X-ray methods. Basic methods of x-ray examination

X-ray research methods

1. The concept of X-ray radiation

X-ray radiation refers to electromagnetic waves with a length of approximately 80 to 10~5 nm. The longest-wave X-ray radiation is overlapped by short-wave ultraviolet radiation, and short-wave X-ray radiation is overlapped by long-wave Y-radiation. Based on the method of excitation, X-ray radiation is divided into bremsstrahlung and characteristic.

The most common source of X-ray radiation is an X-ray tube, which is a two-electrode vacuum device. The heated cathode emits electrons. The anode, often called an anticathode, has an inclined surface in order to direct the resulting X-ray radiation at an angle to the axis of the tube. The anode is made of a highly thermally conductive material to dissipate the heat generated when electrons strike. The anode surface is made of refractory materials that have a large atomic number in the periodic table, for example, tungsten. In some cases, the anode is specially cooled with water or oil.

For diagnostic tubes, the precision of the X-ray source is important, which can be achieved by focusing electrons in one place of the anticathode. Therefore, constructively it is necessary to take into account two opposing tasks: on the one hand, electrons must fall on one place of the anode, on the other hand, in order to prevent overheating, it is desirable to distribute electrons over different areas of the anode. One of the interesting technical solutions is an X-ray tube with a rotating anode. As a result of the braking of an electron (or other charged particle) by the electrostatic field of the atomic nucleus and atomic electrons of the anticathode substance, bremsstrahlung X-rays arise. Its mechanism can be explained as follows. Associated with a moving electric charge is a magnetic field, the induction of which depends on the speed of the electron. When braking, the magnetic induction decreases and, in accordance with Maxwell's theory, an electromagnetic wave appears.

When electrons are decelerated, only part of the energy is used to create an x-ray photon, the other part is spent on heating the anode. Since the relationship between these parts is random, when a large number of electrons are decelerated, a continuous spectrum of X-ray radiation is formed. In this regard, bremsstrahlung is also called continuous radiation.

In each of the spectra, the shortest wavelength bremsstrahlung occurs when the energy acquired by the electron in the accelerating field is completely converted into photon energy.

Short-wave X-rays usually have greater penetrating power than long-wave X-rays and are called hard, while long-wave X-rays are called soft. By increasing the voltage on the X-ray tube, the spectral composition of the radiation is changed. If you increase the filament temperature of the cathode, the emission of electrons and the current in the tube will increase. This will increase the number of X-ray photons emitted every second. Its spectral composition will not change. By increasing the voltage on the X-ray tube, one can notice the appearance of a line spectrum against the background of a continuous spectrum, which corresponds to characteristic X-ray radiation. It occurs due to the fact that accelerated electrons penetrate deep into the atom and knock out electrons from the inner layers. Electrons from the upper levels move to free places, as a result, photons of characteristic radiation are emitted. In contrast to optical spectra, the characteristic X-ray spectra of different atoms are of the same type. The uniformity of these spectra is due to the fact that the internal layers of different atoms are identical and differ only energetically, since the force action from the nucleus increases as the atomic number of the element increases. This circumstance leads to the fact that the characteristic spectra shift towards higher frequencies with increasing nuclear charge. This pattern is known as Moseley's law.

There is another difference between optical and x-ray spectra. The characteristic X-ray spectrum of an atom does not depend on the chemical compound in which this atom is included. For example, the X-ray spectrum of the oxygen atom is the same for O, O 2 and H 2 O, while the optical spectra of these compounds are significantly different. This feature of the X-ray spectrum of the atom served as the basis for the name characteristic.

Characteristic radiation always occurs when there is free space in the inner layers of the atom, regardless of the reason that caused it. For example, characteristic radiation accompanies one of the types of radioactive decay, which consists in the capture of an electron from the inner layer by the nucleus.

The registration and use of X-ray radiation, as well as its impact on biological objects, are determined by the primary processes of interaction of the X-ray photon with the electrons of atoms and molecules of the substance.

Depending on the ratio of photon energy and ionization energy, three main processes take place

Coherent (classical) scattering. Scattering of long-wave X-rays occurs essentially without changing the wavelength, and is called coherent. It occurs if the photon energy is less than the ionization energy. Since in this case the energy of the X-ray photon and the atom does not change, coherent scattering in itself does not cause a biological effect. However, when creating protection against X-ray radiation, the possibility of changing the direction of the primary beam should be taken into account. This type of interaction is important for X-ray diffraction analysis.

Incoherent scattering (Compton effect). In 1922 A.Kh. Compton, observing the scattering of hard X-rays, discovered a decrease in the penetrating power of the scattered beam compared to the incident beam. This meant that the wavelength of the scattered X-rays was longer than the incident X-rays. Scattering of X-rays with a change in wavelength is called incoherent, and the phenomenon itself is called the Compton effect. It occurs if the energy of the X-ray photon is greater than the ionization energy. This phenomenon is due to the fact that when interacting with an atom, the energy of a photon is spent on the formation of a new scattered X-ray photon, on the separation of an electron from the atom (ionization energy A) and the imparting of kinetic energy to the electron.

It is important that in this phenomenon, along with secondary X-ray radiation (energy hv" of the photon), recoil electrons appear (kinetic energy £ k electron). Atoms or molecules in this case become ions.

Photo effect. In the photoelectric effect, X-rays are absorbed by an atom, causing an electron to be ejected and the atom to be ionized (photoionization). If the photon energy is insufficient for ionization, then the photoelectric effect can manifest itself in the excitation of atoms without the emission of electrons.

Let us list some of the processes observed during the action of X-ray radiation on matter.

X-ray luminescence– glow of a number of substances under X-ray irradiation. This glow of platinum-synoxide barium allowed Roentgen to discover the rays. This phenomenon is used to create special luminous screens for the purpose of visual observation of X-ray radiation, sometimes to enhance the effect of X-rays on a photographic plate.

Known chemical action X-ray radiation, for example the formation of hydrogen peroxide in water. A practically important example is the effect on a photographic plate, which allows such rays to be recorded.

Ionizing effect manifests itself in an increase in electrical conductivity under the influence of x-rays. This property is used in dosimetry to quantify the effect of this type of radiation.

One of the most important medical applications of x-rays is the x-ray examination of internal organs for diagnostic purposes (x-ray diagnostics).

X-ray method is a method of studying the structure and function of various organs and systems, based on qualitative and/or quantitative analysis of a beam of X-ray radiation passing through the human body. X-ray radiation generated in the anode of the X-ray tube is directed at the patient, in whose body it is partially absorbed and scattered, and partially passes through. The image converter sensor captures the transmitted radiation, and the converter constructs a visible light image that the doctor perceives.

A typical x-ray diagnostic system consists of an x-ray emitter (tube), a test subject (patient), an image converter and a radiologist.

For diagnostics, photons with an energy of about 60-120 keV are used. At this energy, the mass attenuation coefficient is mainly determined by the photoelectric effect. Its value is inversely proportional to the third power of the photon energy (proportional to X 3), which shows the greater penetrating power of hard radiation, and proportional to the third power of the atomic number of the absorbing substance. The absorption of X-rays is almost independent of the compound in which the atom is present in a substance, so the mass attenuation coefficients of bone, soft tissue, or water can easily be compared. The significant difference in the absorption of X-ray radiation by different tissues allows one to see images of the internal organs of the human body in shadow projection.

A modern X-ray diagnostic unit is a complex technical device. It is full of elements of teleautomation, electronics, and electronic computer technology. A multi-stage protection system ensures radiation and electrical safety of personnel and patients.

Radiology as a science dates back to November 8, 1895, when the German physicist Professor Wilhelm Conrad Roentgen discovered the rays that were later named after him. Roentgen himself called them X-rays. This name has been preserved in his homeland and in Western countries.

Basic properties of X-rays:

X-rays, starting from the focus of the X-ray tube, propagate in a straight line.

They do not deviate in the electromagnetic field.

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

X-rays are invisible, but when absorbed by certain substances they cause them to glow. This light is called fluorescence and is the basis of fluoroscopy.

