrigogram. Cancer blind intestine. The clearance of the blind intestine is sharply narrowed, the contours of the affected area are uneven (in the picture indicated by arrows)

Fig. 2.15.Radiograph of a small intestine, contrasted by the suspension of sulfate barium (enterogram). Norm

Fig. 2.17.Antegrada cholangiogram Ma. Norm

Excretory Urography- X-ray study of urinary organs after intravenous administration of the RCC and the highlighting of its kidneys. A widespread research methodology, which allows to study the morphological and functional state of the kidneys, ureters and bladder (see Fig. 2.19).

Retrograde ureteropelography- X-ray study of ureters and stripe kidney systems after filling their RCS through the ureter catheter. Compared to excretory urography, it allows you to get more complete information about the state of the urinary tract

as a result of their better filling with a contrast drug introduced under low pressure. Widely used in specialized urological departments.

Fig. 2.18.Retrograde Cholangiopan Creaticogram. Norm

Fig. 2.19.Excretory Urogram. Norm

Cystography- X-ray study of the bladder filled with RCS (see Fig. 2.20).

Urerography- X-ray study of the urethra channel after its filling of the RCC. Allows you to get information about the passability and morphological state of the urethra, to identify its damage, stricture, etc. It is used in specialized urological branches.

Hysterosalpingography- X-ray examination of the uterus and uterine pipes after filling out their lumen of the RCC. It is widely used primarily to assess the patency of the uterine pipes.

Positive myelography- X-ray study of sub-web spinal spaces

Fig. 2.20.Downward cystogram. Norm

brain after the introduction of water-soluble RCS. With the advent of MRI applied rarely.

AORTHRAPHY- X-ray study of the aorta after the introduction into its lumen of the RCC.

Arteriography- X-ray examination of the arteries with the help of the PCC surveillance, propagating blood flows. Some private arteriography techniques (coronary art, carotid angiography), being highly informative, at the same time are technically complex and unsafe for the patient, in connection with which they are used only in specialized branches (Fig. 2.21).

Fig. 2.21.Carotid angiograms in straight (a) and lateral (b) projections. Norm

Cardiography- X-ray examination of the cavities of the heart after the introduction of the RCC. Currently, limited use in specialized cardiac surgicial hospitals.

Angiopulmonography- X-ray study of the pulmonary artery and its branches after the introduction of the RCC. Despite the high informativeness, unsafe for the patient, in connection with which in recent years, preference is given to computer-tomographic angiography.

Phlebography- Radiographic examination of the veins after the introduction into their lumen of the RCC.

Lymphography- X-ray study of lymphatic pathways after administration to the Limph Number of the RCC.

Fistulography- X-ray studies of fistula strokes after filling in the RCC.

Vulnerography- X-ray examination of the wound channel after filling it with RKS. It is more often used at blind injuries of the abdomen, when other research methods do not allow to establish, is an injury to penetrating or impermeal.

Kistography- contrast radiographic study of the cyst of various organs in order to clarify the shape and size of the cyst, its topographic location and the state of the inner surface.

Dactography- Contrast X-ray study of Milky Duks. Allows you to evaluate the morphological state of the ducts and identify small breast tumors with intra-prototype growth, indistinguishable on mammograms.

Indications for the use of the X-ray method

Head

1. Anomalies and malformations of the development of bone structures of the head.

2. Head injury:

Diagnosis of fractures of the bones of the brain and facial sections of the skull;

Detection of foreign bodies of the head.

3. Brain tumors:

Diagnosis of pathological occasions characteristic of tumors;

Identification of the vascular network of the tumor;

Diagnosis of secondary hypertensive-hydrocephalic changes.

4. Cerebral vessel diseases:

Diagnosis of aneurysm and vascular malformations (arterial aneurysms, arterio-venous malformations, arterio-sinus fourse, etc.);

Diagnosis of stenosing and occlusive diseases of the vessels of the brain and neck (stenosis, thrombosis, etc.).

5. Diseases of ENT organs and organ of vision:

Diagnosis of tumor and neuhroquim diseases.

6. Diseases of temporal bone:

Diagnosis of sharp and chronic mastoids.

Chest

1. Breast injury:

Diagnostics of chest damage;

Detection of liquid, air or blood in the pleural cavity (pnevo-mo-, hemotorax);

Identification of lung bruises;

Detection of foreign bodies.

2. Lung tumors and mediastinum:

Diagnosis and differential diagnosis of benign and malignant tumors;

Assessment of the state of regional lymph nodes.

3. Tuberculosis:

Diagnostics of various forms of tuberculosis;

Assessment of the state of intragenic lymph nodes;

Differential diagnosis with other diseases;

Evaluation of the effectiveness of treatment.

4. Diseases of pleura, lungs and mediastinum:

Diagnostics of all forms of pneumonia;

Diagnostics of pleuritic, mediastinites;

Diagnosis of pulmonary artery thromboembolism;

Diagnostics of pulmonary edema;

5. Heart and Aorti Study:

Diagnostics of acquired and congenital defects of the heart and aorta;

Diagnosis of heart damage during breast injury and aortic;

Diagnostics of various forms of pericarditis;

Evaluation of the state of coronary blood flow (coronary art);

Diagnostics Aortic aneurysm.

Stomach

1. Abdominal injury:

Detection of free gas and liquid in the abdomen;

Detection of foreign bodies;

The establishment of the penetrating nature of the injury of the abdomen.

2. Exploring the esophagus:

Diagnosis of tumors;

Detection of foreign bodies.

3. Study of the stomach:

Diagnosis of inflammatory diseases;

Diagnosis of peptic ulcer;

Diagnosis of tumors;

Detection of foreign bodies.

4. Interest examination:

Diagnosis of intestinal obstruction;

Diagnosis of tumors;

Diagnosis of inflammatory diseases.

5. Study of urinary authorities:

Determination of anomalies and development options;

Urolithiasis disease;

Identification of the wall and occlusal diseases of the renal arteries (angiography);

Diagnostics of unotic uretera diseases, urethra;

Diagnosis of tumors;

Detection of foreign bodies;

Evaluation of the excretory function of the kidneys;

Control of the effectiveness of the treatment.

Pelvis

1. Injury:

Diagnostics of fractures of bones pelvis;

Diagnosis of urinary bubble breaks, rear urethra and rectum.

2. Congenital and acquired deformities of bone pelvis.

3. Primary and secondary tumors of bone pelvis and pelvic organs.

4. Sacroileit.

5. Diseases of women's genital organs:

Evaluation of the patency of the uterine pipes.

Spine

1. Anomalies and vices of the spine.

2. Spine and spinal cord injury:

Diagnosis of various types of fractures and dislocations of the vertebrae.

3. Congenital and acquired spinal deformations.

4. Tumors of the spine and spinal cord:

Diagnosis of primary and metastatic tumors of the bone structures of the spine;

Diagnosis of extrapullary tumors of the spinal cord.

5. Degenerative dystrophic changes:

Diagnosis of spondyleze, spondyloorder and osteochondrosis and their complications;

Diagnostics of the hernia of intervertebral disks;

Diagnosis of functional instability and functional vertebral block.

6. Inflammatory diseases of the spine (specific and nonspecific spondylitis).

7. Osteochondropathy, fibrous osteodistrophy.

8. Densitometry with systemic osteoporosis.

Limb

1. Injuries:

Diagnostics of fractures and dislocation of the limbs;

Control of the effectiveness of the treatment.

2. Congenital and acquired limb deformations.

3. osteochondropathy, fibrous osteodistrophy; Congenital systemic skeletal diseases.

4. Diagnosis of bone tumors and soft fabrics of the limbs.

5. Inflammatory diseases of bones and joints.

6. Degenerative dystrophic diseases of the joints.

7. Chronic diseases of the joints.

8. Handling and occlusive limb vessel diseases.

X-ray bones It is one of the most common studies conducted in modern medical practice. Most people are familiar with this procedure, since the possibilities for the use of this method are very extensive. List of readings for x-ray Bones includes a large number of diseases. Some injuries and fractures of the limbs require repeated X-ray research.

The edgen of the bones is carried out using various instruments, there is also a variety of methods of this study. The use of the type of x-ray study depends on the specific clinical situation, the age of the patient, the main disease and the concomitant factors. Radiation diagnostic methods are indispensable in the diagnosis of bone system diseases and play a major role in diagnosis.

There are the following types of x-ray bone research:

• film radiography;
• digital radiography;
• x-ray densitometry;
• x-ray bone using contrasting substances and some other methods.

What is x-ray?

X-ray is one of the types of electromagnetic radiation. This type of electromagnetic energy was opened 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 the usual nature. About 1% of the radiation of the Sun reaches the Earth in the form of X-rays, which forms a natural radiation background.

The artificial receipt of X-ray rays was made possible by Wilhelmu by a X-ray conradiation, in whose honor they are named. He also first discovered the possibility of their use in medicine for "translucent" internal organs, first of all - bones. Subsequently, this technology developed, new methods of use of X-ray radiation appeared, reduced dose of radiation.

One of the negative properties of X-ray radiation is its ability to cause ionization in substances through which it passes. Because of this, X-ray radiation is called ionizing. In large doses, X-ray can lead to radiation disease. The first decades after the opening of the X-rays, this feature was unknown, which led to diseases of both doctors and patients. However, today the dose of X-ray radiation is carefully monitored and it is safe to say that you can neglect harm from X-ray radiation.

The principle of receiving an X-ray

For the X-ray image, three components are needed. The first of these is the source of X-ray radiation. X-ray radiation source is an X-ray tube. In it, under the action of electric current, there are interaction of certain substances and the release of energy, from which most of the heat is released in the form of heat, and a small part - as X-ray radiation. X-ray tubes are in all X-ray installations and require significant cooling.

The second component to obtain a snapshot is the object being studied. Depending on its density, a partial absorption of X-ray rays occurs. Due to the difference in the tissues of the human body, the X-ray radiation of various power penetrates the body, which leaves various stains in the picture. Where X-ray radiation was absorbed to a greater extent, the shadows remain, and where it passed almost unchanged - enlightenment is formed.

The third component for obtaining an X-ray is an x-ray receiver. It can be a film or digital ( x-ray sensor). Most often today is used as a radiation film receiver. It is processed by a special emulsion with a silver content that changes the X-rays on it. The enlightenment zones in the picture have a dark shade, and the shadow is a white shade. Healthy bones are highly density and leave a uniform shadow in the picture.

Digital and film x-ray

The first methods of X-ray examination implied the use of a photosensitive screen or film as a receiving element. Today, the X-ray film is the most commonly used X-ray receiver. However, in the coming decades, digital radiography will completely replace the film, as it has a number of undeniable advantages. In digital radiography, the receiving element is sensors sensitive to X-ray radiation.

Digital radiography has the following advantages compared to film radiography:

• the ability to reduce the dose of irradiation due to the higher sensitivity of digital sensors;
• an increase in the accuracy and resolution of the picture;
• simplicity and speed of receiving a picture, no need to process photosensitive film;
• ease of storage and processing of information;
• the ability to quickly transmit information.

