A doctor who performs X-ray examinations. X-ray: methods and types of research

X-rays refer to a special kind of electromagnetic oscillation that is created in the tube of an X-ray machine when the electrons suddenly stop. X-ray is a familiar procedure for many, but some want to know more about it. What is an x-ray? How is an x-ray done?

X-ray properties

In medical practice, the following properties of x-rays have been used:

Great penetrating power. X-rays successfully pass through various tissues of the human body.
X-ray causes light reflection of individual chemical elements. This property underlies fluoroscopy.
The photochemical effect of ionizing rays allows you to create informative, from a diagnostic point of view, images.
X-ray radiation has an ionizing effect.

During an x-ray scan, various organs, tissues, and structures act as targets for x-rays. During an insignificant radioactive load, metabolism can be disturbed, and with prolonged exposure to radiation, acute or chronic radiation sickness can occur.

X-ray machine

X-ray machines are devices that are used not only for diagnostic and therapeutic purposes in medicine, but also in various industries (defectoscopes), as well as in other areas of human life.

The device of the x-ray machine:

emitter tubes (lamp) - one or more pieces;
a power supply device that supplies the device with electricity and regulates the radiation parameters;
tripods that make it easier to control the device;
converters of X-ray radiation into a visible image.

X-ray machines are divided into several groups depending on how they are arranged and where they are used:

stationary - they are, as a rule, equipped with rooms in radiology departments and clinics;
mobile - designed for use in the departments of surgery and traumatology, in intensive care units and outpatients;
portable, dental (used by dentists).

When passing through the human body, X-rays are projected onto the film. However, the angle of reflection of the waves can be different and this affects the image quality. The bones are best seen in the pictures - they are bright white in color. This is due to the fact that calcium absorbs X-rays the most.

Types of diagnostics

In medical practice, X-rays have found application in the following diagnostic methods:

Fluoroscopy is a research method in which in the past the examined organs were projected onto a screen coated with a fluorescent compound. In the process, it was possible to examine the organ from different angles in dynamics. And thanks to modern digital processing, they immediately receive the finished video image on the monitor or display it on paper.
Radiography is the main type of research. The patient is given a film with a fixed image of the examined organ or part of the body.
Radiography and fluoroscopy with contrast. This type of diagnostics is indispensable in the study of hollow organs and soft tissues.
Fluorography is an examination with small-format x-rays that allow it to be used massively during preventive examinations of the lungs.
Computed tomography (CT) is a diagnostic method that allows you to study the human body in detail through a combination of x-rays and digital processing. There is a computer reconstruction of layer-by-layer X-ray images. Of all the methods of radiation diagnostics, this one is the most informative.

X-rays are used not only for diagnosis, but also for therapy. Radiation therapy is widely used in the treatment of cancer patients.

In the case of emergency care, the patient is initially given a survey radiograph.

There are such types of X-ray examination:

spine and peripheral parts of the skeleton;
chest;
abdominal cavity;
detailed image of all teeth with jaws, adjacent sections of the facial skeleton;
checking the patency of the fallopian tubes using x-rays;
x-ray examination of the breast with a low proportion of radiation;
radiopaque examination of the stomach and duodenum;
diagnosis of the gallbladder and ducts using contrast;
examination of the colon with retrograde injection of a radiopaque preparation into it.

An abdominal x-ray is divided into a plain x-ray and a procedure performed with contrast. To determine the pathologies in the lung, fluoroscopy has found wide application. X-ray examination of the spine, joints and other parts of the skeleton is a very popular diagnostic method.

Neurologists, traumatologists and orthopedists cannot make an accurate diagnosis for their patients without using this type of examination. It shows X-ray hernia of the spine, scoliosis, various microtraumas, disorders of the bone and ligamentous apparatus (pathology of a healthy foot), fractures (of the wrist joint) and much more.

Training

Most of the diagnostic manipulations associated with the use of x-rays do not require special training, but there are exceptions. If an examination of the stomach, intestines or lumbosacral spine is planned, then 2-3 days before the X-ray, you need to follow a special diet that reduces flatulence and fermentation processes.

When examining the gastrointestinal tract, it is required on the eve of the diagnosis and directly on the day of the examination to make cleansing enemas in the classical way using Esmarch's mug or cleanse the intestines with the help of pharmacy laxatives (oral preparations or microclysters).

