Radiography is a method of studying the internal structure of objects using x-rays. Reviews, contraindications. Everything you need to know about x-rays: acquisition procedure, assessment of diagnostic hazards, and interpretation of Wren images

Radiation diagnostics is one of the main areas of modern medicine. Today, there are many methods of radiation research, such as radionuclide, magnetic resonance and radiological diagnostics, including fluorography, fluoroscopy, radiography and others, including ultrasound, interventional radiology and thermography.

In this publication, such a research method as radiography will be considered in more detail. What is it?

A method of X-ray study, during which an X-ray image of the body systems and internal organs is obtained by projecting their rays onto a solid carrier, often it is an X-ray film. This research procedure is the first way to help visualize the image of organs and tissues, and then diagnose them.

Radiography was discovered by Wilhelm Conrad Roentgen, a popular physicist from Germany (1895). It was he who was able to fix the property of X-ray radiation, during which the darkening of the photographic plate occurs.

Modern digital x-ray machines make it possible to obtain an image that can be displayed on a display screen, imprinted on paper, possibly in a magneto-optical memory.

This study is performed to study specific lesions in diseases of an infectious nature, such as arthritis, pneumonia or myocarditis, to determine diseases that have arisen in the chest area, namely the heart, lungs. In some specific cases, in the presence of individual indications, diagnostics of the digestive organs, joints, kidneys, spine and liver are performed.

What are the benefits of this study?

Radiography has the following advantages to its implementation, namely:

does not require special training;
wide availability and ease of implementation;
the possibility of using the result obtained by doctors of different directions;
cheapness, except for diagnosing, when the results are obtained in digital form.

Disadvantages of radiography

This type of research is widely used, but it also has certain disadvantages:

in the process of radiography, radiopaque agents are used that have an effect on soft tissues;
ionizing radiation has a rather adverse effect on the organism undergoing research;
the resulting image somewhat complicates the process of assessing the state of the organ;
provides a low level of information content when compared with tomography methods.

The doctor may be assigned to perform x-rays as:

checking the correct installation of the endotracheal tube, central venous catheter in the intensive care unit and general resuscitation;
the control result of the effectiveness of the treatment;
confirmation of damage to various organs.

This procedure is carried out in all medical institutions. A radiograph is a document that can be stored for a long period of time. It can be presented to specialists in various fields.

X-rays are not recommended for women during the period of bearing a baby, since radiation can have a negative effect on the fetus.

Before the start of radiography, the patient is notified of the need to perform this diagnosis, and the procedure is explained. So, for example, when studying the organs of the chest, to improve the quality of the pictures taken, you need to take a deep breath at the command of the health worker and hold your breath for a few seconds.

Before performing x-rays, the patient must remove metal jewelry, watches, and when examining the digestive organs, the amount of food and drink should be reduced.

Survey methodology

Before the start of the study, the health worker must leave the room where the x-ray will be taken. If, for some specific reason, he needs to stay, then he needs to “outfit” himself with a special lead apron.

The patient should stand in front of the x-ray machine, perhaps he should sit in a chair or take a “lying” position on a special table. If the patient is intubated, make sure that the tubing and tubing are not dislodged during placement.

The subject under study is not allowed to perform any movements during the period of the study, until its completion. Depending on the goal that was set for the study, pictures are taken in several projections. Before the patient leaves the office, the health worker checks the quality of the images, if necessary, take a second one.

Radiography is aimed at studying the blood vessels, the work of the heart, lungs, respiratory tract, and contributes to the study of the lymph nodes. As a rule, this diagnostic method involves several images taken from the back and chest, but if the patient is in a serious condition, then one image can be taken.

Conducting this study does not require special training. This study is assigned in such cases:

to determine diseases such as pneumothorax, pneumonia, chronic obstructive and oncological diseases of the lungs;
in order to identify the cause of pain in the chest, the cause of shortness of breath and cough;
to establish foreign bodies in the stomach, respiratory organs and lungs;
to identify lung injuries, rib fractures, including problems that cause pulmonary edema;
with cardiac ailments, such as cardiomegaly or heart failure.

