Introduction

diagnostics medical examination endoscopic

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

In many ways, it is due to the success of radiodiagnosis in leading clinics in America and Europe that the time for making a diagnosis does not exceed 40-60 minutes from the moment the patient enters the hospital. Moreover, we are talking, as a rule, about serious urgent situations, where delay often leads to irreversible consequences. Moreover, the hospital bed has become less and less used for diagnostic activities. All the necessary preliminary studies, and first of all radiation, are performed at the prehospital stage.

Radiological procedures in terms of the frequency of their use have long been ranked second, second only to the most common and mandatory laboratory tests. The summary statistics of the world's major medical centers shows that, thanks to X-ray methods, the number of erroneous diagnoses during the initial visit of a patient today does not exceed 4%.

Modern means visualizations are as follows fundamental principles: impeccable image quality, equipment safety for both patients and medical staff, reliable operation.

The purpose of the work: obtaining knowledge about instrumental methods Examination of patients during X-ray, endoscopic and ultrasound studies.

Instrumental methods for X-ray, endoscopic and ultrasound examinations

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

X-ray methods of research

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

Figure 1. X-ray room.

There are the following main radiological methods of research:

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

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

* Full-format radiography.

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

* Plain radiography - an image of the entire anatomical region.

* Sighting radiography - an image of a limited area of the organ under study.

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

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

4. Contrast fluoroscopy (or radiography) - an X-ray examination method based on the introduction into hollow organs (bronchi, stomach, renal pelvis and ureters, etc.) or vessels (angiography) of special (radio-opaque) substances that delay X-ray radiation, resulting in on the screen (film) receive a clear image of the studied organs.

Before x-ray examination the area of the planned study should be freed from clothing, ointment bandages, adhesive plaster stickers, ECG monitoring electrodes, etc., and asked to remove watches, metal jewelry and pendants.

X-ray examination of the chest organs is an important method for examining patients with diseases of the respiratory system and CVS.

Fluoroscopy and radiography are the most commonly used methods for examining the respiratory organs. X-ray examination allows you to assess the condition of the lung tissue, the appearance in it of areas of compaction and increased airiness, the presence of fluid or air in the pleural cavities. Special preparation of the patient is not required. The study is carried out in the position of the patient standing or, in a serious condition of the patient, lying down.

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

Preparation of the patient for bronchography is carried out in several stages:

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

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

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

4. Direct preparation of the patient for the study: on the eve of the study, the patient is given a light dinner (exclude milk, cabbage, meat). It is necessary to warn the patient that the study is carried out on an empty stomach; On the morning of the study, he should also not drink water, medicines and smoke. The patient needs to be reminded that before the study, he must empty the bladder and intestines (naturally).

5. Premedication: 30-60 minutes before the examination, according to the doctor's prescription, the patient is given special preparations (diazepam, atropine, etc.) in order to create conditions for free access of the bronchoscope. Special attention should be given to the patient after the study, since the following complications may develop:

* the appearance or intensification of coughing with sputum with a large amount of radiopaque substance (sometimes the injected substance is released within 1-2 days); while the patient should be provided with a special jar (spittoon) for sputum;

* increased body temperature;

* the development of pneumonia (in rare cases, with poor contrast agent secretion).

If a patient develops symptoms after bronchography, such as fever, worsening of the general condition, a sharp increase in cough, the appearance of shortness of breath, the nurse should immediately inform the doctor about this.

Fluoroscopy and radiography are also often used to study the CCC (heart, aorta, pulmonary artery). X-ray examination allows you to determine the size of the heart and its chambers, large vessels, the presence of displacement of the heart and its mobility during contractions, the presence of fluid in the pericardial cavity. If necessary, the patient is offered to drink a small amount of a radiopaque substance (a suspension of barium sulfate), which makes it possible to contrast the esophagus and judge the degree of enlargement of the left atrium by the degree of its displacement. Special preparation of the patient is not required.

