Is it possible to do MRI, X-ray and CT on the same day: features of combining procedures. What is the difference between fluorography and x-ray: description of procedures, effectiveness and reviews What is better fluorography or computed tomography

Pathology studies using x-rays are very popular and occupy a leading position in the list of diagnostics. CT of the lungs and fluorography are no exception.

These are modern diagnostic methods based on x-rays that pass through the human body and collect information about the condition of the lungs.

Differences between CT and fluorography

Image projection

The main difference between CT and fluorography is the types of images obtained after the examination. Fluorography provides flat images of the area being examined. During computed tomography, tomography sensors make slices no more than 0.2-0.8 mm thick, which are later converted into three-dimensional images using a specialized program.

Thanks to this, the radiologist, who deciphers the results of the examination, has the opportunity to examine the lungs from different angles and scales, and diagnose pathology at any stage;

Radiation dose

Despite the fact that the patient receives a certain dose of radiation during diagnostics, they are completely safe, since they do not exceed the permissible norm per year. With fluorography, the patient receives 0.5 mSv, and 10 mSv after CT;

Duration

It will take an average of 20 minutes to examine the lungs in computed tomography without the introduction of a contrast agent, and with contrast it will take 10-20 minutes longer. A maximum of 3 minutes is spent on fluorography;

Price

There is a big difference in cost: in Moscow, CT costs an average of 3,500 to 4,500 rubles, fluorography of the lungs in one projection - 200 rubles, in two projections - 400 rubles;

Image clarity

In fluorography, the least clarity of images, since the procedure is more preventive. Based on them, it will not be possible to make a final and accurate diagnosis, but they are enough to get a referral, for example, to a CT scan. In computed tomography, images are of exceptionally high definition, which makes it possible to provide only reliable information in the shortest possible time.

Which examination method to choose?

If there are no complaints about the respiratory organs, then there is no point in undergoing a CT scan right away. Initially, you can go through a fluorography. Due to the fact that it is more of a preventive type of examination, there is no need to obtain a referral from a doctor. It can be done 4-5 times a year if necessary.

If there are suspicions of the presence of pathologies, after fluorography, a CT scan of the lungs should be performed, which will provide all the information about the lungs, confirm or refute the diagnosis.

But there is no point in undergoing fluorography after computed tomography, since the possibilities of research are limited.

AT 1895 In 1998, the German scientist Wilhelm Roentgen discovered a type of radiation previously unknown to science, later named X-ray after the discoverer.

Subsequently, on the basis of this radiation, several methods were born. diagnostics used in medicine to this day.

Fluorographic study

Fluorography is a rather old method, the basics of which were developed almost simultaneously with the discovery of X-rays themselves. Italian scientists are considered the "parents" of this procedure. A. Battelli, A. Carbasso and American J. M. Blair.

X-rays, passing through the human body, weaken to varying degrees, depending on the density of organs and tissues. They leave a trace on a fluorescent screen, which is photographed and converted into a visible image. The size of such a photograph is small: small-frame fluorography - 24x24 mm or 35x35 mm, large frame - 70x70 mm or 100x100 mm.

What is the difference between digital fluorography

Recently, film photography technologies have been replaced everywhere by digital research of organs, and this innovation has not bypassed medicine.

Digital fluorography is also of two types. In the first case, it differs from film only in that the X-ray film changes on the fluorescent screen to special matrix.

In the second case, the study is similar to a scanner, when a beam of rays penetrates the body and is fixed by a detector (in office scanners, such a device moves along the sheet).

The second method of research gives more lesser irradiation, but this procedure takes a little longer, although it is safer.

Fluorography is used:

for the purpose of preventive research;
at various diseases lungs (tuberculosis, pneumonia and other bacterial and fungal infections);
at foreign bodies in the lungs;
at pneumosclerosis;
at pneumothorax(the presence of air in the pleural cavity between the lung and the chest wall, usually caused by trauma).

How does it go

Fluorography requires almost no preliminary preparation, it is carried out quickly and does not take more 5 minutes. The patient enters a special room, undresses to the waist, then approaches the apparatus, presses his chest against the plate so that his shoulders touched with the screen, and the chin lay in a certain place.

Photo 1. During fluorography, the patient presses his chest against the plate and holds his breath, the doctor will take a picture at this moment.