When examining the abdominal organs, at least 3 hours before the procedure, you can not eat, drink, smoke. Before you go for a mammogram, you need to visit a gynecologist. An x-ray examination of the breast should be carried out at the beginning of the menstrual cycle after the end of menstruation. If a woman who plans a breast examination has implants, then this must be reported to the radiologist.

Holding

Entering the X-ray room, he must remove any items of clothing or jewelry that contain metal, and also leave his mobile phone outside the room. As a rule, the patient is asked to undress to the waist if the chest or peritoneum is being examined. If it is necessary to perform an x-ray of the extremities, the patient can remain in clothing. All parts of the body that are not subject to diagnosis should be covered with a protective lead apron.

Pictures can be taken in various positions. But most often the patient is standing or lying down. If you need a series of images from different angles, then the radiologist gives the patient commands to change the position of the body. If an x-ray of the stomach is performed, then the patient will need to take the Trendelenburg position.

This is a special posture in which the pelvic organs are slightly higher than the head. As a result of manipulations, negatives are obtained, which show light areas of denser structures and dark areas, indicating the presence of soft tissues. Decoding and analysis of each area of the body is performed according to certain rules.

X-rays are often taken in children to detect hip dysplasia.

Frequency

The maximum allowable effective dose of radiation is 15 mSv per year. As a rule, only people who need regular X-ray control (after severe injuries) receive such a dose of radiation. If during the year the patient does only fluorography, mammography and X-rays at the dentist, then he can be completely calm, since his radiation exposure will not exceed 1.5 mSv.

Acute radiation sickness can occur only if a person receives a single exposure to a dose of 1000 mSv. But if this is not a liquidator at a nuclear power plant, then in order to receive such a radiation exposure, the patient must do 25,000 x-rays and a thousand x-rays of the spine in one day. And this is nonsense.

The same radiation doses that a person receives during standard examinations, even if they are increased, are not able to have a noticeable negative effect on the body. Therefore, x-rays can be done as often as required by medical indications. However, this principle does not apply to pregnant women.

X-rays are contraindicated for them at any time, especially in the first trimester, when all organs and systems in the fetus are laid. If circumstances force a woman to take an x-ray while carrying a child (serious injuries during an accident), then they try to use the maximum protection measures for the abdomen and pelvic organs. During breastfeeding, women are allowed to do both x-rays and fluorography.

At the same time, according to many experts, she does not even need to express milk. Fluorography for small children is not done. This procedure is valid from the age of 15. As for X-ray diagnostics in pediatrics, they resort to it, but take into account that children have increased radiosensitivity to ionizing radiation (on average 2-3 times higher than adults), which creates a high risk of both somatic and genetic radiation effects.

Contraindications

Fluoroscopy and radiography of organs and structures of the human body has not only many indications, but also a number of contraindications:

active tuberculosis;
endocrine pathologies of the thyroid gland;
the general serious condition of the patient;
bearing a child at any time;
for radiography with the use of contrast - lactation;
serious disorders in the work of the heart and kidneys;
internal bleeding;
individual intolerance to contrast agents.

In our time, you can take an x-ray in many medical centers. If radiographic or fluoroscopic examination is done on digital complexes, then the patient can count on a lower dose of radiation. But even a digital x-ray can be considered safe only if the permissible frequency of the procedure is not exceeded.

About a hundred years ago, the famous scientist K. Roentgen discovered X-rays. From that moment to the present, X-rays have been helping all of humanity, both in the field of medicine and in the field of industry, as well as in many other areas. X-ray diagnostics is currently the most reliable and effective method in the arsenal of both the doctor and the patient. Today, a large number of innovative technologies and methods are known that can minimize adverse effects on the human body, as well as make the research more informative.

Most likely, everyone at least once in their life has dealt with certain modern technologies of X-ray diagnostics. Let's dwell on them in more detail.

Radiography- is perhaps the most common and well-known method. Its use is indicated when there is a need to obtain an image of a certain part of the body by using X-rays, on a special photographic material;

With the use of radiography (better known as X-ray), you can get an image of, for example, teeth or a skeleton. It is also used for fractures, as part of a comprehensive diagnosis of the joints and spine, as well as to detect the presence of foreign bodies in the human body. X-rays can be ordered by specialists such as a dentist, or an orthopedist, or a doctor working in an emergency room.

