Fundamentals and clinical applications of X-ray examination. X-ray is a method of studying the internal structure of objects using X-rays. Reviews, contraindications. Indications and contraindications for X-ray of the bones of the skeleton
State autonomous professional
Educational institution of the Saratov region
"Saratov Regional Basic Medical College"
Course work
The role of a paramedic in preparing patients for X-ray research methods
Specialty: General Medicine
Qualification: paramedic
Student:
Malkina Regina Vladimirovna
Supervisor:
Evstifeeva Tatiana Nikolaevna
Introduction ………………………………………………………………… 3
Chapter 1. The 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 Techniques
research …………………………………………………………… .. 17
Conclusion………………………………………………………………. 21
List of used literature …………………………………… ... 22
Appendices ……………………………………………………………… 23
Introduction
Today, X-ray diagnostics is undergoing a new development. Leveraging centuries of experience in traditional X-ray techniques and armed with new digital technologies, radiation diagnostics continues to lead the way in diagnostic medicine.
X-ray is a time-tested and at the same time quite 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 for examining a patient in order to establish the correct diagnosis or to identify the initial stages of certain diseases that occur without symptoms.
The main advantages of X-ray examination are called the availability of the method and its simplicity. Indeed, in the modern world there are many institutions where you can take x-rays. This mainly does not require any special training, cheapness and availability of images, with which you can seek advice from several doctors in different institutions.
The disadvantages of X-rays are called obtaining a static image, irradiation, in some cases, the introduction of contrast is required. The quality of images sometimes, especially on outdated equipment, does not allow effectively achieving the research goal. Therefore, it is recommended to look for an institution where to make a digital X-ray, which today is the most modern method of research and shows the highest degree of information content.
In the event that, due to the indicated shortcomings of radiography, a potential pathology is not reliably identified, additional studies can be prescribed that can visualize the work of the organ in dynamics.
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), it is difficult to even imagine that it is possible to work with a patient without the ability to "look inside" a living human body.
However, the history of the method really dates back only to 1895, when Wilhelm Konrad Roentgen first discovered the darkening of a photographic plate under the influence of X-rays. In further experiments with various objects, he managed to get an image of the bone 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 that it was impossible to obtain an image of organs and tissues in vivo, without dissection (not 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, X-ray is used in studies of the lungs, gastrointestinal tract, kidneys, etc.
The purpose This work is to show the role of a paramedic in preparing a patient for X-ray research methods.
A task of this work: To reveal the history of radiology, its appearance in Russia, to tell about the radiological methods of research themselves, and the peculiarities of training in some of them.
Chapter 1.
Radiology, without which it is impossible to imagine modern medicine, arose thanks to the discovery of the German physicist V.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.Rentgen (1845 - 1923) began experimental studies of electrical discharges in glass vacuum tubes. Under the action of these discharges in highly 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 covered with platinum-blue barium) under the action of cathode radiation emanating from a vacuum tube. To exclude the effect of visible light emanating from the switched on tube on the crystals of platinum-blue barium, the scientist wrapped it in black paper.
The glow continued, as when the scientist moved the screen almost two meters away from the tube, since it was assumed that the cathode rays penetrate the air layer only a few centimeters. 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 was studying new rays, which he called X-rays. In the process of studying the interaction of rays with objects of different density, which Roentgen substituted in the course of 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 glow 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 substituted his own hand in the direction 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 fix shadow images of objects, Roentgen replaced the screen with a photographic plate. In particular, he received an image of his own brush 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 an exhaustive description of the properties of X-rays. The first article "On a new type of rays" appeared in the journal of the Würzburg Physics and Medicine Society on December 28, 1895.
Thus, a change in the photographic plate under the influence of X-rays was recorded, which marked the beginning of the development of future radiography.
It should be noted that many researchers studied cathode rays before W. 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 was engaged in the study of bremsstrahlung radiation and recorded the results of this study 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 V. 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. X-ray 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 their production, created an X-ray tube with an aluminum cathode and a platinum anode to produce intense X-ray radiation.
For this discovery in 1901 W. Roentgen was awarded the Nobel Prize in Physics, the first in this nomination.
Roentgen's revolutionary discovery revolutionized diagnostics. The first X-ray machines were created in Europe as early as 1896. In the same year, KODAK opened the production of the first X-ray films.
Since 1912, a period of rapid development of X-ray diagnostics all over the world begins, and X-ray begins to occupy an important place in medical practice.
X-ray studies in Russia.
The first X-ray picture in Russia was taken in 1896. In the same year, on the initiative of the Russian scientist AF Ioffe, a student of V. Roentgen, the name "X-rays" was first introduced.
In 1918, the world's first specialized X-ray clinic was opened in Russia, where X-ray was used to diagnose an increasing number of diseases, especially pulmonary diseases.
In 1921 in Petrograd the first in Russia X-ray and dental office began to work. 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 acquire the opportunity to better, more correctly, more confidently, and more actively build the future of this science.
X-ray research methods
All numerous methods of X-ray examination are divided into general and special ones.
The general methods include techniques designed to study any anatomical areas and performed on general-purpose X-ray machines (fluoroscopy and radiography).
A number of techniques should also be referred to the general ones, in which it is also possible to study any anatomical areas, but either special equipment (fluorography, radiography with direct magnification of the image), or additional devices to conventional X-ray machines (tomography, electroradiography) are required. Sometimes these techniques are also called private.
Special techniques include those that allow you to obtain an image on special installations designed for the study of 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
Fluoroscopy- research technique, in which the image of an object is obtained on a luminous (fluorescent) screen in real time. Some substances fluoresce intensely under the influence of X-rays. This fluorescence is used in X-ray diagnostics using cardboard screens coated with a fluorescent substance.
X-ray- This is a technique of X-ray examination, in which a static image of an object is obtained, fixed on any information carrier. Such carriers can be X-ray film, photographic film, digital detector, etc. On radiographs, you can get an image of any anatomical region. Pictures of the entire anatomical region (head, chest, abdomen) are called overview. Pictures showing a small part of the anatomical area that the doctor is most interested in are called sighting pictures.
Fluorography- photographing an X-ray image from a fluorescent screen onto photographic film of various formats. Such an image is always reduced.
Electroradiography is a technique in which a diagnostic image is obtained not on an X-ray film, but on the surface of a selenium plate with transfer to paper. The plate, evenly charged with static electricity, is used instead of a cassette with a film and, depending on the different amount of ionizing radiation hitting different points on its surface, it is discharged in different ways. Finely dispersed carbon powder is sprayed onto the surface of the plate, which, according to the laws of electrostatic attraction, is unevenly distributed 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 adhesion of the carbon powder. Selenium plate, unlike film, can be used repeatedly. The technique is fast, economical, 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 operating under conditions of an increased background radiation (the 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 seals are found in it, as well as for prophylactic purposes.