X-rays have a photochemical effect. Radiography (the currently generally accepted method of producing x-rays) is based on this property of x-rays.

X-ray radiation has an ionizing effect and gives air the ability to conduct electric current. Neither visible, nor thermal, nor radio waves can cause this phenomenon. Based on this property, X-ray radiation, like the radiation of radioactive substances, is called ionizing radiation.

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

From the quality of the rays. The shorter the length of the X-rays (i.e., the harder the X-ray radiation), the deeper these rays penetrate and, conversely, the longer the wavelength of the rays (the softer the radiation), the shallower the depth they penetrate.
Depending on the volume of the body being examined: the thicker the object, the more difficult it is for X-rays to “pierce” it. The penetrating ability of X-rays depends on the chemical composition and structure of the body under study. The more a substance exposed to X-rays contains atoms of elements with a high atomic weight and atomic number (according to the periodic table), the more strongly it absorbs X-rays and, conversely, the lower the atomic weight, the more transparent the substance is to these rays. The explanation for this phenomenon is that electromagnetic radiation with a very short wavelength, such as X-rays, contains a lot of energy.

X-rays have an active biological effect. In this case, the critical structures are DNA and cell membranes.

One more circumstance must be taken into account. X-rays obey the inverse square law, i.e. The intensity of X-rays is inversely proportional to the square of the distance.

Gamma rays have the same properties, but these types of radiation differ in the method of their production: X-rays are produced in high-voltage electrical installations, and gamma radiation is produced due to the decay of atomic nuclei.

Methods of X-ray examination are divided into basic and special, private. The main methods of X-ray examination include: radiography, fluoroscopy, electroradiography, computed X-ray tomography.

Fluoroscopy is the examination of organs and systems using x-rays. Fluoroscopy is an anatomical and functional method that provides the opportunity to study normal and pathological processes and conditions of the body as a whole, individual organs and systems, as well as tissues using the shadow picture of a fluorescent screen.

Advantages:

Allows you to examine patients in various projections and positions, due to which you can choose the position in which pathological shadowing is better revealed.

The ability to study the functional state of a number of internal organs: lungs, during different phases of breathing; pulsation of the heart with large vessels.

Close contact between a radiologist and patients, which allows the X-ray examination to be supplemented with a clinical one (palpation under visual control, targeted anamnesis), etc.

Disadvantages: relatively high radiation exposure for the patient and staff; low throughput during the doctor’s working hours; limited capabilities of the researcher’s eye in identifying small shadow formations and fine tissue structures, etc. Indications for fluoroscopy are limited.

Electron-optical amplification (EOA). The operation of an electron-optical converter (EOC) is based on the principle of converting an X-ray image into an electronic one, followed by its transformation into amplified light. The brightness of the screen is increased up to 7 thousand times. The use of an EOU makes it possible to distinguish parts with a size of 0.5 mm, i.e. 5 times smaller than with conventional fluoroscopic examination. When using this method, X-ray cinematography can be used, i.e. recording an image on film or video tape.

Radiography is photography using x-rays. During radiography, the object being photographed must be in close contact with a cassette loaded with film. The X-ray radiation emerging from the tube is directed perpendicularly to the center of the film through the middle of the object (the distance between the focus and the patient's skin under normal operating conditions is 60-100 cm). The necessary equipment for radiography is cassettes with intensifying screens, screening grids and special X-ray film. The cassettes are made of light-proof material and correspond in size to the standard sizes of produced X-ray film (13 × 18 cm, 18 × 24 cm, 24 × 30 cm, 30 × 40 cm, etc.).

Intensifying screens are designed to increase the light effect of X-rays on photographic film. They represent cardboard that is impregnated with a special phosphor (calcium tungstic acid), which has fluorescent properties under the influence of X-rays. Currently, screens with phosphors activated by rare earth elements: lanthanum oxide bromide and gadolinium oxide sulfite are widely used. The very good efficiency of the rare earth phosphor contributes to the high photosensitivity of screens and ensures high image quality. There are also special screens - Gradual, which can even out existing differences in the thickness and (or) density of the subject being photographed. The use of intensifying screens significantly reduces the exposure time during radiography.

To filter out soft rays of the primary flow that can reach the film, as well as secondary radiation, special movable gratings are used. Processing of captured films is carried out in a darkroom. The processing process boils down to developing, rinsing in water, fixing and thoroughly washing the film in running water, followed by drying. Drying of films is carried out in drying cabinets, which takes at least 15 minutes. or occurs naturally, and the picture is ready the next day. When using developing machines, photographs are obtained immediately after examination. Advantage of radiography: eliminates the disadvantages of fluoroscopy. Disadvantage: the study is static, there is no possibility of assessing the movement of objects during the study process.

Electroradiography. Method for obtaining X-ray images on semiconductor wafers. The principle of the method: when rays hit a highly sensitive selenium plate, the electrical potential in it changes. The selenium plate is sprinkled with graphite powder. Negatively charged powder particles are attracted to those areas of the selenium layer that retain positive charges, and are not retained in those areas that have lost their charge under the influence of X-ray radiation. Electroradiography allows you to transfer an image from a plate to paper in 2-3 minutes. More than 1000 images can be taken on one plate. Advantages of electroradiography:

Rapidity.

Economical.

Disadvantage: insufficiently high resolution when examining internal organs, higher radiation dose than with radiography. The method is used mainly in the study of bones and joints in trauma centers. Recently, the use of this method has become increasingly limited.

Computed X-ray tomography (CT). The creation of X-ray computed tomography was a major event in radiation diagnostics. Evidence of this is the award of the Nobel Prize in 1979 to famous scientists Cormack (USA) and Hounsfield (England) for the creation and clinical testing of CT.

CT allows you to study the position, shape, size and structure of various organs, as well as their relationship with other organs and tissues. The basis for the development and creation of CT was various models of mathematical reconstruction of X-ray images of objects. The successes achieved with the help of CT in the diagnosis of various diseases served as an incentive for the rapid technical improvement of devices and a significant increase in their models. If the first generation of CT had one detector, and the time for scanning was 5-10 minutes, then on tomograms of the third and fourth generations, with from 512 to 1100 detectors and a high-capacity computer, the time for obtaining one slice was reduced to milliseconds, which practically makes it possible to study everything organs and tissues, including the heart and blood vessels. Currently, spiral CT is used, which allows longitudinal image reconstruction and the study of rapidly occurring processes (the contractile function of the heart).

CT is based on the principle of creating X-ray images of organs and tissues using a computer. CT is based on the registration of X-ray radiation with sensitive dosimetric detectors. The principle of the method is that after the rays pass through the patient’s body, they do not fall on the screen, but on detectors, in which electrical impulses arise, which, after amplification, are transmitted to the computer, where, using a special algorithm, they are reconstructed and create an image of the object, which is sent from the computer on the TV monitor. The image of organs and tissues on CT, unlike traditional X-rays, is obtained in the form of cross sections (axial scans). With spiral CT, three-dimensional image reconstruction (3D mode) with high spatial resolution is possible. Modern installations make it possible to obtain sections with a thickness of 2 to 8 mm. The X-ray tube and radiation receiver move around the patient's body. CT has a number of advantages over conventional x-ray examination:

First of all, high sensitivity, which makes it possible to differentiate individual organs and tissues from each other by density within a range of up to 0.5%; on conventional radiographs this figure is 10-20%.

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

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

CT allows one to judge not only the condition of the organ being studied, but also the relationship of the pathological process with surrounding organs and tissues, for example, tumor invasion into neighboring organs, the presence of other pathological changes.

CT allows you to obtain topograms, i.e. a longitudinal image of the area under study, similar to an x-ray, by moving the patient along a stationary tube. Topograms are used to establish the extent of the pathological focus and determine the number of sections.

CT is indispensable when planning radiation therapy (drawing up radiation maps and calculating doses).

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 to determine relapses and associated complications.