Fluoroscopy is the process of obtaining an image on the screen, with its help it is possible to study organs that are in the process of their work - we are talking about processes such as diaphragm movements, heart contractions, peristalsis of the esophagus, intestines and stomach. In addition, the method allows you to get a visual representation of the location of organs relative to each other, to determine the nature of localization and the degree of displacement of pathological formations. With the help of such a method as fluoroscopy, it is possible to perform numerous therapeutic and diagnostic manipulations, for example, vascular catheterization.

It is nothing more than the process of photographing an x-ray image directly from the screen. This becomes possible with the use of special devices. Today, the most commonly used method is digital fluorography. The method has found wide application in the process of examining such organs as the lungs and other organs of the chest cavity, mammary glands, nasal paranasal sinuses.

Tomography , if translated from Greek, means "slice image". In other words, the purpose of tomography is nothing more than obtaining a multilayer image of the internal structure of the research material, that is, an organ. The method is practiced in the process of conducting a study of a number of organs, as well as parts of the body;

Contrast radiography . This method is a conventional x-ray, which is performed using a contrast agent, namely barium sulfate. This technology makes it possible to determine with high accuracy the size, as well as the shape and position, the degree of mobility of an organ, the type of relief, the state of the mucous membrane of the organ. Also, by such a study, it is possible to identify the changes that have occurred or the resulting tumor. The method is used in situations in which more primitive methods do not allow obtaining the required diagnostic results.

Interventional radiology (also known as X-ray surgery) is a whole complex of surgical operations of minor trauma, carried out under strict supervision and using the so-called radiation methods, that is, ultrasound, as well as fluoroscopy, in fact, X-ray, CT, or the method of nuclear magnetic resonance.

Nowadays, X-ray diagnostics steadily continues its development, providing more and more new and modern research options.

X-ray examination - the use of X-rays in medicine to study the structure and function of various organs and systems and to recognize diseases. X-ray examination is based on the unequal absorption of X-ray radiation by different organs and tissues, depending on their volume and chemical composition. The stronger the X-ray radiation absorbed by a given organ, the more intense the shadow cast by it on the screen or film. For x-ray examination of many organs, artificial contrasting is used. A substance is introduced into the cavity of an organ, into its parenchyma or into its surrounding spaces, which absorbs X-rays to a greater or lesser extent than the organ under study (see Shadow contrast).

The principle of X-ray examination can be represented in the form of a simple diagram:
x-ray source → research object → radiation receiver → doctor.

The X-ray tube serves as a source of radiation (see). The object of the study is the patient, directed to identify pathological changes in his body. In addition, healthy people are also examined to detect latent diseases. A fluoroscopic screen or a film cassette is used as a radiation receiver. With the help of a screen, fluoroscopy is performed (see), and with the help of a film - radiography (see).

X-ray examination allows you to study the morphology and function of various systems and organs in the whole organism without disturbing its vital activity. It makes it possible to examine organs and systems at different age periods, allows you to detect even small deviations from the normal picture and thus make a timely and accurate diagnosis of a number of diseases.

X-ray examination should always be carried out according to a certain system. First, they get acquainted with the complaints and the history of the disease of the subject, then with the data of other clinical and laboratory studies. This is necessary because X-ray examination, despite all its importance, is only a link in the chain of other clinical studies. Next, they draw up a plan for an x-ray study, that is, they determine the sequence of applying certain methods to obtain the required data. After completing the X-ray examination, they begin to study the obtained materials (X-ray morphological and X-ray functional analysis and synthesis). The next step is the comparison of x-ray data with the results of other clinical studies (clinical-radiological analysis and synthesis). Further, the obtained data are compared with the results of previous X-ray studies. Repeated x-ray examinations play an important role in the diagnosis of diseases, as well as in the study of their dynamics, in monitoring the effectiveness of treatment.

The result of the x-ray examination is the formulation of the conclusion, which indicates the diagnosis of the disease or, if the data obtained are insufficient, the most likely diagnostic possibilities.