Artificial contrasting techniques:
Diagnostic pneumothorax- X-ray examination of the respiratory organs after the introduction of gas into the pleural cavity. It is performed in order to clarify the localization of pathological formations located on the border of the lung with neighboring organs. With the advent of the CT method, it is rarely used.
Pneumomediastinography- X-ray examination of the mediastinum after the introduction of gas into its tissue. It is performed in order 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 in order to clarify the localization of pathological formations identified in the images against the background of the diaphragm.
Pneumoretroperitoneum- the method of 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 into clinical practice, ultrasound, CT and MRI are practically not used.
Pneumoren- X-ray examination of the kidney and adjacent adrenal gland after the introduction of gas into the perirenal tissue. Currently, it is performed extremely rarely.
Pneumopyelography- study of the cavity system of the kidney after filling it with gas through the ureteral catheter. It is currently used mainly in specialized hospitals for the detection of intralochanical tumors.
Pneumomyelography- X-ray examination of the subarachnoid space of the spinal cord after gas contrasting. It is used to diagnose pathological processes in the area of the spinal canal that cause narrowing of its lumen (herniated intervertebral discs, tumors). It is rarely used.
Pneumoencephalography- X-ray examination of cerebrospinal fluid spaces after gas contrasting. Once introduced into clinical practice, CT and MRI are rarely performed.
Pneumoarthrography- X-ray examination of large joints after the introduction of gas into their cavity. Allows you to study the articular cavity, identify intra-articular bodies in it, detect signs of damage to the menisci of the knee joint. Sometimes it is supplemented by the introduction into the joint cavity
water-soluble RKS. It is widely used in hospitals when it is impossible to perform MRI.
Bronchography- the method of X-ray examination of the bronchi after their artificial contrasting with RCS. Allows you to identify various pathological changes in the bronchi. It is widely used in hospitals when CT is not available.
Pleurography- X-ray examination of the pleural cavity after its partial filling with a contrast agent in order to clarify the shape and size of the pleural enclosures.
Synography- X-ray examination of the paranasal sinuses after their filling with the RCS. It is used when it is difficult to interpret the cause of sinus shadowing on radiographs.
Dacryocystography- X-ray examination of the lacrimal ducts after filling them with the RCC. It is used to study the morphological state of the lacrimal sac and the patency of the lacrimal canal.
Sialography- X-ray examination of the ducts of the salivary glands after filling them with the RCS. It is used to assess the condition of the ducts of the salivary glands.
X-ray examination of the esophagus, stomach and duodenum- carried out after their gradual filling with a suspension of barium sulfate, and, if necessary, with air. Necessarily includes polypositional fluoroscopy and the performance of survey and sighting radiographs. It is widely used in medical institutions to detect 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. It is widely used to diagnose 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, taken orally and excreted in the bile.
Excretory cholegraphy- X-ray examination of the biliary tract, contrasted with iodine-containing drugs, administered intravenously and excreted in the bile.
Cholangiography- X-ray examination of the bile ducts after the introduction of the RCS into their lumen. It is widely used to clarify the morphological state of the bile ducts and identify calculi 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 an X-ray endoscopic co. Excretory urography - X-ray examination of the urinary organs after intravenous administration of RCC and its excretion by the kidneys. A widespread 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 cavity systems of the kidneys after filling them with the RCC through the ureteral catheter. In comparison with excretory urography, it allows obtaining more complete information about the state of the urinary tract as a result of their better filling with a contrast agent injected under low pressure. It is widely used in specialized urological departments.
Cystography- X-ray examination of the bladder filled with RCC.
Urethrography- X-ray examination of the urethra after filling it with the RCC. Allows you to obtain information about the patency and morphological state of the urethra, to 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 of the RCC. It is widely used primarily to assess the patency of the fallopian tubes.
Positive myelography- X-ray examination of the sub-arachnoid 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 the introduction of the RCC into its lumen.
Arteriography- X-ray examination of arteries using the RCS introduced into their lumen, spreading through the blood stream. Some private techniques of arteriography (coronary angiography, carotid angiography), being highly informative, are at the same time technically difficult and unsafe for the patient, and therefore are used only in specialized departments.
Cardiography- X-ray examination of the cardiac cavities after the introduction of the RCC into them. Currently, it finds limited application in specialized cardiac surgery hospitals.
Angiopulmonography- X-ray examination of the pulmonary artery and its branches after the introduction of the RCS into them. Despite the high information content, it is unsafe for the patient, and therefore, in recent years, computed tomographic angiography has been preferred.
Phlebography- X-ray examination of veins after the introduction of the RCC into their lumen.
Lymphography- X-ray examination of the lymphatic tract after the introduction of the RCC into the lymphatic bed.
Fistulography- X-ray examination of the fistulous passages after filling them with the RCS.
Woolnerography- X-ray examination of the wound channel after filling it with the RCC. It is more often used for blind wounds of the abdomen, when other research methods do not allow to establish 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 state of the inner surface.
Ductography- contrast x-ray examination of the lactiferous 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, must be confident in the safety of the upcoming study.
2.Before conducting a study, care must be taken to make the organ more accessible during the study. Before endoscopic examinations, it is necessary to free the examined organ from the contents. The organs of the digestive system are examined on an empty stomach: on the day of the study, you cannot drink, eat, take medicine, brush your teeth, or smoke. On the eve of the upcoming exploration, 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, drugs to reduce gas formation (activated carbon) and improve digestion (enzyme preparations), laxatives; enemas on the eve of the study. According to the special prescription of the doctor, premedication is carried out (the introduction of atropine and anesthetic drugs). Cleansing enemas are placed no later than 2 hours before the upcoming study, 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 5 pm, a light supper: cottage cheese, eggs, jelly, semolina.
3. The research 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 worried 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. Light dinner the night before, no later than 5 pm.
5. At 21 and 22 o'clock in the evening on the eve to do cleansing enemas.
6. In the morning on the day of the study, at 6 and 7 o'clock, cleansing enemas.
7. Light breakfast is allowed.
8. In 40min. - 1 hour before the study, insert the gas outlet tube for 30 minutes.
Cholecystography:
1. Within 3 days, products that cause flatulence are excluded.
2. On the eve of the study, a light dinner no later than 5 pm.
3. From 21.00 to 22.00 hours the day before, the patient uses a contrast agent (billitrast) according to the instructions depending on the body weight.
4. Research is carried out on an empty stomach.
5. The patient is warned that loose stools and nausea may occur.
6. In the R - room the patient should bring 2 raw eggs for the choleretic breakfast.
Intravenous cholegraphy:
1.3 days following a diet with the exclusion of gassing products.