The only drawback of digital radiography is a slightly higher cost of equipment compared to conventional radiography. Because of this, not in all medical centers you can find this equipment. If possible, patients are encouraged to perform a digital x-ray, as it gives more complete diagnostic information and at the same time harmful.

X-ray with contrasting

Radiography of limb bones can be performed using contrasting substances. Unlike other tissues of the body, the bones have a high natural contrast. Therefore, contrast agents are used to clarify the formations adjacent to bones - soft tissues, joints, vessels. These X-ray techniques are applied as often, but in some clinical situations they are indispensable.

There are the following X-ray contrast methods of bone research:

• Fistulography. This technique implies filling of fiscal moves with contrasting substances ( iodolipol, barium sulfate). Swistulas are formed in bones in inflammatory diseases, such as osteomyelitis. After the study, the substance is removed from the fiscaset move using a syringe.
• Pneumography. This study implies gas administration ( air, oxygen, nitrogen rushing) The volume is about 300 cubic centimeters into soft tissues. Pneumaticography is carried out, as a rule, with traumatic injuries, combined with the prosperity of soft tissues, condiscular fractures.
• Arthrography. This method includes filling the body cavity with a liquid x-ray-contrast drug. The volume of the contrasting substance depends on the volume of the custody of the joint. Most often arthrography is performed on the knee joint. This technique allows you to assess the state of the joint surfaces of the bones included in the joint.
• Angiography of bones. This type of study implies the introduction of a contrast agent into the vascular bed. The study of bone vessels is used in tumor formations, to clarify the peculiarities of its growth and blood supply. In malignant tumors, the diameter and the location of the vessels are uneven, the number of vessels is usually greater than in healthy tissues.

The edgen of the bones must be performed in order to accurate diagnosis. In most cases, the use of a contrast agent allows to obtain more accurate information and provide better assistance to the patient. However, it is necessary to take into account that the use of contrasting substances has some contraindications and restrictions. The technique of using contrast substances requires the time and availability of an experience in a radiologist.

X-ray and computed tomography ( Kt.) Bones

Computed tomography - X-ray method, which has high accuracy and informativeness. To date, computed tomography is the best method of studying the bone system. With the help of 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 along with this creates a high radial load.

The advantages of the CT in front of standard radiography are:

• high resolution and accuracy of the method;
• the possibility of obtaining any projection, while X-ray is usually carried out by no more than 2 - 3 projections;
• the possibility of three-dimensional reconstruction of the body's studied;
• lack of distortion, linear dimensions;
• the possibility of simultaneous examination of bones, soft tissues and vessels;
• the ability to conduct a real-time survey.

Computed tomography is carried out in cases where it is necessary to diagnose such complex diseases as osteochondrosis, intervertebral hernias, tumor diseases. In cases where the diagnosis does not submit special difficulties, ordinary radiography is carried out. It is necessary to take into account the high radiation load of this method, which is why CT is not recommended more often than once a year.

X-ray and magnetic resonance tomography ( MRI)

Magnetic resonance imaging ( MRI) - 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 media, MRI makes it possible to perform three-dimensional reconstruction of human organs and tissues. The main advantage of MRI is the complete lack of radiation load.

The principle of operation of the magnetic resonance tomograph lies in the attachment of atoms, of which the human body, a magnetic impulse is built. After that, the energy released by atoms is read when returning to the initial state. One of the restrictions of this method is the impossibility of use in the presence of metal implants in the body, cardiosmulators.

When performing an MRI, the energy of hydrogen atoms is usually measured. Hydrogen in the human body is most common in the composition of water compounds. In the bones, water is contained in much smaller volumes than in other tissues of the body, therefore, when studying the bones of MRI gives less accurate results than in the study of other fields of the body. This MRI is inferior to CT, but it still exceeds the accuracy of ordinary radiography.

MRI is the best method of diagnosing bone tumors, as well as bone tumor metastasis in remote areas. One of the serious disadvantages of this method is high cost and large time spent costs ( 30 minutes and more). All this time, the patient should occupy a fixed position in a magnetic resonance tomograph. This apparatus looks like a closed design tunnel, which is why some people have discomfort.

X-ray and densitometry bones

The study of the structure of bone tissue is carried out under a number of diseases, as well as in the aging of the body. Most often, the study of the structures of the bones is carried out with such a disease as osteoporosis. Reducing the content of mineral substances in the bones leads to their fragility, risk of fractures, deformities and damage to neighboring structures.

The X-ray image allows you to estimate the structure of the bones only subjectively. To determine the quantitative parameters of the bone density, the content of mineral substances is used in it densitometry. The procedure passes quickly and painlessly. While the patient lies motionlessly on the couch, the doctor examines certain sections of the skeleton using a special sensor. The most important is the data of densitometry of the head of the femur and vertebrae.

There are the following types of densitometry of bones:

• quantitative ultrasound densitometry;
• x-ray absorption;
• quantitative magnetic resonance tomography;
• quantitative computed tomography.

X-ray-type densitometry is based on measuring the absorption of the X-ray beam. If the bone is dense, it delays most of the X-ray radiation. This method is very accurate, but has an ionizing effect. Alternative methods of densitometry ( ultrasound densitometry) are safer, but also less accurate.

Densitometry is shown in the following cases:

• osteoporosis;
• mature age ( older than 40 - 50 years);
• menopause in women;
• frequent bone fractures;
• spinal diseases ( osteochondrosis, scoliosis);
• any bone damage;
• sedentary lifestyle ( hydodina).

Indications and contraindications of X-ray skeleton bones

The skeleton bone x-ray has an extensive test list. Various diseases can be characteristic of different ages, but bone injuries or tumors can occur at any age. To diagnose the diseases of the bone system, the X-ray is the most informative method. The X-ray method also has some contraindications that, however, are relative. However, it should be remembered that the bone x-ray can be dangerous and harm with too much use.

Indications for the X-ray

X-ray study is an extremely common and informative study for skeleton bones. The bones are not available for direct surveys, however, on an X-ray, you can get almost all the necessary information about the state of bones, about their form, sizes and structure. However, the edge of the bones due to the release of ionizing radiation can not be completed too often and for any occasion. Indications for the pentgen bones are defined fairly and based on complaints and symptoms of patient diseases.

The edgen of the bones is shown in the following cases:

• traumatic damage to bones with severe pain syndrome, deformation of soft tissues and bones;
• dislocation and other damage to the joints;
• bone development anomalies in children;
• lagging children in growth;
• restriction of mobility in the joints;
• pain in peace or with the moves of any part of the body;
• an increase in bones in volume, if suspected a tumor;
• preparation for surgical treatment;
• assessment of the quality of treatment ( fractures, transplantation, etc.).

List of skeletal diseases that are detected using X-ray is very extensive. This is due to the fact that the diseases of the bone system usually proceed asymptomatic and detected only after X-ray studies. Some diseases such as osteoporosis are age and are almost inevitable when aging the body.

The bone x-ray in most cases allows for differentiation between the listed diseases, due to the fact that each of them has reliable radiographic signs. In difficult cases, especially before carrying out surgical operations, the use of computed tomography is shown. Doctors prefer to use this study, as it is most informative and has the lowest number of distortions compared to the anatomical sizes of bones.

Contraindications for X-ray research

Contraindications to X-ray examination are associated with the presence of an ionizing effect in X-ray radiation. At the same time, all contraindications to the study are relative, since they can be neglected in emergency cases, such as fractures of skeleton bones. However, if possible, it should be limited to the number of X-ray studies and do not conduct them without need.

Relative contraindications of X-ray research include:

• the presence of metal implants in the body;
• acute or chronic mental illness;
• heavy patient condition ( massive blood loss, unconscious condition, pneumothorax);
• first trimester of pregnancy;
• childhood ( up to 18 years old).

X-ray with contrasting substances is contraindicated in the following cases:

• allergic reactions to components of contrast substances;
• endocrine disorders ( diseases of thyroid gland);
• severe liver and kidney diseases;

Due to the fact that the dose of irradiation in modern X-ray installations is reduced, the X-ray method becomes more and more secure and allows for restrictions on its use. In the case of complex injuries, X-ray is carried out almost immediately in order to begin treatment as early as possible.

Doses of radiation with different X-ray methods

Modern radiation diagnostics adheres to strict safety standards. X-ray radiation is measured using special dosimeters, and X-ray installations undergo special certification on compliance with radiological irradiation standards. Doses of irradiation of unequal systems for different methods of research, as well as for various anatomical regions. The unit of measurement of the dose of irradiation is millizer ( msv).

Doses of irradiation with various methods of Kostya X-ray

As can be seen from the given data, computed tomography bears the largest X-ray load. At the same time, computed tomography is the most informative method of studying bones to date. You can also conclude a great advantage of digital radiography before film, since X-ray load decreases from 5 to 10 times.

How often can X-ray?

X-ray radiation carries a certain danger of human body. It is for this reason that all radiation, which was obtained with a medical goal, should be reflected in the medical record of the patient. This accounting should be carried out in order to comply with the annual standards that limit the possible amount of X-ray research. Thanks to the use of digital radiography, their number is enough to solve almost any medical problems.

Annual ionizing radiation that receives the human body from the environment ( natural background), ranges from 1 to 2 mW. The maximum allowable dose of X-ray radiation is 5 mW per year or 1 mW during each of 5 years. In most cases, these values \u200b\u200bdo not exceed, since the dose of irradiation with a one-time study is at times less.

The number of X-ray studies that can be carried out during the year depends on the type of research and anatomical area. On average, 1 computed tomography is allowed or from 10 to 20 digital radiography. However, reliable data on what effects have a radiation dose at 10-20 mW every year, no. With confidence, you can only say that to some extent they increase the risk of some mutations and cellular disorders.

What organs and tissues suffer from ionizing radiation x-ray installations?

The ability to cause ionization is one of the properties of X-ray radiation. Ionizing radiation can lead to spontaneous decay of atoms, cell mutations, a failure in cell reproduction. That is why X-ray examination, which is the source of ionizing radiation, requires rationing and establishing threshold values \u200b\u200bof radiation doses.

Ionizing radiation has the greatest impact on the following organs and fabrics:

• bone marrow, blood-forming organs;
• crystal eye;
• endocrine glands;
• genitals;
• leather and mucous membranes;
• the fruit of a pregnant woman;
• all organs of the children's body.

The ionizing radiation at a dose of 1000 mSv causes a phenomenon of acute radiation disease. Such a dose enters the body only in the case of a disaster ( burst of atomic bombs). In smaller doses, ionizing radiation can lead to premature aging, malignant tumors, cataract. Despite the fact that the dose of X-ray radiation today has decreased significantly, there are a large number of carcinogenic and mutagenic factors in the environment, which together can cause such negative consequences.

Is it possible to make X-ray bones pregnant and nursing mothers?