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

Examination of the esophagus. Preparation of the patient for x-ray examination of the esophagus depends on the indications.

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

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

* If necessary, carry out differential diagnosis organic narrowing and functional damage (spasm of the esophagus), 15 minutes before the study, as prescribed by the doctor, the patient is administered 1 ml of a 0.1% solution of atropine. In the presence of a pronounced organic narrowing of the esophagus, as prescribed by the doctor, using a thick probe and a rubber pear, the accumulated liquid is suctioned from the esophagus.

Examination of the stomach and duodenum. The preparation of the patient for an x-ray examination consists in the release of these sections of the digestive tract from food masses and gases and begins a few days before the examination. The stages of patient preparation are as follows.

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

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

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

4. It is necessary to warn the patient that 12 hours before the study, he should stop eating, in the morning on the day of the study, he should also not drink, take any medicines and smoke.

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

Stages of preparing the patient for the study:

1. Appointment 2-3 days before the study of a diet that excludes food rich in plant fiber and contains other substances that contribute to increased gas formation. It is necessary to exclude fresh rye bread, potatoes, legumes, fresh milk, fresh vegetables and fruits, fruit juices from the diet.

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

3. On the eve of the study, before dinner, the patient is given 30 g of castor oil for oral administration (a contraindication to taking castor oil is intestinal obstruction).

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

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

6. The study is carried out on an empty stomach. If necessary, according to the doctor's prescription, the patient is allowed a light protein breakfast in the morning (low-fat cottage cheese, whipped protein soufflé or protein omelet, boiled fish), which allows you to cause a reflex movement of the contents of the small intestine into the large intestine and prevent the accumulation of gases in the intestine. In this case, the morning cleansing enema is given 20-30 minutes after breakfast.

7. 30 minutes before the examination, the patient is given a gas outlet tube.

Oral lavage is another way to cleanse the intestines before X-ray and endoscopic examination. For its implementation, iso-osmotic solutions are used, for example, Fortrans. Fortrans package intended for one patient consists of four bags containing 64 g of polyethylene glycol in combination with 9 g of electrolytes - sodium sulfate, sodium bicarbonate, sodium chloride and potassium chloride. Each package is dissolved in 1 liter boiled water. As a rule, the patient is prescribed the first 2 liters of solution in the afternoon on the day preceding the study; the second portion in the amount of 1.5-2 liters is given in the morning on the day of the study. The action of the drug (intestinal emptying) is not accompanied by pain and tenesmus, begins 50-80 minutes after the start of taking the solution and lasts for 2-6 hours. Bowel emptying with repeated administration of Fortrans in the morning begins 20-30 minutes after taking the drug. The use of Fortrans is contraindicated in patients with non-specific ulcerative colitis, Crohn's disease, intestinal obstruction, abdominal pain of unknown etiology.

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

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

1. Appointment 2-3 days before the study of a diet that excludes food rich in plant fiber and contains other substances that contribute to increased gas formation. It is necessary to exclude from the diet fresh rye bread, potatoes, legumes, fresh milk, fresh vegetables and fruits, fruit juices.

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

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

4. It is necessary to warn the patient that the study is carried out on an empty stomach. Directly in the X-ray room, the patient receives a choleretic breakfast (100 g of sour cream or 20 g butter on a thin slice of white bread).

With intravenous cholegraphy, the stages of preparing the patient for the study include a mandatory test for individual tolerability of the drug (several days before the study), the appointment of a diet with the exclusion of products that contribute to increased gas formation, the setting of cleansing enemas the night before and in the morning on the day of the study. Intravenous cholegraphy is also performed on an empty stomach. Before the study, a radiopaque substance warmed up to the temperature of the human body is injected intravenously slowly (within 4-5 minutes).

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

contrast radiography. Depending on the method of administration of the radiopaque substance, two types of contrast radiography of the kidneys and urinary tract are distinguished.