2. Find out if the patient is allergic to iodine (runny nose, rash, itchy skin, vomiting). Inform your doctor.
3. Conduct a test 24 hours before the study, for which intravenous injection of 1-2 ml of bilignosta per 10 ml of saline solution.
4. The day before the study, choleretic drugs are canceled.
5. In the evening at 21 and 22 hours, a cleansing enema and in the morning on the day of the study, 2 hours in advance - 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 test for sensitivity to a contrast agent is carried out.
3. In the evening before at 21.00 and 22.00 cleansing enemas. In the morning at 6.00 and 7.00, cleansing enemas.
4. The study is carried out on an empty stomach, before the study, the patient empties the bladder.
Radiography:
1. It is necessary to free the investigated area from clothing as much as possible.
2. The study area should also be free of bandages, patches, electrodes, and other foreign objects that can reduce the quality of the resulting image.
3. Make sure that there are no different chains, watches, straps, hairpins, if they are located in the area to 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 shields X-rays.
Conclusion.
Thus, at the present time, X-ray research methods have found wide diagnostic use, and have become an integral part of the clinical examination of patients. Also, an integral part is the preparation of the patient for X-ray research methods, because each of them has its own characteristics, if not followed, it can lead to difficulty in making a diagnosis.
One of the main parts of preparing a patient for X-ray research methods is psychological preparation. The patient must understand the importance of the upcoming study, 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 diagnostics of diseases of the esophagus, stomach, intestines". - M., 1987.
Medical radiology. - Lindenbraten L. D., Naumov L.B. - 2014;
Medical radiology (fundamentals 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. Vasilieva. - M.: GEOTAR-Media, 2013.
Rutskiy A.V., Mikhailov A.N. "X-ray diagnostic atlas". - Minsk. 2016.
Sivash E.S., Salman M.M. "Possibilities of the X-ray method", Moscow, Izd. "Science", 2015
Fanarjyan V.A. "X-ray diagnostics of diseases of the digestive tract". - Yerevan, 2012.
Shcherbatenko M.K., Beresneva Z.A. "Emergency X-ray diagnostics of acute diseases and injuries of the abdominal organs". - M., 2013.
Applications
Figure 1.1 Procedure for fluoroscopy.
Figure 1.2. X-ray examination.
Figure 1.3. Chest X-ray.
Figure 1.4. Fluorography.
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Date the page was created: 2017-11-19
Roentgenology as a science dates back to November 8, 1895, when the German physicist Professor Wilhelm Konrad 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 the countries of the West.
Basic properties of X-rays:
From the quality of the rays. The shorter the length of the X-rays (i.e. the harder the X-rays), the deeper these rays penetrate and, conversely, the longer the wave of the rays (the softer the radiation), the shallower they penetrate.
On the volume of the investigated body: the thicker the object, the more difficult it is for X-rays to “pierce” it. The penetrating power of X-rays depends on the chemical composition and structure of the body under study. The more atoms of elements with a high atomic weight and serial number (according to the periodic table) in a substance exposed to X-rays, the more it absorbs X-rays and, conversely, the lower the atomic weight, the more transparent the substance is for these rays. The explanation for this phenomenon is that high energy is concentrated in electromagnetic radiation with a very short wavelength, such as X-rays.
X-rays, starting from the focus of the X-ray tube, propagate in a straight line.
They are not deflected in an electromagnetic field.
Their speed of propagation is equal to the speed of light.
X-rays are invisible, but when absorbed by certain substances, they make them glow. This glow is called fluorescence and is the basis of fluoroscopy.
X-rays are photochemical. Radiography is based on this property of X-rays (the currently generally accepted method of producing X-rays).
X-ray radiation has an ionizing effect and gives air the ability to conduct electric current. Neither visible, nor heat, nor radio waves can cause this phenomenon. Based on this property, X-rays, like the radiation of radioactive substances, are 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:
X-ray beams 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 way they are received: X-rays are obtained in high-voltage electrical installations, and gamma radiation - due to the decay of atomic nuclei.
X-ray examination methods are divided into basic and special, private. The main methods of X-ray examination include: X-ray, fluoroscopy, electro-roentgenography, computed X-ray tomography.
Fluoroscopy - transillumination of organs and systems using X-rays. Fluoroscopy is an anatomical and functional method that provides an opportunity to study normal and pathological processes and conditions of the body as a whole, individual organs and systems, as well as tissues by the shadow pattern of a fluorescent screen.
Advantages:
Allows you to examine patients in various projections and positions, due to which you can choose a position in which pathological shadow formation is better detected.
The possibility of studying the functional state of a number of internal organs: lungs, at different phases of respiration; pulsation of the heart with large vessels.
Close contact of the radiologist with patients, which makes it possible to supplement the X-ray examination with a clinical one (palpation under visual control, a targeted history), etc.
Disadvantages: relatively high radiation load on the patient and service personnel; low throughput during the doctor's working time; limited capabilities of the researcher's eye in identifying small shadow formations and fine tissue structures, etc. The indications for fluoroscopy are limited.
Electron-optical amplification (EOO). The operation of an electron-optical converter (EOC) is based on the principle of converting an X-ray image into an electronic one with its subsequent transformation into an amplified light image. The brightness of the screen is amplified up to 7 thousand times. The use of the EOU makes it possible to distinguish between 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 a film or videotape.
X-ray - photography by means of X-rays. During X-ray exposure, the object to be shot must be in close contact with the cassette loaded with film. X-rays coming out of the tube are directed perpendicularly to the center of the film through the middle of the object (the distance between the focus and the patient's skin in normal working conditions is 60-100 cm). The necessary equipment for X-ray imaging are cassettes with reinforcing screens, screening grids and special X-ray films. The cassettes are made of opaque material and correspond in size to the standard dimensions of the produced X-ray film (13 × 18 cm, 18 × 24 cm, 24 × 30 cm, 30 × 40 cm, etc.).
Intensifying screens are designed to enhance the light effect of X-rays on photographic film. They represent cardboard, which is impregnated with a special phosphor (tungsten-sour calcium), which has a fluorescent property under the influence of X-rays. Currently, screens with phosphors activated by rare-earth elements are widely used: lanthanum oxide bromide and gadolinium oxide sulfite. The very good efficiency of the rare earth phosphor contributes to the high light sensitivity of the screens and ensures high image quality. There are also special screens - Gradual, which can equalize the existing differences in the thickness and (or) density of the subject. The use of intensifying screens significantly reduces the exposure time for radiography.
To screen out soft rays of the primary stream that can reach the film, as well as secondary radiation, special movable gratings are used. Films are processed in a darkroom. The processing process is reduced 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 ovens, which takes at least 15 minutes. or occurs naturally, and the picture is ready the next day. When using processing machines, images 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.
