X-ray contrast methods of examination of the patient. X-ray method of research. X-ray and bone densitometry

The most important method for diagnosing tuberculosis at different stages of its formation is the X-ray method of investigation. Over time, it became clear that with this infectious disease there is no “classic”, that is, a permanent x-ray picture. Any lung disease in the pictures may look like tuberculosis. Conversely, tuberculosis infection can be similar to many lung diseases on x-rays. It is clear that this fact makes differential diagnosis difficult. In this case, specialists resort to other, no less informative methods for diagnosing tuberculosis.

Although x-rays have drawbacks, this method sometimes plays a key role in the diagnosis of not only tuberculosis infection, but also other diseases of the chest. It accurately helps to determine the localization and extent of the pathology. Therefore, the described method most often becomes the right basis for making an accurate diagnosis - tuberculosis. For its simplicity and informative value, X-ray examination of the chest organs is mandatory for the adult population in Russia.

How are x-rays taken?

The organs of our body have an unequal structure - bones and cartilage are dense formations, compared with parenchymal or abdominal organs. It is on the difference in the density of organs and structures that X-ray images are based. The rays that pass through the anatomical structures are absorbed differently. This directly depends on the chemical composition of the organs and the volume of the studied tissues. Strong absorption of x-ray radiation by the organ gives a shadow on the resulting image, if it is transferred to film, or on the screen.

Sometimes it is necessary to additionally "mark" some structures that require more careful study. In this case, resort to contrast. In this case, special substances are used that can absorb rays in a larger or smaller volume.

The algorithm for obtaining a snapshot can be represented by the following points:

1. Radiation source - X-ray tube.
2. The object of the study is the patient, while the purpose of the study can be both diagnostic and prophylactic.
3. The receiver of the emitter is a cassette with a film (for radiography), fluoroscopic screens (for fluoroscopy).
4. Radiologist - who examines the image in detail and gives his opinion. It becomes the basis for the diagnosis.

Is x-ray dangerous for humans?

It has been proven that even tiny doses of X-rays can be dangerous for living organisms. Studies conducted on laboratory animals show that X-ray radiation caused disturbances in the structure of their chromosomes of germ cells. This phenomenon has a negative impact on the next generation. The cubs of the irradiated animals had congenital anomalies, extremely low resistance and other irreversible abnormalities.

An X-ray examination, which is carried out in full accordance with the rules of technique for its implementation, is absolutely safe for the patient.

It's important to know! In the case of using faulty equipment for X-ray examination or a gross violation of the algorithm for taking a picture, as well as the lack of personal protective equipment, harm to the body is possible.

Each x-ray examination involves the absorption of microdoses. Therefore, the health care provided for a special decree, which the medical staff undertakes to comply with when taking pictures. Among them:

1. The study is carried out according to strict indications for the patient.
2. Pregnant and pediatric patients are checked with extreme caution.
3. The use of the latest equipment that minimizes radiation exposure to the patient's body.
4. X-ray room PPE - protective clothing, protectors.
5. Reduced exposure time - which is important for both the patient and the medical staff.
6. Control of the received doses at medical personnel.

The most common methods in the X-ray diagnosis of tuberculosis

For the chest organs, the following methods are most often used:

1. X-ray - the use of this method involves translucence. This is the most budgetary and popular x-ray study. The essence of his work is to irradiate the chest area with X-rays, the image of which is projected onto a screen, followed by examination by a radiologist. The method has disadvantages - the resulting image is not printed. Therefore, in fact, it can be studied only once, which makes it difficult to diagnose small foci in tuberculosis and other diseases of the chest organs. The method is most often used to make a preliminary diagnosis;
2. Radiography is a picture that, unlike fluoroscopy, remains on the film, therefore it is mandatory in the diagnosis of tuberculosis. The picture is taken in a direct projection, if necessary - in a lateral one. The rays that have previously passed through the body are projected onto a film that is able to change its properties due to the silver bromide included in its composition - dark areas indicate that silver has recovered on them to a greater extent than on transparent ones. That is, the former display the "air" space of the chest or other anatomical region, and the latter - bones and cartilage, tumors, accumulated fluid;
3. Tomography - allows specialists to get a layered picture. At the same time, in addition to the X-ray machine, special devices are used that can register images of organs in their different parts without overlapping each other. The method is highly informative in determining the localization and size of the tuberculosis focus;
4. Fluorography - a picture is obtained by photographing an image from a fluorescent screen. It can be large- or small-frame, electronic. It is used for mass preventive examination for the presence of tuberculosis and lung cancer.

Other X-ray methods and preparation for them

Some patient conditions require imaging of other anatomical regions. In addition to the lungs, you can take an x-ray of the kidneys and gallbladder, the gastrointestinal tract or the stomach itself, blood vessels and other organs:

• X-ray of the stomach - which will allow you to diagnose an ulcer or neoplasms, developmental anomalies. It should be noted that the procedure has contraindications in the form of bleeding and other acute conditions. Before the procedure, it is necessary to follow a diet three days before the procedure and a cleansing enema. Manipulation is carried out using barium sulfate, which fills the stomach cavity.
• X-ray examination of the bladder - or cystography - is a method that is widely used in urology and surgery to detect kidney pathology. Since with a high degree of accuracy it can show stones, tumors, inflammations and other pathologies. In this case, the contrast is injected through a catheter previously installed in the patient's urethra. For children, manipulation is performed under anesthesia.
• X-ray of the gallbladder - cholecystography - which is also performed using a contrast agent - bilitrast. Preparation for the study - a diet with a minimum fat content, taking iopanoic acid before bedtime, before the procedure itself, it is recommended to conduct a test for sensitivity to contrast and a cleansing enema.

X-ray examination in children

Smaller patients can also be referred for x-rays, and even the neonatal period is not a contraindication for this. An important point for taking a picture is the medical justification, which must be documented either in the child's card or in his medical history.

For older children - after 12 years - an X-ray examination is no different from an adult. Young children and a newborn are examined on x-rays using special techniques. There are specialized X-ray rooms in children's hospitals, where even premature babies can be examined. In addition, the technique of taking pictures is strictly observed in such offices. Any manipulations there are carried out strictly observing the rules of asepsis and antisepsis.

In the case when a picture needs to be taken for a child under 14 years old, three persons are involved - a radiologist, a radiologist and a nurse accompanying a small patient. The latter is needed to help fix the child and to provide care and observation before and after the procedure.

For babies in X-ray rooms, special fixing devices are used and, of course, means for protection against radiation in the form of diaphragms or tubes. Particular attention is paid to the gonads of the child. In this case, electron-optical amplifiers are used and the radiation exposure is reduced to a minimum.

It's important to know! Most often, radiography is used for pediatric patients due to its low ionizing load compared to other methods of X-ray examination.

RADIOLOGICAL METHODS OF INVESTIGATION

Parameter name	Meaning
Article subject:	RADIOLOGICAL METHODS OF INVESTIGATION
Rubric (thematic category)	Radio

X-ray methods play a key role in the diagnosis of diseases of the kidneys and urinary tract. Οʜᴎ are widely used in clinical practice, however, some of them, due to the introduction of more informative diagnostic methods, have now lost their significance (X-ray tomography, pneumothorax, presacral pneumorethroperitoneum, pneumopericistography, prostatography).

The quality of an x-ray examination largely depends on the correct preparation of the patient. To do this, on the eve of the procedure, foods that promote gas formation (carbohydrates, vegetables, dairy products) are excluded from the diet of the subject, and a cleansing enema is performed. If an enema is not possible, laxatives are prescribed (castor oil, fort-rance), as well as drugs that reduce gas formation (activated charcoal, simethicone). In order to avoid the accumulation of "hungry" gases in the morning before the study, a light breakfast (for example, tea with a small amount of white bread) is recommended.

Overview photo. An X-ray examination of a urological patient should always begin with an overview of the kidneys and urinary tract. An overview picture of the urinary tract should cover the location of all organs of the urinary system (Fig. 4.24). A typical X-ray film is 30 x 40 cm.