* Retrograde urography is a research method when a radiopaque substance is injected through a urinary catheter under the control of a cystoscope into the desired ureter. Special preparation of the patient is not required.

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

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

2. Carrying out a test for individual tolerance of a radiopaque substance 12-24 hours before the study.

3. Restriction of fluid intake by the patient 12-18 hours before the study.

4. Statement of a cleansing enema (until "clean" washings are obtained) the night before and in the morning 2 hours before the study. The study is carried out strictly on an empty stomach.

The radiopaque agent is administered to the patient directly in the radiology room.

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 given 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 given fact makes differential diagnosis difficult. In this case, specialists resort to other, no less informative methods for diagnosing tuberculosis.

Although x-rays have disadvantages, this method sometimes plays 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 right basis for making an accurate diagnosis - tuberculosis. For its simplicity and informativeness, chest X-ray examination 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. The 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, 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:

Radiation source - X-ray tube.
The object of the study is the patient, while the purpose 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 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 is 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:

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

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;
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 to a greater extent on them 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;
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;
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 accuracy 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. Children younger age and the 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 an image needs to be performed on a child under 14 years of age, three persons are involved - a radiologist, a radiologist and 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 is 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.

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

These methods allow you to study:

1) anatomical features of the organ

his position;

dimensions, shape, size;

· Availability foreign bodies, stones and tumors.

2) investigate the function of the organ.

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

Types of X-ray research methods:

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

Radiography- a method of photographing with the help of x-rays.

Tomography - a method of radiography that allows you to get a layered image of organs.

Fluorography - a chest x-ray method that produces reduced-sized images based on a small amount of x-rays.

Remember! Only with the right and full training instrumental examination of the patient gives reliable results and is diagnostically significant!

X-ray examination of the stomach

and duodenum

Target:

Diagnosis of diseases of the stomach and duodenum.

Contraindications:

ulcer bleeding;

pregnancy, breastfeeding.

Equipment:

· 150-200 ml of suspension of barium sulfate;

equipment for cleansing enema;

Direction for research.

Procedure:

Stages of manipulation	Rationale for the need
1. Preparation for manipulation
1. Explain to the patient (family members) the purpose and course of the upcoming study, obtain informed consent.	Ensuring the patient's right to information. Motivating the patient to cooperate. Give the patient written information if they have learning difficulties
2. Indicate the consequences of violating the nurse's recommendations.	Violations in preparation will lead to difficulty in research and inaccurate diagnosis
3. If the patient suffers from flatulence, constipation - within 3 days before the study, a non-slag diet No. 4 is prescribed (see below), it is recommended to take activated charcoal.	Before an X-ray examination of the abdominal organs, it is necessary to remove “interferences” - accumulations of gases and feces that make it difficult to conduct an examination. With swelling of the intestines in the evening and in the morning (2 hours before the study), you can put a cleansing enema.
4. Warn the patient: a light dinner the day before no later than 19.00 (tea, White bread, oil); The examination is carried out in the morning on an empty stomach, the patient should not brush his teeth, take medicine, smoke, eat or drink.	Ensuring the reliability of the research result.
5. Spend psychological preparation patient for research.	The patient must be confident in the painlessness and safety of the upcoming study.
6. On an outpatient basis, warn the patient to come to the X-ray room in the morning, at the time appointed by the doctor. In stationary conditions: to conduct (or transport) the patient to the radiology room at the appointed time with a referral.	Note: in the direction, indicate the name of the research method, full name. patient, age, address or case history number, diagnosis, date of examination.
Performing a manipulation
1. In the X-ray room, the patient ingests a suspension of barium sulfate in the amount of 150-200 ml.	In some cases, the dose of the contrast agent is determined by the radiologist.
2. The doctor takes pictures.
End of manipulation
1. Remind the patient to deliver the images to the attending physician. In stationary conditions: it is necessary to take the patient to the ward, to ensure observation and rest.

