X-ray examination, x-ray image, radiograph, x-ray

X-rays

X-rays are electromagnetic rays that are able to influence the matter they pass through. The reason for this is the fact that X-rays have ionizing properties. This means that they are able to remove electrons (negatively charged particles) from atoms or molecules.

As a result, positively charged particles are created. If X-rays hit human tissue during X-raying, cells of the living organism can be permanently damaged. The X-rays emitted during X-rays mainly affect the genome of the affected cells.

By releasing individual electrons, for example, the structure of the base pairs contained in the DNA is changed. In most cases, the organism is able to repair the damage caused by the X-rays by acting on the natural DNA repair system. However, with a correspondingly high radiation dose, such DNA changes can occur to such a high degree that a proper repair is no longer possible.

Indication

In Germany, the X-ray Ordinance and the Radiation Protection Ordinance regulate, among other things, the medical use of X-rays on humans. According to these regulations, X-rays may only be taken if a so-called justifying indication (indication of treatment) has been given. This means that the health benefit of an X-ray image must outweigh the damage caused by the radiation.

This is almost always the case, given the low radiation doses used in today’s X-ray machines and the information content of a fluoroscopy. However, if equivalent methods with lower radiation exposure are available, these must be taken into account. The justifying indication may only be given by experienced physicians with the appropriate expertise, if they are able to treat the patient personally on site.

However, non-expert doctors may also prescribe an X-ray examination. In this case, the performing radiologist assumes responsibility and, if he or she does not see the benefit of the treatment, may refuse the examination. If a doctor makes a justifying indication without the necessary prerequisites, this can constitute bodily injury.

In a clinic, the radiation protection officer is liable for compliance with the law, in a sanatorium organized as an AG or GmbH, the managing director is liable. Fines will be imposed for non-compliance. In practice, the problem arises that even inexperienced assistants without the necessary specialist knowledge must make indications for an X-ray examination.

This happens, for example, on weekends when there is no specialist in the house and strictly speaking, it violates the law. The radiological diagnostics, i.e. without the use of contrast agents, is mainly used for questions concerning the skeleton. It is the most meaningful method here and involves comparatively little radiation exposure.

On the one hand, it is used to detect changes in the bones caused by injuries: On the other hand, bone changes due to inflammatory processes (osteomyelitis), metabolic diseases (malposition of the fingers in gout), tumors or degenerative diseases (arthrosis) can be detected and their course monitored. In addition, the assessment of congenital malformations is an indication for an X-ray examination. A further area of application of natividiagnostics is the radiography of the thorax.

X-rays are a reliable diagnostic tool here because they show the contrast between air and water well. One indication is the external violent impact on the thorax: X-rays provide information about rib fractures and tears in the lung fur, through which the lung collapses. Air, water accumulation and changes in tissue can be detected in the lungs.

For example, an x-ray is indicated if there is a suspicion of pneumonia, tuberculosis, proliferation of connective tissue, an airless section or effusion. Heart diseases can also be detected and specified by an X-ray: The extent of the individual heart chambers in the X-ray image allows conclusions to be drawn about the underlying disease. In the abdominal area, the various organs differ little in their water content.

Consequently, the contrast of an X-ray image is poor. Other imaging techniques, e.g.B. Ultrasound or tomographic procedures, are superior.

However, there is an indication for acute abdominal pain (life-threatening abdominal pain). Air or water retention and calcifications can be detected. X-rays are also used diagnostically for stone detection in the urinary tract.

Mammography (X-ray imaging of the breasts) benefits from a very good resolution. Certain details (microcalcifications) can only be detected in X-rays. An indication is therefore the suspicion (by palpation or external changes) of tumorous growth or the control of e.g. genetically preloaded risk groups.

If the X-ray is combined with the administration of contrast medium, it can also be used for further questions. In the gastrointestinal tract, organ displacements, positional anomalies, and tumorous and inflammatory processes can be detected and their course monitored. The diagnosis of the small intestine is particularly important, as it is difficult to reach with a camera.

However, the administration of contrast medium always carries the risk of significant complications and side effects. As a result, the field of application of X-rays is increasingly being pushed back by the new procedures – CT, MRT, ultrasound. It is only indicated in cases where there is (still) no alternative or where the issue could not be conclusively clarified with other procedures.

These include catheterartheriography (imaging of the aorta by inserting a catheter) in the case of arterial occlusive disease, phlebography (imaging of veins by injecting contrast medium) in the limbs in the event of suspected thrombosis, and functional or structural examination of the urinary drainage pathways (by injecting or taking contrast medium) in the event of suspected urinary reflux, stress incontinence or transfers. An advantage of X-rays over sectional imaging procedures is still that images can also be taken during movement (esophagus when swallowing, ureter when urinating) (dynamic X-ray examination or fluoroscopy).

  • Broken bones,
  • Dislocations,
  • Torn ligaments.

The classic X-ray image:There are different X-ray applications.

By far the most common application is the classic X-ray image. Indications for use in orthopedics are questions concerning the bony holding apparatus. An x-ray image can provide many information about the condition of bones and joints.

In particular, the X-ray image is helpful when it comes to questions of bone fractures and arthrosis of the joints. However, the informative value of the X-ray examination is also limited. The cartilage can only be assessed indirectly.

Soft tissue structures are generally not shown. X-ray fluoroscopy:In addition to the classic X-ray image, there is also X-ray fluoroscopy. X-ray fluoroscopy is used in orthopedics especially when the bone is to be assessed in its three-dimensional sonality.

This is especially the case in surgery, e.g. when assessing fracture lines. In fluoroscopy, less X-rays are used and then projected onto a monitor via an amplifier so that the result is directly visible. In general, fast X-ray pulses are emitted instead of being permanently fluoroscoped.

This allows the amount of radiation to be reduced. Depending on the fluoroscopy time, fluoroscopy is more radiation-intensive than an X-ray image. Computed tomography:Computed tomography (CT) is a special examination that has developed from X-ray examination.

We have dedicated a separate chapter to this topic. Contrast media:X-ray contrast media are liquids that cannot be penetrated by X-rays. The consequence is that the image contrast increases.

Contrast media are used in special cases of herniated discs, disc diseases and often in the search for bone tumors, sometimes in combination with computed tomography. X-rays are so-called ionizing radiation. Ionizing radiation damages the genetic material (DNA).

Due to the natural radiation we are exposed to ionizing rays every day. The harmfulness of X-rays depends mainly on the localization of the applied X-rays. Hands and feet are comparatively insensitive to radiation, while images of internal organs are more radiation-intensive.

In each case, the risks and benefits of a diagnostic procedure are carefully weighed up.Especially in the case of existing pregnancy, the indication for X-ray examination should be checked carefully. In summary, the radiation risk of X-ray examinations is usually overestimated. One should compare the low radiation exposure with the risk of an overlooked disease.

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