The doctor may prescribe such an examination for a patient who has the following symptoms: general weakness, prolonged dry cough, hemoptysis, pain in the back or in the lungs, loss of strength, weight loss and fever. Radiography is able to determine pneumonia, such a serious disease as tuberculosis, neoplasms, fungal diseases of the lungs, including the presence of foreign objects.

Typically, such a study of the lungs involves taking several pictures, which are performed using x-rays located from the side and in front.

Young children should be in the supine position during x-rays. When evaluating the study, the doctor must take into account the characteristics of the blood supply to the lungs and their changed proportions when the person is in this position. Such a diagnosis of the lungs does not require any special training for this.

Radiography in determining various injuries of the brain and skull is uninformative, but it is advisable to do such an examination in order to:

diagnose pituitary tumors;
identify endocrine diseases and metabolic problems;
establish congenital malformations;
identify skull fractures.

The doctor may order an x-ray if the patient has the following symptoms: dizziness, severe headache, hormonal imbalance, and loss of consciousness. Usually this examination is done in five projections. You don't need any special training to do it. When performing an x-ray of the skull, the patient should be free of various kinds of metal objects, such as glasses, any jewelry, in particular dentures.

Taking x-rays of the spine

X-ray of the spine helps to diagnose the displacement of the vertebrae, the presence of erosion, the density and structure of the bone tissue itself, to determine areas of thickening or thinning of the cortical layer of the bones, and uneven contours.

This diagnosis is rational to perform in order to:

as a determination of the condition of the spine with such an ailment as arthritis and metabolic disorders;
to determine infectious diseases, degenerative-dystrophic changes in the spine, congenital anomalies;
to study displacement, subluxations, fractures or distortions of the vertebrae;
establish the destruction of the intervertebral discs.

Such a study of the spine does not imply any preparation. During the x-ray period, it is only necessary to strictly follow the instructions of the health worker, fixing the desired position on the x-ray table and holding your breath at the appropriate moment.

This diagnostic method is used in the case of long-term or chronic arthritis, in particular if osteoarthritis is suspected. In the case of the presence of other rheumatic diseases in the vast majority, this method of examining the joints is able to detect these symptoms much later, in contrast to laboratory diagnostic methods, in particular, and general clinical observation.

The performed x-rays allow you to compare the results of the following examinations, comparing them with the original data.

When studying symmetrical joints, radiography is performed in the following projections: lateral and direct; if diseases of the hip or interphalangeal joints are diagnosed, an auxiliary projection is also needed - oblique. To determine the disease in the results of radiography of the joints are considered:

outlines of the cortical layer;
the contours of the joint space, if its narrowing is determined, this shows the manifestation of rheumatoid arthritis, its initial stage;
articular ends of connecting bones - their size, bone structure, shape and ratio;
the condition of soft periarticular tissues.

When performing an assessment of radiography of the joints, the clinical picture of the disease, the age of the patient, as well as the time period of the existence of the disease, are taken into account.

In addition to the above types of this study, using radiography, you can study the condition of the teeth, as well as all organs located in the abdominal cavity: 12-type intestine, biliary tract, stomach, colon, gallbladder, including the uterine cavity, peripheral parts of the skeleton and its various departments, the patency of the fallopian tubes.

Radiography, as one of the cheapest and simplest non-invasive diagnostic methods, is used almost everywhere in modern medicine. An x-ray medical imaging method is a technique by which tissues and organs can be imaged. This is a kind of photographing opaque "objects", or rather their internal structure.

An X-ray examination is prescribed both for diagnosis and for monitoring the dynamics of the quality of treatment. In order for the method to give the most accurate results, it is important to follow certain rules, a kind of technical conditions.