Modern methods of X-ray studies are classified primarily by the type of hardware visualization of X-ray projection images. That is, the main types of X-ray diagnostics are differentiated by the fact that each is built on the use of one of several existing types X-ray receivers: x-ray film, fluorescent screen, image intensifier tube, digital detector, etc.

Classification of X-ray diagnostic methods

In modern radiology, there are general research methods and special or auxiliary ones. Practical use These methods are only possible with the use of X-ray machines. Common methods include:

radiography,
fluoroscopy,
teleradiography,
digital radiography,
fluorography,
linear tomography,
CT scan,
contrast radiography.

Special studies include an extensive group of methods that allow solving a wide variety of diagnostic problems, and there are invasive and non-invasive methods. Invasive ones are associated with the introduction into various cavities (alimentary canal, vessels) of instruments (radio-opaque catheters, endoscopes) for diagnostic procedures under the control of x-rays. Non-invasive methods do not involve the introduction of instruments.

Each of the above methods has its own advantages and disadvantages, and hence certain limits of diagnostic capabilities. But all of them are characterized by high information content, ease of implementation, accessibility, the ability to complement each other and generally occupy one of the leading places in medical diagnostics: in more than 50% of cases, diagnosis is impossible without the use of X-ray diagnostics.

Radiography

The radiography method is the obtaining of fixed images of an object in the X-ray spectrum on a material sensitive to it (X-ray film, digital detector) according to the principle of inverse negative. The advantage of the method is a small radiation exposure, high quality images with crisp detail.

The disadvantage of radiography is the impossibility of observing dynamic processes and the long processing period (in the case of film radiography). To study dynamic processes, there is a method of frame-by-frame image fixation - X-ray cinematography. It is used to study the processes of digestion, swallowing, respiration, blood circulation dynamics: X-ray phase cardiography, X-ray pneumopolygraphy.

Fluoroscopy

The method of fluoroscopy is the obtaining of an x-ray image on a fluorescent (luminescent) screen according to the direct negative principle. Allows you to study dynamic processes in real time, optimize the position of the patient in relation to the X-ray beam during the study. X-ray allows you to evaluate both the structure of the organ and its functional state: contractility or extensibility, displacement, filling with a contrast agent and its passage. The multiprojectivity of the method allows you to quickly and accurately identify the localization of existing changes.

A significant drawback of fluoroscopy is a large radiation load on the patient and the examining physician, as well as the need to conduct the procedure in a dark room.

X-ray television

Telefluoroscopy is a study that uses the conversion of an X-ray image into a television signal using an image intensifier tube or amplifier (EOP). A positive x-ray image is displayed on a TV monitor. The advantage of the technique is that it significantly eliminates the shortcomings of conventional fluoroscopy: radiation exposure to the patient and staff is reduced, image quality (contrast, brightness, a high resolution, the possibility of increasing the image), the procedure is carried out in a bright room.

Fluorography

The fluorography method is based on photographing a full-length shadow X-ray image from a fluorescent screen onto film. Depending on the film format, analog fluorography can be small-, medium- and large-frame (100x100 mm). Used for bulk preventive research, mainly chest organs. In modern medicine, more informative large-frame fluorography or digital fluorography is used.

Contrast radiodiagnosis

Contrast X-ray diagnostics is based on the use of artificial contrasting by introducing radiopaque substances into the body. The latter are divided into X-ray positive and X-ray negative. X-ray positive substances basically contain heavy metals - iodine or barium, therefore they absorb radiation more strongly than soft tissues. X-ray negative substances are gases: oxygen, nitrous oxide, air. They absorb X-rays less than soft tissues, thereby creating a contrast with respect to the organ being examined.

Artificial contrasting is used in gastroenterology, cardiology and angiology, pulmonology, urology and gynecology, used in ENT practice and in the study of bone structures.

How an x-ray machine works

X-ray examination I

It is used to study the structure and functions of organs in normal and pathological conditions. Allows you to diagnose, determine the localization and extent of the identified pathological changes, as well as their dynamics during the treatment process.

