From Big Medical Encyclopedia

X-RAY INSPECTION — the research of bodies and systems of the person based on receiving and the analysis of the x-ray image of the corresponding body parts. River and. it can be applied to studying of a structure and function of bodies is normal (see. Radioanatomy ), but major importance of R. and. consists that it is one of the main sources of obtaining the objective information about a condition of various bodies and systems of an organism, necessary for timely establishment of the correct diagnosis, exact localization and extent revealed patol. changes, and also their dynamics in the course of treatment (see. Radiodiagnosis ).

Fig. 1. The x-ray image of a brush is normal: and — the positive image observed at roentgenoscopy; to more dense fabrics there correspond more dark sites of the image; — the negative image — the roentgenogram; to more dense fabrics there correspond lighter sites of the image.

At R. and. a bunch of x-ray emission, passing through bodies and fabrics, it is absorbed by them in unequal degree and at the exit becomes heterogeneous. Such bunch, getting on the special screen or a radiographic film, causes emergence of the shadow x-ray image of the studied part of a body, a cut characterizes its interior. The shadow image arising on the fluorescent screen in time roentgenoscopies (see), consists of the light and more dark sites corresponding to the fields of unequal absorption of x-ray emission in fabrics and bodies. Intensive shadows on the screen correspond to the dense bodies and fabrics which absorbed a significant amount of radiation, and lighter shadows belong to less dense educations or bodies containing gas, i.e. the image is positive (fig. 1, a). On roentgenograms (see) a ratio of blackouts and enlightenments the return: light sites correspond to the structures which are most absorbing radiation, and dark — sites, more transparent for x-ray emission, of the studied object, i.e. the image is negative (fig. 1, b). At the description of pictures always proceed from the ratios inherent to the positive image, i.e. call light sites on negative roentgenograms «blackouts», and dark — «enlightenments».

The difference in the optical density of the neighboring sites of the image on the roentgenogram (or a difference in brightness of a luminescence of the fluorescent screen) causes picture contrast. Many bodies and body tissues differ from each other in density and chemical structure, differently absorb x-ray emission that causes natural contrast of the received image. Thanks to this R. and. bones and joints, lungs, heart and nek-ry other bodies it is possible to carry out without any preparation. For a research went. - kish. a path, a liver, kidneys, bronchial tubes, vessels, natural contrast to-rykh is insufficient, resort to artificial contrasting, entering special harmless into an organism radiopaque substances (see), to-rye absorb radiation much stronger (fixed white, iodide organic compounds) or is weaker (gas), than the body which is subject to a research. Artificial contrasting of bodies and fabrics is reached by reception of radiopaque substances inside, napr, at R. and. stomach (see), their introduction to a circulatory bed, napr, at urography (see), in the cavity or fabrics surrounding body, napr at ligamentografiya (see), or directly in a cavity (gleam) or a parenchyma of body, napr, at gaymorografiya (see), bronchographies (see), gepatografiya (see).

Fig. 2. Standard radiological projections: and — dorsoventral (a front straight line); — ventrodorsalny (a back straight line); in — left side; — right side; d — the right lobby slanting; e — the left lobby slanting; — right back slanting; z — left back slanting; 1 — a source of x-ray emission; 2 — a body investigated (conditional cross section); 3 — a backbone; 4 — the receiver of radiation (a film, the fluorescent screen, etc.); F — the frontal plane; the dotted line designated the central beam of a bunch of radiation.