Rice. 4.24.Plain radiograph of the kidneys and urinary tract is normal

When interpreting a radiograph, first of all, they study the state bone skeleton: lower thoracic and lumbar vertebrae, ribs and pelvic bones. Evaluate contours m. psoas, the disappearance or change of which may indicate a pathological process in the retroperitoneal space. Insufficient visibility of retroperitoneal objects should be due to flatulence, that is, the accumulation of intestinal gases.

With good preparation of the patient, shadows can be seen on the overview picture kidney, which are located: on the right - from the upper edge of the I lumbar vertebra to the body of the III lumbar vertebra, on the left - from the body of the XII thoracic to the body of the II lumbar vertebra. Normally, their contours are even, and the shadows are homogeneous. Changes in size, shape, location and contours make it possible to suspect an anomaly or kidney disease. The ureters are not visible on the plain radiograph.

Bladder with tight filling with concentrated urine, it can be defined as a rounded shadow in the projection of the pelvic ring.

kidney stones and urinary tract visualized on the overview image in the form of radiopaque shadows (Fig. 4.25). Evaluate their localization, size, shape, quantity, density. Calcified walls of aneurysmally dilated vessels, atherosclerotic plaques, gallbladder stones, fecal stones, calcified tuberculous caverns, fibromatous and lymph nodes, as well as phleboliths- venous calcified deposits, having a rounded shape and enlightenment in the center.

Rice. 4.25.Plain radiograph of the kidneys and urinary tract. Left kidney stones (arrow)

The presence of urolithiasis cannot be accurately judged by a plain radiograph alone, however, any shadow in the projection of the kidneys and urinary tract should be interpreted as suspicious for a calculus until the diagnosis is excluded or confirmed using radiopaque research methods.

Excretory urography- one of the leading research methods in urology, based on the ability of the kidneys to secrete a radiopaque substance. This method allows you to evaluate the functional and anatomical state of the kidneys, pelvis, ureters and bladder (Fig. 4.26). A prerequisite for performing excretory urography is sufficient kidney function. For research use radiopaque preparations, containing iodine (urografin, urotrast, etc.). There are also modern drugs with low osmolarity (omnipaque). The calculation of the dose of the contrast agent is made taking into account the body weight, age and condition of the patient, the presence of concomitant diseases. With satisfactory renal function, 20 ml of a contrast agent is usually injected intravenously. When it is extremely important, the study is carried out with 40 or 60 ml of contrast.

Rice. 4.26.Excretory urogram is normal

After intravenous administration of a radiopaque substance, after 1 min, an image of a functioning renal parenchyma (nephrogram phase) is revealed on the radiograph. After 3 minutes, the contrast is determined in the urinary tract (pyelogram phase). Usually, several shots are taken at the 7th, 15th, 25th, 40th minute, which allow assessing the condition of the upper urinary tract. In the absence of secretion of a contrast agent by the kidney, delayed pictures are taken, which are performed after 1-2 hours. When filled with contrast, the bladder is imaged (descending cystogram).

When interpreting urograms, attention is paid to the size, shape, position of the kidneys, the timeliness of the release of a contrast agent, the anatomical structure of the pelvicalyceal system, the presence of filling defects and obstacles to the passage of urine. It is necessary to evaluate the saturation of the shadow of the contrast agent in the urinary tract, the time of its appearance in the ureters and bladder. In this case, the shadow of the calculus previously visible on the overview image may be absent.

On the excretory urogram, the shadow of a radio-positive stone disappears due to its layering on a radiopaque substance. It appears on later images as the outflow of contrast and impregnation of the calculus. An X-ray negative stone creates a defect in the filling of the contrast agent.

In the absence of shadows of a contrast agent on the radiograph, one can assume congenital absence of the kidney, blockage of the kidney with a stone in renal colic, hydronephrotic transformation and other diseases accompanied by inhibition of renal function.

Undesirable reactions and complications during intravenous administration of radiopaque agents are more often observed when using hyperosmolar radiopaque agents, less often - low-osmolar ones. To prevent such complications, you should carefully learn the allergic history and, in order to check the sensitivity of the body to iodine, inject 1-2 ml of a contrast agent intravenously, and then, without removing the needle from the vein, if the patient is in a satisfactory condition, after a 2-3-minute interval, slowly inject the entire volume drug.

The introduction of a contrast agent should be done slowly (within 2 minutes) in the presence of a doctor. If side effects occur, 10-20 ml of a 30% sodium thiosulfate solution should be slowly injected into the vein immediately. Minor side effects include nausea, vomiting, and dizziness. Much more dangerous are allergic reactions to contrast agents (urticaria, bronchospasm, anaphylactic shock), which develop in about 5% of cases. When it is extremely important to perform excretory urography in patients with allergic reactions to hyperosmolar contrast agents, only low-osmolar agents are used and premedication with glucocorticoids and antihistamines is preliminarily performed.

Contraindications for excretory urography are shock, collapse, severe liver and kidney disease with severe azotemia, hyperthyroidism, diabetes mellitus, hypertension in the stage of decompensation, and pregnancy.

Retrograde (ascending) ureteropyelography. This study is based on filling the ureter, pelvis and calyces with a radiopaque substance by retrograde introduction of it through a catheter previously installed in the ureter.
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For this purpose, liquid contrast agents (urographine, omnipaque) are used. Gaseous contrasts (oxygen, air) are currently used extremely rarely.

Today, the indications for this study have narrowed significantly due to the advent of more informative and less invasive diagnostic methods, such as sonography, computed tomography (CT) and magnetic resonance imaging (MRI).

Retrograde ureteropyelography (Fig. 4.27) is used in cases where excretory urography does not give a clear image of the upper urinary tract or is not feasible due to severe azotemia, allergic reactions to a contrast agent. This study is used for narrowing of the ureters of various origins, tuberculosis, tumors of the upper urinary tract, X-ray negative stones, anomalies of the urinary system, as well as when it is extremely important to visualize the ureter stump of the removed kidney. Low-contrast solutions or pneumopyelography are used to detect radio-negative stones.

Rice. 4.27.Retrograde ureteropyelogram on the left

Complications of retrograde ureteropyelography are the development of pyelorenal reflux, accompanied by fever, chills, pain in the lumbar region; exacerbation of pyelonephritis; perforation of the ureter.

Antegrade (descending) pyeloureterography- a research method based on visualization of the upper urinary tract by introducing a contrast agent into the renal pelvis using percutaneous puncture or nephrostomy drainage (Fig. 4.28).

Retrograde ureteropyelography is contraindicated in case of massive hematuria, an active inflammatory process in the genitourinary organs, and the inability to perform cystoscopy.

Conducting retrograde ureteropyelography begins with cystoscopy, after which a catheter is inserted into the mouth of the corresponding ureter to a height of 20-25 cm (or, if extremely important, into the pelvis). Next, an overview picture of the urinary tract is taken to control the location of the catheter. A radiopaque substance is slowly injected (usually no more than 3-5 ml) and images are taken. In order to avoid infectious complications, retrograde ureteropyelography should not be performed simultaneously from both sides.

Antegrade percutaneous pyeloureterography is indicated for patients with obstruction of the ureters of various origins (stricture, stone, tumor, etc.), when other diagnostic methods do not allow a correct diagnosis. The study helps to determine the nature and level of obstruction of the ureters.

Antegrade pyeloureterography is used to assess the condition of the upper urinary tract in patients with nephrostomy in the postoperative period, especially after plastic surgery on the pelvis and ureter.

Contraindications to performing antegrade percutaneous pyeloureterography are: infections of the skin and soft tissues in the lumbar region, as well as conditions accompanied by impaired blood clotting.

Rice. 4.28.Antegrade pyeloureterogram on the left. Pelvic ureter stricture

Cystography- a method of X-ray examination of the bladder by pre-filling it with a contrast agent. Cystography should be descending(during excretory urography) and ascending(retrograde), which, in turn, is subdivided into static and voiding(during urination).

