From Big Medical Encyclopedia

RADIODIAGNOSIS [rentgeno-(on a name B. X-ray) + diagnosis] — process of recognition of damages and diseases of various bodies and systems of the person on the basis of data of X-ray inspection. In a broader sense radiodiagnosis is considered as the section of a radiology developing the diagnostic methods based on use of x-ray emission. At the beginning of development of a radiology by range of application of R. there were only two systems — respiratory organs and a skeleton, features of a structure to-rykh provide natural contrast of the x-ray image. In process of improvement of a technique X-ray inspection (see) R. began to find application in a research went. - kish. path, bilious ways, kidneys and uric ways, blood vessels, limf, systems, etc. In a crust, time only the few anatomical structures do not receive direct display at rentgenol yet. research. Nervous trunks, a research to-rykh in a wedge concern to them, e.g., conditions did not gain distribution yet though in an experiment it was succeeded to achieve their identification.

An important role in continuous expansion of range of application of R. is played by the methods of artificial contrasting connected with introduction to an organism of substances to-rye create necessary contrast when under natural conditions it is absent or is insufficient for obtaining the full image on the x-ray screen or a film (see. Radiopaque substances ). These methods are called on bodies and systems, to-rye steel available to R. thanks to radiopaque substances (see. Angiography , Bronchography , Limfografiya etc.). Along with X-ray contrast methods expansion of range of application of R. is promoted also by nek-ry other methods, in particular tomography (see), and especially computer tomography (see. Tomography computer ), allowing to study without additional contrasting earlier inaccessible for rentgenol. researches bodies — a brain, a liver, kidneys, a pancreas, etc.

Further development of R. is connected with improvement of the equipment and creation of essentially new installations, development of new ways and drugs for artificial contrasting of various bodies and systems. Also the combination rentgenol is perspective. researches with radio isotope, endoscopic, ultrasonic, thermographic, etc. R.'s possibility on the basis of obtaining the volume holographic image is studied (see. Holography ). Development of the methods combining X-ray diagnostic procedures with medical is of great importance. E.g., the sounding of vessels used for an angiography expansions patholologically of the narrowed vessels apply to elimination of blood clots, sklerozirovaniye of varicose nodes (see. X-ray endovascular surgery ); the puncture of kidneys and lungs under control of roentgenoscopy is combined with sealing patol. cavities in these bodies; transdermal transhepatic holangiografiya (see) — with drainage of a gall bladder and administration of medicines in it.

The main objectives of R. is the following: to establish whether is available at investigated any disease and whenever possible to define its nosological accessory (the establishing diagnosis); to reveal the signs distinguishing this disease from other patol. processes with similar manifestations (differential diagnosis); to establish exact localization and prevalence available patol. process (topical diagnosis); to establish a form and a phase of development of a disease, existence or lack of complications (high-quality diagnosis); to estimate the general condition of the patient, to reveal associated diseases, etc.

Tactics rentgenol. researches in a crust, time became complicated because the arsenal of radiological procedures contains many tens of names, and the qualified radiologist can define in each separate case what methods it is reasonable to use and in what sequence. Use of usual roentgenoscopies (see) and X-ray analysis (see) often happens sufficient for establishment of the diagnosis. However in some cases need for use additional rentgenol appears. methods. Their choice shall meet the requirements: a maximum of reliable information in the shortest possible time at the minimum quantity of the used methods.

In the course of R. reveal both morphological, and functional changes in these or those bodies or systems. So, at detection morfol. signs of a carcinoma of the stomach (defect of filling, reorganization of a relief of a mucous membrane, etc.) at the same time define character of a vermicular movement at the level of defeat and in the next departments, removability of a stomach at breath and change of position of a body, etc. For identification of a functional condition of this or that body in some cases use pharmaceuticals. E.g., to stimulation of a vermicular movement of a stomach Apply morphine, prozerin, to acceleration of emptying of a gall bladder and secondary contrasting of the general bilious and hepatic channels — secretin, cholecystokinin, etc., in case of need to Weaken motility of the studied bodies, e.g. a duodenum, the ileocecal valve, apply atropine, Methacinum and other drugs. For a spasmolysis of sphincters, napr, a pylorus, use drugs from group of nitrites, etc. In a crust, time functional methods P. find the increasing application at a research of a respiratory organs, the musculoskeletal device, cardiovascular system.