Diagnosis using CT is based on direct radiological signs, i.e. determining the exact location, shape, size of individual organs and the pathological focus and, most importantly, on indicators of density or absorption. The absorption rate is based on the degree to which an x-ray beam is absorbed or attenuated as it passes through the human body. Each tissue, depending on the density of atomic mass, absorbs radiation differently, therefore, currently, for each tissue and organ, an absorption coefficient (HU) according to the Hounsfield scale is normally developed. According to this scale, HU of water is taken as 0; bones, which have the highest density, cost +1000, air, which has the lowest density, cost -1000.

The minimum size of a tumor or other pathological lesion, determined using CT, ranges from 0.5 to 1 cm, provided that the HU of the affected tissue differs from that of healthy tissue by 10 - 15 units.

In both CT and X-ray studies, there is a need to use “image intensification” techniques to increase resolution. CT contrast is performed with water-soluble radiocontrast agents.

The “enhancement” technique is carried out by perfusion or infusion of a contrast agent.

Such methods of X-ray examination are called special. Organs and tissues of the human body become distinguishable if they absorb X-rays to varying degrees. Under physiological conditions, such differentiation is possible only in the presence of natural contrast, which is determined by the difference in density (chemical composition of these organs), size, and position. The bone structure is clearly visible against the background of soft tissues, the heart and large vessels against the background of airborne pulmonary tissue, but the chambers of the heart cannot be distinguished separately under conditions of natural contrast, just like the organs of the abdominal cavity, for example. The need to study organs and systems that have the same density with X-rays led to the creation of an artificial contrast technique. The essence of this technique is the introduction of artificial contrast agents into the organ under study, i.e. substances having a density different from the density of the organ and its environment.

Radiocontrast agents (RCAs) are usually divided into substances with high atomic weight (X-ray positive contrast agents) and low (X-ray negative contrast agents). Contrast agents must be harmless.

Contrast agents that intensively absorb x-rays (positive x-ray contrast agents) are:

Suspensions of salts of heavy metals - barium sulfate, used to study the gastrointestinal tract (it is not absorbed and is excreted through natural routes).

Aqueous solutions of organic iodine compounds - urografin, verografin, bilignost, angiographin, etc., which are injected into the vascular bed, enter all organs with the bloodstream and provide, in addition to contrasting the vascular bed, contrasting other systems - urinary, gall bladder, etc. .

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

Non-ionic water-soluble iodine-containing radiocontrast agents: Ultravist, Omnipaque, Imagopaque, Visipaque are characterized by the absence of ionic groups in the chemical structure, low osmolarity, which significantly reduces the possibility of pathophysiological reactions, and thereby causes a low number of side effects. Nonionic iodine-containing radiocontrast agents cause a lower number of side effects than ionic high-osmolar radiocontrast agents.

X-ray-negative or negative contrast agents – air, gases “do not absorb” x-rays and therefore well shade the organs and tissues under study, which have a high density.

Artificial contrast according to the method of administration of contrast agents is divided into:

Introduction of contrast agents into the cavity of the organs being studied (the largest group). This includes studies of the gastrointestinal tract, bronchography, studies of fistulas, and all types of angiography.

Introduction of contrast agents around the organs being examined - retropneumoperitoneum, pneumoren, pneumomediastinography.

Introduction of contrast agents into the cavity and around the organs being examined. This includes parietography. Parietography for diseases of the gastrointestinal tract consists of obtaining images of the wall of the hollow organ under study after introducing gas first around the organ and then into the cavity of this organ. Parietography of the esophagus, stomach and colon is usually performed.

A method that is based on the specific ability of some organs to concentrate individual contrast agents and at the same time shade it against the background of surrounding tissues. This includes excretory urography, cholecystography.

Side effects of RCS. The body's reactions to the administration of RCS are observed in approximately 10% of cases. Based on their nature and severity, they are divided into 3 groups:

Complications associated with the manifestation of toxic effects on various organs with functional and morphological lesions.

The neurovascular reaction is accompanied by subjective sensations (nausea, feeling of heat, general weakness). Objective symptoms include vomiting and low blood pressure.

Individual intolerance to RCS with characteristic symptoms:

From the central nervous system - headaches, dizziness, agitation, anxiety, fear, seizures, cerebral edema.
Skin reactions – urticaria, eczema, itching, etc.
Symptoms associated with disruption of the cardiovascular system - pallor of the skin, discomfort in the heart, drop in blood pressure, paroxysmal tachy- or bradycardia, collapse.
Symptoms associated with respiratory failure - tachypnea, dyspnea, attack of bronchial asthma, laryngeal edema, pulmonary edema.

RKS intolerance reactions are sometimes irreversible and lead to death.

The mechanisms of development of systemic reactions in all cases are of a similar nature and are caused by activation of the complement system under the influence of RKS, the influence of RKS on the blood coagulation system, the release of histamine and other biologically active substances, a true immune reaction, or a combination of these processes.

In mild cases of adverse reactions, it is enough to stop the RCS injection and all phenomena, as a rule, go away without therapy.

In case of severe complications, it is necessary to immediately call the resuscitation team, and before its arrival, administer 0.5 ml of adrenaline, intravenously 30–60 mg of prednisolone or hydrocortisone, 1–2 ml of an antihistamine solution (diphenhydramine, suprastin, pipolfen, claritin, hismanal), intravenously 10 % calcium chloride. In case of laryngeal edema, perform tracheal intubation, and if it is impossible, tracheostomy. In case of cardiac arrest, immediately begin artificial respiration and chest compressions, without waiting for the arrival of the resuscitation team.

To prevent side effects of RCS, on the eve of an X-ray contrast study, premedication with antihistamines and glucocorticoids is used, and one of the tests is also performed to predict the patient’s increased sensitivity to RCS. The most optimal tests are: determining the release of histamine from peripheral blood basophils when mixed with RCS; the content of total complement in the blood serum of patients prescribed for X-ray contrast examination; selection of patients for premedication by determining the levels of serum immunoglobulins.

Among the more rare complications, “water” poisoning during irrigoscopy in children with megacolon and gas (or fat) vascular embolism may occur.

A sign of “water” poisoning, when a large amount of water is quickly absorbed through the intestinal walls into the bloodstream and an imbalance of electrolytes and plasma proteins occurs, may be tachycardia, cyanosis, vomiting, respiratory failure with cardiac arrest; death may occur. First aid in this case is intravenous administration of whole blood or plasma. Prevention of complications is to perform irrigoscopy in children with a barium suspension in an isotonic salt solution, instead of an aqueous suspension.

Signs of vascular embolism are: the appearance of a feeling of tightness in the chest, shortness of breath, cyanosis, a decrease in pulse and a drop in blood pressure, convulsions, and cessation of breathing. In this case, you should immediately stop the administration of RCS, place the patient in the Trendelenburg position, begin artificial respiration and chest compressions, administer 0.1% - 0.5 ml of adrenaline solution intravenously and call the resuscitation team for possible tracheal intubation, artificial respiration and carrying out further therapeutic measures.

Introduction

diagnostics medical examination endoscopic

The last decade of the 20th century is characterized by the rapid development of radiation diagnostics. The main reason for this is the emergence of a whole series of so-called “new technologies”, which have made it possible to dramatically expand the diagnostic potential of “old” traditional radiology. With their help, the concept of so-called white spots in classical radiology was essentially “closed” (for example, the pathology of the entire group of parenchymal organs of the abdominal cavity and retroperitoneal space). For a large group of diseases, the introduction of these technologies has dramatically changed the existing capabilities of their radiological diagnosis.

Largely due to the success of radiation diagnostics in leading clinics in America and Europe, the time for diagnosis does not exceed 40-60 minutes from the moment the patient is admitted to the hospital. Moreover, we are talking, as a rule, about serious urgent situations, where delay often leads to irreversible consequences. Moreover, the hospital bed has become less and less used for diagnostic procedures. All necessary preliminary studies, and primarily radiation, are performed at the prehospital stage.

Radiological procedures have long been second in frequency of use, second only to the most common and mandatory laboratory tests. Summary statistics from the world's major medical centers show that thanks to radiation methods, the number of erroneous diagnoses during a patient's initial visit today does not exceed 4%.