Descending cystography is the standard x-ray examination of the bladder during excretory urography.(Fig. 4.29).

Purposefully, it is used to obtain information about the state of the bladder when its catheterization is impossible due to obstruction of the urethra. With normal kidney function, a distinct shadow of the bladder appears 30-40 minutes after the introduction of a contrast agent into the bloodstream. If the contrast is insufficient, later pictures are taken, after 60-90 minutes.

Rice. 4.29.Excretory urogram with a descending cystogram is normal

Retrograde cystography- a method of X-ray identification of the bladder by introducing liquid or gaseous (pneumocystogram) contrast agents into its cavity through a catheter installed along the urethra (Fig. 4.30). The study is performed in the position of the patient on the back with the hips abducted and bent at the hip joints. Using a catheter, 200-250 ml of a contrast agent is injected into the bladder, after which an x-ray is taken. A normal bladder with sufficient filling has a rounded (mainly in men) or oval (in women) shape and clear, even contours. The lower edge of its shadow is located at the level of the upper border of the symphysis, and the upper one is at the level of the III-IV sacral vertebrae. In children, the bladder is located higher above the symphysis than in adults.

Rice. 4.30.Retrograde cystogram is normal

Cystography is the main method for diagnosing penetrating ruptures of the bladder, which allows you to determine the flow of radiopaque substance outside the organ(see ch. 15.3, fig. 15.9). It can also be used to diagnose cystocele, vesical fistulas, tumors and bladder stones. In patients with benign prostatic hyperplasia, the cystogram can clearly determine the rounded filling defect caused by it along the lower contour of the bladder (Fig. 4.31). Diverticula of the bladder are detected on the cystogram in the form of sac-like protrusions of its wall.

Rice. 4.31.Excretory urogram with descending cystogram. A large rounded filling defect along the lower contour of the bladder is determined, due to benign prostatic hyperplasia (arrow)

Contraindications to retrograde cystography are acute inflammatory diseases of the lower urinary tract, prostate gland and scrotal organs. In patients with traumatic injury to the bladder, the integrity of the urethra is first verified by urethrography.

Most of the previously proposed modifications of cystography due to the advent of more informative research methods have now lost their significance. Only stood the test of time voiding cystography(Fig. 4.32) - X-ray performed during the release of the bladder from the contrast agent, that is, at the time of urination. Voiding cystography is widely used in pediatric urology to detect vesicoureteral reflux. Also, this study is resorted to when it is extremely important to visualize the posterior urethra (antegrade urethrography) in patients with strictures and valves of the urethra, ectopia of the mouth of the ureter into the urethra.

Rice. 4.32.Miction cystogram. At the time of urination, the posterior urethra is contrasted (1), right-sided vesicoureteral reflux is determined (2)

Genitography- X-ray examination of the vas deferens through their contrasting. It is used in the diagnosis of diseases of the epididymis (epididymography) and seminal vesicles (vesiculography), assessment of the patency of the vas deferens (vasography).

The study consists in the introduction of a radiopaque substance into the vas deferens by percutaneous puncture or vasotomy. Due to the invasiveness of this study, indications for it are strictly limited. Genitography is used in the differential diagnosis of tuberculosis, tumors of the epididymis, seminal vesicles. Vasography allows you to identify the cause of infertility caused by impaired patency of the vas deferens.

A contraindication to the implementation of this study is an active inflammatory process in the organs of the genitourinary system.

urethrography- a method of X-ray examination of the urethra by its preliminary contrasting. Distinguish descending(antegrade, voiding) and ascending(retrograde) urethrography.

Antegrade urethrography performed at the time of urination after pre-filling the bladder with a radiopaque substance. In this case, a good image of the prostatic and membranous parts of the urethra is obtained, in connection with this, this study is used primarily for the diagnosis of diseases of these parts of the urethra.

Much more frequently performed retrograde urethrography(Fig. 4.33). It is usually performed in an oblique position of the patient on the back: the rotated pelvis forms an angle of 45 ° with the horizontal plane of the table, one leg is bent at the hip and knee joints and pressed to the body, the second is extended. In this position, the urethra is projected onto the soft tissues of the thigh. The penis is pulled parallel to the bent thigh. The contrast agent is slowly injected into the urethra using a rubber-tipped syringe (to avoid urethrovenous reflux). During the injection of contrast, an x-ray is taken.

Rice. 4.33.Retrograde urethrogram is normal

Urethrography is the main method for diagnosing injuries and strictures of the urethra. A characteristic radiological sign of a penetrating rupture of the urethra is the spread of a contrast agent beyond its limits and the absence of its entry into the overlying sections of the urethra and bladder (see Chapter 15.4, Figure 15.11). Indications for it are also anomalies, neoplasms, deverticula and fistulas of the urethra. Urethrography is contraindicated in acute inflammation of the lower urinary tract and genital organs.

Renal angiography- a method of studying the renal vessels by their preliminary contrasting. With the development and improvement of radiation diagnostic methods, angiography to a certain extent has lost its former importance, since visualization of the great vessels and kidneys using multislice CT and MRI is more accessible, informative and less invasive.

The method allows to study the features of angioarchitectonics and the functional ability of the kidneys in cases where other research methods fail to do this. Indications for this study are hydronephrosis (especially if there is a suspicion of lower polar renal vessels causing ureteral obstruction), anomalies in the structure of the kidneys and upper urinary tract, tuberculosis, kidney tumors, differential diagnosis of volumetric formations and kidney cysts, nephrogenic arterial hypertension, tumors of the adrenal glands and others

Given the dependence on the method of administration of the contrast agent, renal angiography is performed translumbar(puncture of the aorta from the lumbar region) and transfemoral(after puncture of the femoral artery, the catheter is passed along it to the level of the renal arteries) using Seldinger access. Today, translumbar aortography is used extremely rarely, only in cases where it is technically impossible to puncture the femoral artery and pass a catheter through the aorta, for example, with severe atherosclerosis.

Transfemoral aortography and arteriography of the kidneys have become widespread (Fig. 4.34).

Rice. 4.34.Transfemoral renal arteriogram

In renal angiography, the following phases of organ contrast are distinguished: arteriographic- contrasting of the aorta and renal arteries; nephrographic- visualization of the kidney parenchyma; venographic- renal veins are determined; phase of excretory urography, when a contrast agent is released into the urinary tract.

The blood supply of the kidney is carried out according to the main or loose type. The loose type of blood supply is characterized by the fact that two or more arterial trunks bring blood to the kidney. Feeding the corresponding part of the organ, they do not have anastomoses, in connection with this, each of them is the main source of blood supply for the kidney. In one patient, both of these types of blood supply can be observed at once.

In some cases, kidney disease is characterized by a specific angiographic picture. With hydronephrosis, there is a sharp narrowing of the intrarenal arteries and a decrease in their number. A kidney cyst is characterized by the presence of an avascular area. Kidney neoplasms are accompanied by a violation of the architectonics of the renal vessels, a unilateral increase in the diameter of the renal artery, and the accumulation of contrast fluid in the tumor area.

To obtain a detailed image of the area of ​​interest allows the method selective renal arteriography(Fig. 4.35). At the same time, with the help of transfemoral sounding of the aorta, renal artery and its branches, it is possible to obtain a selective angiogram of one kidney or its individual segments.

Rice. 4.35.Selective renal arteriogram is normal

Renal angiography is a highly informative method for diagnosing various kidney diseases. However, this study is quite invasive and should have limited and specific indications for use.

One of the promising research methods is digital subtraction angiography- a method of contrast study of blood vessels with subsequent computer processing. Its advantage is the ability to image only objects containing a contrast agent. The latter can be administered intravenously without resorting to catheterization of large vessels, which is less traumatic for the patient.

venography, including renal,- a method for studying venous vessels by their preliminary contrasting. It is performed by puncturing the femoral vein, through which a catheter is passed into the inferior vena cava and renal veins.