With proper technique and methodology, X-ray examination is safe and cannot harm the subjects. But even relatively small doses of X-ray radiation are potentially capable of causing changes in the chromosomal apparatus of germ cells, which can manifest itself in subsequent generations by changes harmful to offspring (developmental abnormalities, a decrease in overall resistance, etc.). Although each X-ray examination is accompanied by the absorption of a certain amount of X-ray radiation in the patient's body, including his gonads, the likelihood of this kind of genetic damage in each specific case is negligible. However, in view of the very high prevalence of X-ray examinations, the problem of safety in general deserves attention. Therefore, special regulations provide for a system of measures to ensure the safety of X-ray examinations.

These measures include: 1) conducting X-ray examinations according to strict clinical indications and special care when examining children and pregnant women; 2) the use of advanced x-ray equipment, which allows to reduce the radiation exposure to the patient to a minimum (in particular, the use of electron-optical amplifiers and television devices); 3) the use of various means of protecting patients and personnel from the effects of X-ray radiation (enhanced radiation filtration, the use of optimal technical conditions for shooting, additional protective screens and diaphragms, protective clothing and protectors of the gonads, etc.); 4) reducing the duration of X-ray examination and the time spent by personnel in the field of action of X-ray radiation; 5) systematic dosimetric monitoring of radiation exposure of patients and personnel of X-ray rooms. Dosimetry data are recommended to be entered in a special column of the form, on which a written conclusion is given on the X-ray examination performed.

X-ray examination may only be carried out by a doctor with special training. The high qualification of the radiologist ensures the effectiveness of radiodiagnostics and the maximum safety of all x-ray procedures. See also X-ray diagnostics.

X-ray examination (X-ray diagnostics) is an application in medicine for studying the structure and function of various organs and systems and for recognizing diseases.

X-ray examination is widely used not only in clinical practice, but also in anatomy, where it is used for the purposes of normal, pathological and comparative anatomy, as well as in physiology, where X-ray examination makes it possible to observe the natural course of physiological processes, such as contraction of the heart muscle, respiratory movements of the diaphragm, peristalsis of the stomach and intestines, etc. An example of the use of X-ray examination for preventive purposes is (see) as a method of mass examination of large human contingents.

The main methods of X-ray examination are (see) and (see). Fluoroscopy is the simplest, cheapest and most easily performed method of X-ray examination. An essential advantage of fluoroscopy is the ability to conduct research in various arbitrary projections by changing the position of the body of the subject in relation to the translucent screen. Such a multi-axis (poly-positional) study makes it possible to establish during the transillumination the most advantageous position of the organ under study, in which certain changes are revealed with the greatest clarity and completeness. At the same time, in some cases it is possible not only to observe, but also to feel the organ under study, for example, the stomach, gallbladder, intestinal loops, by the so-called X-ray palpation, carried out in lead rubber or using a special device, the so-called distinctor. Such targeted (and compression) under the control of a translucent screen provides valuable information about the displacement (or non-displacement) of the organ under study, its physiological or pathological mobility, pain sensitivity, etc.

Along with this, fluoroscopy is significantly inferior to radiography in terms of the so-called resolution, i.e., the detectability of details, since, compared with the image on a translucent screen, it more fully and accurately reproduces the structural features and details of the organs under study (lungs, bones, internal relief of the stomach and intestines etc.). In addition, fluoroscopy, compared with radiography, is accompanied by higher doses of x-ray radiation, i.e., increased radiation exposure to patients and staff, and this requires, despite the rapidly transient nature of the phenomena observed on the screen, to limit the time of transmission as much as possible. Meanwhile, a well-executed radiograph, reflecting the structural and other features of the organ under study, is available for repeated study by different people at different times and is, therefore, an objective document that has not only clinical or scientific, but also expert, and sometimes forensic value. .

Repeated radiography is an objective method of dynamic monitoring of the course of various physiological and pathological processes in the organ under study. A series of radiographs of a certain part of the same child, taken at different times, makes it possible to trace in detail the development of ossification in this child. A series of radiographs made over a long period of a number of chronic diseases (stomach and duodenum, and other chronic bone diseases) makes it possible to observe all the subtleties of the evolution of the pathological process. The described feature of serial radiography makes it possible to use this method of X-ray examination also as a method for monitoring the effectiveness of therapeutic measures.