The study is based on the fact that X-ray radiation passing through organs and tissues is absorbed by them to an unequal degree, which makes it possible to obtain their image on a special screen or radiographic film. Difference in optical density neighboring areas of the image on the radiograph (or the difference in the brightness of the fluorescent screen) determines the images. Many organs and tissues of the body, differing from each other in density and chemical composition, absorb differently, which causes the natural contrast of the resulting image. Thanks to this, R. and. bones and joints, lungs, heart and some other organs can be performed without special preparation. To study the gastrointestinal tract, liver, kidneys, bronchi, vessels, the natural contrast of which is insufficient, they resort to artificial contrasting: they introduce special harmless X-ray contrast agents that absorb much stronger (barium sulfate, organic iodine compounds) or weaker (gas) than investigated structure. For the purpose of artificial contrasting of organs and tissues, they are taken orally (for example, with R. and. of the stomach), injected into the bloodstream (for example, with urography), into the cavities or tissues surrounding (for example, with ligamentography), or directly into the cavity (lumen ) or the parenchyma of the organ (for example, with sinusography, bronchography, hepatography). At fluoroscopy (X-ray) intense shadows on the screen correspond to dense organs and tissues, lighter shadows refer to less dense formations containing gas, i.e. image is positive ( rice. 1, a ). On radiographs, the ratio of darkening and clearing is reversed, i.e. image is negative ( rice. 1, b ). When describing images, one always proceeds from the ratio inherent in a positive image, i.e. light areas on x-rays are called blackouts, dark areas are enlightenments.

The choice of the optimal method depends on the diagnostic task in each specific case. to R. and. are determined by the patient's condition and the specifics of a specific R. method and. (for example, contraindicated in acute inflammatory diseases of the respiratory tract).

X-ray examination is carried out in X-ray rooms. When examining individuals being in a serious condition (for example, shock or the damages demanding urgent interventions), R. and. carried out directly in the intensive care unit or in the operating room using ward or dressing X-ray units. According to indications, it is possible to examine patients in dressing rooms, emergency departments, hospital wards, etc.

The study, depending on the direction of the X-ray beam relative to the plane of the body, is carried out mainly in direct, lateral and oblique projections. With direct projection ( rice. 2, a, b ) is directed sagittally, i.e. perpendicular to the frontal plane of the body. In the anterior direct (dorsoventral) projection, the radiation source is located behind the subject, and or the film is adjacent to the front surface of the body, in the posterior direct (ventrodorsal) projection, the location of the radiation source and receiver is reversed. With a lateral projection (left or right), the central beam passes perpendicular to the sagittal plane of the body, i.e. along its frontal plane ( rice. 2, c, d ). Oblique projections are characterized by the direction of the central beam at an angle to the frontal and sagittal planes ( rice. 2, e, f, g, h ). There are four oblique projections - right and left anterior and right and left posterior. In some cases at R. and. it is necessary to use additional projections obtained by rotating the patient around one axis (often longitudinal). Such a study is called multi-projection. If this is not enough, the patient is also turned around other axes (see Polypositional study). When examining a number of anatomical formations, for example, the orbit, the middle ear, special projections are used - axial (the central beam is directed along the axis of the organ), tangential (the central beam is directed tangentially to the surface of the organ), etc.

X-ray examination usually begins with fluoroscopy (fluoroscopy) or radiography (radiography). X-rays are used to examine the motor function of some internal organs(heart, stomach, intestines, etc.), determine the displacement of pathological formations during palpation or a change in the position of the patient, etc., which has a high resolution, makes it possible to more clearly and clearly display the structures of the body.

Fluoroscopy and constitute a group of general radiological methods. They also underlie private and special radiological methods based on the use of special techniques and technical means, which are used to obtain additional information about the function and structure of the organ under study. Private methods include Teleroentgenography and Electroroentgenography, Tomography, Fluorography, etc. To register the movements of organs (for example, the heart, lungs, diaphragm), fluoroscopy is used using video magnetic recording of the image. Special Methods(Bronchography, cholegraphy, urography, Angiography, etc.) are designed to study a specific system, organ or part of it, usually after artificial contrasting. They are used according to strict indications only in cases where more simple methods do not provide the necessary diagnostic results.