The doctor controls the correct posture, then leaves the room, asks the subject hold the breath and takes a picture. This completes the fluorography procedure, you can get dressed.

Important! It is necessary to remove everything from the chest metal objects: due to their reflectivity, the fluorographic image will be blurry (usually doctors recommend holding a cross or pendant with your lips), and women should collect long hair in a high bun.

X-ray of the lungs: what is the difference

Radiography, in fact, differs little from fluorography: the radiation, passing through the internal organs of a person, is projected onto special paper or film. In other words, the difference is that the rays are absorbed by tissues, bones and organs, creating an image of organs of varying intensity.

The fundamental difference from fluorography is more image size, and permission its better. Fluorography gives a very rough idea of the problems in the organs, if you need to get more accurate data, x-rays are prescribed.

Penetrating the body through radiation, the X-ray machine produces an image in full size. The dose of radiation in an X-ray study is approximately 0.26 mSv.

Recently, film technologies in X-rays are also being replaced by digital ones, which provide more informative images and less exposure ( up to 0.03 mSv).

When are x-rays taken?

A couple of decades ago, X-rays were used everywhere, gradually they were replaced by safer methods like Ultrasound, MRI and CT, but there are areas in which radiography is still relevant:

in the study spine and joints, especially with injuries;
during examination mammary glands;
during examination lungs;
to take pictures teeth;
to take pictures ENT organs(for example, sinuses with sinusitis);
with obstruction and suspicion of foreign objects in the stomach or intestines.

How is a chest exam done?

X-ray examination is probably familiar to every inhabitant of our country, it does not require special preparation in most cases. It is carried out sitting, lying or standing, depending on which organ is being examined, other parts of the body can be covered with a special protective apron. It is forbidden to move during the x-ray. The healthcare worker either leaves the room during the examination or puts on some kind of protective clothing for safety reasons.

Important! Talk to your doctor about preparing for x-rays. When examining organs gastrointestinal tract, for example, you need eliminate from the diet foods that cause high flatulence so as not to get a questionable result due to the accumulation of gas bubbles.

The main sign of the correct position of the patient is the placement of the photographed part of the body as close as possible to the cassette: if the x-ray is blurry, it may need to be repeated.

Computed tomography (CT): difference

Computed tomography also refers to x-ray studies.

This research method is based on the principle layered scanning, that is, X-rays pass through the human body from different angles, then they are attenuated in the tissues and organs of the body, and at the exit they are recorded by detectors.

The information received in different projections is processed by the computer, forming three-dimensional An image that allows you to study the desired organ in detail is the main advantage of CT over other radiography methods.

Computed tomography is a relatively recent invention, its development refers to 1972 year, its creators G. Hounsfield and A. Kormak later receive the Nobel Prize. The newest research method is also the most expensive; it requires the most powerful tomographs with sophisticated software.

In what cases is it used

The range of use of computed tomography is quite wide - almost all organs in certain cases can be examined on a tomograph. Recently, computed tomography, along with the newer method - MRI, has become of particular importance for the study of diseases. spine, intervertebral discs and nearby tissues.

How does it go

The MSCT procedure is very often performed with the introduction contrast, that is, a special liquid (often iodine-containing), which improves the contrast of the organs in the picture in relation to each other. When examining the gastrointestinal tract, you can take the contrast orally, that is, drink it. The second option - intravenous administration - for vessels, circulatory system, etc.

Photo 2. Magnetic resonance imaging SOMATOM Definition Edge, manufacturer - Siemens, is used for computed tomography.

For the procedure of computed tomography, the patient undresses, lies down on a special table, fastens with belts, then the table begins to move into the circle of the tomograph, at the same time tilting slightly horizontally. It is important to remain still so that the images are clear. A health worker monitors the process from an adjacent room, he may also ask you not to breathe for a while. The study takes an average 30 minutes.

Important! Don't forget to take everything off metal things, they will distort the result of the picture.

How often can research be done?

In our country, fluorography is carried out annually to the entire adult population over 15 years old for the diagnosis of tuberculosis. Why is the age of 15 years and the term once a year set? The fact is that fluorography, like any x-ray examination, exposes the body to radiation with a dose of 0.6-0.8 mSv. For the same reason, the method is not used for studies of other organs. Digital fluorography allows you to reduce the radiation dose to 0.05 mSv.