Any radiographic study is not recommended for pregnant women. According to the World Health Organization, a dose of 100 mSV almost inevitably causes violations of the development of the fetus or mutation leading to cancer. The first trimester of pregnancy is the greatest value, since during this period the most active development of the fetus tissues and the formation of organs occurs. If necessary, all X-ray studies are transferred to the second and third trimester of pregnancy. Studies conducted in humans showed that X-ray made after 25 weeks of pregnancy does not lead to anomalies in a child.

For nursing mothers, there are no restrictions in the implementation of X-rays, as the ionizing effect does not affect the composition of breast milk. Full studies in this area were not carried out, so in any case, doctors recommend nursing mothers to see the first portion of milk with breastfeeding. This will help to be reinforced 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 influence 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 study. That is why X-ray children are performed, but various protective devices are used, which allow to protect developing organs from irradiation.

X-ray examination is also required when the growth of children is delayed. In this case, the x-ray is carried out as many times as required, since radiological research is included in terms of treatment after a certain period of time ( usually 6 months). Rahit, congenital anomalies of the skeleton, tumors and tumor-like diseases - all these diseases require radiation diagnostics and cannot be replaced by other methods.

Preparation for the Kosti X-ray

Preparation for the study underlies any successful research. It depends on both the quality of diagnosis and the result of treatment. Preparation for X-ray study is a fairly simple event and usually does not create difficulties. Only in some cases, such as a pelvic x-ray or spine, the performance of X-ray requires special preparation.

There are some features of the preparation for the X-ray of children. Parents should help doctors and properly psychologically configure children to research. Children are difficult for a long time to remain motionless, also often they are afraid of doctors, people "in white coats". Thanks to cooperation between parents and doctors, you can achieve a good diagnosis and qualitative treatment of childhood diseases.

How to get a direction on the edgen of the bones? Where do X-ray examination perform?

The edgen of the bones can be performed today in almost any center where they provide medical care. Despite the fact that today X-ray equipment is widely available, X-ray examination is performed only in the direction of the doctor. This is due to the fact that X-ray to a certain extent harms human health and has some contraindications.

The edgen of the bones is performed in the direction of doctors of different specialties. It is most often carried out in an urgent basis when first aid in traumatology departments, emergency hospitals. In this case, the direction gives a duty officer traumatologist, orthopedist or surgeon. The edgen of the bones can also be completed in the direction of family doctors, dentists, endocrinologists, oncologists and other doctors.

The X-ray bone snapshot is performed in various medical centers, clinics, hospitals. For this, they are equipped with special X-ray cabinets in which there is everything necessary for this kind of research. X-ray diagnostics are carried out by radiologists with special knowledge in this area.

What does the X-ray office look like? What is in it?

X-ray cabinet is a place where X-ray pictures of various parts of the human body are performed. The X-ray Cabinet must comply with high standards of anti-radiation protection. In the decoration of walls, windows and doors, special materials are used, which have a lead equivalent, which characterizes their ability to delay ionizing radiation. In addition, it has dosimeters radiometers and individual means of protection against radiation, such as aprons, collars, gloves, skirts and other elements.

In the X-ray office there should be good lighting, primarily artificial, as the windows have small sizes and natural lighting is not enough for quality work. The main equipment of the office is X-ray installation. X-ray installations are of various forms, as they are intended for various purposes. In major medical centers there are all types of X-ray installations, but the simultaneous work of several of them is prohibited.

The following types of X-ray installations are present in the modern X-ray office:

• stationary X-ray apparatus ( allows Radiography, Radioscopy, Linear Those);
• chamber mobile X-ray installation;
• orthopantomograph ( installation for performing x-ray jaws and teeth);
• digital radio composition.

In addition to X-ray installations in the office there are a large number of auxiliary tools and equipment. It also includes the equipment of the device-radiologist and laboratory technician, tools for obtaining and processing X-rays.

Additional equipment of X-ray cabinets include:

• computer for processing and storing digital pictures;
• equipment for film shots;
• cabinets for drying film;
• consumables ( film, photorectivations);
• negatoscopes ( bright screens for viewing pictures);
• tables and chairs;
• documentation storage cabinets;
• bactericidal lamps ( quartz) For disinfection of premises.

Preparation for the Kosti X-ray

The tissues of the body of a person, differing in different density and chemical composition, absorb x-ray radiation in different ways and due to this have a characteristic X-ray image. The bones have high density and very good natural contrast, thanks to which the X-ray of most bones is performed without special training.

If a person has a X-ray study of most bones, it is enough to come to an x-ray office for this. At the same time there are no restrictions in the meal, fluid, smoking in front of a x-ray study. It is recommended not to take with you any metal things, especially decorations, because they will have to be removed before performing the study. Any metal objects create interference on an X-ray.

The process of obtaining an X-ray snapshot does not take much time. However, in order for the picture to be high-quality, the patient is very important to maintain immobility during its execution. This is especially important for young children who are restless. X-ray children are held in the presence of parents. For children less than 2 years old, X-ray is carried out in the lying position, it is possible to use a special fixation that secures the position of the child on the X-ray table.

One of the major advantages of X-ray is the possibility of its use in emergency cases ( injuries, Falls, Road Transports) No preparation. At the same time there is no loss as pictures. If the patient is not transported or is in serious condition, then there is a possibility of performing X-ray directly in the ward, where the patient is located.

Preparation for the x-ray of the bones of the pelvis, the lumbar and sacral spine

The X-ray of the bones of the pelvis, the lumbar and sacral spine is one of the few species of X-rays, which requires special training. It is explained by anatomical closeness with the intestines. Intestinal gases reduce the sharpness and contrast of the X-ray, which is why special training is carried out on the intestinal cleansing before this procedure.

Preparation for the pelvic bone x-ray and the lumbar spine includes the following main elements:

• purification of the intestine with the help of laxatives and enemas;
• compliance with a diet that reduces the formation of gases in the intestine;
• research on an empty stomach.

The diet should begin in 2 - 3 days before the study. It eliminates the flour, cabbage, onions, legumes, fatty meat and dairy products. In addition, it is recommended to take enzyme preparations ( pancreatin) and activated carbon after meals. A day before the study, the enema is carried out or drugs are taken as Fortrans that help to clean the intestines naturally. The last meal must be 12 hours before the study, in order for the intestines to remain unfilled until the moment of the study.

X-ray learning techniques

X-ray study is intended for the study of all skeleton bones. Naturally, for the study of most bones there are special methods for receiving X-rays. The principle of obtaining pictures in all cases remains the same. It implies the premises of the studied part of the body between the X-ray tube and the radiation receiver, so that X-rays take place at a right angle to the bone under study and to the cassette with the X-ray film or sensors.

Positions that occupy the components of the X-ray installation regarding the human body are called styling. Over the years of practice, a large number of X-ray stacks were developed. The quality of X-rays depends on the accuracy of their observance. Sometimes to fulfill these prescriptions, the patient has to occupy a forced position, but X-ray study is performed very quickly.

Styling usually imply the execution of images in two mutually perpendicular projections - straight and lateral. Sometimes the study is complemented by an oblique projection that helps to get rid of the imposition of some parts of the skeleton on each other. In case of severe injury, performing some styling becomes impossible. In this case, an x-ray is performed in a position that causes the smallest discomfort to the patient and which will not lead to the displacement of fragments and aggravation injury.

Methods of study of the bones of the limbs ( hands and legs)

X-ray study of the tubular skeleton bones is the most frequent X-ray study. These bones make up the bulk of bones, the skeleton of hands and legs is fully consisted of tubular bones. The X-ray study technique should be familiar to everyone who at least once in his life received damage to the hands or feet. The study takes no more than 10 minutes, it does not cause pain or unpleasant sensations.

Tubular bones can be investigated in two perpendicular projections. The main principle of any x-ray is the location of the object under study between the emitter and the x-ray sensitive film. The only condition of the qualitative picture is the patient's immobility during the study.

Before studying, the finiteness department is exposed, remove all metal objects from it, the study zone is located in the center of the cassette with an X-ray film. The limb should freely "lie" on the cassette with the film. The x-ray beam is directed to the center of the cassette perpendicular to its plane. The snapshots are performed in such a way that the adjacent joints also hit the X-ray. Otherwise, it is difficult to distinguish the upper and lower end of the tubular bone. In addition, the big coverage of the area helps to exclude damage to the joints or adjacent bones.

Usually each bone is investigated in a straight and lateral projection. Sometimes snapshots are performed in conjunction with functional tests. They consist in flexion and extension of the joint or the load on the limb. Sometimes due to injury or inability to change the position of the limb you have to use special projections. The main condition is the observance of the perpendicularity of the cassette and the X-ray emitter.

Method of X-ray study of the bones of the skull

X-ray examination of the skull is usually performed in two mutually perpendicular projections - side ( in profile) and straight ( in the face). The X-ray X-ray is prescribed during head injuries, with endocrine disorders, for diagnosing deviations from the indicators of the age-related bone development in children.

The X-ray of the bones of the skull in a straight front projection gives general information about the state of bones and connections between them. It can be performed in the standing position or lying. Usually the patient falls on the X-ray table on the stomach, under the forehead put the roller. The patient maintains immobility within a few minutes, while the X-ray tube is directed to the occipital area and take a picture.

The X-ray of the bones of the skull in the side projection is used to study the bones of the base of the skull, nose bones, but less informative for other bones of the facial skeleton. To perform the X-ray in the lateral projection, the patient is laid on the X-ray table on the back, the cassette with the film is put 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 earnest lines.

Sometimes doctors are used by the X-ray of the skull in the so-called axial projection. It corresponds to the vertical axis of the human body. This styling has a dark and chin direction, depending on which side the X-ray tube is located. It is informative for studying the base of the skull, as well as some bones of the facial skeleton. Its advantage is that it avoids many bone overlaps to each other, characteristic of direct projection.

X-ray of skulls in an axial projection consists of the following steps:

• the patient removes metallic objects, upper clothes;
• the patient occupies a horizontal position on the X-ray table, lying on the stomach;
• the head is in such a way that the chin performed as much as possible forward, and the tables only touched the chin and the front of the neck;
• under the chin is a cassette with an X-ray film;
• the X-ray tube is directed perpendicular to the plane of the table, to the area of \u200b\u200bthe pattern, the distance between the cassette and the tube should be 100 cm;
• after that, a snapshot with a chifferent direction of the X-ray tube in the standing position is performed;
• the patient throws the head in such a way that the dummy touch the reference site, ( raised x-ray table), and the chin was as high as possible;
• the X-ray tube is directed perpendicular to the front surface of the neck, the distance between the cassette and the X-ray tube is also 1 meter.

The methods of X-ray of temporal bone in the sinter, on Shuller, by Mayer

Temple bone is one of the main bones forming a 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. Because of the abundance of bone formations in the facial region, the x-ray examination of the temporal bone is difficult. That is why various styling was proposed to obtain special X-ray pictures of temporal bone.