Modern visualization tools meet the following fundamental principles: impeccable image quality, equipment safety for both patients and medical personnel, operational reliability.

Purpose of the work: to gain knowledge about instrumental methods of examining patients during X-ray, endoscopic and ultrasound examinations.

Instrumental methods for X-ray, endoscopic and ultrasound examinations

Methods for studying the structure and functions of human organs using special equipment are called instrumental. They are used for medical diagnostic purposes. The patient must be psychologically and physically prepared for many of them. A nurse must be proficient in the technology of preparing patients for instrumental examinations.

X-ray research methods

X-ray (x-ray) examination is based on the property of x-rays to penetrate body tissue to varying degrees. The degree of absorption of X-ray radiation depends on the thickness, density and physico-chemical composition of human organs and tissues, therefore denser organs and tissues (bones, heart, liver, large vessels) are visualized on the screen (X-ray fluorescent or television) as shadows, and lung tissue due to the large amount of air, it is represented by an area of \u200b\u200bbright glow. Wilhelm Conrad Roentgen (1845-1923) - German experimental physicist, founder of radiology, discovered X-rays (X-rays) in 1895. On X-rays of the intestine with contrast, you can see changes in the lumen of the intestine, an increase in the length of the organ, etc. (Annex 1).

Figure 1. X-ray room.

The following main radiological research methods are distinguished:

1. Fluoroscopy (Greek skopeo - examine, observe) - x-ray examination in real time. A dynamic image appears on the screen, allowing you to study the motor function of organs (for example, vascular pulsation, gastrointestinal motility); the structure of the organs is also visible.

2. Radiography (Greek grapho - to write) - x-ray examination with registration of a still image on a special x-ray film or photographic paper. With digital radiography, the image is recorded in the computer's memory. Five types of radiography are used.

* Full-format radiography.

* Fluorography (small-format radiography) - radiography with a reduced size of the image obtained on a fluorescent screen (Latin fluor - flow, flow); it is used for preventive examinations of the respiratory system.

* Survey radiography - an image of an entire anatomical area.

* Sight radiography - an image of a limited area of the organ being studied.

* Serial radiography - sequential acquisition of several radiographs to study the dynamics of the process being studied.

3. Tomography (Greek tomos - segment, layer, layer) - a layer-by-layer visualization method that provides an image of a layer of tissue of a given thickness using an X-ray tube and a film cassette (X-ray tomography) or with the connection of special counting cameras from which electrical signals are supplied to a computer (computed tomography).

4. Contrast fluoroscopy (or radiography) is an X-ray research method based on the introduction into hollow organs (bronchi, stomach, renal pelvis and ureters, etc.) or vessels (angiography) of special (radiopaque) substances that block X-ray radiation, resulting in A clear image of the organs being studied is obtained on the screen (photo film).

Before conducting an X-ray examination, you should clear the area of the planned examination from clothing, ointment bandages, adhesive plaster stickers, electrodes for ECG monitoring, etc., ask to remove watches, metal jewelry and pendants.

Chest X-ray is an important method for examining patients with respiratory and cardiovascular diseases.

Fluoroscopy and radiography are the most commonly used methods for examining the respiratory system. X-ray examination allows us to assess the condition of the lung tissue, the appearance of areas of compaction and increased airiness in it, the presence of fluid or air in the pleural cavities. No special preparation of the patient is required. The study is carried out with the patient standing or, if the patient’s condition is serious, lying down.

Contrast radiography of the bronchi (bronchography) is used to identify tumor processes in the bronchi, dilation of the bronchi (bronchiectasis) and cavities in the lung tissue (abscess, cavity). A radiopaque substance is injected into the bronchial cavity.

Preparing a patient for bronchography is carried out in several stages:

1. Conducting a test for individual tolerance to iodine-containing drugs (iodine test): for 2-3 days, as prescribed by the doctor, the patient is asked to drink 1 tbsp. 3% potassium iodide solution. Another option for conducting an iodine test: on the eve of the test, the skin of the inner surface of the patient’s forearm is treated with a 5% alcohol solution of iodine. It is necessary to ask the patient about his tolerance to medications, in particular anesthetics (tetracaine, lidocaine, procaine), and if necessary, conduct intradermal allergy tests. The medical history should reflect the date of the drug tolerance test, a detailed description of the patient’s condition (the presence or absence of signs of hypersensitivity); The signature of the nurse who observed the patient for 12 hours after the test is required.

2. Cleansing the bronchial tree in the presence of purulent sputum: 3-4 days in advance, as prescribed by the doctor, the patient is prescribed bronchial drainage (by the patient adopting the appropriate position, optimal for sputum discharge, with the foot end of the bed raised), expectorants and bronchodilators.

3. Psychological preparation: the patient should be explained the purpose and necessity of the upcoming study. In some cases, patients may develop insomnia and increase blood pressure before the study. In this case, as prescribed by the doctor, the patient is given sedatives and antihypertensive drugs.

4. Direct preparation of the patient for the study: on the eve of the study, the patient is given a light dinner (milk, cabbage, meat are excluded). It is necessary to warn the patient that the study is carried out on an empty stomach; on the morning of the test, he should also not drink water, take medications or smoke. The patient should be reminded that before the study he must empty his bladder and bowels (naturally).

5. Premedication: 30-60 minutes before the examination, as prescribed by the doctor, the patient is administered special drugs (diazepam, atropine, etc.) in order to create conditions for free access of the bronchoscope. Particular attention should be paid to the patient after the study, as the following complications may develop:

* the appearance or intensification of a cough with the release of sputum with a large amount of radiopaque substance (sometimes the injected substance is released within 1-2 days); in this case, the patient must be provided with a special jar (spittoon) for sputum;

* increased body temperature;

* development of pneumonia (in rare cases with poor contrast agent release).

If a patient develops symptoms such as increased body temperature, deterioration in general condition, a sharp increase in cough, or shortness of breath after bronchography, the nurse should immediately inform the doctor about this.

Fluoroscopy and radiography are also often used to study the cardiovascular system (heart, aorta, pulmonary artery). X-ray examination makes it possible to determine the size of the heart and its chambers, large vessels, the presence of displacement of the heart and its mobility during contractions, and the presence of fluid in the pericardial cavity. If necessary, the patient is offered to drink a small amount of a radiopaque substance (a suspension of barium sulfate), which makes it possible to contrast the esophagus and, based on the degree of its displacement, judge the degree of enlargement of the left atrium. No special preparation of the patient is required.

Contrast radiography (angiocardiography) is used to determine the condition of large vessels and chambers of the heart. A radiopaque substance is injected into large vessels and cavities of the heart through special probes. This procedure is actually a surgical operation; it is performed in a specially equipped operating room, usually in a cardiac surgery department. On the eve of the study, the patient must undergo tests to determine the tolerance of iodine-containing drugs and anesthetics. The study is carried out on an empty stomach. In addition, the nurse should pay special attention to the patient after the examination, since the introduction of a radiopaque substance into the heart cavity can cause not only early but also late complications. X-ray examination of the digestive organs makes it possible to assess the condition of hollow (esophagus, stomach, intestines, bile ducts) and parenchymal (liver, pancreas) organs. X-ray and fluoroscopy of the digestive organs without radiopaque contrast agent are used to detect intestinal obstruction or perforation of the stomach and intestines. The use of a radiopaque substance (a suspension of barium sulfate) makes it possible to determine the motor function and relief of the mucous membrane of the digestive tract, the presence of ulcers, tumors, areas of narrowing or expansion of various parts of the digestive tract.

Examination of the esophagus. Preparing the patient for X-ray examination of the esophagus depends on the indications.

* No special preparation is required to identify a foreign body in the esophagus.

* To assess the motor function of the esophagus and its contours (identifying areas of narrowing and expansion, tumors, etc.), fluoroscopy and/or serial radiography are performed; in this case, before the study, the patient is given a radiopaque substance to drink (150-200 ml of barium sulfate suspension).