Sometimes the main objective of R. is not establishment of existence and character patol. process, and only definition of exact localization of the available changes (topical R.), napr, in the presence of a foreign body. In these cases specify its arrangement, a depth, relationship with the next bodies and influence on their function (e.g., at foreign bodys in bronchial tubes); at an opportunity define the most rational approaches for removal of a foreign body. Topical R. has important, and sometimes crucial importance at localization patol. educations, especially tumors, on border of anatomic areas: chest and belly cavities, peritoneal cavity and retroperitoneal space, lungs and mediastinum etc.

The major component is the analysis of data rentgenol. researches and creation of the diagnostic inference. This work consists of the following stages: analysis of skialogichesky signs; establishment of pathomorphologic and pathophysiological substrate of the revealed skialogichesky changes; comparison rentgenol. pictures with clinical laboratory data; carrying out the differential diagnosis; formulation of the diagnostic inference.

The analysis of skialogichesky signs demands profound knowledge of anatomy and physiology of the studied bodies, options of their development, features of x-ray display of structure and function of these bodies. Any x-ray shadows (see. Skialogiya ) describe taking into account the following parameters: quantity, localization, form, sizes, intensity, structure, character of contours, smeshchayemost. Shadows can be single and multiple; in the latter case specify their quantity (under a condition if them a little). If there are tens and, especially, hundreds of shadows as it is observed, e.g., at dissimination patol. process, it is impossible to specify their quantity. Localization of a shadow (shadows) in the presence of one roentgenogram is specified approximately; e.g., the shadow is in an upper belt of the right pulmonary field, in the third mezhreberye, in an upper third of a body of a stomach, in a projection of a liver, etc. In the presence of at least two roentgenograms in mutually perpendicular projections there is a possibility of the exact description of an arrangement of the object which caused emergence of a shadow. Specify in these cases, e.g., the corresponding share or a segment of a lung, a part of a mediastinum etc. The best way of the description of a form of a shadow — comparison with geometrical figures — a circle, an oval, a triangle, a ring, etc. In some cases make exact size discrimination of shadows — rentgenogrammetriya (see); if the picture is made at small focal length, consider projective increase in a shadow in comparison with an object. What closer located an object to a film, by that projective distortion less. It is not recommended to designate the sizes of a shadow by comparison with various objects, napr, apple, nut. Intensity of a shadow is defined by brightness of a luminescence of the respective site of the fluorescent screen or optical density of the roentgenogram and is estimated in comparison with a background as a shadow of high, average, small intensity; sometimes speak about the «limy», «bone», «metal» density of a shadow. The shadow can be homogeneous and unstructured. If against the background of blackout sites of an enlightenment or, on the contrary, dense inclusions are visible, in detail describe them with the indication of quantity, a form, the sizes. Outlines of a shadow can be equal or uneven, accurate or indistinct, hilly, wavy, gear, etc. Smeshchayemost of a shadow define at roentgenoscopies (see), rentgenokimografiya (see), X-ray cinematographies (see). Along with definition of a smeshchayemost note existence or lack of a pulsation of a shadow.

After the detailed description patol. to a shadow (or shadows) the characteristic is given to other changes, to-rye can take place in the struck body or system. E.g., after the description of a shadow against the background of the pulmonary field in detail describe a condition of the pulmonary drawing, roots of lungs, diaphragms of pi of pleural sine, bodies of a mediastinum, an opposite lung, if necessary — a skeleton and soft tissues of a thorax, abdominal organs. At detection of defect in a wall of a stomach in detail describe a relief of his mucous membrane, a condition of walls and their motility, the nature of evacuation, a condition of the next bodies, etc. Only the integrated skialogichesky analysis gives the chance to make the correct diagnosis. The neglect any detail leads to diagnostic mistakes.