Currently, three projections of the x-ray study of temporal bones are used:

• Meeer technique ( axial projection). It is used to study the state of the middle ear, the pyramids of the temporal bone and the mastoid process. The Mayer X-ray is performed in the lying position. The head turns at an angle of 45 degrees to the horizontal plane, under the ear under study lay the cassette with the X-ray film. The X-ray tube is directed through the frontal bone of the opposite side, it should be directed precisely to the center of the outer hearing hole of the studied side.
• Technique on Shuller ( oblique projection). With this projection, the state of the temporomandibular joint, the deputyoid process, as well as the pyramids of the temporal bone is estimated. X-ray is performed lying on the side. The patient's head is turned the sideways, between the ear of the studied side and the couch is a cassette with an X-ray film. The X-ray tube is located at a slight angle to the vertical and directed to the foot end of the table. The X-ray tube is centered on the ear shell of the studied side.
• Spere technique ( cross projection). The snapshot in the transverse projection allows you to estimate the state of the inner ear, as well as the pyramids of the temporal bone. The patient lies on the stomach, the head is rotated at an angle of 45 degrees to the body symmetry line. The cassette is placed in cross position, the X-ray tube is mounted at an angle to the head end of the table, the beam is sent to the center of the cassette. For all three techniques, an X-ray tube is used in a narrow tube.

Various X-ray techniques are used to study the specific formations of temporal bone. In order to determine the need for one or another laying, doctors are guided by patient complaints and objective inspection data. Currently, a computer tomography of temporal bone is an alternative to different types of x-ray styling.

Laying with X-ray bone x-ray in tangential projection

The so-called tangential projection is used to examine the zylon bone. It is characterized by the fact that X-rays are applied by tangential ( tangential) in relation to the edge of the zick bone. Such stacking is used in order to reveal the fractures of the zick bone, the outer edge of the socket, the maxillary sinus.

The X-ray Bone X-ray technique includes the following steps:

• the patient removes the upper clothes, decorations, metal prostheses;
• the patient occupies a horizontal position on the abdomen on the X-ray table;
• the patient's head turns at an angle of 60 degrees and is placed on a cassette containing X-ray film with a size of 13 x 18 cm;
• the studied side of the person is located on top, the X-ray tube is located strictly vertically, but due to the inclination of the head, X-rays pass regarding the surface of the zohl bone;
• in the course of the study, 2 - 3 shots with small head turns are performed.

Depending on the task of the study, the angle of rotation of the head may vary within 20 degrees. The focal length between the tube and the cassette is 60 centimeters. The X-ray bone can be supplemented with a survey snapshot of the skull bones, as all the formations studied in a tangential projection are quite well distinguishable.

Methods of X-ray study bones pelvis. Projections in which the pelvis bone x-ray is performed

The pelvic x-ray is the main study of damage, tumors, as well as other diseases of the bones of this area. The pelvic bone x-ray takes no more than 10 minutes, but there is a wide variety of techniques of this study. The most frequently performed pore x-ray of pelvic bones in the rear projection.

The sequence of performing overview X-ray of pelvic bones in the rear projection includes the following steps:

• the patient enters the X-ray office, removes metal decorations and clothes, except for underwear;
• the patient falls on the X-ray table on the back and saves such a position throughout the procedure;
• hands should be crossed on the chest, and the roller is put under the knees;
• legs should be slightly spread, the feet are fixed in the set position using a ribbon or sandbags;
• the cassette with a film with dimensions of 35 x 43 cm is located transversely;
• the X-ray emitter is directed perpendicular to the cassette, between the upper front iliac comb and the LONA joint;
• the minimum distance between the emitter and the film is one meter.

If the patient is damaged by the limbs, the legs are not given a special position, as this may lead to displacement of fragments. Sometimes x-ray is performed for examination only one part of the pelvis, for example, during damage. In this case, the patient occupies a position on the back, but a slight rotation is performed in the basin, so that a healthy half was 3 - 5 cm above. The intact foot is bent and raised, the thigh is located vertically and goes beyond the study. X-rays are directed perpendicular to the neck of the femur and the cassette. Such a projection gives a side view of the hip joint.

For the study of sacral-iliac articulation, the rear oblique projection is used. It is performed when lifting the part under study by 25 - 30 degrees. In this case, the cassette should be located strictly horizontally. The X-ray ray is directed perpendicular to the cassette, the distance from the beam to the anterior ileum is about 3 centimeters. With such a patient laying on an X-ray, the connection between the sacrum and the iliac bones is clearly displayed.

Definition of the age of a skeleton by the X-ray of the brush in children

The bone age accurately indicates the biological maturity of the body. Accounting rates are points of ossification and the fighting of individual parts of the bones ( synostose). On the basis of bone age, you can accurately determine the final growth of children, set the lag or advance in development. Bone age is determined by radiographs. After the radiographs were performed, the results obtained are compared with the standards on special tables.

The most significant in determining the age of the skeleton is x-ray brushes. The convenience of this anatomical area is explained by the fact that in the brush point of ossification appear with a rather high frequency, which makes it possible to regularly conduct research and observe growth rates. The definition of bone age is mainly used to diagnose endocrine disorders, such as a lack of growth hormone ( somatotropin).

Comparison of the age of the child and the appearance of points of ossification on the X-ray image of the brush

Points of ossification

Basic methods of x-ray research

Classification of x-ray research methods

Radiological techniques

Main methods	Additional methods	Special methods - additional contrasts need
Radiography	Linear tomography	X-ray substances (gases)
Radioscopy.	Ziography	Positive substances	Salts of heavy metals (barium oxide sulfak)
Fluorography	Kymography	Iodine-containing water-soluble substances
Electro-radiography	Electrocimography	· Ionic
	Stereoprentgen-graphic	· Neonna
	X-ray infection	Iodine-containing fat soluble substances
	CT scan	Trop validity of the substance.
	MRI

X-ray - a method of x-ray study, in which the image of the object is obtained on an X-ray film by direct exposure to the radiation beam.

Film radiography is performed either on a universal X-ray apparatus, or on a special tripod, intended only for shooting. The patient is located between the X-ray tube and film. The resulting part of the body is as close as possible to the cassette. This is necessary to avoid a significant increase in the image due to the diverging character of the X-ray beam. In addition, it provides the necessary image sharpness. The X-ray tube is installed in this position so that the central beam passes through the center of the body being removed and perpendicular to the film. The investigated body department is exposed and fixed by special devices. All other parts of the body cover protective screens (for example, a luminous rubber) to reduce radiation load. X-ray can be produced in a vertical, horizontal and inclined position of the patient, as well as in the side position. The shooting in different positions allows you to judge the offshifting of the organs and identify some important diagnostic signs, such as spreading fluid in a pleural cavity or liquid levels in bowel hinges.

The picture on which part of the body is depicted (head, pelvis, etc.) or the entire organ (lungs, stomach) is called visibility. The pictures on which the image of the physician of the body of interest is of interest to the doctor in the optimal projection, which is most favorable for the study of one or another part, is called targeted. They are often produced by the doctor under the control of translucent. Snapshots can be solitary or serial. The series may consist of 2-3 radiographs, which recorded different states of the organ (for example, the peristalistic of the stomach). But more often under serial radiography understands the manufacture of several radiographs during one study and usually in a short period of time. For example, when arteriography is produced using a special device - seri-to-6-8 shots per second.

Among the radiography options, the shooting with a direct increase in the image deserves mention. Increases achieve the fact that the X-ray cassette moves from the subject of the shooting. As a result, the radiograph is obtained an image of small parts, indistinguishable on ordinary pictures. This technology can only be used in the presence of special X-ray tubes that have very small focal spots sizes - about 0.1 - 0.3 mm2. To study the bone-articular system optimal, an increase in the image is 5-7 times.

On radiographs, you can get an image of any part of the body. Some organs are well distinguishable in pictures due to the conditions of natural contrast (bone, heart, lungs). Other organs are clearly displayed only after their artificial contrast (bronchi, vessels, heart cavities, bile ducts, stomach, intestine, etc.). In any case, the x-ray picture is formed from light and dark areas. The blackening of the X-ray film, as well as the film, is due to the restoration of metallic silver in its exposed emulsion layer. For this, the film is subjected to chemical and physical processing: it is shown, fixed, washed and dried. In modern X-ray cabinets, the entire process is fully automated due to the presence of developing machines. The use of microprocessor equipment, high temperature and high-speed reagents makes it possible to reduce the receiving time of the radiograph to 1-1.5 minutes.

It should be remembered that X-ray in relation to the image apparently on the fluorescent screen when translucent is a negative. Therefore, transparent areas on radiographs are called dark ("dimming"), and dark - light ("enlightenment"). But the main feature of the radiograph is in the other. Each ray on its path through a person's body crosses not one, but a huge number of points located both on the surface and in the depths of the fabrics. Consequently, each point in the picture corresponds to the many valid points of the object, which are projected by each other. X-ray image is a summary, plane. This circumstance leads to the loss of the image of many elements of the object, since the image of some details is superimposed on the shadow of others. It follows the main rule of X-ray research: the study of any part of the body (body) must be made at least two mutually perpendicular projections - direct and lateral. Additionally, they may need snapshots in oblique and axial (axial) projections.

Radiographs are studied in accordance with the overall scheme for analyzing radiation images.

The radiography method is used everywhere. It is available for all therapeutic institutions, simple and easy for the patient. Snapshots can be made in a stationary X-ray office, in the ward, in the operating room, in the intensive care unit. With the right choice of technical conditions, small anatomical parts are displayed in the picture. A radiograph is a document that can be stored for a long time, to be used to compare with repeated radiographs and for discussion to the unlimited number of specialists.

Indications for X-ray diffraction, but in each individual case should be justified, since X-ray study is associated with radial load. Relative contraindications are extremely severe or strongly excited patient's condition, as well as acute states that require emergency surgical care (for example, bleeding from a large vessel, open pneumothorax).

Advantages of radiography

1. Wide availability of the method and ease in conducting research.

2. For most studies, special patient training is required.

3. Relatively low cost of research.

4. Snapshots can be used to consult another specialist or in another institution (as opposed to ultrasonic snapshots, where it is necessary to conduct a repeated study, since the resulting images are operator-dependent).

Disadvantages of radiography

1. The "frozenness" of the image is the complexity of the evaluation of the function of the organ.

2. The presence of ionizing radiation capable of having a harmful effect on the body under study.

3. The informative of classical radiography is significantly lower than modern methods of medical imaging, as CT, MRI, etc. Ordinary X-ray images reflect the projection layering of complex anatomical structures, that is, their summary X-ray shadow, in contrast to layering series of images obtained by modern tomographic methods.

4. Without the use of radiography contrasting substances, it is almost non-informative to analyze changes in soft tissues.

Electrodenthitrographic - method of obtaining X-ray image on semiconductor plates, followed by transferring it to paper.

The electric power process includes the following steps: charging the plate, its exposure, manifestation, image transfer, image fixation.