The development of angiography contributed to the emergence of a new industry - X-ray endovascular surgery.

In urology, the most widely used methods are: embolization, balloon dilatation and vascular stenting.

Embolization- the introduction of various substances for selective occlusion of blood vessels. It is used to stop bleeding in patients with trauma or tumors of the kidneys and as a minimally invasive treatment for varicocele. Balloon angioplasty and stenting of renal vessels involve the endovascular introduction of a special balloon, which is then inflated and restores the patency of the vessel. It is important to note that in order to preserve the newly shaped artery, a special self-expanding vascular endoprosthesis - a stent - is installed.

CT scan. This is one of the most informative diagnostic methods. Unlike conventional radiography, CT allows you to get a picture of a transverse (axial) section of the human body with a layer-by-layer step of 1-10 mm.

The method is based on the measurement and computer processing of the difference in X-ray attenuation by tissues of different density. With the help of a movable X-ray tube moving around the object at an angle of 360°, an axial layer-by-layer scanning of the patient's body with a millimeter step is performed. In addition to conventional CT, there is spiral CT and more perfect multislice CT(Fig. 4.36).

Rice. 4.36.Multispiral CT is normal. Axial section at the level of the renal hilum

To improve the differentiation of organs from each other, various amplification techniques are used using oral or intravenous contrast.

With spiral scanning, two actions are performed simultaneously: the rotation of the radiation source - the x-ray tube and the continuous movement of the table with the patient along the longitudinal axis. The best image quality is provided by multislice CT. The advantage of a multispiral study is a larger number of perceiving detectors, which makes it possible to obtain a better picture with the possibility of a three-dimensional image of the organ under study with less radiation exposure to the patient (Fig. 4.37). However, this method makes it possible to obtain multiplanar, three-dimensional and virtual endoscopic images of the urinary tract.

Rice. 4.37.Multislice CT. Multiplanar reformation in frontal projection. Excretory phase is normal

CT is one of the leading methods for diagnosing urological diseases; due to its higher information content and safety compared to other x-ray methods, it has become the most widespread throughout the world.

Multispiral CT with intravenous contrast enhancement and 3D image reconstruction is currently one of the most advanced imaging modalities in modern urology.(fig. 36, see color insert). Indications for the implementation of this research method have recently expanded significantly. This is a differential diagnosis of cysts, neoplasms of the kidneys and adrenal glands; assessment of the state of the vascular bed, regional and distant metastases in tumors of the genitourinary system; tuberculous lesion; kidney injury; volumetric formations and purulent processes of the retroperitoneal space; retroperitoneal fibrosis; urolithiasis disease; diseases of the bladder (tumors, diverticula, calculi, etc.) and the prostate gland.

Positron emission tomography (PET)- radionuclide tomographic research method.

At the root of it lies the possibility, using special detecting equipment (PET scanner), to track the distribution in the body of biologically active compounds labeled with positron-emitting radioisotopes. The method is most widely used in oncourology. PET provides valuable information in patients with suspected cancer of the kidney, bladder, prostate, testicular tumors.

The most informative are positron emission tomographs, combined with computed tomography, allowing simultaneous study of anatomical (CT) and functional (PET) data.

RADIOLOGICAL RESEARCH METHODS - concept and types. Classification and features of the category "X-RAY RESEARCH METHODS" 2017, 2018.

Radiography is one of the research methods based on obtaining a fixed on a certain carrier, most often X-ray film plays this role.

The latest digital devices can also capture such an image on paper or on a display screen.

Radiography of organs is based on the passage of rays through the anatomical structures of the body, as a result of which a projection image is obtained. Most often, X-rays are used as a diagnostic method. For greater information content, it is better to perform x-rays in two projections. This will allow you to more accurately determine the location of the organ under study and the presence of pathology, if any.

The chest is most often examined using this method, but X-rays of other internal organs can also be taken. There is an X-ray room in almost every clinic, so it will not be difficult to undergo such a study.

What is the purpose of radiography?

This type of study is carried out in order to diagnose specific lesions of internal organs in infectious diseases:

• Inflammation of the lungs.
• Myocarditis.
• Arthritis.

It is also possible to identify diseases of the respiratory and heart organs using X-rays. In some cases, if there are individual indications, radiography is necessary to examine the skull, spinal column, joints, and organs of the digestive tract.

Indications for carrying out

If X-ray is an additional research method for diagnosing certain diseases, then in some cases it is prescribed as mandatory. This usually happens if:

1. There is confirmed damage to the lungs, heart, or other internal organs.
2. It is necessary to monitor the effectiveness of therapy.
3. There is a need to check the correct placement of the catheter and

Radiography is a research method that is used everywhere, it is not particularly difficult for both the medical staff and the patient himself. The picture is the same medical document as other research findings, therefore it can be presented to different specialists to clarify or confirm the diagnosis.

Most often, each of us undergoes a chest x-ray. The main indicators for its implementation are:

• Prolonged cough accompanied by chest pain.
• Detection of tuberculosis, lung tumors, pneumonia or pleurisy.
• Suspicion of pulmonary embolism.
• There are signs of heart failure.
• Traumatic lung injury, rib fractures.
• Foreign bodies entering the esophagus, stomach, trachea or bronchi.
• Preventive checkup.

Quite often, when a complete examination is required, radiography is prescribed among other methods.

X-ray benefits

Despite the fact that many patients are afraid to once again undergo an x-ray, this method has many advantages compared to other studies:

• It is not only the most accessible, but also quite informative.
• Relatively high spatial resolution.
• No special training is required to complete this study.
• X-rays can be stored for a long time to monitor the progress of treatment and detect complications.
• Not only radiologists, but also other specialists can evaluate the image.
• It is possible to carry out radiography even for bedridden patients using a mobile device.
• This method is also considered one of the cheapest.

So, if you undergo such a study at least once a year, you will not cause harm to the body, but it is quite possible to identify serious diseases at the initial stage of development.

X-ray methods

Currently, there are two ways to take x-rays:

1. Analog.
2. Digital.

The first of them is older, time-tested, but requires some time to develop the picture and see the result on it. The digital method is considered new and now it is gradually replacing the analog one. The result is displayed immediately on the screen, and you can print it, and more than once.

Digital radiography has its advantages:

• Significantly improves the quality of images, and hence the information content.
• Ease of doing research.
• Ability to get instant results.
• The computer has the ability to process the result with a change in brightness and contrast, which allows more accurate quantitative measurements.
• The results can be stored for a long time in electronic archives, you can even transfer them over the Internet over distances.
• Economic efficiency.

Cons of radiography

Despite the numerous advantages, the method of radiography has its drawbacks:

1. The image in the picture is static, which makes it impossible to assess the functionality of the organ.
2. In the study of small foci, the information content is insufficient.
3. Changes in soft tissues are poorly detected.
4. And, of course, one cannot but say about the negative effect of ionizing radiation on the body.

But be that as it may, radiography is a method that continues to be the most common for detecting pathologies of the lungs and heart. It is he who allows to detect tuberculosis at an early stage and save millions of lives.

Preparing for an x-ray

This method of research is different in that it does not require any special preparatory measures. You only need to come to the X-ray room at the appointed time and take an x-ray.

If such a study is prescribed for the purpose of examining the digestive tract, then the following preparation methods will be required:

• If there are no deviations in the work of the gastrointestinal tract, then special measures should not be taken. In case of excessive flatulence or constipation, it is recommended to give a cleansing enema 2 hours before the study.
• If there is a large amount of food (liquid) in the stomach, lavage should be done.
• Before cholecystography, a radiopaque preparation is used, which penetrates the liver and accumulates in the gallbladder. To determine the contractility of the gallbladder, the patient is given a cholagogue.
• To make cholegraphy more informative, a contrast agent is injected intravenously before it, for example, Bilignost, Bilitrast.
• An irrigography is preceded by a contrast enema with barium sulfate. Before this, the patient should drink 30 g of castor oil, in the evening make a cleansing enema, do not have dinner.