The x-ray image is plane and summatsionny (see. Skialogiya ), therefore apply R. to obtaining the volume characteristic of an object and. in various projections. Based on the ratio of the direction of a bunch of x-ray emission with the planes of a body distinguish direct, side and slanting projections. At a direct projection the central beam of a bunch of radiation of a X-ray tube is directed sagittalno, i.e. perpendicular to the frontal plane of a body. Distinguish a dorsoventral, or front direct projection when the source of radiation is located behind investigated, and the receiver of radiation (the screen, a film) prilezhit to a front surface of a body (fig. 2, a) and a ventrodorsalny, or back direct projection when the source of radiation is located in front, and the receiver — behind (fig. 2, b). At a side projection the central beam passes perpendicular to the sagittal plane of a body, i.e. along its frontal plane. Distinguish right and left side projections, depending on to what surface prilezhit the receiver of radiation (fig. 2, in, d). At slanting projections the central beam is directed at an angle to the frontal and sagittal planes. To similarly direct projections slanting projections also divide on front and back. Distinguish 4 typical slanting projections when the corner formed by the central beam with the specified planes is equal 45 ° - it is the right and left front slanting projections (fig. 2, d, e) both the right and left back slanting projections (fig. 2, h). At a research of a thorax front slanting projections call mamillar, and back — scapular. River and., at Krom use various projections by rotation of the patient around one axis, usually longitudinal, is called multiprojective. In some cases the similar research happens insufficiently and in addition apply the projections which are carried out by rotation around cross, sagittal or frontal axes (see. Polyposition research ). At a research of a number of anatomic educations, e.g. eye-sockets (see), middle ear (see), use special projections — axial, at to-rykh the central beam of a bunch of radiation it is directed along an axis of body; tangential, at to-rykh the central beam it is directed on a tangent to a surface of body in the chosen point, etc.

Indications to R. and. are extremely wide. Choice of an optimum method P. and. is defined by a diagnostic task in each case.

Contraindications to R. and. are defined by a condition of the patient and specifics of this method P. and. So, e.g., R. and. contraindicated at the serious menacing condition of the patient demanding carrying out immediate to lay down. actions, or carrying out a bronchography is contraindicated at acute inflammatory respiratory diseases.

River and. begins, as a rule, with roentgenoscopies (see) or X-ray analysis (see). The roentgenoscopy allows to investigate motive function of nek-ry internals (heart, a stomach, intestines, etc.), to define a smeshchayemost patol. educations at a palpation or change of position of the patient, etc. Use of electron-optical converters and television (see. Television in medicine ) not only considerably reduces beam loading at roentgenoscopy, but also increases its diagnostic efficiency. The main advantage of a X-ray analysis — high resolving power. On roentgenograms is much more distinct also relyefny, than on the fluorescent screen, building blocks of various bodies and systems are displayed. The roentgenogram is the objective document P. and., to-ry it can be stored and serve long for comparison with the subsequent pictures for studying of dynamics patol. process.

The roentgenoscopy and a X-ray analysis make group of the general rentgenol. methods. They are also the cornerstone private and special rentgenol. methods, to the Crimea resort for the purpose of obtaining additional information on function and structure of the studied body. Private methods (telex-ray analysis, fluorography, tomography, electrox-ray analysis, X-ray television raying, video magnetic record of the image, etc.) are based on use of special receptions and technical means.

In a basis electrox-ray analysis (see) the principle of receiving rentgenol lies. images on a selenic plate with its subsequent transfer on usual paper.

Fluorography (see) it is based on the photography of the x-ray image of an object from the screen on a film of the smaller sizes which is carried out by means of special devices — photofluorographs. The fluorography is widely applied to mass R.' carrying out and. bodies of a chest cavity, mammary glands, adnexal bosoms of a nose, etc.

To dismember usual summatsionny rentgenol. a picture on the image of separate layers of an object resort to a layer-by-layer research — tomographies (see). On the tomogram receive a sharp image of any layer of the studied part of a body or body. The tomography is widely used at a research of lungs, bones and joints, a liver, kidneys and other bodies.

Registration of the movements of bodies (e.g., hearts, lungs, a diaphragm) is carried out using such methods as rentgenokimografiya (see), elektrokimografiya (see), X-ray cinematography (see).

Special methods (bronchography, holegrafiya, urography, angiography, pariyetografiya, etc.) are intended for studying of a certain system, body or its part, usually after artificial contrasting. Apply them according to strict indications only when simpler methods do not provide necessary diagnostic results.

In some cases R. and. demands pre-treatment investigated, providing quality of a research, reducing connected with R. and. unpleasant feelings, or preventing development of complications. So, e.g., before R.'s carrying out and. a large intestine for release it from fecal masses is appointed by purgatives, cleansing enemas; at R.'s carrying out and. with a puncture of a vessel or a channel apply local anesthesia, analgetics; before R.'s carrying out and. using nek-ry radiopaque substances appoint the hyposensibilizing means. Various pharmaceuticals can be applied to more accurate identification during R. and. a functional condition of the studied body, e.g. medicamentous stimulation of a vermicular movement of a stomach, a spasmolysis of sphincters, etc.