Electroradiography. A method for obtaining an X-ray image on semiconductor wafers. The principle of the method: when the rays hit a highly sensitive selenium plate, the electric potential changes in it. The selenium plate is sprinkled with graphite powder. Negatively charged particles of the powder are attracted to those areas of the selenium layer in which positive charges are preserved, and are not retained in those places that have lost their charge under the action of X-ray radiation. Electroradiography allows transferring the image from the plate to the paper in 2-3 minutes. More than 1000 images can be taken on one plate. The advantage of electroradiography:
Rapidity.
Profitability.
Disadvantage: insufficiently high resolution when examining internal organs, a higher radiation dose than with X-ray. The method is mainly used in the study of bones and joints in trauma centers. Recently, the application of this method has become increasingly limited.
Computed x-ray tomography (CT). The development of X-ray computed tomography was the most important event in radiation diagnostics. This is evidenced by the award of the Nobel Prize in 1979 by renowned scientists Cormack (USA) and Hounsfield (England) for the creation and clinical trial 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. Various models of mathematical reconstruction of X-ray images of objects served as the basis for the development and creation of CTs. The successes achieved with the help of CT in the diagnosis of various diseases have stimulated 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 min, then on tomograms of the third - fourth generations, with 512 to 1100 detectors and a large-capacity computer, the time for obtaining one slice decreased to milliseconds, which practically allows examining all organs and tissues, including the heart and blood vessels. Currently, spiral CT is used, which allows for longitudinal reconstruction of the image, to investigate rapidly proceeding 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 fall not on the screen, but on the detectors, in which electrical impulses appear, which are transmitted after amplification to the computer, where, according to a special algorithm, they are reconstructed and create an image of the object, which is fed from the computer. on the TV monitor. The image of organs and tissues on CT, in contrast to traditional X-ray images, 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 cuts with a thickness of 2 to 8 mm. The X-ray tube and radiation receiver move around the patient's body. CT has several advantages over conventional X-ray examination:
First of all, high sensitivity, which makes it possible to differentiate individual organs and tissues from each other in terms of density within up to 0.5%; on conventional radiographs, this figure is 10-20%.
CT allows you to get an image of organs and pathological foci only in the plane of the investigated section, which gives a clear image without stratification of the formations lying above and below.
CT provides the ability 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 state of the organ under study, but also the relationship of the pathological process with the surrounding organs and tissues, for example, the invasion of a tumor 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, like an X-ray, by displacing the patient along a fixed tube. Topograms are used to establish the length of the pathological focus and determine the number of slices.
CT is indispensable for 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 detect pathological changes, but also to assess the effectiveness of treatment and, in particular, anticancer therapy, as well as to determine relapses and associated complications.
Diagnosis with CT is based on direct radiographic findings, i.e. determining the exact location, shape, size of individual organs and pathological focus and, which is especially important, on the 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 travels through the human body. Each tissue, depending on the density of the atomic mass, absorbs radiation in different ways, therefore, the absorption coefficient (HU) according to the Hounsfield scale is currently developed for each tissue and organ. According to this scale, HUwater is taken as 0; bones with the highest density - for +1000, air with the lowest density - for -1000.
The minimum size of a tumor or other pathological focus, 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.
Both in CT and X-ray studies, it becomes necessary to use the “image enhancement” technique to increase the resolution. Contrast for CT is performed with water-soluble radiopaque agents.
The “enhancement” technique is carried out by perfusion or infusion of contrast medium.
Such methods of X-ray examination are called special. The 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 due to the difference in density (chemical composition of these organs), size, position. The bone structure is well revealed against the background of soft tissues, the heart and large vessels against the background of air lung tissue, however, the chambers of the heart in conditions of natural contrast cannot be distinguished separately, like the organs of the abdominal cavity, for example. The need to study organs and systems with the same density by X-rays has led to the creation of an artificial contrasting technique. The essence of this technique lies in the introduction of artificial contrast agents into the examined organ, i.e. substances with a density different from the density of the organ and its environment.
Radiopaque contrast agents (RCS) are usually subdivided 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 absorb X-rays intensively (positive radiopaque contrast agents) are:
Suspensions of salts of heavy metals - barium sulfate, used for the study of the gastrointestinal tract (it is not absorbed and excreted through natural routes).
Aqueous solutions of organic iodine compounds - urografin, verografin, bilignost, angiografin, etc., which are introduced into the vascular bed, enter all organs with the blood stream and give, in addition to contrasting the vascular bed, contrasting of other systems - urinary, gallbladder, etc. ...
Oil solutions of organic iodine compounds - iodolipol and others, which are introduced into fistulas and lymphatic vessels.
Non-ionic water-soluble iodine-containing X-ray contrast agents: ultravist, omnipak, imagopak, visipak 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. Non-ionic iodine-containing X-ray contrast agents cause a lower number of side effects than ionic high-osmolarity RCCs.
X-ray negative or negative contrast agents - air, gases “do not absorb” X-rays and therefore well shade the organs and tissues under investigation, which have a high density.
Artificial contrasting according to the method of administration of contrast agents is subdivided into:
The introduction of contrast agents into the cavity of the organs under study (the largest group). This includes studies of the gastrointestinal tract, bronchography, fistula studies, all types of angiography.
The introduction of contrast agents around the organs under study - retropneumoperitoneum, pneumoren, pneumomediastinography.
The introduction of contrast agents into the cavity and around the organs under study. This includes parietography. Parietography in diseases of the gastrointestinal tract consists in obtaining images of the wall of the studied hollow organ after the introduction of gas, first around the organ, and then into the cavity of this organ. Parietography of the esophagus, stomach and colon is usually done.
A method based on the specific ability of certain organs to concentrate individual contrast agents and at the same time set it off against the background of surrounding tissues. This includes excretory urography, cholecystography.
Side effects of RCC. The body's reactions to the introduction of PKC are observed in about 10% of cases. By nature and severity, they are divided into 3 groups:
From the side of the central nervous system - headaches, dizziness, agitation, anxiety, fear, seizures, cerebral edema.
Skin reactions - urticaria, eczema, itching, etc.
Symptoms associated with impaired activity of the cardiovascular system - pallor of the skin, discomfort in the heart, drop in blood pressure, paroxysmal tachycardia or bradycardia, collapse.
Symptoms associated with breathing disorders - tachypnea, dyspnea, an attack of bronchial asthma, laryngeal edema, pulmonary edema.
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, fever, general weakness). Objective symptoms in this case are vomiting, lowering of blood pressure.
Individual intolerance to CSW with characteristic symptoms:
PKC intolerance reactions are sometimes irreversible and fatal.
The mechanisms of development of systemic reactions in all cases are of a similar nature and are caused by the activation of the complement system under the influence of PKC, the effect of PKC on the blood coagulation system, the release of histamine and other biologically active substances, a true immune response, or a combination of these processes.