Sometimes an X-ray examination is prescribed for people from risk groups (suspected tumors, blackouts in the lungs, contact with patients with tuberculosis), in such cases it is allowed to carry out the procedure more often, usually once every 6 months.

All kinds of x-rays should not be used if there is alternative. But if there is a suspicion of a particular disease, it is better not to refuse the procedure, because if the diagnosis is confirmed, the treatment of the disease that has not been started on time will obviously cause you more damage than a small dose of radiation from the procedure.

For example, in the treatment of oncological diseases, patients often have to resort to computed tomography. several times a year. Everything is individual, the main thing is that the expected benefit of the study is higher than the possible harm.

Can research be done at the same time?

Simultaneity should be understood as carrying out all three research in 1 day. Such a need is rare, but if it happens, simultaneity will not affect the result in any way. The main thing is not to exceed total annual dose of radiation.

Reference! Permissible total exposure in annual terms in Russia is taken equal to 1.4 mSv, in the UK it equals − 0.3 mSv, in Japan - 0.8 mSv, in the USA - 0.4 mSv.

Contraindications for radiography and tomography

pregnant women, especially in the first trimester;
at severe the patient's condition;
in the presence of open bleeding and pneumothorax.

The ban on contrast tomography is associated with the need to remove the substance from the body, therefore, contrast CT is not done to people:

With renal insufficiency;
with severe form diabetes;
With active form of tuberculosis.

It is possible to do a contrast CT scan for lactating women, with the proviso that feeding will have to be interrupted for two days until the substance is out of the body.

Children's age is not an absolute contraindication for radiography, you just need to be careful, perform studies only when necessary and take into account the total amount of radiation.

Photo 3. During pregnancy, you can take an x-ray of your teeth: for this, a special apron is put on the woman, which will protect both the patient and the fetus from radiation.

If a woman needs an x-ray during pregnancy tooth, then it is possible, but with certain precautions. So, the stomach, pelvis and chest will be closed with a special apron, which will protect the baby from radiation during the procedure. With regard to head and neck irradiation, studies have shown that it does not have a significant effect on the fetus.

Is it the same or is there a difference?

It is obvious that the fluorographic study that we do every year is a less accurate and effective method. Why do more accurate X-rays and CT only perform confirmatory functions?

The fact is that an X-ray examination costs approximately 6 times more expensive fluorography (let alone computed tomography), so this decision is usually made for economic reasons. However, this is not a cause for concern, since for preventive purposes, for the diagnosis of tuberculosis, fluorography is quite 0 out of 5 is enough.
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Features of modern methods of radiation diagnostics, their impact on the human body, as well as why women should not ignore mammology, Daria Lepikhina, candidate of medical sciences, CT and MRI doctor, told the correspondent of the special project "Life without barriers".

— Tell us, what methods of radiation diagnostics are currently used in Russian medicine?

- Radiation diagnostics includes x-rays, computed tomography (CT), magnetic resonance imaging (MRI) and, in most clinics, ultrasound examinations. Now, patients are more likely to be prescribed positron emission tomography combined with computed tomography (PET CT). It is used to estimate the prevalence of a cancer or the "response" of a tumor to treatment. For example, a primary tumor has been detected somewhere: it is necessary to assess its size, the degree of penetration into adjacent organs and its spread throughout the body. Labeled radioisotopes, atoms that are distributed in tissues, accumulate where there is activity of cancer cells, and "highlight" them, literally show them visually.

However, PET CT is located in specialized institutions where patients are sent according to strict indications. Just like the primary method of examination, it is not used.

— Can these methods replace each other?

— PET CT and CT are X-ray methods, MRI is based on a magnetic field and electromagnetic radiation. Hence the different algorithms for the procedures. Externally, the devices are similar, but they work differently.

Each method has its indications. Usually CT is used for clarifying diagnosis. Let's say that some changes in the lungs were found on fluorography. Then the patient will be sent for a CT scan of the chest to clarify what these changes are and how widespread they are. Or, after an ultrasound detects a liver mass, the doctor will prescribe a CT scan with contrast.

As for MRI, it is better to use it to detect diseases of the brain and spinal cord, joints, various processes in the organs of the abdominal cavity and pelvis. Both CT and MRI examine the cardiovascular system (you can see the degree of narrowing of the arteries of the heart in atherosclerosis, recognize blood clots in the vessels in time, and detect heart defects). The appointment of one or another type of tomography directly depends on the clinical task, there are urgent (according to urgent indications), planned studies.