Research technique

At present, almost everyone knows where to take an x-ray, what this study is. Its methodology is as follows:

1. The patient is placed in front of, if required, the study is carried out in a sitting position or lying on a special table.
2. If there are tubes or hoses inserted, make sure they have not moved during preparation.
3. Until the end of the study, the patient is forbidden to make any movements.
4. The medical worker leaves the room before starting the X-ray, if his presence is mandatory, then puts on a lead apron.
5. Pictures are most often taken in several projections for greater information content.
6. After developing the images, their quality is checked, if necessary, a second examination may be required.
7. To reduce projection distortion, the body part should be placed as close to the cassette as possible.

If the radiography is performed on a digital machine, then the image is displayed on the screen, and the doctor can immediately see the deviations from the norm. The results are stored in a database and can be stored for a long time, if necessary, they can be printed on paper.

How are X-ray results interpreted?

After X-rays are taken, the results must be correctly interpreted. To do this, the doctor evaluates:

• Location of internal organs.
• Integrity of bone structures.
• The location of the roots of the lungs and their contrast.
• How distinguishable are the main and small bronchi.
• Transparency of the lung tissue, the presence of blackouts.

If carried out, then it is necessary to identify:

• The presence of fractures.
• Expressed with an increase in the brain.
• Pathology of the "Turkish saddle", which appears as a result of increased intracranial pressure.
• The presence of brain tumors.

To make a correct diagnosis, the results of an x-ray examination must be compared with other analyzes and functional tests.

Contraindications for radiography

Everyone knows that the radiation exposure that the body experiences during such a study can lead to radiation mutations, despite the fact that they are very small. To minimize the risk, it is necessary to take an x-ray only strictly according to the doctor's prescription and in compliance with all protection rules.

It is necessary to distinguish between diagnostic and prophylactic radiography. The first has practically no absolute contraindications, but it must be remembered that it is also not recommended for everyone to do it. Such a study should be justified, you should not prescribe it to yourself.

Even during pregnancy, if other methods fail to make a correct diagnosis, it is not forbidden to resort to x-rays. The risk to the patient is always less than the harm that an undiagnosed disease can bring in time.

For prevention, X-rays should not be taken by pregnant women and children under 14 years of age.

X-ray examination of the spine

Radiography of the spine is performed quite often, the indications for its implementation are:

1. Pain in the back or limbs, the appearance of a feeling of numbness.
2. Identification of degenerative changes in the intervertebral discs.
3. The need to identify spinal injuries.
4. Diagnosis of inflammatory diseases of the spinal column.
5. Detection of curvature of the spine.
6. If there is a need to recognize congenital anomalies in the development of the spine.
7. Diagnosis of changes after surgery.

The X-ray procedure of the spine is performed in the prone position, you must first remove all jewelry and undress to the waist.

The doctor usually warns that you should not move during the examination so that the pictures are not blurry. The procedure does not take more than 15 minutes and the patient does not cause inconvenience.

There are some contraindications for X-ray of the spine:

• Pregnancy.
• If an X-ray examination using a barium compound has been done in the last 4 hours. In this case, the pictures will not be of high quality.
• Obesity also does not allow you to get informative pictures.

In all other cases, this research method has no contraindications.

X-ray of the joints

Such diagnostics is one of the main methods for studying the osteoarticular apparatus. Joint x-rays can show:

• Violations in the structure of the articular surfaces.
• The presence of bone growths along the edge of the cartilage tissue.
• Areas of calcium deposits.
• The development of flat feet.
• Arthritis, arthrosis.
• Congenital pathologies of bone structures.

Such a study helps not only to identify violations and deviations, but also to recognize complications, as well as determine the treatment tactics.

Indications for radiography of the joints may be:

• Joint pain.
• Changing its shape.
• Pain during movement.
• Limited mobility in the joint.
• Received injury.

If there is a need to undergo such a study, then it is better to ask your doctor where to take an x-ray of the joints in order to get the most reliable result.

Requirements for conducting a radiological examination

In order for an X-ray examination to give the most effective result, it must be carried out in compliance with certain requirements:

1. The region of interest should be in the center of the image.
2. If there is damage to the tubular bones, then one of the adjacent joints must be visible in the picture.
3. In case of a fracture of one of the bones of the lower leg or forearm, both joints should be recorded in the picture.
4. It is desirable to carry out radiography in different planes.
5. If there are pathological changes in the joints or bones, then it is necessary to take a picture of a symmetrically located healthy area so that changes can be compared and evaluated.
6. To make a correct diagnosis, the quality of the images must be high, otherwise a second procedure will be required.

How often can you have x-rays

The effect of radiation on the body depends not only on the duration, but also on the intensity of exposure. The dose also directly depends on the equipment on which the study is carried out, the newer and more modern it is, the lower it is.

It is also worth considering that for different parts of the body there is a specific radiation rate, since all organs and tissues have different sensitivities.

Carrying out x-rays on digital devices reduces the dose by several times, so it can be done more often on them. It is clear that any dose is harmful to the body, but it should also be understood that radiography is a study that can detect dangerous diseases, the harm from which to a person is much greater.

Lecture number 2.

Before the doctor of any specialty, after the appeal of the patient, the following tasks are:

Determine if this is normal or pathological

Then establish a preliminary diagnosis and

Determine the order of examination

Then make a definitive diagnosis and

Prescribe treatment, and after which it is necessary

Monitor the results of treatment.

A skillful doctor establishes the presence of a pathological focus already on the basis of an anamnesis and examination of the patient; for confirmation, he uses laboratory, instrumental and radiation methods of examination. Knowledge of the possibilities and basics of interpretation of various imaging methods allows the doctor to correctly determine the order of the examination. The end result is the appointment of the most informative examination and a correctly established diagnosis. Currently, up to 70% of information about the pathological focus is given by radiation diagnostics.

Radiation diagnostics is the science of using various types of radiation to study the structure and function of normal and pathologically altered human organs and systems.

The main goal of radiation diagnostics: early detection of pathological conditions, their correct interpretation, as well as control over the process, restoration of morphological structures and functions of the body during treatment.

This science is based on a scale of electromagnetic and sound waves, which are arranged in the following order - sound waves (including ultrasonic waves), visible light, infrared, ultraviolet, x-ray and gamma radiation. It should be noted that sound waves are mechanical vibrations, for the transmission of which any medium is required.

With the help of these rays, the following diagnostic tasks are solved: clarification of the presence and prevalence of the pathological focus; study of the size, structure, density and contours of education; determination of the relationship of the identified changes with the surrounding morphological structures and clarification of the possible origin of education.

There are two types of rays: ionizing and non-ionizing. The first group includes electromagnetic waves, with a short wavelength, capable of causing tissue ionization; they form the basis of X-ray and radionuclide diagnostics. The second group of rays is considered harmless and forms MRI, ultrasound diagnostics and thermography.

For more than 100 years, mankind has been familiar with a physical phenomenon - rays of a special kind, which have penetrating power and are named after the scientist who discovered them, X-rays.

These rays opened a new era in the development of physics and all of natural science, helped to penetrate the secrets of nature and the structure of matter, had a significant impact on the development of technology, and led to revolutionary changes in medicine.

On November 8, 1895, Wilhelm Conrad Roentgen (1845-1923), professor of physics at the University of Würzburg, drew attention to an amazing phenomenon. While studying the work of an electrovacuum (cathode) tube in his laboratory, he noticed that when a high voltage electric current was applied to its electrodes, a greenish glow of nearby platinum-cyanogen barium appeared. Such a glow of phosphors was already known by that time. Similar tubes have been studied in many laboratories around the world. But on the X-ray table during the experiment, the tube was tightly wrapped in black paper, and although the platinum-cyanogen barium was at a considerable distance from the tube, its glow resumed with each application of an electric current to the tube. He came to the conclusion that some kind of rays unknown to science arise in the tube, which have the ability to penetrate solid bodies and propagate in the air over a distance measured in meters.