In mild cases of adverse reactions, it is sufficient to discontinue the injection of the PKC and all the 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, inject 0.5 ml of adrenaline, intravenously 30-60 mg of prednisolone or hydrocortisone, 1-2 ml of an antihistamine solution (diphenhydramine, suprastin, pipolfen, claritin, gismanal), intravenously 10 % calcium chloride. In case of laryngeal edema, perform tracheal intubation, and if it is impossible, tracheostomy. In case of cardiac arrest, immediately start artificial respiration and chest compressions without waiting for the arrival of the resuscitation team.
For the prevention of side effects of RCC, on the eve of the X-ray contrast study, premedication with antihistamines and glucocorticoid drugs is used, and one of the tests is performed to predict the patient's hypersensitivity to RCC. The most optimal tests are: determination of the release of histamine from the basophils of peripheral blood when mixed with PKC; 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, there may be "water" poisoning during irrigoscopy in children with megacolon and gas (or fatty) vascular embolism.
A sign of "water" poisoning, when a large amount of water is rapidly absorbed through the intestinal wall into the bloodstream and an imbalance of electrolytes and plasma proteins occurs, there may be tachycardia, cyanosis, vomiting, respiratory failure with cardiac arrest; death may occur. First aid for this is intravenous administration of whole blood or plasma. Prevention of complications is to conduct irrigoscopy in children with a suspension of barium in an isotonic solution of salt, 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 rate and a drop in blood pressure, convulsions, cessation of breathing. In this case, the introduction of the RCC should be stopped immediately, the patient should be placed in the Trendelenburg position, the patient should be resuscitated and the chest compressions are applied, intravenously administered 0.1% - 0.5 ml of adrenaline solution and the resuscitation team should be called for possible tracheal intubation, artificial respiration and carrying out further treatment measures.
Plan:
1) X-ray examinations. The essence of X-ray research methods. X-ray research methods: fluoroscopy, radiography, fluorography, roentgenotomography, computed tomography. Diagnostic value of X-ray studies. The role of the nurse in preparing for X-ray examinations. Rules for preparing a patient for fluoroscopy and radiography of the stomach and duodenum, bronchography, cholecystography and cholangiography, irrigoscopy and graphy, plain radiography of the kidneys and excretory urography.
X-ray examination of the renal pelvis (pyelography) is performed using intravenous urografin. X-ray examination of the bronchi (bronchography) is carried out after spraying a contrast agent in the bronchi - iodolipol. X-ray examination of blood vessels (angiography) is performed using intravenous cardiotrast. In some cases, the contrasting of the organ is made by means of air, which is introduced into the surrounding tissue or cavity. For example, during X-ray examination of the kidneys, when there is a suspicion of a kidney tumor, air is injected into the perirenal tissue (pneumoren) ; To detect the growth of the stomach walls by the tumor, air is introduced into the abdominal cavity, that is, the study is carried out under conditions of artificial pneumoperitoneum.
Tomography is a layer-by-layer radiography. With tomography, due to the movement during shooting with a certain speed of the X-ray tube on the film, a sharp image is obtained only of those structures that are located at a certain, predetermined depth. The shadows of organs located at a shallower or greater depth are blurred and do not overlap with the main image. Tomography facilitates the detection of tumors, inflammatory infiltrates and other pathological formations. The tomogram indicates in centimeters at what depth, counting from the back, the picture was taken: 2, 4, 6, 7, 8 cm.
One of the most advanced techniques that provide reliable information is CT scan, which allows, thanks to the use of a computer, to differentiate tissues and changes in them, which differ very slightly in the degree of absorption of X-ray radiation.
On the eve of any instrumental study, it is necessary to inform the patient in an accessible form about the essence of the upcoming study, the need for it and obtain written consent to conduct this study.
Preparing the patient for X-ray examination of the stomach and duodenum. This is a research method based on X-ray exposure of hollow organs using a contrast agent (barium sulfate), which allows to determine the shape, size, position, mobility of the stomach and duodenum, localization of ulcers, tumors, to assess the relief of the mucous membrane and the functional state of the stomach ( its evacuation ability).
Before the study, you must:
1. To instruct the patient according to the following plan:
a) 2-3 days before the study, it is necessary to exclude gas-forming products from the diet (vegetables, fruits, black bread, milk);
b) on the eve of the study at 18 oo - a light dinner;
c) warn that the study is carried out on an empty stomach, therefore, on the eve of the study, the patient should not eat or drink, take medications and smoke.
2. In case of persistent constipation, as prescribed by a doctor, in the evening, on the eve of the study, a cleansing enema is given.
5. In order to contrast the esophagus, stomach and duodenum - in the X-ray room, the patient drinks an aqueous suspension of barium sulfate.
It is performed to diagnose diseases of the gallbladder and biliary tract. It is necessary to warn the patient about the possibility of nausea and loose stools as a reaction to receiving a contrast agent. It is necessary to weigh the patient and calculate the dose of contrast agent.
The patient is instructed according to the following scheme:
a) on the eve of the study, for three days the patient follows a diet without high fiber content (exclude cabbage, vegetables, coarse bread);
b) 14 - 17 hours before the study, the patient takes a contrast agent fractionally (0.5 grams) for an hour every 10 minutes, washed down with sweet tea;
c) at 18 oo - light dinner;
d) in the evening, 2 hours before bedtime, if the patient cannot empty the intestines in a natural way, put a cleansing enema;
e) in the morning of the study day, the patient must appear on an empty stomach in the X-ray room (do not drink, do not eat, do not smoke, do not take medications). Take 2 raw eggs with you. In the X-ray room, general images are taken, after which the patient takes a choleretic breakfast (2 raw egg yolks or sorbitol solution (20 g per glass of boiled water) for a choleretic effect). 20 minutes after taking the choleretic breakfast, a series of overview images is performed at regular intervals for 2 hours.
Preparing the patient for cholegraphy(X-ray examination of the gallbladder of the biliary tract after intravenous administration of a contrast agent).
1. To find out the allergic history (intolerance to iodine preparations). 1 - 2 days before the study, conduct a test for sensitivity to contrast agent. For this, 1 ml of contrast agent, warmed up to t = 37-38 o C, is administered intravenously, to monitor the patient's condition. An easier way is to take potassium iodide orally in a tablespoon 3 times a day. With a positive allergy test, a rash, itching, etc. appears. If there is no reaction to the injected contrast agent, continue preparing the patient for the study
2. Before the study, instruct the patient according to the following plan:
2 - 3 days before the study - slag-free diet.
At 18 oo - a light dinner.
2 hours before bedtime - a cleansing enema if the patient cannot empty the intestines naturally.
- The study is carried out on an empty stomach.