February 15 is the International Day of Children with Cancer. The head of the Department of Chemotherapy and Bone Marrow Transplantation of the Cancer Research Center named after M.V. N.N. Blokhin, Professor Georgy Mentkevich.

As a rule, ultrasound, radiography, fluorography, mammography have already been performed before CT and MRI, which successfully work as screening. Unfortunately, often people delay contacting doctors with a disturbing illness or do not undergo medical examinations on time. Separately, I note that the information content of screening methods is high, and I strongly recommend that all women over 39 years of age do mammography.

Do not be afraid of radiation

- They say that these methods have a negative impact on the human body, in particular the effects of radiation. Is it so?

- Of course, all instrumental diagnostic methods, including radiography, CT, MRI and ultrasound, have an impact on the body. The patient receives a small dose of X-ray radiation on modern devices. Thanks to digital X-ray technology, the share of radiation exposure is significantly less than 20 years ago. Each exposure to a patient is documented so that physicians and patients can control the dose of radiation received from x-rays. Diagnosticians are legally required to do so. The radiation dose depends on the anatomical area to be examined. If it is the head, then due to the fact that there are more dense bones, the x-ray beam will be more powerful than for the chest. There is a lot of air in the lungs, through which the particles "fly freely" during X-ray radiation.

Radiation safety doctors have determined the permissible dose of X-ray exposure for ordinary people who do not work with X-ray units - 1 millisievert per year, but in case of clinical necessity, this level can be exceeded. For employees of x-ray departments, the annual dose is higher - 5 millisieverts. For comparison, the average value of the dose received by the patient after chest X-ray is 0.1-0.4 mSv, brain CT - 3-5 mSv, mammography - 0.2-0.4 mSv.

They used to say that one CT is a day spent on a beach in Egypt.

There is no x-ray radiation on MRI, and the effect of electromagnetic radiation is recognized by scientists as safe.

What to fear

— Why did you focus on mammology?

- The diagnosis of breast / breast cancer is not so easy to establish. Sometimes this tumor is very small and malignant. In order to recognize it in time, you need to do a mammogram in a timely manner, follow the recommendations of mammologists. Until the age of 39, as a rule, the gland is examined by ultrasound, there are exceptions - for example, before plastic surgery for young patients. Of course, if there are complaints or clinical data suspicious of oncology, the doctor may prescribe mammography for young patients even before performing an ultrasound scan.

As screening, mammography is performed for all women starting from the age of 39 every two years. Depending on the results, further actions are determined: if the norm is fixed on mammograms, including age-related, functional variations, the next control is in two years. To assess the degree of danger of the identified changes in terms of the development of malignant tumors, radiologists mammologists use a generally accepted scale in their work, where the numbers reflect the degree of risk of cancer detection - from 0 to 5. Depending on what the radiologist determines, the tactics of patient observation will be chosen. It is optimal if there are two medical signatures in the conclusion of the mammography protocol, indicating the objective opinion of two specialists. Yes, and it is very important to compare mammograms over time. Bring previous examinations to the radiologists or indicate that they may be in the archives of the clinic where you are observed.

The main problem is that women do not come, despite the fact that there is medical examination. A lot of money is allocated for it. The offices are already open from 8 to 20, and the appointment has been canceled for this study, in a word, they did everything to make the process of getting to the radiologist as simple as possible. Unfortunately, women still come only when something is already sick or they themselves have found some visible changes. This is one of the reasons for the high mortality from breast cancer.

Sometimes different symptoms can appear in young girls. Do not be shy, in this case, you should immediately contact the clinic at the place of residence, where no one has the right to refuse an examination.

How to get diagnosed

— Please tell us how an ordinary patient can have an MRI or CT scan? Do I need special preparation before the examination?

- All diagnostic studies are prescribed by the attending physicians. If there are clinical indications, any doctor - therapist, surgeon, neurologist, urologist, gynecologist, otolaryngologist or other - directs to X-ray diagnostics, ultrasound, CT or MRI. If deviations are found after screening methods, for example, an unclear picture of the fluorogram or inconsistency of the x-ray findings with the clinical picture, the patient will be sent for additional examination.