X-ray for an adult

Radiography allows you to determine the position of certain organs, their tone, shape, peristalsis, etc. Both children and adults, regardless of gender, can prescribe such a diagnosis.

X-ray of the spine may be needed if a tumor is suspected, with inflammatory and infectious diseases, as well as degenerative-dystrophic disorders, including osteochondrosis.
Chest X-ray is almost indispensable in the diagnosis of the heart, lungs and airways. Using this method, it is possible to detect various neoplasms, deformations of organs and tissues, inflammatory processes, for example, to detect foreign objects in the respiratory tract.
X-ray of the stomach and duodenum can be prescribed for tumor processes, suspected ulcers, or, for example, gastritis.
Bone x-ray can help detect neoplastic, infectious, and traumatic changes.
X-ray of the nose, or rather the paranasal sinuses, can be prescribed to determine the tumor, to detect the inflammatory process, etc.
An x-ray of the colon will help identify diverticula, obstructions, polyps, etc.

Today, there are many radiation diagnostic methods, and the task of a medical specialist is to select only those options that will be the most informative, painless and minimal in terms of finances. The X-ray method is an excellent way to obtain data on the structure and functions of various organs and systems.

Radiography for a child can be carried out with various devices, specialized and universal equipment is distinguished. Universal devices are most often installed in clinics and sanatoriums. Specialized units are designed for one type of research in a narrow field of medicine. It can be dentistry, mammology, etc.

In pediatric practice, the field of application of radiography is extensive, including urology, orthopedics, and abdominal surgery.

Digital radiography

For the first time, radiography (as a method of medical imaging) was invented back in 1895. This diagnostic method immediately became popular in all developed countries of the world, and already in 1986 the first pictures were taken in Russia.

In 1918, the first hospital was opened, where radiography was the main manipulation. The method has been improved every year and today radiography is considered the most basic way to study the human musculoskeletal system. It is also worth noting lung diagnostics, where radiography is a screening imaging technique.

The modern world of innovations uses the X-ray machine not only in medical practice, but also in forensics and technology. After all, computer diagnostics have replaced classical radiography. Digital radiography has a lot of advantages, it allows you to make more accurate and clear images of tissues and organs, it is convenient to work with it in terms of speed. It is also important to highlight the fact that X-ray results no longer need to be stored on film, which patients lose in most cases. Computer diagnostic results are stored electronically and can be easily moved from the database of one clinic to another.

Digital radiography can be carried out using portable or stationary equipment. The diagnostic unit operates at high speed and can produce up to 200 images in 60 minutes. The equipment consists of a computer, keyboard, display, which are connected to the scanner. And that, in turn, is most often located inside the x-ray machine. Diagnostic beams pass through the organs and tissues of the patient and fall on the plate. Which is instantly scanned. The resulting image is transferred to a computer, thanks to which the diagnostician can study it in detail, print it out on a printer, send it by e-mail, or, for example, save it to a separate disk or memory card. Thus, it is always possible to make a backup copy of the snapshot.

There are also disadvantages in digital radiography. For health, strong X-ray exposure is not desirable. However, the clarity of the picture may deteriorate. To obtain a high quality image, it is desirable to increase the radiation doses. This is the main drawback of this diagnostic.

The informative value of such diagnostics in traumatic brain injuries is negligible. But the method, of course, plays a role in the examination of patients with pituitary neoplasms, skull fractures. The method is often prescribed after birth injuries. With the help of radiography, congenital malformations can be determined.

Carry out diagnostics under the supervision of a specialist. The procedure does not require any specific preparatory manipulations (food restrictions are not needed). During irradiation, it is desirable for the patient to free his head from metal products, you need to remove jewelry, glasses.

When x-raying the skull, the patient is seated in a comfortable chair or laid on a couch. During the diagnosis, it is not advisable for him to move. To prevent the patient from moving his head during X-ray exposure, specialists prefer to use assistive devices and objects. These can be textile bags filled with sand, bandages for fixation, foam pads, etc. Most often, x-rays of the skull are performed in five projections.