3. In the X-ray room, slowly inject 20-30 ml of contrast agent warmed up to t = 37-38 0 С intravenously over 10 minutes.
4. The patient undergoes a series of survey images.
5. Ensure control over the patient's condition within 24 hours after the study in order to exclude the delayed type of allergic reactions.
Preparing the patient for bronchography and bronchoscopy.
Bronchography is a study of the airways, which allows you to obtain an X-ray image of the trachea and bronchi after the introduction of a contrast agent into them using a bronchoscope. Bronchoscopy- an instrumental, endoscopic method for examining the trachea and bronchi, which makes it possible to inspect the mucous membrane of the trachea and larynx, to take the contents or washings of the bronchi for bacteriological, cytological and immunological studies, as well as to carry out treatment.
1. To exclude idiosyncrasy to iodolipol, 1 tablespoon of this drug is prescribed once inside for 2-3 days before the study and during these 2-3 days the patient takes a 0.1% solution of atropine 6-8 drops 3 times a day).
2. If bronchography is prescribed for a woman - warn that there is no varnish on the nails, and lipstick on the lips.
3. The night before, as prescribed by a doctor with a sedative purpose, the patient should take 10 mg of seduxen (in case of sleep disturbance - sleeping pills).
4. 30-40 minutes before performing the manipulation, carry out premedication as prescribed by the doctor: inject subcutaneously 1 ml - 0.1% solution of atropine and 1 ml of 2% solution of promedol (make an entry in the medical history and drug logbook).
Preparing the patient for X-ray examination of the large intestine (irrigoscopy, irrigography), which allows you to get an idea of the length, position, tone, shape of the colon, to identify violations of motor function.
1. To instruct the patient according to the following scheme:
a) three days before the study, a slag-free diet is prescribed; b) if the patient is worried about intestinal bloating, then it is possible to recommend taking an infusion of chamomile, carbolene or enzyme preparations for three days;
c) on the eve of the study, at 15-16 o'clock, the patient receives 30 g of castor oil (in the absence of diarrhea);
d) at 19:00 - light dinner; e) at 20 00 and 21 00 on the eve of the study, cleansing enemas are carried out to the effect of "pure water";
f) in the morning on the day of the study, no later than 2 hours before the irrigoscopy, 2 cleansing enemas are performed with an interval of one hour;
g) on the day of the study, the patient should not drink, eat, smoke and take medications. With the help of Esmarch's mug in the nurse's office, an aqueous suspension of barium sulfate is introduced.
Preparing the patient for X-ray examination of the kidneys (overview image, excretory urography).
1. Conduct instructions on preparing the patient for the study:
Exclude gas-forming products from the diet (vegetables, fruits, dairy, yeast-like products, black bread, fruit juices) for 3 days before the study.
Take activated charcoal for flatulence as directed by your doctor.
Avoid food intake 18-20 hours before the study.
2. On the eve of the evening at about 22 00 hours and in the morning for 1.5-2 hours before the study, put cleansing enemas
3. Offer the patient to empty the bladder just before the examination.
In the X-ray room, the X-ray doctor takes an overview of the abdominal cavity. The nurse carries out a slow (within 5-8 minutes), constantly monitoring the patient's well-being, the introduction of a contrast agent. A series of pictures is taken by a radiologist.
X-RAY METHODS OF RESEARCH
| Parameter name | Meaning |
| Topic of the article: | X-RAY METHODS OF RESEARCH |
| Rubric (thematic category) | Radio |
X-ray methods play a key role in the diagnosis of kidney and urinary tract diseases. 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, pneumoren, presacral pneumoretroperitoneum, pneumopericystography, prostatography).
The quality of the X-ray examination largely depends on the correct preparation of the patient. To do this, on the eve of the procedure, products that promote gas formation (carbohydrates, vegetables, dairy products) are excluded from the subject's diet, and a cleansing enema is performed. If an enema is not possible, laxatives are prescribed (castor oil, fort-race), as well as drugs that reduce gas formation (activated carbon, simethicone). In order to avoid the accumulation of "hungry" gases, a light breakfast (for example, tea with a little white bread) is recommended in the morning before the examination.
Overview snapshot. An X-ray examination of a urological patient should always begin with an overview of the kidneys and urinary tract. An overview image of the urinary tract should cover the area of the location of all organs of the urinary system (Fig. 4.24). Usually, an X-ray film with dimensions of 30 x 40 cm is used.
Rice. 4.24.Plain X-ray of the kidneys and urinary tract is normal
When interpreting a radiograph, first of all, study the condition 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 objects in the retroperitoneal space should be due to flatulence, that is, the accumulation of intestinal gases.
With good preparation of the patient, shadows can be seen in the overview image kidneys, which are located: on the right - from the upper edge of the I lumbar vertebra to the body of the III lumbar vertebra, to the left - from the body of the XII thoracic vertebra to the body of the II lumbar vertebra. Normally, their contours are even, and the shadows are homogeneous. Changes in size, shape, location, and contour may suggest a kidney abnormality or 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 are visualized in the overview image in the form of radiopaque shadows (Fig. 4.25). Their localization, size, shape, quantity, density are assessed. Calcified walls of aneurysmically dilated vessels, atherosclerotic plaques, gallbladder stones, fecal stones, calcified tuberculous cavities, fibromatous and lymph nodes, as well as phlebolitis- vein 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)
It is impossible to judge with certainty the presence of urolithiasis only on the plain radiograph, but any shadow in the projection of the kidneys and urinary tract should be interpreted as suspicious of a calculus, until the diagnosis is excluded or confirmed with the help of radio-opaque 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 assess the functional and anatomical state of the kidneys, pelvis, ureters and bladder (Fig. 4.26). A prerequisite for performing excretory urography is sufficient renal function. For research use X-ray contrast agents, 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. In case of satisfactory renal function, 20 ml of contrast medium is usually administered intravenously. If 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 contrast agent, after 1 min, an image of a functioning renal parenchyma (nephrogram phase) is revealed on the roentgenogram. After 3 minutes, the contrast is determined in the urinary tract (pyelogram phase). Usually, several images are taken at 7, 15, 25, 40 minutes to assess the condition of the upper urinary tract. In the absence of contrast agent secretion by the kidney, delayed images are taken, which are performed in 1-2 hours. When the bladder is filled with contrast, an image is obtained (descending cystogram).
When interpreting urograms, attention is paid to the size, shape, position of the kidneys, the timeliness of the release of contrast agent, the anatomical structure of the pelvicellular system, the presence of filling defects and obstructions to the passage of urine. The saturation of the contrast agent shadow in the urinary tract, the time of its appearance in the ureters and bladder should be assessed. In this case, the shadow of a calculus, previously visible in the overview image, may be absent.