As an example: a young patient at the appointment of a neurologist complains of a loss of vision, persistent headache, dizziness. If the doctor after the examination has a suspicion of multiple sclerosis, without any preliminary research, the neurologist immediately sends for an MRI of the brain. The waiting time for a study in Moscow clinics depends on various factors, but usually does not exceed 10 days. Another example: ultrasound revealed single or multiple foci of the liver - to identify the nature of the formations, the doctor will refer you to CT scan with contrast.

As a rule, no special preparation is required. For contrast techniques, preliminary blood tests are required to rule out kidney disease and assess the risk of complications from the introduction of contrast. For CT colonoscopy (a non-invasive analogue of fibrocolonoscopy is a wonderful method, well tolerated by patients), you need to prepare a day in advance.

— How popular and accessible are these studies today?

- Just like conventional X-ray methods, CT and MRI have become available in Moscow in district clinics. Of course, these are highly informative, easy-to-practice methods that help to determine the underlying disease even before hospitalization of patients or to treat at the site of attachment. In addition, CT can also be used as screening, for example, for the early diagnosis of lung cancer. Such studies are performed with reduced radiation exposure (low-dose CT) for patients at risk (smokers over 50 years of age).

Usually therapists rarely give such referrals, which is surprising.

As a rule, they are sent for fluorography - a good method for screening active forms of tuberculosis, but very limited in diagnosing early stages of cancer.

Fluorography in Russia is widely used to detect tuberculosis as an inexpensive method.

Often patients come to CT who say that they have recently been on fluorography and nothing was revealed there, but because of the clinical manifestations, the doctor reasonably prescribes this study. Many of them have various diseases, including tumors.

— Are there any contraindications for CT or MRI?

— CT is contraindicated in pregnant women. On MRI, pregnant women can be examined when the benefits of the study outweigh the potential risks. Patients with a pacemaker MRI should not be done.

A relative contraindication is claustrophobia, because sometimes the patient turns green, he becomes ill, his heart rate is very fast, he becomes so ill that he will not come here for a kilometer more. And there are those who calm down, take a breath, take a walk and already tune in - lie down for an MRI.

Interviewed by Konstantin Ermolaev

CT and fluorography use X-rays to produce images of human organs and tissues. X-rays pass through human organs, soft tissues and bones in different ways. This makes it possible to use them as a diagnostic method to obtain a display of the internal organs and bones of the skeleton on a film or screen. This principle is used in CT, fluorography and radiography.

The difference between CT and fluorography is that fluorography gives a flat image of all the structures through which ionizing beams pass, while CT takes pictures of thin sections of the human body. Then, using special software, they are combined together, which allows you to get a three-dimensional image that can be studied in different planes.

Fluorography is used for mass preventive examinations of the population, and CT, as a diagnostic method, to clarify the diagnosis, carry out diagnostic or therapeutic procedures.

Both methods are unsafe, because the patient receives a certain dose of radiation during the examination. With CT of the chest, it is 10 mSm, and with fluorography, 0.5 mSv.

Studies show that irradiation in this volume very rarely causes cell mutations or oncological degeneration, but there is still a limitation for the use of these diagnostic methods.

What can CT or fluorography show

CT or fluorography can help diagnose a number of chest diseases, and computed tomography can be used to examine other parts of the body (brain, joints, abdominal and pelvic organs, spine, and others).

Fluorography is done to determine the diseases of the organs of the chest cavity. These include

diseases of the lungs and bronchi (pneumonia, tuberculosis, pleurisy, abscesses);
injuries (pneumothorax, fractures of the ribs, sternum);
neoplasms in the lung tissue, bronchi, mediastinum or mammary glands (benign or malignant tumors, cysts, echinococcus).

Fluorographic images are small, so it is difficult to identify small formations on them, but if a pathological process is suspected, CT or X-rays are prescribed after fluorography.

Unlike fluorography, CT allows you to detect and study formations of small sizes, as well as to diagnose the vascular bed. For this, an iodine-containing contrast is introduced. The capabilities of CT are much higher than those of fluorography, but the level of radiation is also relatively high. The cost of computed tomography also differs significantly, it is more expensive.

If we compare what is better than CT or fluorography, for an accurate diagnosis, CT is a more informative examination, although it has its drawbacks and contraindications.