* If it is necessary to carry out a differential diagnosis of organic narrowing and functional damage (spasms of the esophagus), 15 minutes before the examination, as prescribed by the doctor, the patient is injected with 1 ml of a 0.1% atropine solution. If there is a pronounced organic narrowing of the esophagus, as prescribed by a doctor, using a thick probe and a rubber bulb, the accumulated fluid is suctioned from the esophagus.

Examination of the stomach and duodenum. Preparing the patient for an x-ray examination involves freeing these parts of the digestive tract from food masses and gases and begins several days before the examination. The stages of preparing the patient are as follows.

1. Prescribe a diet 3 days before the study that excludes foods rich in plant fiber and containing other substances that promote increased gas formation. It is necessary to exclude freshly baked rye bread, potatoes, legumes, milk, vegetables and fruits, and fruit juices from the diet.

2. On the eve of the study, the patient is prescribed a light dinner (no later than 8 pm). Allowed are eggs, cream, caviar, cheese, meat and fish without seasoning, tea or coffee without sugar, porridge cooked in water.

3. The night before and in the morning, 2 hours before the study, the patient is given a cleansing enema.

4. It is necessary to warn the patient that 12 hours before the test he must stop eating, and on the morning of the test he should not drink, take any medications or smoke.

Colon examination. To carry out an X-ray examination of the colon - irrigoscopy (Latin irrigatio - irrigation) - a complete cleansing of the intestines from contents and gases is necessary. A radiopaque substance - up to 1.5 liters of warm (36-37 °C) barium sulfate suspension - is injected into the intestines using an enema directly in the X-ray room. Contraindications to irrigoscopy: diseases of the rectum and its sphincters (inflammation, tumor, fistula, sphincter fissure). Situations are possible when the patient cannot keep the fluid administered to him in the intestines (rectal prolapse, sphincter weakness), which makes this procedure impossible.

Stages of preparing the patient for the study:

1. Prescribe a diet 2-3 days before the study, excluding foods rich in plant fiber and containing other substances that promote increased gas formation. It is necessary to exclude fresh rye bread, potatoes, legumes, fresh milk, fresh vegetables and fruits, and fruit juices from the diet.

2. On the eve of the study, the patient is prescribed a light dinner (no later than 8 pm). Omelette, kefir, caviar, cheese, boiled meat and fish without seasoning, tea or coffee without sugar, semolina porridge cooked in water are allowed.

3. On the eve of the study, before lunch, the patient is given 30 g of castor oil to take orally (contraindication to taking castor oil is intestinal obstruction).

4. The night before (30-40 minutes after dinner), the patient is given cleansing enemas with an interval of 1 hour until “clean” rinsing water is obtained.

5. In the morning, 2 hours before the study, the patient is given a cleansing enema, also until “clean” rinsing water is obtained.

6. The study is carried out on an empty stomach. If necessary, as prescribed by the doctor, the patient is allowed a light protein breakfast in the morning (low-fat cottage cheese, whipped egg white soufflé or protein omelet, boiled fish), which allows for a reflex movement of the contents of the small intestine into the large intestine and prevents the accumulation of gases in the intestines. In this case, a morning cleansing enema is given 20-30 minutes after breakfast.

7. 30 minutes before the study, a gas tube is inserted into the patient.

Another way to cleanse the intestines before x-ray and endoscopic examination is oral lavage. To carry it out, isoosmotic solutions are used, for example fortrans. The Fortrans package, intended for one patient, consists of four packets containing 64 g of polyethylene glycol in combination with 9 g of electrolytes - sodium sulfate, sodium bicarbonate, sodium chloride and potassium chloride. Each packet is dissolved in 1 liter of boiled water. As a rule, the patient is prescribed the first 2 liters of solution in the afternoon on the day preceding the study; a second portion of 1.5-2 liters is given in the morning on the day of the study. The effect of the drug (bowel emptying) is not accompanied by pain and tenesmus, begins 50-80 minutes after starting to take the solution and continues for 2-6 hours. Bowel emptying when Fortrans is re-administered in the morning begins 20-30 minutes after taking the drug. The use of Fortrans is contraindicated if the patient has ulcerative colitis, Crohn's disease, intestinal obstruction, or abdominal pain of unknown etiology.

X-ray examination of the gallbladder (cholecystography) allows us to determine its shape, position and deformations, the presence of stones in it, and the degree of emptying. A radiopaque substance (for example, sodium iopodate - “Bilimin”) is given to the patient to drink; in this case, the concentration of the contrast agent reaches its maximum in the gallbladder 10-15 hours after its administration. If a radiopaque contrast agent is administered intravenously, this study is called intravenous cholegraphy. This method allows contrasting of intrahepatic bile ducts. In this case, after 20-25 minutes you can get an image of the bile ducts, and after 2-2.5 hours of the gallbladder. Preparing the patient for the study depends on the method of administration of the contrast agent.

The stages of preparing a patient for cholecystography are as follows:

2. On the eve of the study, after a light dinner (with the exception of fats), the patient is given a cleansing enema.

3. 12 hours before the study, the patient takes a radiopaque substance (for example, 3 g of Bilimin), washed down with warm tea. If the patient is obese, the patient is given to drink "Bilimin" twice - 3 g at 20 o'clock and at 22 o'clock.

4. The patient must be warned that the study is being performed on an empty stomach. Directly in the X-ray room, the patient receives a choleretic breakfast (100 g of sour cream or 20 g of butter on a thin piece of white bread).

With intravenous cholegraphy, the stages of preparing the patient for the study include the mandatory testing of individual tolerance to the drug (several days before the study), the prescription of a diet with the exclusion of foods that contribute to increased gas formation, and the administration of cleansing enemas the night before and in the morning on the day of the study. Intravenous cholegraphy is also performed on an empty stomach. Before the study, a radiopaque contrast agent heated to human body temperature is injected intravenously slowly (over 4-5 minutes).

Survey radiography of the kidneys and urinary tract makes it possible to determine the shape and position of the renal pelvis and ureters, and in some cases, to assess the presence of stones (calculi).

Contrast radiography. Depending on the method of administration of the radiocontrast agent, two types of contrast radiography of the kidneys and urinary tract are distinguished.

* Retrograde urography is a research method when a radiopaque substance is injected through a urinary catheter under the control of a cystoscope into the desired ureter. No special preparation of the patient is required.

* For excretory urography, a radiopaque substance is administered intravenously. This research method allows you to identify the presence of stones, anomalies, cicatricial narrowings, and tumor formations in the kidneys and urinary tract. The rate of release of the radiopaque substance characterizes the functional capacity of the kidneys.

The stages of preparing a patient for x-ray examination of the kidneys and urinary tract are as follows:

2. Conducting a test to determine individual tolerance to a radiocontrast agent 12-24 hours before the study.

3. Limiting the patient’s fluid intake 12-18 hours before the test.

4. Administration of a cleansing enema (before receiving “clean” rinsing water) the night before and in the morning 2 hours before the study. The study is carried out strictly on an empty stomach.

The radiopaque contrast agent is administered to the patient directly in the X-ray room.

The use of X-rays for diagnostic purposes is based on their ability to penetrate tissue. This ability depends on the density of organs and tissues, their thickness, and chemical composition. Therefore, the permeability of R-rays is different and creates different shadow densities on the device screen.

These methods allow you to study:

1) anatomical features of the organ

· its position;

· sizes, shape, size;

· presence of foreign bodies, stones and tumors.

2) examine the function of the organ.

Modern X-ray equipment makes it possible to obtain a spatial image of an organ, a video recording of its work, to enlarge any part of it in a special way, etc.

Types of radiological research methods:

X-ray- scanning the body with x-rays, giving an image of organs on the screen of an x-ray machine.

Radiography- a method of photographing using x-rays.

Tomography – a radiography method that allows you to obtain layer-by-layer images of organs.

Fluorography – a method of radiography of the chest organs with obtaining reduced-sized images based on a small number of x-rays.

Remember! Only with proper and complete preparation of the patient, instrumental examination gives reliable results and is diagnostically significant!

X-ray examination of the stomach

and duodenum

Target:

· diagnosis of diseases of the stomach and duodenum.