The analysis received at R. and. information develops of several consecutive stages: allocations rentgenol. symptoms, interpretation of a skialogichesky picture from the anatomic and physiological points of view, comparison rentgenol. data with results kli-shkhchesky and carried out earlier rentgenol. researches, carrying out the differential diagnosis and, at last, a formulation of the diagnostic inference (see. Radiodiagnosis ).

Complications, connected using R. and., are observed rather seldom. They can arise at artificial contrasting of cavities, bodies and systems of an organism (allergic reactions, acute disorder of breath, a collapse, a metastasis ad nervos of cordial activity, an embolism, damage of bodies and fabrics, etc.). The vast majority of complications develops in the course of carrying out a research or within the first 30 min. after its termination. Therefore it is important to provide continuous medical control of a condition of the patient before the expiration of this term, and also rendering in case of need to urgent medical assistance.

Beam damages at strict observance of all rules antiactinic protection (see) are not observed. They can arise only at gross violation of rules of work with sources of ionizing radiation (operation of the faulty equipment, disturbance of a technique of a research, failure from use of individual protection equipment, etc.). Protection against the radiation of patients and personnel for the purpose of the prevention of possible genetic effects is reached by the correct design X-ray department (see), restriction of the field of radiation with the sizes of the explored area and shielding of a zone of gonads, the choice optimum for this R. and. physics and technology conditions, use of additional filtering of primary bunch of radiation and individual protection equipment.

Urgent X-ray inspection it is carried out for the purpose of recognition of acute damages of various anatomic areas and nek-ry other diseases, preferential bodies of chest and belly cavities. Besides, urgent R. and. it is quite often carried out in connection with suddenly developed, life-threatening complications of a number of diseases (perforation of stomach ulcer or a duodenum, went. - kish. bleeding, heart attack of a lung, etc.), and also operative measures. In the course of urgent R. and. the radiologist shall establish features of this damage or a disease, localization and volume (extent) of a zone of defeat. At the same time paramount value has identification of those damages or patol. states, to-rye cause disease severity and demand urgent to lay down. actions.

Contraindications to urgent R. and. (at the appropriate organization and a technique of its carrying out) are extremely limited. Usually they are exhausted by existence of symptoms of profuse bleeding, sharp disturbance of vital signs of an organism, and also the expressed excitement which is not eliminated with the help pharmakol. means.

Urgent R. and. it has to be carried out at any time. Depending on the nature of acute damage (disease), the general condition of the victim and hardware to lay down. institutions it can be executed in X-ray department or directly in that place where at present there is a patient. In the presence at the affected heavy shock and damages demanding an urgent operative measure, R. and. if necessary it has to be executed directly in the operating room on the operating table adapted for this purpose by means of ward or figurative X-ray apparatus (see). At the same time resuscitation events can be held. Sick (victims), arrived in to lay down. establishment in state of shock, but not needing an urgent operative measure, it is reasonable to inspect in the intensive care unit directly in a bed, on a stretcher or on a special wheelchair. In these cases use the figurative or ward x-ray equipment. Similarly in the presence of the emergency indications carry out pictures in a reception otdelenirg, dressing, plaster, hospital chambers, chambers of an intensive care, etc. The patients who are in satisfactory condition and also patients, at inspection to-rykh use of special methods P. is necessary and., deliver in the X-ray department equipped with all necessary for performance of urgent researches of various bodies and systems.

Urgent R. and. patients in a serious condition it has to be carried out whenever possible without change of position of a body of the patient what use the special devices allowing to make a X-ray analysis (electrox-ray analysis) of any anatomic area in two mutually perpendicular projections directly on the operating table, a wheelchair or a stretcher to. Rentgenol. the conclusion is made out and given out at once after the end of a research.