Charging plate. The metal plate coated with a selene semiconductor layer is placed in the electrolyantgent charger. In it, the semiconductor layer is reported to an electrostatic charge that can be maintained for 10 minutes.

Exposure. X-ray examination is carried out in the same way as in conventional radiography, only instead of a cassette with a film use a cassette with a plate. Under the influence of X-ray irradiation, the resistance of the semiconductor layer decreases, it partially loses its charge. But in different places, the plate is not the same in different places, but in proportion to the number of X-ray quanta falling on them. The plate creates a hidden electrostatic image.

Manifestation. The electrostatic image is manifested by spraying on the plate of the dark powder (toner). Negatively charged powder particles are attracted to those areas of the selenium layer, which retained a positive charge, and to the degree, proportional value of the charge.

Transferring and fixing the image. In an electric train, an image with a plate is transferred to a corona discharge on paper (most often used paper) and fixed in the adapter pairs. The plate after purification from the powder is again suitable for use.

The electrolyantgen image is different from film two main features. The first is its large photographic latitude - on the electric unit is well displayed both dense formations, in particular bones and soft tissues. With film X-ray, it is much more difficult to achieve this. The second feature is the phenomenon of underline contours. At the boundary of the tissues of different density, they seem like cited.

The positive sides of the electric power agent are: 1) efficiency (cheap paper, per 1000 or more pictures); 2) the speed of receiving the image is only 2.5-3 minutes; 3) All research is carried out in an unmeasised room; 4) "Dry" character of obtaining an image (therefore abroad electrodegenesis is called xeroadography - from Greek. Xeros - dry); 5) the storage of electric agent diffuses is much easier than X-ray films.

At the same time, it should be noted that the sensitivity of the electric agent plate is significantly (1.5-2 times) is inferior to the sensitivity of the film combination - reinforcing screens used in conventional radiography. Consequently, when shooting, it is necessary to increase the exposure, which is accompanied by an increase in radial load. Therefore, the electric agent is not used in pediatric practice. In addition, artifacts (spots, bands) are often arising on electric agent. Taking into account the above, the main indication for its application is an urgent x-ray study of the limbs.

Radioscopy (X-ray shocking)

Radioscopy is a radiological research method, in which the image of the object is obtained on a luminous (fluorescent) screen. The screen is a cardboard coated with a special chemical composition. This composition under the influence of X-ray radiation begins to glow. The intensity of the glow at each point of the screen is proportional to the number of X-ray quanta on it. From the side facing the doctor, the screen is covered with lead glass that protects the doctor from direct exposure to X-ray radiation.

Fluorescent screen glows weakly. Therefore, the radioscopy is performed in a darkened room. The doctor must be accustomed to the dark to the dark to distinguish the low-intensity image within 10-15 minutes. The retina of the human eye contains two types of visual cells - columns and wands. Columns ensure the perception of color images, while the sticks are the mechanism of twilight. It can be figped to say that the radiologist works with "chopsticks" with normal shocking.

Radioscopy has many advantages. It is a freight, publicly available, economical. It can be produced in the X-ray office, in the dressing, in the ward (using a mobile x-ray). Radioscopy allows you to study the movement of organs when changing the position of the body, cutting and relaxing the heart and the ripple of the vessels, the respiratory movements of the diaphragm, the peristalsis of the stomach and the intestine. Each body is not difficult to explore in different projections, from all sides. A similar method of research of radiologists is called a multi-axle, or by rotating the patient behind the screen. Radioscopy is used to select the best projection for radiography in order to perform so-called sighting pictures.

Advantages of radioscopyThe main advantage of the radiography is a real-time research. This makes it possible to evaluate not only the structure of the body, but also its displaceability, contractility or extensibility, the passage of the contrast agent, the filler. The method also allows you to quickly evaluate the localization of some changes, due to the rotation of the object of the study during transmission (multidiscorant study). When radiography requires several pictures for this, which is not always possible (the patient left after the first shot without waiting for the results; a large flow of patients at which pictures are taken only in one projection). Radioscopy allows you to control some instrumental procedures - setting catheters, angioplasty (see angiography), fistulography.

However, conventional x-ray has weaknesses. It is associated with a higher radial load than x-ray. It requires darkening the office and thoroughly dark adaptation of the doctor. After it, there is no document (snapshot), which could be stored and would be suitable for re-consideration. But most importantly, in the other: on the screen for transmission, small details of the image cannot be distinguished. This is not surprising: take into account that the brightness of the glow of a good negatoscope is 30,000 times greater than the fluorescent screen during radioscopy. Due to the high radial load and low resolution, x-ray is not allowed to apply for verification studies of healthy people.

All marked disadvantages of conventional X-ray to a certain extent are eliminated if the X-ray radiation system introduced an amplifier of an X-ray image (Uri). Flat Uri type "Cruise" increases the brightness of the screen glow 100 times. A uri, which includes a television system, provides a strengthening of several thousand times and allows us to replace the usual radioscopy with X-ray radiosal translucent.

Plan:

1) X-ray studies. Essence of radiological research methods. X-ray research methods: X-ray, radiography, fluorography, X-ray diffraction, computed tomography. Diagnostic value of radiological studies. The role of a medical sister in preparation for X-ray studies. Rules for preparing the patient to the x-ray and radiography of the stomach and 12-risen intestine, bronchomography, cholecistography and cholangiography, irrigoscopy and graphy, reinforcement radiography kidney and excretory urography.

X-ray study of kidney pelvis (pyelography) is carried out with the help of urographic introduced intravenously. Radiographic study of the bronchi (bronchography) is carried out after spraying in bronchops of a contrast substance - iodolipol. X-ray examination of vessels (angiography) is carried out with the help of a cardiotract, administered intravenously. In some cases, contrasting the organ is carried out due to air, which is introduced into the surrounding tissue or cavity. For an example, with a X-ray study of the kidneys, when there is a suspicion of the kidney tumor, the air into the amusement fiber is introduced (pneumulan) ; to detect germination, the tumor of the stomach walls is introduced into the abdominal position, i.e., the study is carried out under conditions of art-stemperitoneal pneumoperitoneum.

Tomography - layered radiography. With tom-graphics, due to the movement during shooting at a certain speed of the X-ray tube on the film, it is obtained a sharp image of only those structures that are located on a certain, predetermined depth-not. The shadows of organs located on a smaller or pain of depth are obtained by lubricated and not superimposed on the main image. Tomography facilitates the identification of tumors, inflammatory infiltrates and other pathologies. On the tomogram, it is indicated in centimeters - at what depth, counting from the back, a picture is taken: 2, 4, 6, 7, 8 cm.

One of the most advanced techniques giving duvvuny information is cT scanwhich allows the use of computer to delete tissues and changes to them, very slightly differing in the degree of absorption of X-ray radiation.

On the eve of any instrumental study, it is necessary to inform in the affordable form of a patient about the essence of the upcoming study, the need to conduct it and consent to carry out this study in writing.

Preparation of patient K. x-ray study of the stomach and duodenum. This is a method of study based on transluency by the X-ray rays of hollow organs using a contrast agent (barium sulfate), which allows to determine the shape, magnitude, position, the mobility of the stomach and 12-risen, localization of ulcers, tumors, evaluate the relief of the mucous membrane and the functional state of the stomach ( His evacuation ability).

Before study, it is necessary:

1. Touch the patient according to the following plan:

a) 2-3 days before the study it is necessary to eliminate gas-forming products (vegetables, fruits, black bread, milk);

b) on the eve of the study in 18 oo - light dinner;

c) warn that the study is conducted on an empty stomach, so on the eve of the patient's study should not eat and drink, take medicines and smoke.

2. In the case of stubborn constipation on the appointment of a doctor in the evening, on the eve of the study, the cleansing enema is put.

5. For the purpose of contrasting the esophagus, the stomach and the 12-tupest intestine - in the radiographic office of the patient drinks the aqueous suspension of barium sulfate.

Performed with the purpose of the diseases of the gallbladder and biliary tract. It is necessary to prevent the patient about the possibility of nausea and liquid stool as a reaction to the reception of a contrast agent. You need to weigh the patient and calculate the dose of a contrast agent.

Instructing the patient according to the following scheme:

a) on the eve of the study for three days the patient complies with a diet without high fiber content (eliminate cabbage, vegetables, coarse bread);

b) 14-7 hours before the study of the patient takes a contrasting substance fractionally (0.5 grams) for an hour every 10 minutes, drinking sweet tea;

c) in 18 oo - light dinner;

d) in the evening 2 hours before sleep, if the patient cannot free the intestines in a natural way, put the cleansing enema;

e) in the morning on the day of the study, the patient must be an empty stomach in X-ray (not to drink, do not eat, do not smoke, do not take medicinal substances). Take with me 2 raw eggs. In the X-ray, sightsets are made, after which the sick takes a gilent breakfast (2 raw egg yolk or a solution of sorbitol (20g on a glass of boiled water) for a choleretic effect). 20 minutes after receiving a choleretic breakfast, a series of overview pictures is performed at certain intervals of time for 2 hours.

Preparation of patient K. hawp (X-ray study of the gallbladder of biliary tract after intravenous administration of a contrast substance).

1. Find out allergic history (intolerance to iodine drugs). For 1 - 2 days before the study, test the sensitivity to the contrasting substance. To do this, 1 ml of a contrast agent heated to T \u003d 37-38 o C, introduce intravenously, monitor the patient's condition. A simpler method is a reception inside iodide potassium on a tablespoon 3 times a day. With a positive allergyr, rash, itching, etc. appears. In the absence of a reaction to the instructed contrast agent, continue the preparation of the patient to the study

2. Before studying, taking care of the patient according to the following plan:

2 - 3 days before the study - a sonslary diet.

In 18 oo - light dinner.

2 hours before sleep - cleansing enema, if the patient cannot free the intestines in a natural way.

- The study is conducted on an empty stomach.

3. In X-ray, introduce intravenously slowly for 10 minutes 20-30 ml of a contrast agent heated to T \u003d 37-38 0 C.

4. The patient is performed a series of overview pictures.

5. Ensure control over the state of the patient during the day after the study in order to eliminate the slow-type allergic reaction.

Preparation of patient K. bronchograms and bronchoscopy.

Bronchography is a study of respiratory tract that allows you to obtain X-ray image of trachea and bronchi after the contrasting agent in them with a bronchoscope. Bronchoscopy. - Instrumental, endoscopic method of study of trachea and bronchi, allowing to inspect the trachea mucous membrane, larynx, to prevent the contents of the contents or wash waters of bronchi for bacteriological, cytological and immunological studies, as well as treatment.

1. To exclude idiosyncraysia to iodolipol, a single-color spoon of this drug is prescribed inwards in 2-3 days before the study and during these 2-3 days the patient takes a 0.1% solution of atropine to 6-8 drops 3 times a day).

2. If the bronchography is assigned to a woman - to warn that there is no varnish on the nails, and on the lips - lipstick.

3. On the eve of the evening for the appointment of a doctor with a sedative purpose, the patient is to take 10 mg of sadocent (when sleeping - sleeping pills).