Contraindications:

· Ulcerative bleeding;

· pregnancy, breastfeeding.

Equipment:

· 150-200 ml of barium sulfate suspension;

· equipment for cleansing enema;

· referral for research.

Procedure:

Stages of manipulation	Justification of the need
1. Preparation for manipulation
1. Explain to the patient (family members) the purpose and course of the upcoming study, obtain informed consent.	Ensuring the patient's right to information. Patient motivation to cooperate. Give the patient written information if he has learning difficulties
2. Indicate the consequences of violating the nurse’s recommendations.	Irregularities in preparation will lead to difficulty in research and inaccuracy of diagnosis.
3. If the patient suffers from flatulence or constipation, a slag-free diet No. 4 is prescribed for 3 days before the study (see below), and it is recommended to take activated carbon.	Before an X-ray examination of the abdominal organs, it is necessary to remove “interference” - accumulations of gases and feces that complicate the examination. If the intestines are bloated in the evening and in the morning (2 hours before the test), you can give a cleansing enema.
4. Warn the patient: · light dinner the day before no later than 19.00 (tea, white bread, butter); · the examination is carried out in the morning on an empty stomach; the patient should not brush his teeth, take medications, smoke, eat or drink.	Ensuring the reliability of the research result.
5. Conduct psychological preparation of the patient for the study.	The patient must be confident in the painlessness and safety of the upcoming study.
6. In an outpatient setting, warn the patient to come to the X-ray room in the morning, at the time prescribed by the doctor. In an inpatient setting: conduct (or transport) the patient to the X-ray room at the appointed time with a referral.	Note: in the direction indicate the name of the research method, full name. patient, age, address or case history number, diagnosis, date of examination.
Performing a manipulation
1. In the X-ray room, the patient ingests a suspension of barium sulfate in the amount of 150-200 ml.	In some cases, the dose of the contrast agent is determined by the radiologist.
2. The doctor takes pictures.
End of manipulation
1. Remind the patient to deliver the images to the attending physician. In an inpatient setting: it is necessary to take the patient to the ward, ensure observation and rest.

State autonomous professional

Educational institution of the Saratov region

"Saratov Regional Basic Medical College"

Course work

The role of the paramedic in preparing patients for x-ray examination methods

Specialty: General Medicine

Qualification: paramedic

Student:

Malkina Regina Vladimirovna

Supervisor:

Evstifeeva Tatyana Nikolaevna

Introduction………………………………………………………………………………… 3

Chapter 1. History of the development of radiology as a science………………… 6

1.1. Radiology in Russia…………………………………………….. 8

1.2. X-ray research methods……………………….. 9

Chapter 2. Preparing the patient for x-ray methods

research…………………………………………………………….. 17

Conclusion………………………………………………………………. 21

List of references………………………………………………………... 22

Applications………………………………………………………………………………… 23

Introduction

Today, X-ray diagnostics is receiving new developments. Using centuries of experience in traditional radiology techniques and armed with new digital technologies, radiology continues to lead the way in diagnostic medicine.

X-ray is a time-tested and at the same time completely modern way of examining the internal organs of a patient with a high degree of information content. Radiography can be the main or one of the methods of examining a patient in order to establish a correct diagnosis or identify the initial stages of certain diseases that occur without symptoms.

The main advantages of X-ray examination are the accessibility of the method and its simplicity. Indeed, in the modern world there are many institutions where you can do x-rays. This mainly does not require any special training, it is cheap and the images are available, with which you can consult several doctors in different institutions.

The disadvantages of X-rays include obtaining a static image, exposure to radiation, and in some cases the administration of contrast is required. The quality of images sometimes, especially with outdated equipment, does not effectively achieve the research goal. Therefore, it is recommended to look for an institution where you can take digital x-rays, which today is the most modern method of research and shows the highest degree of information content.

If, due to the indicated shortcomings of radiography, a potential pathology is not reliably identified, additional studies may be prescribed that can visualize the functioning of the organ over time.

X-ray methods for studying the human body are one of the most popular research methods and are used to study the structure and function of most organs and systems of our body. Despite the fact that the availability of modern computed tomography methods is increasing every year, traditional radiography is still in wide demand.

Today it is difficult to imagine that medicine has been using this method for just over a hundred years. Today's doctors, “spoiled” by CT (computed tomography) and MRI (magnetic resonance imaging), find it difficult to even imagine that it is possible to work with a patient without the opportunity to “look inside” a living human body.

However, the history of the method really dates back to just 1895, when Wilhelm Conrad Roentgen first discovered the darkening of a photographic plate under the influence of x-rays. In further experiments with various objects, he managed to obtain an image of the bony skeleton of the hand on a photographic plate.

This image, and then the method, became the world's first medical imaging method. Think about it: before this it was impossible to obtain images of organs and tissues intravitally, without an autopsy (non-invasively). The new method became a huge breakthrough in medicine and instantly spread throughout the world. In Russia, the first x-ray was taken in 1896.

Currently, radiography remains the main method for diagnosing lesions of the osteoarticular system. In addition, radiography is used in studies of the lungs, gastrointestinal tract, kidneys, etc.

Purpose This work is to show the role of the paramedic in preparing the patient for x-ray examination methods.

Task of this work: Reveal the history of radiology, its appearance in Russia, talk about the radiological research methods themselves, and the features of training for some of them.

Chapter 1.

Radiology, without which it is impossible to imagine modern medicine, originated thanks to the discovery of the German physicist W.K. X-ray penetrating radiation. This industry, like no other, has made an invaluable contribution to the development of medical diagnostics.

In 1894, the German physicist V. K. Roentgen (1845 - 1923) began experimental studies of electrical discharges in glass vacuum tubes. Under the influence of these discharges in conditions of very rarefied air, rays are formed, known as cathode rays.

While studying them, Roentgen accidentally discovered the glow in the dark of a fluorescent screen (cardboard coated with barium platinum sulfur dioxide) under the influence of cathode radiation emanating from a vacuum tube. To prevent the crystals of barium platinum oxide from being exposed to visible light emanating from the switched on tube, the scientist wrapped it in black paper.

The glow continued as when the scientist moved the screen almost two meters from the tube, since it was assumed that the cathode rays penetrated only a few centimeters of air. Roentgen concluded that either he managed to obtain cathode rays with unique abilities, or he discovered the action of unknown rays.

For about two months, the scientist studied new rays, which he called X-rays. In the process of studying the interaction of rays with objects of different densities, which Roentgen placed along the course of the radiation, he discovered the penetrating ability of this radiation. Its degree depended on the density of objects and was manifested in the intensity of the fluorescent screen. This glow either weakened or intensified and was not observed at all when the lead plate was substituted.

In the end, the scientist placed his own hand along the path of the rays and saw on the screen a bright image of the bones of the hand against the background of a weaker image of its soft tissues. To capture shadow images of objects, Roentgen replaced the screen with a photographic plate. In particular, he received an image of his own hand on a photographic plate, which he irradiated for 20 minutes.

Roentgen studied X-rays from November 1895 to March 1897. During this time, the scientist published three articles with a comprehensive description of the properties of X-rays. The first article, “On a new type of rays,” appeared in the journal of the Würzburg Physico-Medical Society on December 28, 1895.

Thus, changes in the photographic plate under the influence of X-rays were recorded, which marked the beginning of the development of future radiography.

It should be noted that many researchers studied cathode rays before V. Roentgen. In 1890, an X-ray image of laboratory objects was accidentally obtained in one of the American laboratories. There is information that Nikola Tesla studied bremsstrahlung and recorded the results of this research in his diary entries in 1887. In 1892, G. Hertz and his student F. Lenard, as well as the developer of the cathode ray tube, W. Crookes, noted in their experiments the effect of cathode radiation on the blackening of photographic plates.

But all these researchers did not attach serious importance to the new rays, did not study them further and did not publish their observations. Therefore, the discovery of X-rays by V. Roentgen can be considered independent.

Roentgen’s merit also lies in the fact that he immediately understood the importance and significance of the rays he discovered, developed a method for producing them, and created the design of an X-ray tube with an aluminum cathode and a platinum anode to produce intense X-ray radiation.

