X-Ray

this presentation includes the basic information about the uses of x-ray in medical field.

1. X-RAY - Aurodeep Dasgupta B.P.T. 4 th Year B.I.M.L.S. Burdwan

2. INTRODUCTION X-radiations (or x-rays) is a form of electromagnetic radiations. Most x-rays have a wavelength of 0.01-10 nanometeres , corresponding frequencies in the range of 30 petahertz (3X10¹⁶ Hz) to 30 exahertz (3*X10¹⁹Hz) and energies in the range of 100eV to 100 keV . It was invented by a German physicist Wilhelm Röntgen in 1895. He named it X-Radiations to signify an unknown type of radiation. It is an important diagnostic tool for medical conditions like bone fractures, pulmonary tuberculosis, etc.

3. Discoverer of X-Radiations-

4. World’s first X-Ray image The first x-ray image obtained was of the hands of Wilhelm Rontgen’s wife, taken on 22 nd December,1895.

5. Properties- X-Ray photons carry enough energy to ionize atoms and disrupt the molecular bonds. This makes it a type of ionizing radiation. This ionizing property is used to kill the malignant cells by radiotherapy. It is absorbed by solid/radio-opaque substances like bones & metals.

6. Interaction with Matter- X-rays interact with matter in three main ways, through photo-absorption, Compton scattering, and Rayleigh scattering. The strength of these interactions depend on the energy of the X-Rays and the elemental composition of the material, but not much on chemical properties since the X-Ray photon energy is much higher than chemical binding energies. Photo-absorption or photoelectric absorption is the dominant interaction mechanism in the soft X-ray regime and for the lower hard X-ray energies. At higher energies, Compton scattering dominates.

7. Uses- Based on the energy of the radiations, x-rays have wide range of uses like in the medical field, industrial work places, security purposes etc. Used in X-Ray scanners. X-Ray crystallography. Industrial radiography and CT scanning. X-Rays has an immense role in the medical field – diagnostic as well as therapeutic.

8. Uses(cont.)- Diagnostic Uses- X-ray is the most preferred tool for detecting any bone related problem, such as fracture, tumor, degenerations. It is also used detect other cases like pulmonary tuberculosis, lung abcess , etc. Therapeutic Uses- It is used in cancer treatment to kill malignant cells.

9. Standard X-Ray machine-

10. Cont.-

11. Cont.-

12. Radiation Monitor-

13. Radiation monitor(cont.)- It is a device that let us have an eye on the amount of exposure of X-radiations to the technician, thus enabling us to reduce the hazardous effect of the radiation on the human tissues.

14. Role of X-Ray: Helps confirm the clinical diagnosis. Helps study the fracture anatomy. Helps study the fracture displacement. Helps to detect crack and stress fractures. Helps to plan the treatment. Helps to detect fracture dislocation combination, e.g. Monteggia fracture. Helps to ascertain post-reduction status of fractures. Helps in medico legal studies.

15. Asking for an X-Ray: Before asking for an x-ray, the following points should be kept in mind- Both, AP and lateral views should be taken in most of the cases. Special views in some cases show the fracture better. X-ray requisition must specify the area of suspension. X-ray of the pelvis with both hips should be asked for in all cases of suspected pelvic injury. For an x-ray evaluation of the hands and feet, antero -lateral and oblique views (not lateral) are required.

16. Points to Remember or Rules in X-Ray: Better no X-Ray than one view X-Ray. X-Ray is a shadow, it conceals and distorts. Hence interpret X-Ray with caution. A joint above and joint below should be included with the fracture under study. The fracture should in the middle of the film. Exposure should be adequate and the soft tissue shadow be delineated properly. X-Ray should be read by holding the film in an anatomical position. Avoid unnecessary X-Rays. Check X-Rays are to be taken without disturbing the plaster cast.

17. Patient Preparation:- Most of the time, the body part that is to be seen under X-Ray is to be exposed properly, i.e. the cloth over it should be removed. Any accessory or jewellery on the focused part should be removed. Patient needs to be calm and maintain the posture which is instructed to him/her. Patient needs to follow the given instructions strictly.

18. Some Normal Views:- Antero-posterior view: The X-Ray beam is exposed from the anterior side of the body part. The beam casts a shadow on the X-Ray plate that is kept behind the body part.

19. Lateral view: The X-Ray beam is exposed from the lateral aspect of the body part.

20. Oblique View: In this view, the X-Ray beam is exposed from a plane which is oblique to the body part on which the X-Ray beam is focused.

21. Some Special Views: Oblique view wrist is done to detect Scaphoid fracture . The X-Ray beam is given in a plain perpendicular to a plain which is slightly slanting.

22. Special views(cont.): Judet view to detect Acetabular fracture . It is a modification of oblique view of the hip. Here the patient’s trunk is rotated to contra-lateral side in relation to the hip whose image is being taken.

23. Special views(cont.): Merchant view is done for patello -femoral joint. It is taken is such a way that only the image of the patella is obtained. The procedure is given the pictures below.

24. Special view(cont.): Skyline view for Calcaneum fracture . It is taken by the same principle as the Merchant view of patella. The X-Ray beam is directed obliquely , so that it only casts a shadow of calcaneum on the film.

25. Special views(cont.): ‘Y’ view for scapula . It is taken perpendicularly to scapular plain from the lateral aspect. The X-Ray image looks like the one given below.

26. Special Views(cont.)- Dunn view is an antero -posterior view of the hip with the patient supine and the hips and knees flexed at 90˚, the legs abducted 15˚ -20˚, and the femur in the neutral rotation.

27. Special Views(cont.)- Modified Dunn view is the slight modification of the Dunn view, where the hip is flexed to 45˚. Dunn view and modified Dunn view is mainly to see the asphericity of the femoral head, which is the cause of premature arthritis.

28. Special Views(cont.)- Cross table lateral view is the lateral projection radiography of a supine subject using a horizontal X-Ray beam. Mainly used to detect neonatal pneumo -thorax, hair-line fracture in the neck of the femur.

29. Reading an X-Ray: An x-ray view box should be used in all cases. If a fracture is obvious, one must make note of the following points- Which bone is affected? Which part of the bone is affected? E.g., shaft etc. At what level is the fracture? i.e., whether the fracture is in the upper, middle, or lower third. What is the pattern of the fracture? Is the fracture displaced? Is the fracture extended to nearby joints? Does the underlying bone appear pathological? E.g., a cyst, abnormal texture of the whole bone, etc. Is it a fresh or an old fracture?

30. Some sample X-Ray plates: Shaft ulna fracture

31. Osteo -arthritis knee

32. Crush injury of left foot

33. Scoliosis

34. Thoracic kyphosis

35. Postero -lateral subluxation of knee

36. Lobectomy

37. Callous formed at fracture site

38. Fracture both bone of forearm

39. Adverse effects- Diagnostic X-Rays increase the risk of developmental problems and cancer in those exposed cells. X-Rays are classified as a carcinogen by both World Health Organisation’s International Agency for Research on Cancer and the U.S. government. It is estimated that 0.4% of current cancer cases in the United States are due to diagnostic X-Rays and CT Scans. That’s why when it comes to perform an X-Ray on a pregnant woman, proper assessment of benefit versus risk is done.

40. References: Essential Orthopaedics wikipedia wikiRadiography

41. Thank You