With the aforementioned skull diagnosis, the radiologist immediately after the procedure develops the film and checks the results. The specialist will without fail pay attention to the thickness, size and shape of the bones of the skull, evaluate the vascular pattern and cranial sutures. In such a study of the results, age norms will be taken into account.

X-ray of the nose: paranasal sinuses

The paranasal sinuses are located inside the upper jaw. They are air cavities lined with mucous membranes.

The bone walls of the sinuses of the nose can be deformed due to the inflammatory process, mechanical injuries. Changes in the mucous membranes can also be observed, but the sinus cavities are often filled with fluid or dense masses. X-ray of the paranasal sinuses allows you to determine pathological changes in one or both sinuses, to refute or confirm the diagnosis associated with a tumor process or tissue inflammation. Also, such diagnostics helps to identify the exact localization of benign and malignant tumors.

Nasal x-rays are prescribed for acute and chronic sinusitis, mucocele, fractures of the structures that form the paranasal sinuses, etc.

Normally, the paranasal sinuses appear black on x-rays and are radiolucent. Deviations from the norm can be different:

foreign bodies;
liquid;
linear bone defects;
loss of transparency, dark spots;
thickening of the bone walls;
destruction of the walls;
a formation that bulges into the sinus cavity, etc.

As for precautionary measures, radiography of the nose and other organs is not prescribed during the period of gestation. Before the procedure, it is desirable to remove all metal jewelry.

X-ray beams easily penetrate the lung tissue. Any formations, foreign bodies, infiltrates, liquids look like dark areas on the diagnostic results.

Chest X-ray allows you to quickly and accurately detect:

lung diseases that are accompanied by inflammatory processes, such as pneumonia, pleurisy, etc.;
diseases of the heart and mediastinum, or rather heart failure and tumors;
foreign bodies, their shape, size, localization (in the gastrointestinal tract or respiratory tract).

Also, chest x-ray allows you to evaluate the work of the lungs, determine the location of the drainage in the pleural cavity, the catheter in the pulmonary artery, etc.

Radiography of the stomach and small intestine

Diagnosis of the small intestine and stomach using radiography can be prescribed by the attending physician to assess their condition. Carry out the procedure with contrast.

The patient takes orally a barium suspension that passes through the gastrointestinal tract. It is at the moment of movement of barium that the diagnostician observes the peristalsis of the gastrointestinal tract. To fix data on any violations, targeted x-rays are performed.

persistent heartburn and/or diarrhea,
swallowing problems.
vomiting with an admixture of blood.
sudden weight loss.

X-ray examination can determine the motility of the gastrointestinal tract, esophagus, hernia, etc. The procedure is contraindicated in pregnancy, intestinal perforation and obstruction.

It is important to know that barium can cause constipation, so your doctor may recommend laxatives. After the diagnostic procedure, the feces will be discolored, possibly even 2-3 days. Any worrisome symptoms, including pain, bloating, constipation, should be reported to your doctor as soon as possible.

X-rays are also used to examine the duodenum. Relaxation duodenography involves the introduction (through a catheter) of air and a special solution of barium sulfate. A procedure is prescribed when signs of disturbances in the work of the pancreas and directly in the duodenum are detected.

Diagnosis of this kind is not prescribed for pregnant women, as well as patients with glaucoma and severe diseases of the cardiovascular system. Contraindications apply to patients with type 1 diabetes mellitus (prescribe with caution).

Oral cholecystography

X-ray examination is performed using a contrast agent.

Oral cholecystography is prescribed for symptoms that indicate a violation of the patency of the bile ducts. It can be pain in the right hypochondrium, yellowness of the skin, intolerance to fats. The study is prescribed to confirm or refute the preliminary diagnosis associated with gallbladder diseases. With the help of oral cholecystography, stones, tumors and various inflammatory changes can be detected.