4. 30-40 minutes before the manipulation is performed to conduct premedication for the purpose of the doctor: to introduce subcutaneously 1 ml - 0.1% of the atropine solution and 1 ml of 2% of the proprietol solution (place an entry in the history of the disease and the journal of narcotic drugs).

Preparation of patient K. x-ray study of the large intestine (irrigoscopy, irrigography)which allows you to obtain an idea of \u200b\u200blength, position, tone, the shape of the colon, identify violations of the motor function.

1. Touch the patient according to the following scheme:

a) Three days before the study, a slicing diet is appointed; b) if the patient is worried about the intestinal disgrace, then you can recommend the infusion of chamomile, carricul or enzyme preparations for three days;

c) on the eve of the study at 15-16 hours the patient receives 30 g of castor oil (in the absence of diarrhea);

d) at 19 00 - light dinner; e) at 20 00 and 21 00 On the eve of the study, cleaning belizes are carried out to the effect of "pure water";

e) in the morning on the day of the study no later than 2 hours before irrigoscopy, 2 cleansing belizes are performed at an interval of one hour;

g) On the day of research, the patient should not drink, eat, smoke and take medicines. Using the Esmark circle in the office of the nurse, aqueous suspension of barium sulfate is introduced.

Preparation of patient K. x-ray studies of the kidneys (surveying shot, excretory urography).

1. To conduct instruction in preparing a patient to research:

Exclude gas generating products (vegetables, fruits, dairy, yeast-like products, black bread, fruit juices) within 3 days before the study.

Take in the meteorism to appoint a doctor activated carbon.

To eliminate meals for 18-20 hours before the study.

2. On the eve in the evening about 22 00 hours and in the morning 1.5-2 hours before the study, put cleansing enemas

3. Suggest a patient to free the bladder immediately before the study.

In the x-ray office, the radiologist performs a survey picture of the abdominal cavity. The nurse exercises slow (for 5-8 minutes), constantly controlling the health of the patient, the introduction of a contrast agent. A series of pictures is performed by a radiologist.

Radiology as science originates from November 8, 1895, when a German physicist Professor Wilhelm Conrad X-rays opened rays, subsequently called him name. X-ray himself called them X-rays. This name has been preserved in his homeland and in the West countries.

The main properties of X-rays:

X-rays, based on the focus of the X-ray tube, are distributed straightforwardly.

They do not deviate in the electromagnetic field.

The speed of propagation is equal to the speed of light.

The X-rays are invisible, but, absorbing with some substances, they force them to glow. This glow is called fluorescence, it underlies x-ray.

X-rays have a photochemical action. At this property of X-rays, X-ray is based on (the currently generally accepted method of production of X-ray pictures).

X-ray radiation has an ionizing effect and gives air the ability to carry out an electric current. Neither visible, neither thermal nor radio wave can cause this phenomenon. Based on this property, X-rays, as well as radiation of radioactive substances, is called ionizing radiation.

An important property of X-ray rays is their penetrating ability, i.e. The ability to pass through the body and objects. The penetrating ability of X-rays depends:

From the quality of the rays. The shorter the length of the X-ray rays (i.e., the tougher X-ray radiation), the deeper it penetrates these rays and, on the contrary, the longer the wave of the rays (the softer radiation), to the smaller depth they penetrate.

From the volume of the body under study: the thicker the object, the harder the X-rays "break through" it. The penetrating ability of X-ray rays depends on the chemical composition and structure of the body under study. The larger in the substance subjected to the effect of X-rays, the atoms of elements with a high atomic weight and a sequence number (according to the Mendeleev table), the stronger it absorbs X-ray radiation and, on the contrary, the less atomic weight, the more transparent substance for these rays. The explanation of this phenomenon is that in electromagnetic radiations with a very small wavelength, which are X-rays, a large energy is concentrated.

Rays of X-rays have an active biological effect. At the same time, critical structures are DNA and cell membranes.

It is necessary to consider another circumstance. X-rays obey the law of reverse squares, i.e. The intensity of X-rays is inversely proportional to the square square.

Gamma rays have the same properties, but these types of radiation differ in the method of obtaining them: X-ray radiation is obtained on high-voltage electrical installations, and gamma radiation - due to the decay of atomic cores.

Radiological research methods are divided into basic and special, private.

Major radiological methods:x-ray, radioscopy, computer X-ray tomography.

Radiography and x-ray are performed on x-ray apparatus. Their main elements are the supply device, emitter (X-ray tube), devices for the formation of X-ray radiation and radiation receivers. X-ray apparatus

it feeds from the urban network by alternating current. The feeding device increases the voltage to 40-150 kV and reduces the ripple, in some devices the current is practically permanent. The quality of X-ray radiation depends on the voltage, in particular, its penetrating ability. With increasing voltage, the radiation energy increases. In this case, the wavelength is reduced and the penetrating ability of the resulting radiation increases.

The X-ray tube is an electrovascular device that converts electrical energy into the energy of X-ray radiation. An important element of the tube is a cathode and anode.

When the low voltage current is supplied to the cathode, the heat thread is heated and begins to emit free electrons (electronic emission), forming an electronic cloud around the thread. When the high voltage is turned on, the electrons emitted by the cathode are accelerated in the electric field between the cathode and the anode, fly from the cathode to the anode and, hovering on the surface of the anode, is braked, highlighting X-ray quanta. To reduce the effect of scattered radiation on the informativeness of radiographs, selecting lattices are used.

X-ray receivers are X-ray film, fluorescent screen, digital radiography systems, and in CT - dosimetric detectors.

Radiography- X-ray study, in which the image of the object under study is obtained, fixed on the photosensitive material. When radiography, a removable object should be in close contact with a magazine charged with a film. X-ray radiation coming out of the tube is sent perpendicular to the center of the film through the middle of the object (the distance between the focus and the skin of the patient under normal conditions of 60-100 cm). The necessary equipment for radiography is cassettes with reinforcing screens, pulling the lattices and a special X-ray film. To select soft X-rays, which can reach the film, and the secondary radiation uses special moving lattices. Cassettes are made from a light-tight material and in size correspond to the standard sizes of the produced X-ray film (13 × 18 cm, 18 × 24 cm, 24 × 30 cm, 30 × 40 cm et al.).

The X-ray film is usually covered on both sides by a photographic emulsion. The emulsion contains crystals of silver bromide, which are ionized by photons of X-rays and visible light. The X-ray film is located in a light-proof cassette with X-ray reinforcing screens (RES). The RAU is a flat base on which a layer of X-ray fighter is applied. The radiographic film acts in radiography not only X-rays, but also the light from the RAU. The reinforcing screens are designed to increase the light effect of X-rays on the film. Currently, screens with phosphors activated by rare-earth elements are widely used: lanthanum oxide bromide and sulfite of gadolinium oxide. A good efficiency ratio of the luminofor of rare earth elements contributes to high light sensitivity and provides high image quality. There are also special screens - gradual, which can equalize the available differences in the thickness and (or) density of the shooting object. The use of reinforcing screens reduces to a large extent exposure time during radiography.

The blackening of the X-ray film occurs due to the restoration of metallic silver under the action of X-ray radiation and light in its emulsion layer. The number of silver ions depends on the number of photons acting on the film: the more their number, the greater the number of silver ions. The changing density of silver ions forms the image hidden inside the emulsion, which becomes visible after special processing by developer. The processing of the filmed films is carried out in the photo laboratory. The processing process is reduced to manifestation, fastening, flushing the film with subsequent drying. In the process of film manifestation, metallic silver black is deposited. Non-ionized silver bromide crystals remain unchanged and invisible. Lock removes silver bromide crystals leaving metallic silver. After fixing, the film is insensitive to the light. The drying of the films is carried out in drying cabinets, which takes up at least 15 minutes, or occurs in a natural way, while the snapshot is ready the next day. When using development machines, pictures get immediately after the study. The image on the X-ray film is due to varying degrees of blaracing caused by changes in the density of black silver granules. The most dark areas on the X-ray film correspond to the highest radiation intensity, so the image is called negative. White (light) areas on radiographs are called dark (dimming), and black - light (enlightenment) (Fig. 1.2).

Advantages of radiography:

An important advantage of radiography is a high spatial resolution. For this indicator, no visualization method can be compared with it.

The dose of ionizing radiation is lower than when x-ray and X-ray computed tomography.

Radiography can be made both in an X-ray office and directly in the operating, dressing, drying or even in the ward (using mobile x-ray installations).

X-ray is a document that can be stored for a long time. It can be studied by many experts.

Lack of radiography: Static study, there is no possibility to assess the movement of objects in the process of research.

Digital radiographyincludes a detection of radiation pattern, image processing and writing, image presentation and viewing, saving information. With digital radiography, analog information is converted to a digital form using analog-to-digital converters, the reverse process occurs with digital-analog converters. To display the image, the digital matrix (numeric lines and columns) is transformed into the matrix of the visible elements of the image - pixels. Pixel - reproducible image formation system minimum pattern element. Each pixel, in accordance with the value of the digital matrix, is assigned one of the shades of the gray scale. The number of possible shades of the gray scale in the range between black and white is often determined on a binary basis, for example, 10 bits \u003d 2 10 or 1024 shade.

Currently, four digital radiography systems have been technically implemented and already obtained:

- digital radiography from the screen of an electron-optical converter (EOP);

- digital luminescent radiography;

- scanning digital radiography;

- Digital selenium radiography.

The system of digital radiography from the EUC screen consists of the EEA screen, a television tract and analog-to-digital converter. The image is used as an image detector. The television camera turns the optical image on the EOP screen into an analog video signal, which is further generated using an analog-digital converter to a set of digital data and is transmitted to the accumulative device. Then this data computer translates into a visible image on the monitor screen. The image is studied on the monitor and can be printed on the film.

In digital fluorescent radiography, luminescent storage plates after their exposure of X-ray radiation are scanned by a special laser device, and the light beam occurs during the laser scanning is transformed into a digital signal, which reproduces the image on the monitor screen, which can be printed. Fluorescent plates are built into cassettes, repeatedly used (from 10,000 to 35,000 times) with any X-ray apparatus.

In scanning digital radiography, through all parts of the object under study, a moving narrow X-ray beam is passed, which is then recorded by the detector and after digitizing in an analog-to-digital converter is transmitted to the computer monitor screen with a possible subsequent printout.

Digital selena radiography as a radiation receiver uses a detector covered with a selenium layer. A hidden image in the selent layer after exposure is a hidden image in the form of sections with different electrical charges is read by scanning electrodes and is transformed into a digital view. Further, the image can be viewed on the monitor screen or printed on the film.

Advantages of digital radiography:

reducing dose loads on patients and medical personnel;

efficiency in operation (during shooting immediately the image immediately disappears the need to use X-ray film, other consumables);

high performance (about 120 images per hour);

digital image processing improves the image quality and thereby increases the diagnostic informativeness of digital radiography;

cheap digital archiving;

quick search for an X-ray image in memory of the computer;

reproduction of an image without loss of its quality;

the ability to unite into a single network of various equipment of the radiation diagnostics;

the possibility of integration into the overall local network of the institution ("Electronic History of Disease");

the possibility of organizing remote consultations ("telemedicine").