Roentgen closed himself in his laboratory and, without leaving it for 50 days, studied the properties of the rays he had discovered.

Roentgen's first report "On a new kind of rays" was published in January 1896 in the form of brief theses, from which it became known that open rays are capable of:

Penetrate to some extent through all bodies;

Cause the glow of fluorescent substances (phosphors);

Cause blackening of photographic plates;

Reduce their intensity inversely with the square of the distance from their source;

Spread in a straight line;

Do not change its direction under the influence of a magnet.

The whole world was shocked and excited by this event. In a short time, information about the discovery of Roentgen began to be published not only by scientific, but also by general journals and newspapers. People were amazed that it became possible to look inside a living person with the help of these rays.

Since that time, a new era has come for doctors. Much of what they could only see before on a corpse, they now saw on photographs and fluorescent screens. It became possible to study the work of the heart, lungs, stomach and other organs of a living person. Sick people began to reveal certain changes in comparison with healthy ones. Within the first year after the discovery of x-rays, hundreds of scientific reports appeared in the press devoted to the study of human organs with their help.

In many countries there are specialists - radiologists. A new science - radiology has stepped far forward, hundreds of different methods of X-ray examination of human organs and systems have been developed. In a relatively short period, radiology has done more than any other science in medicine has done.

Roentgen was the first among physicists to be awarded the Nobel Prize, which was awarded to him in 1909. But neither Roentgen himself nor the first radiologists suspected that these rays could be deadly. And only when the doctors began to suffer from radiation sickness in its various manifestations, the question arose of protecting patients and staff.

Modern x-ray complexes provide maximum protection: the tube is located in a casing with a strict limitation of the x-ray beam (diaphragm) and many additional protective measures (aprons, skirts and collars). As a control of "invisible and intangible" radiation, various control methods are used, the timing of control examinations is strictly regulated by the Orders of the Ministry of Health.

Methods for measuring radiation: ionization - ionization chambers, photographic - by the degree of blackening of the film, thermoluminescent - using phosphors. Each employee of the X-ray room is subject to individual dosimetry, which is carried out quarterly using dosimeters. Individual protection of patients and staff is a strict rule in research. The composition of protective products previously included lead, which, due to its toxicity, has now been replaced by rare earth metals. The effectiveness of protection has become higher, and the weight of the devices has significantly decreased.

All of the above makes it possible to minimize the negative impact of ionizing waves on the human body, however, tuberculosis or a malignant tumor detected in time will outweigh the “negative” consequences of the image taken many times over.

The main elements of X-ray examination are: emitter - electrovacuum tube; the object of study is the human body; the radiation receiver is a screen or a film and naturally a RADIOLOGIST who interprets the received data.

X-ray radiation is an electromagnetic oscillation artificially created in special electrovacuum tubes on the anode and cathode of which, by means of a generator device, a high (60-120 kilovolt) voltage is supplied, and a protective casing, a directed beam and a diaphragm allow to limit the irradiation field as much as possible.

X-rays refer to the invisible spectrum of electromagnetic waves with a wavelength of 15 to 0.03 angstroms. The energy of quanta, depending on the power of the equipment, ranges from 10 to 300 or more KeV. The speed of propagation of X-ray quanta is 300,000 km/sec.

X-rays have certain properties that lead to their use in medicine for the diagnosis and treatment of various diseases.

• The first property is penetrating power, the ability to penetrate solid and opaque bodies.
• The second property is their absorption in tissues and organs, which depends on the specific gravity and volume of tissues. The denser and more voluminous the fabric, the greater the absorption of rays. Thus, the specific gravity of air is 0.001, fat 0.9, soft tissue 1.0, bone tissue 1.9. Naturally, the bones will have the greatest absorption of x-rays.
• The third property of X-rays is their ability to cause the glow of fluorescent substances, which is used when conducting transillumination behind the screen of an X-ray diagnostic apparatus.
• The fourth property is photochemical, due to which an image is obtained on x-ray film.
• The last, fifth property is the biological (negative) effect of X-rays on the human body, which is used for good purposes, the so-called. radiation therapy.

X-ray methods of research are performed using an X-ray apparatus, the device of which includes 5 main parts:

X-ray emitter (X-ray tube with cooling system);

Power supply device (transformer with electric current rectifier);

Radiation receiver (fluorescent screen, film cassettes, semiconductor sensors);

Tripod device and table for laying the patient;

Remote Control.

The main part of any X-ray diagnostic apparatus is an X-ray tube, which consists of two electrodes: a cathode and an anode. A constant electric current is applied to the cathode, which heats up the cathode filament. When a high voltage is applied to the anode, electrons, as a result of a potential difference with a large kinetic energy, fly from the cathode and are decelerated at the anode. When the electrons decelerate, the formation of X-rays occurs - bremsstrahlung beams emerging at a certain angle from the X-ray tube. Modern X-ray tubes have a rotating anode, the speed of which reaches 3000 rpm, which significantly reduces the heating of the anode and increases the power and service life of the tube.

Registration of weakened X-ray radiation is the basis of X-ray diagnostics.

The X-ray method includes the following techniques:

• fluoroscopy, that is, obtaining an image on a fluorescent screen (X-ray image intensifiers - through a television path);
• radiography - obtaining an image on an x-ray film placed in a radiolucent cassette, where it is protected from ordinary light.
• additional techniques include: linear tomography, fluorography, X-ray densitometry, etc.

Linear tomography - obtaining a layered image on x-ray film.

The object of study, as a rule, is any area of ​​the human body that has a different density. These are air-containing tissues (lung parenchyma), and soft tissue (muscles, parenchymal organs and gastrointestinal tract), and bone structures with a high calcium content. This makes it possible to examine both under conditions of natural contrasting and with the use of artificial contrasting, for which there are various types of contrast agents.

For angiography and visualization of hollow organs in radiology, contrast agents are widely used that delay X-rays: in studies of the gastrointestinal tract - barium sulfate (per os) is insoluble in water, water-soluble - for intravascular studies, the genitourinary system and fistulography (urographin, ultravist and omnipack), and also fat-soluble for bronchography - (iodlipol).

Here is a brief overview of the complex electronic system of an x-ray machine. At present, dozens of varieties of X-ray equipment have been developed, from general-purpose devices to highly specialized ones. Conventionally, they can be divided into: stationary X-ray diagnostic complexes; mobile devices (for traumatology, resuscitation) and fluorographic installations.

Tuberculosis in Russia has by now assumed the scope of an epidemic, and oncological pathology is steadily growing, and screening FLH is being carried out to detect these diseases.

The entire adult population of the Russian Federation is required to undergo a fluorographic examination once every 2 years, and decreed groups must be examined annually. Previously, for some reason, this study was called a “preventive” examination. The image taken cannot prevent the development of the disease, it only states the presence or absence of a lung disease, and its purpose is to identify early, asymptomatic stages of tuberculosis and lung cancer.

Allocate medium-, large-format and digital fluorography. Fluorographic installations are produced by the industry in the form of stationary and mobile (installed on a car) cabinets.

A special section is the examination of patients who cannot be delivered to the diagnostic room. These are predominantly resuscitation and trauma patients who are either on mechanical ventilation or on skeletal traction. Especially for this, mobile (mobile) X-ray machines are produced, consisting of a generator and a low-power emitter (to reduce weight), which can be delivered directly to the patient's bed.

Stationary devices are designed to study various areas in various projections using additional devices (tomographic attachments, compression belts, etc.). X-ray diagnostic room consists of: treatment room (place of examination); a control room where the apparatus is controlled and a photo laboratory for X-ray film processing.