At urgent R. and. it is reasonable to apply the simplest and at the same time rather informative methods. In most cases this, necessary for the characteristic patol. process, receive by means of a X-ray analysis (elektrorentgenografir1) in two mutually perpendicular projections or polipozitsion-ny raying in combination with aim shooting. However at nek-ry damages and acute diseases the most valuable information can be obtained only by means of contrast researches. E.g., leading method of rents-genol. diagnoses of injuries of a bladder are retrograde tsistografiya (see). In not clear cases, and also at bystry development patol. process repeated R. are necessary and. At recognition of nek-ry damages and acute diseases the combination of radiological, endoscopic, ultrasonic and radio-isotope methods of a research is very effective. Urgent R. and. (including carried out out of X-ray department) it is necessary to carry out with observance of all safety regulationss and measures of antiactinic protection of patients and personnel.

X-ray inspection of children differs in the following features: 1) difficulty of collecting the anamnesis and the limitation connected with it a wedge, data, 2) difficulty in R.'s carrying out and., the fixing of the child consisting in need, and also in undesirability and often impossibility of use of nek-ry additional diagnostic methods, 3) need of especially strict restriction of radiation of the child.

By the main method P. and. children, especially newborn, the X-ray analysis (electrox-ray analysis) is, edges allows to lower beam load of the patient and to obtain rather complete and objective information about the studied body. At a research of children of more advanced age the X-ray analysis is supplemented with short-term roentgenoscopy. At the same time preference is given to a X-ray television research. For fixing of children of early age in vre-sya researches in optimum situation use the corresponding devices and devices. The areas of a body which are not subject to a research shield the leaded rubber or a protective screen. Mass fluorographic researches of children to 12-year age are prohibited.

X-ray inspection in field conditions carry out in x-ray department field mobile hospital (see) or directly on the operating table, in a bed or on a stretcher using field X-ray diagnostic devices (see. X-ray apparatus ). Urgent R.'s carrying out and. it is shown preferential at the closed injuries of the head, breast, a basin, the fire or closed fractures of extremities and is frequent — at wounds of a stomach. In R. and. also somatic patients need: contused, the wounded having diseases of internals and also the wounded burned and struck at to-rykh in the course of treatment arose various complications from respiratory organs, digestion, etc.

Indications and priority at R.'s carrying out and. establish taking into account the nature of damage, terms of development of possible complications or patol. the changes caused by this or that striking factor and also the established volume of the help at this stage of medical evacuation. At mass single-step arrival of the struck R. and. it is limited to roentgenoscopy or a X-ray analysis in standard projections only of those persons, the Crimea medical care is provided first of all. Upon transition of hospital to planned treatment of R. and. extend depending on the nature of pathology. River and. in field conditions carry out with observance of all safety regulationss and measures of antiactinic protection of patients and personnel.

Bibliography: Baklanova V. F. and Vladykina M. I. The guide to radiodiagnosis of diseases of a respiratory organs at children, L., 1978, bibliogr.; 3 e d-@ e N and d z e G. A. and About with and p to about in and T. A. Urgent radiodiagnosis at children, L., 1980, bibliogr.; To and sh to about in - with to and y A. N. and T yu t and L. A. Organization's N of urgent radiodiagnosis, L., 1980; they, Technique and equipment of an electrox-ray analysis, M., 1982; Lindenbraten L. D. Technique of studying of x-ray films, M., 1971; Lindenbraten L. D. and Naumov L. B. Methods of X-ray inspection of bodies and systems of the person, Tashkent, 1976; Fundamentals of radiological semiotics, under the editorship of A. I. Pozmogov, Kiev, 1978, bibliogr.; T and e r I. L. and Filippkin M. A. Radiodiagnosis of diseases of the digestive system at children, M., 1974, bibliogr.; Bodies and h to about F. F. Beam loadings at X-ray inspections, M., 1976; Tikhonov K. B. Equipment of X-ray inspection, L., 1978; Feoktistov V. I. The x-ray image, its metric properties and their use in clinic, L., 1966, bibliogr.; Haspekov G. E. Polipo-zitsionny a method in radiodiagnosis, M., 1975; Shcherbatenko M. K. and Beresneva E. A. Urgent radiodiagnosis of diseases and injuries of abdominal organs, M., 1977, bibliogr.

A. N. Kishkovsky.