Image quality When using digital systems can be characterized, as with other radiation methods, physical parameters such as spatial resolution and contrast. The contrast of the shadow is the difference in optical densities between adjacent images of the image. Spatial resolution is the minimum distance between the two objects, in which they can still be separated from each other. Digitization and processing of the image lead to additional diagnostic capabilities. So, a significant distinctive feature of digital radiography is a larger dynamic range. That is, X-rays with a digital detector will be of good quality in the larger range of X-ray doses than with conventional radiography. The possibility of free adjustment of the contrast image with digital processing is also a significant difference between traditional and digital radiography. Contrast transmission is thus not limited to choosing a receiver image and research parameters and can additionally adapt to solving diagnostic tasks.

Radioscopy.- transmission of organs and systems using X-rays. Radioscopy is an anatomical functional method that provides the ability to study the normal and pathological processes of organs and systems, as well as tissues by the shadow picture of the fluorescent screen. The study is performed real-time, i.e. Production of the image and obtaining it by the researcher coincide in time. With radioscopy, a positive image is obtained. The visible light areas are called light, and dark-dark.

Advantages of X-ray:

allows you to investigate patients in various projections and positions, which is why the position can be selected in which pathological education is better detected;

the possibility of studying the functional state of a number of internal organs: lungs, with different phases of breathing; heart pulsation with large vessels, motor functioning of the digestive channel;

close contact of the radiologist with patients, which allows to supplement X-ray examination with clinical (palpation under visual control, targeted anamnesis), etc.;

the possibility of performing manipulations (biopsies, catheterisations, etc.) under the control of the X-ray image.

Disadvantages:

relatively large radiation load on the patient and attendants;

small bandwidth for the work time of the doctor;

limited ability of the eye of the researcher in identifying small tenons and thin structures of tissues; Indications for radoscopy are limited.

Electron Optical Strength (EOU).It is based on the principle of radiation transformation into an electronic one, followed by its transformation into reinforced light. X-ray eope is a vacuum tube (Fig. 1.3). The X-rays carrying the image from a transmission object fall on the input fluorescent screen, where their energy is converted into the lighting energy of the input fluorescent screen. Next, photons emitted by a luminescent screen fall onto a photocatode that converts light radiation into the electron flow. Under the influence of a constant electric field of high voltage (up to 25 kV) and as a result of focusing with electrodes and anode of a special form, the electron energy increases several thousand times and they are sent to the output fluorescent screen. The brightness of the output screen is amplified up to 7 thousand times, compared to the input screen. The image from the output luminescent screen with the help of a television tube is transmitted to the display screen. The use of the AO allows you to distinguish between the parts of 0.5 mm, i.e. 5 times smaller than with a conventional x-ray examination. When using this method, X-ray can be used, i.e. Recording an image on a movie or video flashlight and digitizing the image using an analog-to-digital converter.

Fig. 1.3. Scheme eop. 1 - X-ray tube; 2 - object; 3 - input luminescent screen; 4 - focusing electrodes; 5 - anode; 6 - output luminescent screen; 7 - outer shell. The dotted lines indicate the flow of electrons.

X-ray computed tomography (CT).Creating X-ray computed tomography was an essential event in radiation diagnosis. Evidence of this is the award of the Nobel Prize in 1979 by the famous scientist Kormaku (USA) and Hounsfield (England) for the creation and clinical test of CT.

CT allows you to study the position, shape, size, and structure of various organs, as well as their ratio with other organs and tissues. The successes achieved by the CT in the diagnosis of various diseases served as an incentive of the rapid technical improvement of devices and a significant increase in their models.

The CT is based on the registration of X-ray radiation with sensitive dosimetry detectors and the creation of X-ray images of organs and tissues using a computer. The principle of the method is that after passing the rays through the patient's body, they are not on the screen, but on detectors in which electrical impulses arise transmitted after amplification in the computer, where they are reconstructed using a special algorithm and create an image of an object studied on the monitor ( Fig. 1.4).

An image of organs and tissues on CT, in contrast to traditional X-ray shots, is obtained in the form of transverse sections (axial scans). On the basis of axial scans, the image is reconstructed in other planes.

In the practice of radiology, it is currently used mainly three types of computer tomographs: ordinary steps, spiral or screw, multi-section.

In conventional step-down computer tomographs, high voltage to the X-ray tube is supplied by high-voltage cables. Because of this, the tube cannot rotate constantly, but should perform swinging movements: one turnover clockwise, stop, one turn counterclockwise, stop and back. As a result of each rotation, one image is obtained with a thickness of 1 - 10 mm for 1 - 5 seconds. In the interval between the cuts, the tomograph table with the patient moves to the installed distance of 2-10 mm, and the measurements are repeated. With a cutting thickness of 1 - 2 mm, stepst hard drives allow you to perform a study in the "High Resolution" mode. But these devices have a number of shortcomings. The duration of scanning is relatively large, and artifacts from movement and breathing can appear on images. Reconstruction of the image in projections other than axial, difficulty or simply impossible. Serious restrictions are available when performing dynamic scans and research with contrast gain. In addition, low-dimensional formations between cuts during the patient's uneven breathing may not be detected.

In spiral (screw) computer tomographs, the constant rotation of the tube is combined with the simultaneous movement of the patient's desk. Thus, during the study, they receive information immediately from the total volume of tissues (entire head, chest), and not from individual sections. With a spiral CT, a three-dimensional reconstruction of the image (3D-mode) with a high spatial resolution is possible, including a virtual endoscopy, which allows visualizing the inner surface of the bronchi, stomach, colon, larynx, apparent sinuses of the nose. Unlike endoscopy using fiber optics, the narrowing of the lumen of the object under study is not an obstacle to virtual endoscopy. But in the conditions of the last color of the mucous membrane differs from natural and it is impossible to perform a biopsy (Fig. 1.5).

In stepper and spiral tomographs use one or two rows of detectors. Multi-section (multi-detector) Computer tomographs are equipped with 4, 8, 16, 32, and even 128 rows of detectors. In multi-section devices, the scanning time is significantly reduced and the spatial resolution in the axial direction is improved. They can receive information using the high resolution technique. The quality of multipplanic and voluminous reconstructions is significantly improved. CT has a number of advantages over the usual X-ray study:

First of all, high sensitivity, which allows the differentiation of individual organs and tissues from each other by density within up to 0.5%; On ordinary radiographs, this indicator is 10-20%.

CT allows you to obtain an image of organs and pathological foci only in the plane of the study of the cut, which gives a clear image without the layering of the above and below formations.

CT makes it possible to obtain accurate quantitative information about the size and density of individual organs, tissues and pathological formations.

CT allows you to judge not only about the state of the organ under study, but also on the relationship of the pathological process with surrounding organs and tissues, for example, invasion of the tumor in neighboring bodies, the presence of other pathological changes.

CT allows you to get a topogram, i.e. The longitudinal image of the area under study like an X-ray image by displacement of the patient along the still tube. Topograms are used to establish the length of the pathological focus and determining the number of slices.

With a spiral CT under the conditions of three-dimensional reconstruction, you can perform virtual endoscopy.

CT is indispensable when planning radiation therapy (drawing up irradiation cards and dose calculation).

CT data can be used for diagnostic puncture, which can be successfully used not only to identify pathological changes, but also to assess the effectiveness of treatment and, in particular, antitumor therapy, as well as determining recurrences and related complications.

Diagnosis with CT is based on direct radiographic signs, i.e. The determination of accurate localization, shapes, sizes of individual organs and the pathological focus and, especially important, on density or absorption indicators. The absorption indicator is based on the degree of absorption or weakening of the X-ray beam when passing through the human body. Each tissue, depending on the density of the atomic mass, absorbs the radiation in different ways, so at present, for each tissue and organ, the absorption coefficient (KA) is developed, denoted in Hounsfield units (HU). HUNDERS TAKE FOR 0; The bones with the greatest density are +1000, the air having the smallest density is 1000.

When CT, the entire range of the gray scale, which shows the image of the tomogram on the video monitor screen, is from - 1024 (black level) to + 1024 HU (white level). Thus, with a CT "Window", that is, the range of HU changes (HounSfield units) is measured from - 1024 to + 1024 HU. For visual analysis of information in a gray scale, it is necessary to limit the "window" of the scale according to the image of the tissues with close density indicators. Consistently changing the magnitude of the "windows", it can be studied in optimal conditions of visualization different areas of the object. For example, for optimal estimates of the lungs, the black level is chosen, close to the middle lung density (between - 600 and 900 Hu). Under the "window" with a width of 800 with a level - 600 HU is meant that the density - 1000 HU is visible as black, and all densities are 200 Hu and more - like white. If the same image is used to assess the details of the bone structures of the chest, the "window" of 1000 width 1000 and the + 500 HU level will create a complete gray scale in the range between 0 and + 1000 HU. The CT image is studied on the monitor screen, it is placed in the long-term memory of the computer or is obtained on a hard medium - a film. Bright areas on a computed tomogram (with a black and white image) are called "hyperdissive", and dark - "hypodenistic". Immision means the density of the structure under study (Fig. 1.6).

The minimum magnitude of the tumor or another pathological focus determined by CT varies from 0.5 to 1 cm, provided that what the tissue is different from such a healthy to 10-15 units.

The disadvantage of CT is an increase in the radiation load on patients. Currently, the CT accounts for 40% of the collective dose of irradiation obtained by patients with X-ray diagnostic procedures, while the CT study is only 4% of the number of all X-ray studies.

Both in CT and with radiological studies, there is a need to use to increase the resolution of the "Strengthen Image" technique. Contrasting with CT is made with water-soluble radiocontrase.

The "reinforcement" technique is carried out by perfusion or infusion administration of a contrast agent.

Radiological research methods are called special, if artificial contrasts are used.The organs and tissues of the human body become distinguishable if they absorb X-ray rays to varying degrees. In physiological conditions, such differentiation is possible only in the presence of a natural contrast, which is due to the difference in the density (chemical composition of these organs), the magnitude, position. The bone structure is well detected against the background of soft tissues, hearts and large vessels against the background of air pulmonary fabric, but the heart chambers in the conditions of natural contrast can not be isolated separately, as, for example, the abdominal organs. The need to study the X-rays of organs and systems with the same density has led to the creation of an artificial contrasting technique. The essence of this technique is to introduce into the studied organ of artificial contrasting substances, i.e. substances having a density that differs from the density of the organ and the surrounding medium (Fig. 1.7).

X-ray contrast (RCS)it is customary to divide on substances with high atomic weight (X-ray-positive contrast agents) and low (X-ray-negative contrasting substances). Contrast substances should be harmless.