The carrier of the received information is a radiographic film, called X-ray, with high resolution. It is usually expressed as the number of separately perceived parallel lines per 1 mm. It is produced in various formats from 35x43 cm, for examining the chest or abdominal cavity, up to 3x4 cm, for taking a picture of the tooth. Before performing the study, the film is placed in x-ray cassettes with intensifying screens, which can significantly reduce the x-ray dose.

There are the following types of radiography:

Overview and sighting shots;

Linear tomography;

Special styling;

With the use of contrast agents.

Radiography allows you to study the morphological state of any organ or part of the body at the time of the study.

To study the function, fluoroscopy is used - a real-time examination with X-rays. It is mainly used in studies of the gastrointestinal tract with contrasting of the intestinal lumen, less often as a clarifying addition in lung diseases.

When examining the chest organs, the X-ray method is the "gold standard" of diagnostics. On a chest x-ray, the lung fields, median shadow, bone structures, and soft tissue component are distinguished. Normally, the lungs should be of the same transparency.

Classification of radiological symptoms:

1. Violation of anatomical relationships (scoliosis, kyphosis, developmental anomalies); changes in the area of ​​lung fields; expansion or displacement of the median shadow (hydropericardium, mediastinal tumor, change in the height of the dome of the diaphragm).

2. The next symptom is “darkening or decrease in pneumatization”, caused by compaction of the lung tissue (inflammatory infiltration, atelectasis, peripheral cancer) or fluid accumulation.

3. The symptom of enlightenment is characteristic of emphysema and pneumothorax.

The musculoskeletal system is examined under conditions of natural contrast and allows to detect many changes. It is necessary to remember about age features:

up to 4 weeks - no bone structures;

up to 3 months - the formation of a cartilaginous skeleton;

4-5 months to 20 years the formation of the bone skeleton.

Types of bones - flat and tubular (short and long).

Each bone is composed of a compact and spongy substance. Compact bone substance, or cortical layer, in different bones has a different thickness. The thickness of the cortical layer of long tubular bones decreases from the diaphysis to the metaphysis and is most thinned in the epiphyses. Normally, the cortical layer gives an intense, homogeneous darkening and has clear, smooth contours, while the defined irregularities strictly correspond to the anatomical tubercles, ridges.

Under the compact layer of the bone is a spongy substance, consisting of a complex interlacing of bone trabeculae, located in the direction of action of the forces of compression, tension and torsion on the bone. In the department of the diaphysis, there is a cavity - the medullary canal. Thus, the spongy substance remains only in the epiphyses and metaphyses. The epiphyses of growing bones are separated from the metaphyses by a light transverse strip of growth cartilage, which is sometimes mistaken for a fracture line.

The articular surfaces of bones are covered with articular cartilage. The articular cartilage does not show a shadow on the x-ray. Therefore, between the articular ends of the bones there is a light strip - the X-ray joint space.

From the surface, the bone is covered with periosteum, which is a connective tissue sheath. The periosteum normally does not give a shadow on the radiograph, but in pathological conditions it often calcifies and ossifies. Then, along the surface of the bone, linear or other forms of the shadow of periosteal reactions are found.

The following radiological symptoms are distinguished:

Osteoporosis is a pathological restructuring of the bone structure, which is accompanied by a uniform decrease in the amount of bone substance per unit of bone volume. For osteoporosis, the following radiological signs are typical: a decrease in the number of trabeculae in the metaphyses and epiphyses, thinning of the cortical layer and expansion of the medullary canal.

Osteosclerosis is characterized by signs opposite to osteoporosis. Osteosclerosis is characterized by an increase in the number of calcified and ossified bone elements, the number of bone trabeculae increases, and there are more of them per unit volume than in normal bone, and thereby the marrowy spaces decrease. All this leads to radiological symptoms opposite to osteoporosis: the bone on the radiograph is more compacted, the cortical layer is thickened, its contours both from the side of the periosteum and from the side of the medullary canal are uneven. The medullary canal is narrowed, and sometimes not visible at all.

Destruction or osteonecrosis is a slow process with a violation of the structure of entire sections of the bone and its replacement with pus, granulations or tumor tissue.

On x-ray, the focus of destruction looks like a defect in the bone. The contours of fresh destructive foci are uneven, while the contours of old foci become even and compacted.

Exostoses are pathological bone formations. Exostoses occur either as a result of a benign tumor process, or as a result of an anomaly of osteogenesis.

Traumatic injuries (fractures and dislocations) of bones occur with a sharp mechanical impact that exceeds the elastic capacity of the bone: compression, stretching, flexion and shear.

X-ray examination of the abdominal organs in conditions of natural contrast is used mainly in emergency diagnostics - this is free gas in the abdominal cavity, intestinal obstruction and radiopaque calculi.

The leading role is occupied by the study of the gastrointestinal tract, which allows you to identify a variety of tumor and ulcerative processes affecting the gastrointestinal mucosa. An aqueous suspension of barium sulfate is used as a contrast agent.

The types of examination are as follows: X-ray of the esophagus; fluoroscopy of the stomach; passage of barium through the intestines and retrograde examination of the colon (irrigoscopy).

The main radiological symptoms: a symptom of local (diffuse) expansion or narrowing of the lumen; a symptom of an ulcerative niche - in the case when the contrast agent spreads beyond the border of the organ contour; and the so-called filling defect, which is determined in cases where the contrast agent does not fill the anatomical contours of the organ.

It must be remembered that FGS and FCS currently occupy a dominant place in examinations of the gastrointestinal tract, their disadvantage is the inability to detect formations located in the submucosal, muscular and further layers.

Most doctors examine the patient according to the principle from simple to complex - performing "routine" methods at the first stage, and then supplementing them with more complex studies, up to high-tech CT and MRI. However, now the prevailing opinion is to choose the most informative method, for example, if a brain tumor is suspected, an MRI should be done, and not a picture of the skull on which the bones of the skull will be visible. At the same time, the parenchymal organs of the abdominal cavity are perfectly visualized by the ultrasound method. The clinician must know the basic principles of a complex radiological examination for particular clinical syndromes, and the diagnostician will be your consultant and assistant!

These are studies of the chest organs, mainly the lungs, the musculoskeletal system, the gastrointestinal tract and the vascular system, provided that the latter are contrasted.

Based on the possibilities, indications and contraindications will be determined. There are no absolute contraindications! Relative contraindications are:

Pregnancy, lactation.

In any case, it is necessary to strive for the maximum limitation of radiation exposure.

Any doctor of practical health care repeatedly sends patients for X-ray examination, and therefore, there are rules for issuing a referral for research:

1. the surname and initials of the patient and age are indicated;

2. the type of study is assigned (FLG, fluoroscopy or radiography);

3. the area of ​​examination is determined (organs of the chest or abdominal cavity, osteoarticular system);

4. the number of projections is indicated (general view, two projections or special styling);

5. it is necessary to set the purpose of the study before the diagnostician (exclude pneumonia or a hip fracture, for example);

6. date and signature of the doctor who issued the referral.

X-ray methods research is based on the ability of X-rays to penetrate the organs and tissues of the human body.

Fluoroscopy- the method of transillumination, examination of the organ under study behind a special x-ray screen.

Radiography- a method of obtaining images, it is necessary to document the diagnosis of the disease, to monitor the observation of the functional state of the patient.

Dense fabrics delay the rays to varying degrees. Bone and parenchymal tissues are capable of retaining x-rays, and therefore do not require special patient preparation. To obtain more reliable data on the internal structure of the organ, the contrast method of research is used, which determines the "visibility" of these organs. The method is based on the introduction of special substances into the organs that delay x-rays.

As contrast agents in X-ray examination of the organs of the gastrointestinal tract (stomach and duodenum, intestines), a suspension of barium sulfate is used; in fluoroscopy of the kidneys and urinary tract, gallbladder and biliary tract, iodine contrast preparations are used.

Iodine-containing contrast agents are often administered intravenously. 1-2 days before the study, the nurse should test the patient's tolerance to the contrast agent. To do this, 1 ml of a contrast agent is injected very slowly intravenously and the patient's reaction is observed during the day. With the appearance of itching, runny nose, urticaria, tachycardia, weakness, lowering blood pressure, the use of radiopaque substances is contraindicated!