This diagnostic method is not very common and doctors increasingly prefer ultrasound and computed tomography. In diseases with a severe clinical picture and pregnancy, oral cholecystography is not prescribed.

Percutaneous transhepatic cholangiography

X-ray diagnosis of the biliary tract using an iodine-containing contrast solution is called percutaneous transhepatic cholangiography. Thanks to such a study, it is possible to establish the cause of pain in the right hypochondrium, determine obstructive jaundice, clarify the level and causes of obstruction in the bile ducts.

The attending physician will tell you about the preparation for the procedure, aftercare and precautions. It is worth noting that this diagnostic method is not performed on patients who are allergic to iodine, pregnant women and people with cholangitis (inflammation in the intra- and extrahepatic biliary tract).

X-ray diagnosis of pathologies of the biliary tract and pancreatic ducts is carried out using a contrast agent, which is injected through the nipple. Doctors recommend such a study for suspected various diseases of the pancreas, as well as for jaundice, the cause of which has not been determined.

With the help of endoscopic retrograde cholangiopancreatography, stones or tumors in the pancreatic ducts and bile ducts can be detected. Such diagnostics are not prescribed during the period of gestation, as well as for infectious lesions, diseases of the lungs and heart. Endoscopic retrograde cholangiopancreatography is not used for obstruction of the duodenum and esophagus.

Angiography of the celiac trunk and mesenteric arteries

Examination of the vessels of the abdominal cavity using radiography involves the use of a contrast agent injected intra-arterially. Thanks to a special diagnostic technique, the doctor can visualize the abdominal vasculature. Step-by-step X-ray images are a great opportunity to study the bloodstream of blood vessels. This research method is indispensable in cases where it is impossible to establish the source of GI bleeding using an endoscope. Also, angiography can be recommended for tumor formations, when ultrasound diagnostics and CT did not give accurate results.

Angiography can also be prescribed for cirrhosis of the liver, and also as a diagnosis, which is performed after abdominal injuries. Using this method, you can visualize the inferior vena cava.

Angiography as a method of radiography allows:

Distinguish a benign tumor from a malignant tumor.
Confirm liver cirrhosis.
Determine the type of damage to the vascular bed in mechanical injuries of the abdomen.
Detect violations in the work of the vascular system of the abdominal cavity.
Identify the source of LC bleeding, etc.

Angiography as a method of radiography is not prescribed for women during the period of gestation. Several factors can affect the result of such a diagnosis, including the patient's mobility during angiography, as well as gases and feces in the intestines.

The condition of urological patients is often diagnosed precisely with the help of x-rays. This method allows you to suspect stones or tumors of a benign and malignant nature, bladder and kidneys.

Plain radiography helps to carry out a differential diagnosis, which allows to exclude gynecological diseases and diseases of the gastrointestinal tract, which often have similar symptoms. But such a study is carried out only in combination with other diagnostic methods, because it is not customary in medical practice to focus only on the results of a survey radiography of the urinary system.

An x-ray of this type will help:

Determine the localization of the kidneys.
Reveal some diseases.
Detect kidney stones.

The quality of radiographic images can be affected by gases in the intestines, overweight of the patient, bulky tumors of the ovaries or uterus.

Radiography: tomography of the kidneys

In modern medicine, tomography makes it possible to obtain layered images of human organs. In the case of the kidneys, this method can be performed separately or in combination with excretory urography. This diagnosis is especially informative in the presence of tumors. Thanks to the tomography of the kidneys, it is possible to identify the size, density, boundaries and localization of the tumor, parenchymal rupture, etc.

This method of radiography is prescribed mainly for men. A contrast agent is injected into the urethra, thanks to which the diagnostician can obtain clear images of all its departments. Retrograde urethrography can detect diverticula and various malformations, detect damage, and even assess the condition of the urethra in the postoperative period.