On the excretory urogram, the shadow of the X-ray-positive stone disappears due to its layering on the radio-opaque substance. It appears in later photographs as the outflow of contrast and impregnation of calculus with it. An X-ray negative stone creates a defect in the filling of the contrast agent.
In the absence of contrast agent shadows on the radiograph, it is possible to assume a congenital absence of the kidney, block of the kidney with a stone in renal colic, hydronephrotic transformation and other diseases accompanied by suppression of renal function.
Adverse reactions and complications with intravenous administration of X-ray contrast agents are more often observed with the use of hyperosmolar radiopaque substances, less often with low-osmolarity. To prevent such complications, you should carefully learn the allergic history and, in order to check the body's sensitivity 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, slowly inject the entire volume after a 2-3-minute interval 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 30% sodium thiosulfate solution should be slowly introduced into the vein. Minor side effects include nausea͵ vomiting͵ 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 conduct excretory urography in patients with allergic reactions to hyperosmolar contrast agents, only low-osmolar substances are used and premedication with glucocorticoids and antihistamines is preliminarily carried out.
Contraindications to 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 through a catheter pre-installed in the ureter.
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For this purpose, liquid contrast agents (urografin, omnipak) are used. Gaseous contrasts (oxygen, air) are rarely used today.
Today, the indications for this study have narrowed significantly due to the emergence 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 impracticable due to severe azotemia, allergic reactions to contrast media. This study is used in cases of narrowing of the ureters of various origins, tuberculosis, tumors of the upper urinary tract, X-ray stones, anomalies of the urinary system, as well as when it is extremely important to visualize the stump of the ureter of the removed kidney. Low-concentration contrast medium solutions or pneumopyelography are used to detect X-ray 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 by nephrostomy drainage (Fig. 4.28).
Retrograde ureteropyelography is contraindicated in case of massive hematuria, active inflammatory process in the genitourinary organs, and the impossibility of performing cystoscopy.
Retrograde ureteropyelography begins with cystoscopy, after which a catheter is inserted into the orifice of the corresponding ureter to a height of 20-25 cm (or, if extremely important, into the pelvis). Next, a survey of the urinary tract is taken to control the location of the catheter. A radiopaque contrast agent (usually no more than 3-5 ml) is injected slowly and images are taken. To avoid infectious complications, retrograde ureteropyelography should not be performed simultaneously from both sides.
Antegrade percutaneous pyeloureterography is indicated for patients with ureteral obstruction of various origins (stricture, stone, tumor, etc.), when other diagnostic methods do not allow the correct diagnosis to be established. The study helps to determine the nature and level of ureteral obstruction.
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- method of X-ray examination of the bladder by pre-filling it with a contrast agent. Cystography should be downward(during excretory urography) and ascending(retrograde), which, in turn, is subdivided into static and mixing(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 if it is impossible to catheterize 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 photographs are taken, after 60-90 minutes.
Rice. 4.29.Excretory urogram with descending cystogram is normal
Retrograde cystography- the 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 carried out in the position of the patient on the back with the hips abducted and bent in the hip joints. With the help of a catheter, 200-250 ml of contrast medium is injected into the bladder, after which an x-ray is taken. A normal bladder, with sufficient filling, has a round (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 at the level of 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 makes it possible to determine the leakage of a radiopaque contrast agent outside the organ.(see Ch. 15.3, Fig. 15.9). It can also diagnose cystocele, bladder fistula, tumors and bladder stones. In patients with benign prostatic hyperplasia on the cystogram, the resulting rounded filling defect along the lower contour of the bladder can be clearly determined (Fig. 4.31). Diverticula of the bladder are detected on the cystogram in the form of bag-like protrusions of its wall.
Rice. 4.31.Excretory urogram with a 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 bladder injury, the integrity of the urethra is preliminarily convinced by urethrography.
Most of the previously proposed modifications of cystography due to the emergence of more informative research methods have now lost their meaning. Withstood the test of time only vocal cystography(Fig. 4.32) - X-ray performed during the release of the bladder from the contrast agent, that is, at the time of urination. Vocal cystography is widely used in pediatric urology to detect vesicoureteral reflux. Also, this study is used when it is extremely important to visualize the posterior parts of the urethra (antegrade urethrography) in patients with strictures and valves of the urethra, ectopia of the urethral orifice into the urethra.
Rice. 4.32.Vocational 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 by means of 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 means of its percutaneous puncture or vasotomy. Due to the invasiveness of this study, the indications for it are strictly limited. Genitography is used in the differential diagnosis of tuberculosis, epididymal tumors, seminal vesicles. Vasography allows you to identify the cause of infertility caused by a violation of the patency of the vas deferens.
A contraindication to this study is an active inflammatory process in the organs of the genitourinary system.
Urethrography- the method of X-ray examination of the urethra by preliminary contrasting. Distinguish downward(antegrade, mixing) and ascending(retrograde) urethrography.
Antegrade urethrography performed at the time of urination after preliminary filling of the bladder with a radiopaque substance. In this case, a good image of the prostatic and membranous parts of the urethra is obtained, in this regard, this study is used primarily for the diagnosis of diseases of these parts of the urethra.
Significantly more often perform 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 tucked towards the body, the other is extended. In this position, the urethra is projected onto the soft tissue of the thigh. The penis is pulled parallel to the bent hip. The contrast agent is slowly injected into the urethra using a rubber-tipped syringe (to avoid urethrovenous reflux). In the process of injecting 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 urethral rupture is the spread of the contrast agent beyond its limits and the absence of its entry into the overlying parts of the urethra and the bladder (see Chapter 15.4, Fig. 15.11). Indications for it are also abnormalities, neoplasms, deverticula and fistulas of the urethra. Urethrography is contraindicated in acute inflammation of the lower urinary tract and genitals.
Renal angiography- a method for studying renal vessels by preliminary contrasting. With the development and improvement of radiation diagnostic methods, angiography to a certain extent has lost its former importance, since the visualization of the great vessels and kidneys using multislice CT and MRI is more accessible, informative and less invasive.
The method allows you to study the features of angioarchitectonics and the functional ability of the kidneys in cases where it is not possible to do this by other research methods. Indications for this study are hydronephrosis (especially if the presence of lower polar renal vessels causing obstruction of the ureter is suspected), abnormalities in the structure of the kidneys and upper urinary tract, tuberculosis, kidney tumors, differential diagnosis of masses and renal cysts, nephrogenic arterial hypertension, tumors of the adrenal glands and dr.
Given the dependence on the method of administration of the contrast medium, 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 through it to the level of the renal arteries) by Seldinger access. Today, transluminal 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, in severe atherosclerosis.
Transfemoral aortography and renal arteriography have become widespread (Fig. 4.34).
Rice. 4.34.Transfemoral renal arteriogram
With renal angiography, the following phases of organ contrasting are distinguished: arteriographic- contrasting of the aorta and renal arteries; nephrographic- visualization of the renal parenchyma; venographic- renal veins are determined; phase of excretory urography, when the contrast agent is released into the urinary tract.