Fluorography- large-frame photography from the X-ray screen on a small film. The method is used for mass survey of the population.

Tomography- obtaining images of individual layers of the studied area: lungs, kidneys, brain, bones. Computed tomography is used to obtain layered images of the tissue under study.

Chest X-ray

Research objectives:

1. Diagnosis of diseases of the chest organs (inflammatory, neoplastic, and systemic diseases, heart defects and large vessels, lung, pleura.).

2. Control of the treatment of the disease.

Training objectives:

Training:

5. Find out if the patient can stand for the time necessary for the study and hold his breath.

6.Determine the method of transportation.

7. The patient must have a referral, outpatient card or medical history with him. If you have previously had lung studies, take the results (images).

8. The study is performed on a patient naked to the waist (a light T-shirt without radiopaque fasteners is possible).

Fluoroscopy and radiography of the esophagus, stomach and duodenum

Purpose of the study - assessment of radioanatomy and function of the esophagus, stomach and duodenum:

Identification of structural features, malformations, attitudes towards surrounding tissues;

Determination of violations of the motor function of these organs;

Identification of submucosal and infiltrating tumors.

Training objectives:

1. Ensure the possibility of conducting a study.

2. Get reliable results.

Training:

1. Explain to the patient the essence of the study and the rules for preparing for it.

2. Obtain the consent of the patient for the upcoming study.

3.Inform the patient about the exact time and place of the study.

4. Ask the patient to repeat the preparation for the study, especially on an outpatient basis.

5. For 2-3 days before the study, foods that cause flatulence (gas formation) are excluded from the patient's diet: rye bread, raw vegetables, fruits, milk, legumes, etc.

6. Dinner the night before must be no later than 19.00

7. On the evening before and in the morning no later than 2 hours before the examination, the patient is given a cleansing enema.

8. The study is carried out on an empty stomach, no need to drink, smoke, take medication.

9. When examining with a contrast agent (barium for X-ray studies), find out an allergic history; ability to absorb contrast.

10. Remove removable dentures.

11. The patient must have with him: a referral, an outpatient card / medical history, data from previous studies of these organs, if any.

12. Get rid of tight clothing and clothing that has radiopaque fasteners.

Note. Salt laxative instead of an enema should not be given, as it increases gas formation.

Breakfast is served to the patient in the ward.

The medical history after the study is returned to the department.

Possible Patient Problems

Real:

1. The appearance of discomfort, pain during examination and / or preparation for it.

2. Inability to swallow barium due to impaired swallowing reflex.

Potential:

1. The risk of developing pain due to spasms of the esophagus and stomach caused by the procedure itself (especially in the elderly) and when the stomach is distended.

2. Risk of vomiting.

3. The risk of developing an allergic reaction.

X-ray examination of the large intestine (irrigoscopy)

An x-ray examination of the large intestine is performed after the introduction of a barium suspension into the large intestine using an enema.

Research objectives:

1. determination of the shape, position, condition of the mucous membrane, tone and peristalsis of various sections of the colon.

2. Identification of malformations and pathological changes (polyps, tumors, diverticula, intestinal obstruction).

Training objectives:

1. Ensure the possibility of conducting a study.

2. Get reliable results.

Training:

1. Explain to the patient the essence of the study and the rules for preparing for it.

2. Obtain the consent of the patient for the upcoming study.

3.Inform the patient about the exact time and place of the study.

4. Ask the patient to repeat the preparation for the study, especially on an outpatient basis.

5.For three days before the study, a slag-free diet (see the composition of the diet in the appendix).

6 As prescribed by the doctor - taking enzymes and activated charcoal for three days before the study, chamomile infusion 1/3 cup three times a day.

7.the day before studies the last meal at 14 - 15 hours.

At the same time, fluid intake is not limited (you can drink broth, jelly, compote, and so on). Avoid dairy products!

8. On the day before the study, taking laxatives - orally or rectally.

9. At 22:00 you need to make two cleansing enemas of 1.5 - 2 liters. If, after the second enema, the wash water is colored, then make another enema. The water temperature should not be higher than 20 - 22 0 C (room temperature, when pouring, the water should feel cool).

10. In the morning on the day of the study you need to do two more enemas 3 hours before irrigoscopy (in the presence of dirty washings, repeat the enemas, achieving clean washings).

11. The patient must have with him: a referral, an outpatient card / medical history, data from a previous colonoscopy, barium enema, if performed.

12. Patients over 30 years of age should carry an ECG no more than a week old.

13. If the patient cannot go without food for so long (diabetics and so on), then in the morning, on the day of the study, you can eat a piece of meat or another high-protein breakfast.

Possible Patient Problems

Real:

1. Inability to diet.

2. Inability to take a certain position.

3. Insufficient preparation due to constipation for many days, non-compliance with the temperature regime of the water in the enema, the volume of water and the number of enemas.

Potential:

1. The risk of pain due to intestinal spasm caused by the procedure itself and / or preparation for it.

2.Risk violation of cardiac activity and respiration.

3. The risk of obtaining unreliable results with insufficient preparation, the impossibility of introducing a contrast enema.

Preparation option without enemas

The method is based on the effect of an osmotically active substance on the motility of the colon and the excretion of feces along with the drunk solution.

Procedure sequence:

1. Dissolve one packet of Fortrans in one liter of boiled water.

2. During this examination, for complete cleansing of the intestines, it is necessary to take 3 liters of an aqueous solution of the Fortrans preparation.

3. If the examination is carried out in the morning, then the prepared Fortrans solution is taken on the eve of the examination, 1 glass every 15 minutes (1 liter per hour) from 16:00 to 19:00. The effect of the drug on the intestines lasts up to 21 hours.

4. On the eve of the evening until 18:00, you can take a light dinner. Liquid is not limited.

Oral cholecystography

The study of the gallbladder and biliary tract is based on the ability of the liver to capture and accumulate iodine-containing contrast agents, and then excrete them with bile through the gallbladder and biliary tract. This allows you to get an image of the biliary tract. On the day of the examination in the X-ray room, the patient is given a choleretic breakfast, after 30-45 minutes a series of images are taken

Research objectives:

1. Assessment of the location and functions of the gallbladder and extrahepatic bile ducts.

2. Identification of malformations and pathological changes (presence of gallstones, tumors)

Training objectives:

1. Ensure the possibility of conducting a study.

2. Get reliable results.

Training:

1. Explain to the patient the essence of the study and the rules for preparing for it.

2. Obtain the consent of the patient for the upcoming study.

3.Inform the patient about the exact time and place of the study.

4. Ask the patient to repeat the preparation for the study, especially on an outpatient basis.

5. Find out if you are allergic to the contrast agent.

The day before:

6. When examining, pay attention to the skin and mucous membranes, in case of jaundice - tell the doctor.

7. Compliance with a slag-free diet for three days before the study

8. As prescribed by the doctor - taking enzymes and activated charcoal for three days before the study.

9. The night before - a light dinner no later than 19:00.

10. 12 hours before the study - taking a contrast agent orally for 1 hour at regular intervals, drinking sweet tea. (contrast agent is calculated on the patient's body weight). The maximum concentration of the drug in the gallbladder is 15-17 hours after its administration.

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

On the day of the study:

12. In the morning, come to the X-ray room on an empty stomach; You can not take medicine, smoke.

13. Bring with you 2 raw eggs or 200 g of sour cream and breakfast (tea, sandwich).

14. The patient must have with him: a referral, an outpatient card / medical history, data from previous studies of these organs, if any.

Possible Patient Problems

Real:

1. The impossibility of carrying out the procedure due to the appearance of jaundice (direct bilirubin absorbs the contrast agent).

Potential:

risk of an allergic reaction.

2. The risk of developing biliary colic when taking choleretic drugs (sour cream, egg yolks).