Doctors warn that after carrying out this diagnostic manipulation, the patient may feel unwell during the day, sometimes the body temperature rises. Allergic reactions to the contrast agent are possible.

Retrograde cystography

With this x-ray diagnosis, a contrast agent is injected directly into the bladder. The study allows you to determine the state of the body and identify the gap. Also, the attending physician may recommend cystography if fistulas, diverticula, cysts, vesicoureteral reflux are suspected. A study is also prescribed for infectious diseases of the bladder.

Retrograde cystography is not performed for acute diseases of the bladder, as well as in cases where a rupture of the urethra is traced or an obstacle is determined in it that simply does not allow the catheter to be inserted.

Retrograde ureteropyelography

The method of radiography in the form of retrograde ureteropyelography allows you to determine the integrity of the upper urinary tract, as well as their anatomical features. At the time of cystoscopy, a catheter is inserted into the ureter, where a contrast agent is injected. The image of the upper urinary tract will help the attending physician to diagnose diseases and disorders that could not be confirmed by excretory urography. The quality of the images can be affected by the presence of gases and feces in the intestines.

Such diagnostics is one of the methods of radiography, which makes it possible to detect violations, or rather, most often to obtain clear images of the urinary tract, especially in the situation when retrograde ureteropyelography and / or cystoscopy cannot be performed against the background of ureteral obstruction. Diagnosis is carried out, starting with a puncture (through the skin), after which a safe contrast agent is injected into the pelvicalyceal system.

It is the puncture stage that allows you to collect urine for laboratory tests, to determine the pressure inside the pelvis. Also antegrade pyelography:

Able to identify the causes that contributed to the blockage of the upper urinary tract. It can be stones, various formations and even blood clots.
Clarify the diagnosis, which was previously made after ultrasound. For example, it can be hydronephrosis.

Distort the results of such x-ray diagnostics (antegrade pyelography) can be accumulations of gases and feces in the intestine. Excessive body weight of the patient can also affect the result.

Excretory or intravenous urography

This study is an excellent way to obtain x-ray images of the bladder, kidney parenchyma, ureters. Urography of the excretory type will help to assess the anatomical features of the organs and the excretory function of the kidneys.

If the amount of contrast medium is insufficient, then this fact may adversely affect the results of the study. The presence of feces and gases in the intestines also plays an important role, which most often leads to poor image quality.

Arteriography of the kidneys

The X-ray method, namely the arteriography of the kidneys, is performed using a contrast agent, which is injected into the artery. At the moment of advancing (filling) the contrast agent, the diagnostician takes several x-rays to obtain the desired images.

Today, thanks to arteriography, a doctor can fully examine the structure of the vascular system of the kidneys, which is often prescribed before surgery. The X-ray method mentioned above will help determine the provoking factors (stenosis, thrombosis, etc.) of renovascular hypertension. Also, such a diagnosis is indispensable for kidney tumors.

This kind of X-ray examination can help to identify hematomas, parenchymal rupture and even kidney infarction in a patient. The results of the study may be affected by the patient's mobility during the procedure, the presence of feces and gases in the intestines, as well as a recent X-ray examination of the gastrointestinal tract with a contrast medium.

Chest X-ray, or rather bronchography (examination of the tracheobronchial tree) is performed after the use of a contrast agent. Fluid is injected into the lumen of the bronchi and trachea. But such radiography is used extremely rarely, because today the more popular method is CT.

Angiopulmonography

Radiography of the pulmonary circulation is called angiopulmonography. A study is carried out after the introduction of a contrast agent into the pulmonary artery. Manipulation may be prescribed in order to detect or exclude thromboembolism. Also, radiography of this type makes it possible to identify pathological disorders in the pulmonary circulation, as well as to determine the location of a large embolus before its surgical removal.