For this discovery in 1901, V. Roentgen was awarded the Nobel Prize in Physics, the first in this category.

The revolutionary discovery of X-ray revolutionized diagnostics. The first X-ray machines were created in Europe already in 1896. In the same year, the KODAK company opened the production of the first X-ray films.

Since 1912, a period of rapid development of X-ray diagnostics throughout the world began, and radiology began to occupy an important place in medical practice.

Radiology in Russia.

The first X-ray photograph in Russia was taken in 1896. In the same year, on the initiative of the Russian scientist A.F. Ioffe, a student of V. Roentgen, the name “X-rays” was first introduced.

In 1918, the world's first specialized radiology clinic opened in Russia, where radiography was used to diagnose an increasing number of diseases, especially pulmonary ones.

In 1921, the first X-ray and dental office in Russia began operating in Petrograd. In the USSR, the government allocates the necessary funds for the development of the production of X-ray equipment, which reaches the world level in quality. In 1934, the first domestic tomograph was created, and in 1935, the first fluorograph.

“Without the history of the subject there is no theory of the subject” (N. G. Chernyshevsky). History is written not only for educational purposes. By revealing the patterns of development of X-ray radiology in the past, we gain the opportunity to better, more correctly, more confidently, and more actively build the future of this science.

X-ray research methods

All numerous X-ray examination techniques are divided into general and special.

General techniques include those designed to study any anatomical area and performed on general-purpose X-ray machines (fluoroscopy and radiography).

The general ones include a number of techniques in which it is also possible to study any anatomical areas, but require either special equipment (fluorography, radiography with direct image magnification) or additional devices for conventional X-ray machines (tomography, electroradiography). Sometimes these methods are also called private.

Special techniques include those that allow you to obtain images using special installations designed to study certain organs and areas (mammography, orthopantomography). Special techniques also include a large group of X-ray contrast studies, in which images are obtained using artificial contrast (bronchography, angiography, excretory urography, etc.).

General methods of X-ray examination

X-ray- a research technique in which an image of an object is obtained on a luminous (fluorescent) screen in real time. Some substances fluoresce intensely when exposed to X-rays. This fluorescence is used in x-ray diagnostics using cardboard screens coated with a fluorescent substance.

Radiography is an x-ray examination technique that produces a static image of an object recorded on some storage medium. Such media can be X-ray film, photographic film, digital detector, etc. X-ray images can be used to obtain an image of any anatomical area. Pictures of the entire anatomical area (head, chest, abdomen) are called overview. Pictures that depict a small part of the anatomical area that is of most interest to the doctor are called targeted pictures.

Fluorography- photographing an X-ray image from a fluorescent screen onto photographic film of various formats. This image is always reduced.

Electroradiography is a technique in which a diagnostic image is obtained not on X-ray film, but on the surface of a selenium plate and transferred to paper. A plate uniformly charged with static electricity is used instead of a film cassette and, depending on the different amounts of ionizing radiation hitting different points on its surface, is discharged differently. Fine carbon powder is sprayed onto the surface of the plate, which, according to the laws of electrostatic attraction, is distributed unevenly over the surface of the plate. A sheet of writing paper is placed on the plate, and the image is transferred to the paper as a result of the adhesion of carbon powder. Selenium plate, unlike film, can be used repeatedly. The technique is fast, economical, and does not require a darkened room. In addition, selenium plates in an uncharged state are indifferent to the effects of ionizing radiation and can be used when working under conditions of increased background radiation (X-ray film will become unusable under these conditions).

Special methods of X-ray examination.

Mammography- X-ray examination of the breast. It is performed to study the structure of the mammary gland when lumps are detected in it, as well as for preventive purposes.

Techniques using artificial contrast:

Diagnostic pneumothorax- X-ray examination of the respiratory organs after the introduction of gas into the pleural cavity. It is performed to clarify the localization of pathological formations located on the border of the lung with neighboring organs. With the advent of CT, it is rarely used.

Pneumomediastinography- X-ray examination of the mediastinum after the introduction of gas into its tissue. It is performed to clarify the localization of pathological formations (tumors, cysts) identified in the images and their spread to neighboring organs. With the advent of the CT method, it is practically not used.

Diagnostic pneumoperitoneum- X-ray examination of the diaphragm and organs of the abdominal cavity after the introduction of gas into the peritoneal cavity. It is performed to clarify the localization of pathological formations identified on photographs against the background of the diaphragm.

Pneumoretroperitoneum- a technique for x-ray examination of organs located in the retroperitoneal tissue by introducing gas into the retroperitoneal tissue in order to better visualize their contours. With the introduction of ultrasound, CT and MRI into clinical practice, they are practically not used.

Pneumoren- X-ray examination of the kidney and the adjacent adrenal gland after the injection of gas into the perinephric tissue. Currently performed extremely rarely.

Pneumopyelography- examination of the renal cavity system after filling it with gas through a ureteral catheter. Currently used primarily in specialized hospitals to identify intrapelvic tumors.

Pneumomyelography- X-ray examination of the subarachnoid space of the spinal cord after contrasting it with gas. It is used to diagnose pathological processes in the area of the spinal canal that cause a narrowing of its lumen (herniated intervertebral discs, tumors). Rarely used.

Pneumoencephalography- X-ray examination of the cerebrospinal fluid spaces of the brain after contrasting them with gas. Since their introduction into clinical practice, CT and MRI are rarely performed.

Pneumoarthrography- X-ray examination of large joints after introducing gas into their cavity. Allows you to study the articular cavity, identify intra-articular bodies in it, and detect signs of damage to the meniscus of the knee joint. Sometimes it is supplemented by injection into the joint cavity

water-soluble RKS. It is widely used in medical institutions when it is impossible to perform MRI.

Bronchography- a technique for x-ray examination of the bronchi after artificial contrasting of the bronchi. Allows you to identify various pathological changes in the bronchi. Widely used in medical institutions when CT is not available.

Pleurography- X-ray examination of the pleural cavity after it has been partially filled with a contrast agent in order to clarify the shape and size of the pleural encystations.

Sinography- X-ray examination of the paranasal sinuses after filling them with RCS. It is used when difficulties arise in interpreting the cause of shadowing of the sinuses on radiographs.

Dacryocystography- X-ray examination of the lacrimal ducts after filling them with RCS. It is used to study the morphological state of the lacrimal sac and the patency of the nasolacrimal canal.

Sialography- X-ray examination of the ducts of the salivary glands after they are filled with RCS. Used to assess the condition of the salivary gland ducts.

X-ray of the esophagus, stomach and duodenum- carried out after they are gradually filled with a suspension of barium sulfate, and, if necessary, with air. It necessarily includes polypositional fluoroscopy and the performance of survey and targeted radiographs. Widely used in medical institutions to identify various diseases of the esophagus, stomach and duodenum (inflammatory and destructive changes, tumors, etc.) (see Fig. 2.14).

Enterography- X-ray examination of the small intestine after filling its loops with a suspension of 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 of its lumen with a suspension of barium sulfate and air. Widely used for the diagnosis of many diseases of the colon (tumors, chronic colitis, etc.) (see Fig. 2.16).

Cholecystography- X-ray examination of the gallbladder after the accumulation of a contrast agent in it, taken orally and excreted with bile.

Excretory cholegraphy- X-ray examination of the biliary tract, contrasted with iodine-containing drugs administered intravenously and excreted in bile.

Cholangiography- X-ray examination of the bile ducts after the introduction of RCS into their lumen. Widely used to clarify the morphological state of the bile ducts and identify stones in them. It can be performed during surgery (intraoperative cholangiography) and in the postoperative period (through a drainage tube).

Retrograde cholangiopancreaticography- X-ray examination of the bile ducts and pancreatic duct after the introduction of a contrast agent into their lumen under X-ray endoscopy. Excretory urography - X-ray examination of the urinary organs after intravenous administration of RCS and its excretion by the kidneys. A widely used research technique that allows you to study the morphological and functional state of the kidneys, ureters and bladder.