The blood supply to 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 this regard, 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. The cyst of the kidney 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 area of the tumor.
To obtain a detailed image of the area of interest, the method allows 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- the method of contrast study of blood vessels with subsequent computer processing. Its advantage is the ability to obtain an image of 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 of studying venous vessels by preliminary contrasting. It is performed by puncture of the femoral vein, through which a catheter is passed into the inferior vena cava and renal veins.
The development of angiography contributed to the formation of a new branch - endovascular surgery.
In urology, such techniques as embolization, balloon dilatation and vascular stenting.
Embolization- the introduction of various substances for the selective occlusion of blood vessels. It is used to stop bleeding in patients with trauma or kidney tumors and as a minimally invasive treatment for varicocele. Balloon angioplasty and stenting of the renal vessels involve the endovascular introduction of a special balloon, which is then inflated and restores the vessel's patency. 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. In contrast to conventional radiography, CT allows you to obtain an image 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 the attenuation of X-ray radiation 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 carried out. In addition to conventional CT, there is spiral CT and more perfect multispiral 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 contrasting.
During spiral scanning, two actions are performed simultaneously: rotation of the radiation source - an X-ray tube and continuous movement of the table with the patient along the longitudinal axis. The best image quality is provided by multispiral CT. The advantage of a multispiral study is a larger number of perceiving detectors, which allows you to get a better picture with the possibility of a three-dimensional image of the organ under study with a lower radiation load on the patient (Fig. 4.37). At the same time, this method makes it possible to obtain multiplanar, three-dimensional and virtual endoscopic images of the urinary tract.
Rice. 4.37.Multispiral 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 in comparison with other X-ray methods, it has become the most widespread in the whole world.
Multispiral CT with intravenous contrast enhancement and three-dimensional image reconstruction is currently one of the most advanced imaging techniques 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 its root lies the ability to track the distribution of biologically active compounds labeled with positron-emitting radioisotopes in the body with the help of special detecting equipment (PET scanner). The method is most widely used in oncourology. PET provides valuable information in patients with suspected kidney, bladder, prostate, and testicular cancer.
The most informative are positron emission tomographs combined with computed tomographs, which allow simultaneous study of anatomical (CT) and functional (PET) data.
X-RAY METHODS OF RESEARCH - concept and types. Classification and features of the category "X-RAY RESEARCH METHODS" 2017, 2018.
The most important method for diagnosing tuberculosis at different stages of its formation is the X-ray method of research. Over time, it became clear that with this infectious disease there is no "classic", that is, a permanent X-ray picture. Any pulmonary disease on the pictures can resemble tuberculosis. Conversely, a TB 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-ray has disadvantages, this method sometimes plays a key role in the diagnosis of not only tuberculosis infection, but also other diseases of the chest organs. It accurately helps to determine the localization and extent of the pathology. Therefore, the described method most often becomes the correct basis for making an accurate diagnosis - tuberculosis. For its simplicity and information content, chest X-ray examination is mandatory for the adult population in Russia.
How are X-rays obtained?
The organs of our body have an unequal structure - bones and cartilage - dense formations, in comparison with parenchymal or cavity organs. It is on the difference in the density of organs and structures that X-ray images are obtained. The rays that pass through the anatomical structures are not absorbed in the same way. It 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 a film, or on a screen.
Sometimes it is necessary to additionally “mark” some structures that require more careful study. In this case, they resort to contrasting. 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:
- The radiation source is an X-ray tube.
- The object of the study is the patient, and the aim of the study can be both diagnostic and prophylactic.
- The receiver of the emitter is a cassette with a film (for radiography), fluoroscopic screens (for fluoroscopy).
- Radiologist - who examines the picture 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 minuscule doses of X-rays can be dangerous to living organisms. Studies carried out on laboratory animals show that X-ray radiation caused abnormalities in the structure of their germ cell chromosomes. This phenomenon negatively affects the next generation. Cubs of irradiated animals had congenital anomalies, extremely low resistance, and other irreversible deviations.
X-ray examination, which is carried out in full accordance with the rules of the technique of 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 gross violation of the algorithm for taking a picture, as well as the absence of personal protective equipment, harm to the body is possible.
Each X-ray examination involves the absorption of micro-doses. Therefore, health care provided a special decree, which is obliged to comply with medical personnel when taking pictures. Among them:
- The study is carried out according to the strict indications of the patient.
- Pregnant women and pediatric patients are checked with extreme caution.
- The use of the latest equipment that minimizes the radiation exposure to the patient's body.
- PPE of the X-ray room - protective clothing, protectors.
- Reduced exposure time - which is important for both the patient and the medical staff.
- Monitoring of the received doses by medical personnel.
The most common methods in X-ray diagnostics of tuberculosis
For the chest organs, the following methods are most often used:
- Fluoroscopy - the use of this method implies transillumination. This is the most affordable and popular X-ray examination. 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;
- X-ray 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 projection. The rays that previously passed through the body are projected onto a film that is capable of changing its properties due to the silver bromide included in its composition - dark areas indicate that silver on them has been reduced to a greater extent than on transparent ones. That is, the former represent the "air" space of the chest or other anatomical region, and the latter - bones and cartilage, tumors, accumulated fluid;
- Tomography - allows specialists to get a layer-by-layer image. Moreover, in addition to the X-ray apparatus, 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 tuberculous focus;
- 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 methods of X-ray examination and preparation for them
Some patient conditions require imaging of other anatomical areas. In addition to the lungs, you can make 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 neoplasm, 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 imperative to follow the diet three days before the procedure and a cleansing enema. The manipulation is carried out using barium sulfate, which fills the stomach cavity.
- Bladder x-rays - or cystography - are widely used in urology and surgery to identify kidney problems. Since it can show stones, tumors, inflammation and other pathologies with a high degree of accuracy. In this case, the contrast is injected through a catheter previously installed in the patient's urethra. For children, the 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 carry out a test for sensitivity to contrast and a cleansing enema.
X-ray examination in children
Even small patients can be sent to take 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 on the child's card or in his medical history.
For older children - after 12 years of age - X-ray examination is no different from that of an adult. Young children and newborns are examined on x-rays using special techniques. In children's health care facilities there are specialized X-ray rooms, in which even premature babies can be examined. In addition, the technique of taking pictures is strictly observed in such rooms. Any manipulations there are carried out strictly observing the rules of asepsis and antiseptics.
In the case when the image must be taken by a child under 14 years old, three persons are involved - a radiologist, a radiologist and a nurse accompanying the little 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, necessarily, 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, X-ray is used for pediatric patients - due to its low ionizing load in comparison with other methods of X-ray examination.
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