Phlebography

Radiography of the veins of the lower extremities is called phlebography. This procedure is not particularly relevant today due to the increased radiation exposure. Doctors prefer to prescribe Doppler ultrasound as a diagnosis of the condition of the deep veins of the legs.

Irrigoscopy

X-ray of the intestine, or rather the colon with retrograde injection of contrast fluid, is prescribed to assess its condition. This method allows you to find out about the degree of damage, for example, in Crohn's disease or ulcerative colitis, to detect diverticula and various formations. It is irrigoscopy that allows you to evaluate the anatomical and functional features of the colon, its size and location.

If we compare the x-ray of the intestine with, then the first option is safer, rarely leads to injuries and other complications. It is also important to note that the level of radiation during barium enema is minimal compared to CT of the abdominal cavity.

Thanks to the x-ray of the spine, the doctor can get pictures not only of its individual parts, but of the entire column. Such an informative method can be prescribed at any age, and for diagnosing not only fractures, displacements and other deformities, but also for detecting tumors. Images on x-ray images allow visualization of intervertebral relationships, bone density, irregularities, thickenings, etc.

The column of the spine is conditionally divided into five parts. Of course, all vertebrae are of the same type in their structure, but the fact that the articular surfaces, shapes and sizes here have their own differences should be highlighted.

Radiography of the spine is prescribed for the diagnosis of congenital malformations, displacements, fractures. A research method is prescribed to analyze the condition of the spine in its chronic diseases, for example, arthritis.

Densitometry: X-ray of bones

This diagnostic method is an excellent solution for assessing bone mass. This kind of radiography of the bones allows you to establish their mineral density. The results of the study are transmitted to a computer, thanks to which the volumetric density of bones, their thickness and dimensions are calculated. These data help to assess the level of bone resistance to various kinds of mechanical damage.

Densitometry is a good diagnostic solution that can help assess the risks of developing osteoporosis, as well as the effectiveness of therapy, which is primarily aimed at tissue demineralization. X-ray of bones is contraindicated during pregnancy.

Arthrography: radiography of the joints

With the help of radiography, it is possible to diagnose ruptures of the joint capsules, various lesions inside the joints, and to detect synovial cysts. Conduct a study of the joint after the introduction of a contrast agent or/and air into its cavity. With such a diagnosis, as a rule, several pictures are taken.

From an alternative point of view, today X-rays of the joints can be replaced by MRI. It is also important to know that such a diagnostic method is contraindicated during the period of gestation, with exacerbation of arthritis and infectious diseases.

Plan:

1) X-ray studies. The essence of radiological research methods. X-ray examination methods: fluoroscopy, radiography, fluorography, X-ray tomography, computed tomography. Diagnostic value of X-ray studies. The role of the nurse in preparing for X-ray examinations. Rules for preparing the 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 urographin administered intravenously. An X-ray examination of the bronchi (bronchography) is performed after spraying a contrast agent, iodolipol, into the bronchi. X-ray examination of blood vessels (angiography) is carried out using cardiotrast administered intravenously. In some cases, the organ is contrasted with air that is introduced into the surrounding tissue or cavity. For example, during an X-ray examination of the kidneys, when there is a suspicion of a kidney tumor, air is introduced into the perirenal tissue (pneumoren) ; to detect the germination of the tumor walls of the stomach, air is introduced into the abdominal cavity, i.e., the study is carried out under conditions of artificial pneumoperitoneum.

Tomography - layered radiography. In tomography, due to the movement of the X-ray tube during shooting at a certain speed, the film produces a sharp image of only those structures that are located at a certain, predetermined depth. The shadows of organs located at a smaller 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 methods that provide reliable information is CT scan, which allows, thanks to the use of a computer, to differentiate tissues and changes in them that 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-rays of hollow organs using a contrast agent (barium sulfate), which allows you to determine the shape, size, position, mobility of the stomach and duodenum 12, localization of ulcers, tumors, assess the relief of the mucous membrane and the functional state of the stomach ( its evacuation capacity).