Sometimes necessary preliminary preparation the patient providing R.'s quality and., reducing the discomfort connected with a research, preventing development of complications. So, before carrying out R. and. colon prescribe , cleansing ; in case of need of carrying out at R. and. punctures of the vessel or duct apply local anesthesia; before the introduction of some radiopaque substances, hyposensitizing drugs are prescribed; for a clearer identification during the study functional state body, you can use various medications(stimulating peristalsis of the gastrointestinal tract, reducing sphincters, etc.).

The analysis received at R. and. information consists of several successive stages: the allocation of x-ray symptoms, the interpretation of the x-ray picture, the comparison of x-ray data with the results of clinical and previous x-ray studies, the differential diagnosis and the formulation of the final conclusion.

The complications connected with R.'s use and. are observed seldom. They mainly occur during artificial contrasting of cavities, organs and systems of the body and are manifested by allergic reactions, acute respiratory distress, collapse, reflex disorders of cardiac activity, embolism, damage to organs and tissues. The vast majority of complications develop during the course of the study or in the first 30 min after its completion. Complications in the form of radiation damage (Radiation damage) with strict observance of all the rules of radiation protection (Ray protection) are not observed. They can arise only in case of gross violation of the rules for working with sources of ionizing radiation (operation of faulty equipment, violation of research methods, refusal to use personal protective equipment, etc.). Radiation protection for patients and personnel is achieved by proper planning of the X-ray room, limiting the irradiation field to the size of the area under study and shielding the area of the genital organs, using additional filtration of the primary radiation beam and personal protective equipment, etc.

X-ray examination of children. The main method of R. and. children, especially newborns, is radiography. It is accompanied by a lower radiation exposure to the patient and at the same time allows obtaining sufficiently complete and objective information about the organ under study. In the study of older children, radiography is supplemented with fluoroscopy, while preference is given to X-ray television research, which allows to reduce radiation exposure. Most of the special studies in children are not possible. For fixing children early age during the study in the optimal position, use the appropriate devices and devices. Areas of the body that are not subject to examination are shielded with lead rubber or a protective screen. Mass X-ray examinations of children under the age of 12 are prohibited.

Bibliography: Zedgenidze G.A. and Osipkova T.A. Urgent at children, L., 1980, bibliogr.; Kishkovsky A.N. and Tyutin L.A. Methodology and technique of electroroentgenography, M., 1982; Lindenbraten L.D. and Naumov L.B. Methods of X-ray examination of human organs and systems, Tashkent, 1976.

X-ray image of the hand is normal: a positive image observed on fluoroscopy (dense tissues correspond to darker areas of the image) "\u003e

Rice. 1a). X-ray image of the hand is normal: positive image observed on fluoroscopy (dense tissue corresponds to darker areas of the image).

Rice. Fig. 2. Standard radiological projections: a - anterior straight line; b - back straight line; in - left lateral; g - right side; d - right anterior oblique; e - left anterior oblique; g - right rear oblique; h - left rear oblique; 1 - X-ray source; 2 - cross section of the body of the subject; 3 - spine; 4 - radiation receiver; Ф - frontal plane, the dotted line indicates the central beam of the radiation beam.

II X-ray examination

in medicine - the study of morphological and functional features human organs and systems, incl. for the purpose of diagnosing diseases, based on the receipt and analysis of x-ray images of the corresponding parts of the body.

1. Small medical encyclopedia. - M.: Medical Encyclopedia. 1991-96 2. First health care. - M.: Great Russian Encyclopedia. 1994 3. Encyclopedic dictionary of medical terms. - M.: Soviet Encyclopedia. - 1982-1984.

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