Contrast substances intensely absorbing X-rays (positive X-ray infertour) is:

The suspension of heavy metals salts - the sulfur-acid barium used to study the gastrointestinal tract (it is not absorbed and is displayed through natural paths).

Aquatic solutions of iodine organic compounds - ultrasound, verte, bilignoste, angiography, etc., which are introduced into the vascular bed, with blood flow fall into all organs and give, besides contrasting the vascular bed, contrasting other systems - urinary, gallbladder, etc. .

Oil solutions of iodine organic compounds - iodolipol, etc., which are introduced into fistula and lymphatic vessels.

Non-ionic water-soluble Iodine-containing X-ray inferties: ultravist, omnipak, imagopac, Visionak are characterized by the absence in the chemical structure of ion groups, low osmolarity, which significantly reduces the possibility of pathophysiological reactions, and thereby causes a low number of side effects. Non-ionic iodine-containing radiopaphrants determine the lower number of side effects than ionic high-temperature RCCs.

X-ray detection, or negative contrast agents - air, gases "do not absorb" X-ray rays and therefore well the studied organs and tissues that have a big density.

Artificial contrasts by the method of introducing contrast drugs is divided into:

The introduction of contrast agents into the cavity of the organs under study (the largest group). This includes studies of the gastrointestinal tract, bronchography, fistula research, all kinds of angiography.

The introduction of contrasting substances around the underlying organs - retropnemperitoneum, pneumulane, pneumomediastinography.

The introduction of contrast agents into the cavity and around the organs under study. This group belongs to pariosmography. Pariosogencies in diseases of the busty organs consists in obtaining pictures of the wall of the studied hollow organ after the administration of the gas is initially around the organ, and then into the cavity of this organ.

The method based on the specific ability of some organs to concentrate individual contrast drugs and at the same time shall apply them against the background of surrounding tissues. This includes excretory urography, cholecystography.

Side effect of the RCC. The reactions of the body on the introduction of the RCC are observed in approximately 10% of cases. By character and severity, they are divided into 3 groups:

Complications related to the manifestation of toxic action to various organs with functional and morphological lesions.

A neuro-vascular reaction is accompanied by subjective sensations (nausea, heat sensation, general weakness). Objective symptoms are vomiting, a decrease in blood pressure.

Individual RCS intolerance with characteristic symptoms:

1. On the part of the central nervous system - headaches, dizziness, excitement, anxiety, feeling of fear, the occurrence of convulsions, swelling of the brain.

   Skin reactions - urticaria, eczema, itching, etc.

   Symptoms associated with violation of the activity of the cardiovascular system - the pallor of the skin, unpleasant sensations in the field of the heart, the drop in blood pressure, paroxysmal tachy, or bradycardia, collapse.

   The symptoms associated with the respiratory impairment are Tahipne, the dance, the attack of bronchial asthma, the swelling of the larynx, the swelling of the lungs.

RCC intolerance reactions are sometimes irreversible and lead to death.

Mechanisms for the development of systemic reactions in all cases are similar in nature and are due to the activation of the complement system under the influence of the RCC, the influence of the RCC on the rolling system of blood, the release of histamine and other biologically active substances, a true immune response or a combination of these processes.

In light cases of adverse reactions, it is sufficient to stop the injection of the RCC and all phenomena, as a rule, pass without therapy.

In the development of pronounced adverse reactions, primary emergency assistance should begin at the place of production of the research by the X-ray Cabinet. First of all, it is necessary to immediately stop intravenous administration of an X-ray-contrast drug, call a doctor, the duties of which include the provision of emergency medical care, to establish reliable access to the venous system, to ensure the airway passability, for which you need to turn the patient's head on the side and fix the language, as well as provide The ability to conduct (if necessary) inhalation of oxygen at a speed of 5 l / min. When anaphylactic symptoms appear, it is necessary to carry out the following urgent anti-deposit measures:

- introduce intramuscularly 0.5-1.0 ml of 0.1% solution of hydrochloride adrenaline;

- in the absence of a clinical effect with the preservation of pronounced hypotension (below 70 mm Hg. Art.) To begin intravenous infusion with a speed of 10 ml / h (15-20 drops in one minute) of a mixture of 5 ml of 0.1% solution of adrenaline hydrochloride, diluted in 400 ml of 0.9% sodium chloride solution. If necessary, the rate of infusion can be increased to 85 ml / h;

- With a serious condition of the patient, it is additionally intravenously to introduce one of the drugs of glucocorticoids (methylprednisolone 150 mg, dexamethasone 8-20 mg, hydrocortisone hemisuccinate 200-400 mg) and one of antihistamine preparations (DIMEDROL 1% -2.0 ml, suprastin 2% -2 , 0 ml, taverned 0.1% -2.0 ml). The introduction of Pipolfen (diprazine) is contraindicated due to the possibility of the development of hypotension;

- with adrenalind-resistant bronchospasm and an attack of bronchial asthma, intravenously slowly introduce 10, 0 ml of 2.4% of the solution of euphilline. In the absence of the effect, re-introduce the same dose of Euphillin.

In the case of a clinical death to carry out artificial respiration "mouth in the mouth" and indirect heart massage.

All anti-deposit measures must be carried out as quickly as possible until the normalization of blood pressure and the restoration of the patient's consciousness.

When developing moderate vasoactive adverse reactions without a significant impairment of respiration and blood circulation, as well as under the skin manifestations, emergency assistance can be limited to the introduction of only antihistamine preparations and glucocorticoids.

In the swelling of the larynx, along with these drugs, it is necessary to intravenously to introduce 0.5 ml of 0.1% of the solution of adrenaline and 40-80 mg of the lazix, as well as to ensure the inhalation of moisturized oxygen. After carrying out mandatory anti-depository therapy, regardless of the severity of the state, the patient should be hospitalized to continue intensive therapy and rehabilitation treatment.

In connection with the possibility of developing adverse reactions, all radiographic rooms in which intravascular radiocontrase studies are conducted must have tools, instruments and medicines necessary to provide emergency medical care.

For the prevention of the side effect of the RCC, the on the eve of X-ray-contrast research is used by antihistamine and glucocorticoid drugs, and one of the tests are carried out to predict the increased sensitivity of the patient to the RCC. The most optimal tests are: determining the release of histamine from peripheral blood basophils when mixing it with RCC; the content of the general complement in the serum of patients assigned to the X-ray-contrast examination; Selection of patients for premedication by determining whey immunoglobulin levels.

Among the rare complications may occur "water" poisoning during irrigoscopy in children with megalon and gas (or well) embolism of vessels.

A sign of "water" poisoning, when a large amount of water is quickly absorbed through the walls of the intestine in the circuit and there is an imbalance of electrolytes and plasma proteins, there may be tachycardia, cyanosis, vomiting, respiratory disorder with a heart stop; May come death. First aid at the same time - intravenous administration of solid blood or plasma. The prevention of complication is the conduct of irrigoscopy in children with a barium suspension in an isotonic solution of salt, instead of aqueous suspension.

Signs of vessel embolism are as follows: the appearance of the feeling of constraints in the chest, shortness of breath, cyanosis, pulse gentity and drop in blood pressure, convulsions, stopping breathing. At the same time, the introduction of the RCC should be immediately terminated, to put the patient to the Trendelenburg position, proceed to artificial respiration and indirect massage of the heart, introduce intravenously 0.1% - 0.5 ml of the adrenaline solution and cause a resuscitation brigade for possible tracheal intubation, the implementation of hardware artificial respiration and holding further medical events.

Private radiological methods.Fluorography- Method of mass flow x-ray examination, consisting in photographing an X-ray image from a translucent screen on a fluorographic film with a camera. Film size 110 × 110 mm, 100 × 100 mm, less often - 70 × 70 mm. The study is performed on a special X-ray apparatus - fluorograph. It has a fluorescent screen and a mechanism for automatic moving a roll film. Photographing the image is performed using the camera to roll film (Fig. 1.8). The method is used for mass examination to recognize the pulmonary tuberculosis. Other diseases can be found along the way. Fluorography is more economical and produced than radiography, but significantly inferior to her by informative. Dose of radiation with fluorography is greater than during radiography.

Fig. 1.8. Scheme of fluorography. 1 - X-ray tube; 2 - object; 3 - luminescent screen; 4- Linzing optics; 5 - camera.

Linear tomographydesigned to eliminate the summary nature of the X-ray image. In tomographs for linear tomography, an X-ray tube and a film cassette is driven in opposite directions (Fig. 1.9).

During the movement of the tube and the cassettes in opposite directions, the axis of the tube movement is formed - a layer, which remains as if fixed, and on the tomographic image of this layer are displayed in the form of shadows with rather sharp outlines, and the tissue is higher and below the layer of the movement axis are displaced and not Received in the image of the specified layer (Fig. 1.10).

Linear tomograms can be performed in sagittal, frontal and intermediate planes, which is unattainable with step CT.

X-rayiayevik- Therapeutic and diagnostic procedures. There are in mind combined x-ray endoscopic procedures with therapeutic intervention (interventional radiology).

Interventions and radiological interventions are currently include: a) transcatette interventions on the heart, aorta, arteries and veins: renovalization of vessels, disagreement of congenital and acquired arteriovenous stations, thrombectomy, endoprosthetics, installation of stents and filters, embolization of vessels, closure of defects of interdestrial and interventricular partitions , selective drug administration in various sections of the vascular system; b) percutaneous drainage, filling and sclerosis of cavities of various localization and origin, as well as drainage, dilatation, stenting and endoprosthetics of ducts of different organs (liver, pancreas, salivary gland, tear-axis channel, etc.); c) dilatation, endoprosthetics, stenting trachea, bronchi, esophagus, guts, dilatation of intestinal strictures; d) prenatal invasive procedures, radial interventions on the fruit under the control of ultrasound, recanalization and stenting of uterine pipes; e) removal of foreign bodies and concrections of various nature and different location. As a navigation (guide) study, in addition to X-ray, an ultrasound method is used, and ultrasound apparatus is provided with special puncture sensors. Types of interventions are constantly expanding.

Ultimately, the subject of study in radiology is a shadow image.The features of the shadow x-ray image are:

An image that is folded from many dark and light areas - respectively, the areas of unequal weakening of the X-rays in different parts of the object.

The size of the X-ray image is always increased (except CT), compared with the object being studied, and the greater the further object is from the film, and the smaller the focal length (the distance of the film from the X-ray tube) (Fig. 1.11).

When the object and the film is not in parallel planes, the image is distorted (Fig. 1.12).

The image is comprehensive (except tomography) (Fig. 1.13). Consequently, X-rays should be made at least in two mutually perpendicular projections.

Negative image with radiography and CT.

Each fabric and pathological formations detected at radiation

Fig. 1.13. The sum of x-ray image during radiography and radioscopy. Subcontraction (A) and superposition (b) of x-ray shadows.

the study is characterized by strictly defined features, namely: the number, position, shape, size, intensity, structure, the nature of the contours, the presence or absence of mobility, the dynamics in time.