Establishment patomorfo logical and pathophysiological substrate of the revealed skialogichesky changes is an important stage P. Interpretation of a shadow picture with replacement of skialogichesky categories by pathoanatomical and pathophysiological represents complex process since rentgenol. signs seldom happen pathognomonic. Similar logical signs of a ski can be found at various patol. processes. E.g., the ring-shaped shadow in a lung is caused by a tubercular cavity, abscess, a cyst, the breaking-up tumor, some other sacculated by pheumothorax of N patol. educations; defect of filling of a gullet, stomach or intestines can reflect existence of a tumor, local hypostasis of a wall, pressure from the outside, etc.; roundish defect in bones of a calvaria can be a consequence of development of a solitary metastasis of a malignant tumor, an eosinophilic granuloma, syphiloma, etc. The known difficulties arise during the definition of substrate of miliary dissiminations in easy, different types of osteoporosis, reorganization of a relief of a mucous membrane went. - kish. path and some other rentgenol. pictures. Considering specifics of a ski of logical semiotics, for its interpretation it is necessary to know well not only patol. anatomy and patol. physiology, but also variety rentgenol. these or those manifestations patol. processes. In each separate case the radiologist shall correlate all main and indirect skialogichesky signs with morfol. structures and fiziol. phenomena.

It must be kept in mind that rentgenol. the picture can be absolutely normal in initial, and sometimes and in far come stages of a row patol. processes. E.g., ulcer colitis, acute osteomyelitis, tubercular bronkhadenit, metastasises of malignant tumors in a skeleton, defects of bodies of vertebrae, small exudates in pericardiac and belly cavities, small tumors of kidneys and many other processes can not be followed throughout certain time rentgenol. changes. Need to approach extremely carefully an exception patol is connected with it. processes at absence rentgenol. changes.

Comparison rentgenol. pictures with clinical laboratory data is obligatory for establishment of the diagnosis. Only detailed acquaintance to the anamnesis, wedge, picture of a disease and data lab. researches gives the chance to estimate correctly revealed rentgenol. signs. Rentgenol. a research — a component complex a wedge, inspections of the patient (see). At the same time rentgenol. data are designed not to replace, and it is essential to add results of inspection. The opinion existing at nek-ry doctors that preliminary acquaintance to clinical materials deprives of the radiologist of objectivity, is not proved.

Carrying out the differential diagnosis is necessary practically almost in all cases of River. Reduction of a lung lobe can be caused by cirrhosis as a result hron. inflammations or an atelectasis owing to bronchial obstruction a foreign body, a benign tumor or cancer. Volume education in a mediastinum can be a tumor, a cyst, phrenic hernia or an aortic aneurysm. The esophageal stenosis can be result of hems after a burn, cancer infiltration, a sclerosing mediastinitis, a disease Krone, sclerodermas, etc. Widespread osteoporosis in one cases is caused by a multiple myeloma, in others — hron. a disease of kidneys, in the third — disturbance of absorption in a small bowel. In each of similar situations estimate all available data: the age of the patient, duration of a disease previous patol. processes, complaints, results wedge, inspections and, of course, character rentgenol. changes. If all these data are not enough, then in coordination with the attending physician appoint additional researches. And only then start the most responsible stage P. — the formulation of the diagnostic inference. This stage P. represents a result of all carried-out work. The conclusion can be various depending on a number of factors: completeness of the available data, duration of observation, etc. In one cases it represents the exact diagnosis with the indication of a nosological form, prevalence, a form and phase of a course of a disease, the available complications. The similar conclusion is optimum. However there is not always an opportunity to formulate the conclusion unambiguously. In some cases specify the list of diseases in the conclusion, to-rye can cause available rentgenol. a picture, as the decreasing probability. At the same time often specify what additional procedures are able to afford to narrow this differentsialnodiagnostichesky row, napr, an endoscopic research, a biopsy. Inadmissibly in the conclusion to repeat only the description of a skialogichesky picture («a roundish shadow in a lung», «defect of filling in a stomach»).

Sometimes in the conclusion it can be specified that, despite existence a wedge, sikhmptomatik, rentgenol. the picture does not represent aberrations. It can be caused by the following: the developed disease in character is not shown accurate rentgenol. signs, napr, acute bronchitis or tracheitis, renal colic, adnexitis; a phase of development of process such is that rentgenol. the picture was not created yet, napr, an early stage of pneumonia, disease Krone, ulcer colitis, acute osteomyelitis; in connection with not clear a wedge, a picture the attending physician directed the patient for rentgenol. researches not of that body (system), to-ry it is actually struck, napr, at the acute abdomen imitating pneumonia when the radiologist does not find changes in bodies of a thorax; simulation or aggravation.

The conclusion shall be clear, whenever possible laconic, but rather full. If necessary point out expediency of a repeated research through a certain term. Protocol rentgenol. researches enter or paste in a case history.

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L. S. Rozenshtraukh.