Before the study, you must:

1. Instruct the patient according to the following plan:

a) 2-3 days before the study, gas-producing foods (vegetables, fruits, black bread, milk) should be excluded from the diet;

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 and drink, take medications and smoke.

2. In case of persistent constipation, a cleansing enema is given in the evening, on the eve of the examination, as prescribed by the doctor.

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 for the purpose of diagnosing 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 taking a contrast agent. It is necessary to weigh the patient and calculate the dose of the contrast agent.

The patient is instructed according to the following scheme:

a) on the eve of the study, the patient follows a diet without a high fiber content for three days (excluding cabbage, vegetables, wholemeal bread);

b) 14 - 17 hours before the study, the patient takes a contrast agent fractionally (0.5 grams) for an hour every 10 minutes, drinking sweet tea;

c) at 18 oo - a light dinner;

d) in the evening 2 hours before bedtime, if the patient cannot empty the intestines naturally, put a cleansing enema;

e) in the morning on the day of the study, the patient should come to the X-ray room on an empty stomach (do not drink, do not eat, do not smoke, do not take medicinal substances). Take 2 raw eggs with you. Survey pictures are taken in the X-ray room, after which the patient takes a choleretic breakfast (2 raw egg yolks or a sorbitol solution (20 g per glass of boiled water) for a choleretic effect). 20 minutes after taking a choleretic breakfast, a series of overview shots is taken 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. Find out an allergic history (intolerance to iodine preparations). 1 - 2 days before the study, conduct a test for sensitivity to a contrast agent. To do this, 1 ml of a contrast agent, warmed up to t=37-38 o C, is administered intravenously, to monitor the patient's condition. An easier way is to ingest potassium iodide 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 - a non-slag 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, inject intravenously slowly over 10 minutes 20-30 ml of a contrast agent heated to t = 37-38 0 С.

4. The patient is given a series of overview shots.

5. Provide control over the patient's condition within a day 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 respiratory tract, which allows you to obtain a radiographic 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 allows examining the mucous membrane of the trachea, larynx, sampling the contents or washings of the bronchi for bacteriological, cytological and immunological studies, as well as treatment.

1. To exclude idiosyncrasy to yodolipol, 1 tablespoon of this drug is administered orally 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 a bronchography is prescribed for a woman, warn that there is no varnish on the nails, and no lipstick on the lips.

3. On the eve of the evening, 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 the manipulation, premedicate as prescribed by the doctor: inject 1 ml subcutaneously - 0.1% atropine solution and 1 ml 2% promedol solution (make an entry in the medical history and drug log).

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. 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 bloating, then it can be recommended to take chamomile infusion, carbolen or enzyme preparations for three days;

c) on the eve of the study at 15-16 hours the patient receives 30 g of castor oil (in the absence of diarrhea);

d) at 1900 - a light dinner; e) at 2000 and 2100 on the eve of the study, cleansing enemas are performed until the effect of "clean water";

f) in the morning on the day of the study, no later than 2 hours before 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 or take medication. With the help of Esmarch's mug in the office, a nurse introduces an aqueous suspension of barium sulfate.

Preparing the patient for X-ray examination of the kidneys (general view, excretory urography).

1. Conduct a briefing on preparing the patient for the study:

Exclude gas-forming foods (vegetables, fruits, dairy, yeast-like products, black bread, fruit juices) from the diet for 3 days before the study.

Take activated charcoal for flatulence as directed by your doctor.

Exclude food intake 18-20 hours before the study.

2. The night before at about 2200 hours and in the morning 1.5-2 hours before the examination, put cleansing enemas

3. Invite the patient to empty the bladder immediately before the study.

In the radiology room, a radiologist takes an overview of the abdominal cavity. The nurse performs a slow (within 5-8 minutes), constantly monitoring the patient's well-being, the introduction of a contrast agent. The radiologist takes a series of images.