Retrograde ureteropyelography- X-ray examination of the ureters and renal cavity systems after filling them with RCS through a ureteral catheter. Compared with excretory urography, it allows you to obtain more complete information about the condition of the urinary tract as a result of their better filling with a contrast agent administered under low pressure. Widely used in specialized urology departments.

Cystography- X-ray examination of the bladder filled with RCS.

Urethrography- X-ray examination of the urethra after filling it with RCS. Allows you to obtain information about the patency and morphological state of the urethra, identify its damage, strictures, etc. It is used in specialized urological departments.

Hysterosalpingography- X-ray examination of the uterus and fallopian tubes after filling their lumen with RCS. Widely used primarily to assess tubal patency.

Positive myelography- X-ray examination of the subarachnoid spaces of the spinal cord after the introduction of water-soluble RCS. With the advent of MRI, it is rarely used.

Aortography- X-ray examination of the aorta after insertion of RCS into its lumen.

Arteriography- X-ray examination of arteries using RCS introduced into their lumen, spreading through the blood flow. Some private arteriography techniques (coronary angiography, carotid angiography), while highly informative, are at the same time technically complex and unsafe for the patient, and therefore are used only in specialized departments.

Cardiography- X-ray examination of the cavities of the heart after the introduction of RCS into them. Currently, it has limited use in specialized cardiac surgery hospitals.

Angiopulmonography- X-ray examination of the pulmonary artery and its branches after the introduction of RCS into them. Despite the high information content, it is unsafe for the patient, and therefore, in recent years, preference has been given to computed tomographic angiography.

Phlebography- X-ray examination of the veins after the introduction of RCS into their lumen.

Lymphography- X-ray examination of the lymphatic tract after injection of RCS into the lymphatic bed.

Fistulography- X-ray examination of fistula tracts after filling them with RCS.

Vulnerography- X-ray examination of the wound canal after filling it with RCS. It is more often used for blind abdominal wounds, when other research methods do not allow one to determine whether the wound is penetrating or non-penetrating.

Cystography- contrast X-ray examination of cysts of various organs in order to clarify the shape and size of the cyst, its topographic location and the condition of the internal surface.

Ductography- contrast X-ray examination of the milk ducts. Allows you to assess the morphological state of the ducts and identify small breast tumors with intraductal growth, indistinguishable on mammograms.

Chapter 2.

General rules for patient preparation:

1.Psychological preparation. The patient must understand the importance of the upcoming study and must be confident in the safety of the upcoming study.

2. Before conducting the study, care must be taken to make the organ more accessible during the study. Before endoscopic examinations, it is necessary to empty the organ being examined of its contents. The organs of the digestive system are examined on an empty stomach: on the day of the examination you cannot drink, eat, take medications, brush your teeth, or smoke. On the eve of the upcoming study, a light dinner is allowed, no later than 19.00. Before examining the intestines, a slag-free diet (No. 4) is prescribed for 3 days, medications to reduce gas formation (activated carbon) and improve digestion (enzyme preparations), laxatives; enemas on the eve of the study. If specifically prescribed by a doctor, premedication is carried out (administration of atropine and painkillers). Cleansing enemas are given no later than 2 hours before the upcoming test, as the relief of the intestinal mucosa changes.

R-scopy of the stomach:

1. 3 days before the study, foods that cause gas formation are excluded from the patient’s diet (diet 4)

2. In the evening, no later than 17:00, light dinner: cottage cheese, egg, jelly, semolina porridge.

3. The study is carried out strictly on an empty stomach (do not drink, do not eat, do not smoke, do not brush your teeth).

Irrigoscopy:

1. 3 days before the study, exclude from the patient’s diet foods that cause gas formation (legumes, fruits, vegetables, juices, milk).

2. If the patient is concerned about flatulence, activated charcoal is prescribed for 3 days 2-3 times a day.

3. The day before the study, before lunch, give the patient 30.0 castor oil.

4. The night before, light dinner no later than 17:00.

5. At 21 and 22 hours the evening before, do cleansing enemas.

6. On the morning of the study at 6 and 7 o’clock, cleansing enemas.

7. A light breakfast is allowed.

8. In 40 minutes. – 1 hour before the study, insert a gas outlet tube for 30 minutes.

Cholecystography:

1. For 3 days, avoid foods that cause flatulence.

2. On the eve of the study, have a light dinner no later than 17:00.

3. From 21.00 to 22.00 hours the day before, the patient uses a contrast agent (billitrast) according to the instructions depending on body weight.

4. Studies are carried out on an empty stomach.

5. The patient is warned that loose stools and nausea may occur.

6. In the R-office, the patient must bring with him 2 raw eggs for a choleretic breakfast.

Intravenous choleography:

1. 3 days of following a diet with the exclusion of gas-forming foods.

2. Find out if the patient is allergic to iodine (runny nose, rash, itchy skin, vomiting). Tell your doctor.

3. Conduct a test 24 hours before the test, for which 1-2 ml of bilignost per 10 ml of physiological solution is administered intravenously.

4. The day before the study, choleretic drugs are discontinued.

5. In the evening at 21 and 22 hours, a cleansing enema and in the morning on the day of the study, 2 hours before, a cleansing enema.

6. The study is carried out on an empty stomach.

Urography:

1. 3 days slag-free diet (No. 4)

2. A day before the study, a sensitivity test to the contrast agent is performed.

3. The evening before at 21.00 and 22.00 cleansing enemas. In the morning at 6.00 and 7.00 cleansing enemas.

4. The examination is carried out on an empty stomach; before the examination the patient empties the bladder.

X-ray:

1. It is necessary to free the area under study from clothing as much as possible.

2. The study area should also be free of dressings, patches, electrodes and other foreign objects that could reduce the quality of the resulting image.

3. Make sure that there are no various chains, watches, belts, hairpins if they are located in the area that will be studied.

4. Only the area of interest to the doctor is left open; the rest of the body is covered with a special protective apron that screens out X-rays.

Conclusion.

Thus, at present, radiological research methods have found wide diagnostic use and have become an integral part of the clinical examination of patients. Also an integral part is preparing the patient for x-ray examination methods, because each of them has its own characteristics, which, if not followed, can lead to difficulty making a diagnosis.

One of the main parts of preparing a patient for x-ray examinations is psychological preparation. The patient must understand the importance of the upcoming study and must be confident in the safety of the upcoming study. After all, the patient has the right to refuse this study, which will greatly complicate the diagnosis.

Literature

Antonovich V.B. "X-ray diagnosis of diseases of the esophagus, stomach, intestines." – M., 1987.

Medical radiology. - Lindenbraten L.D., Naumov L.B. - 2014;

Medical radiology (basics of radiation diagnostics and radiation therapy) - Lindenbraten L.D., Korolyuk I.P. - 2012;

Fundamentals of medical X-ray technology and methods of X-ray examination in clinical practice / Koval G.Yu., Sizov V.A., Zagorodskaya M.M. and etc.; Ed. G. Yu. Koval. - K.: Health, 2016.

Pytel A.Ya., Pytel Yu.A. "X-ray diagnostics of urological diseases" - M., 2012.

Radiology: atlas / ed. A. Yu. Vasilyeva. - M.: GEOTAR-Media, 2013.

Rutsky A.V., Mikhailov A.N. "X-ray diagnostic atlas". – Minsk. 2016.

Sivash E.S., Salman M.M. “Possibilities of the X-ray method”, Moscow, Publishing house. "Science", 2015

Fanarjyan V.A. "X-ray diagnosis of diseases of the digestive tract." – Yerevan, 2012.

Shcherbatenko M.K., Beresneva Z.A. "Emergency X-ray diagnosis of acute diseases and injuries of the abdominal organs." – M., 2013.

Applications

Figure 1.1. Fluoroscopy procedure.

Figure 1.2. Carrying out radiography.

Figure 1.3. Chest X-ray.

Figure 1.4. Carrying out fluorography.

Portal for schoolchildren. Self-preparation

Introduction

Instrumental methods for X-ray, endoscopic and ultrasound examinations

X-ray research methods

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