X ray

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1. X RAY Dr Nisar Ahmed Arain Assistant professor Anesthesia/Critical Care/ER

2. -DISCOVERER OF X RADIATIONS -Wilhelm Rontgen

3. -WORLD’S FIRST X RAY IMAGE Worlds first x ray image obtained was of the Hands of Wilhelm Rontgen’s wife on 22 nd December 1895 The first x ray Photograph: Roentgen’s Wife “Bertha’s Hand” --Hand mit Ringen (Hand with rings) print of Wilhelm Roentgen’s First Medical x ray of his Wife’s hand taken on 22 nd December 1895 and Presented to “Ludwig Zehnder” of physic Institute, “University of Freiberg” on 1 st January 1896

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

5. -A simplified diagram of a water cooled X Ray tube - PROPERTIES contd.

6. ---The 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 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 -INTER ACTION WITH MATTER

7. --1-Based on the energy of the radiations X Rays have wide range of uses like in the Medical field, security purposes ect . --It is used in X Ray scanners --X Ray crystallography --Industrial radiography and CT scanning --X Rays has an immense role in the medical field --This is diagnostic as well as therapeutic -USES

8. DIAGNOSTIC USES --X Ray is the most preferred tool for detecting any bone related problem such as --Fracture --Tumor --Degenerations --It is also used to detect other cases like --Pulmonary Tuberculosis --Lung abscess THERAPEUTIC USES --It is used in cancer treatment to kill malignant cells -USES contd.

9. -STANDERD X RAY MACHINE

10. -CONTROLL PANNEL

11. - CONTROLL PANNEL contd.

12. -RADIATION MONITOR

13. --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 - RADIATION MONITOR contd.

14. --1-This helps to confirm the Diagnosis --2-Helps to study the fracture anatomy -3-Helps to study the fracture Displacement --4-Helps to Detect Crack and stress fractures --5-Helps to plan the treatment --6-Helps to detect fracture dislocation OR combination (Monteggia fracture) --7-Helps to ascertain post-Reduction status of fractures --8-Helps in Medicolegal studies -ROLE OF X RAY

15. -Before asking for an X Ray the following points should be kept in mind -ASKING FOR AN X RAY --1-Both AP and Lateral views should be taken in most of the cases --2-Special views in some cases show the fracture better --3-X Ray requisition must specify the area of suspension --4-X Ray of the pelvis with both Hips should be asked for in all cases of suspected Pelvic injury --5-For an X Ray evaluation of the hands and feet “Antero -Lateral and Oblique views (Not Lateral) are required

16. ---Better No X Ray is requested 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 be middle of the exposed 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 un-necessary X Rays --Check X Rays are to be taken without disturbing the plaster cast -BASIC RULES IN X RAY -Points to be remembered

17. ---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 item 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 -PATIENTS PREPARATION FOR X RAY

18. -ANTERIOR – POSTERIOR VIEW -SOME NORMAL VIEWS IN X RAY DIAGNOSIS --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 body part

19. -LATERAL VIEW - SOME NORMAL VIEWS IN X RAY DIAGNOSIS -The X Ray beam is exposed from the Lateral aspect of the body part

20. - SOME NORMAL VIEWS IN X RAY DIAGNOSIS -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. --Frame:- A—(AP – Elbow) --Frame:- B—(Lateral view Elbow) --Frame:- C—(AP and Oblique views Elbow) Medial or internal rotation --Frame – D—(AP and Oblique view Elbow ) External Rotation - SOME NORMAL VIEWS IN X RAY DIAGNOSIS

22. -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 -SOME SPECIAL VIEWS IN X RAY -SCAPHOID FRACTURE

23. - SOME SPECIAL VIEWS IN X RAY -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 -ACETABULAR FRACTURE

24. -Merchant view is done for “Patello – Femoral joint. It is taken in such A way that only the image of the patella is obtained. The procedure Is given in the picture below - SOME SPECIAL VIEWS IN X RAY -PATELLO FEMOAL

25. -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 - SOME SPECIAL VIEWS IN X RAY -CALCANEUM FRACTURE -Technique of X Ray

26. -(Y) VIEW OF SCAPULA - SOME SPECIAL VIEWS IN X RAY ---It is taken perpendicularly to scapular plain from the Lateral aspect. The X Ray image looks like the one given below

27. - DUNN view - is an antero – posterior view of the hip with the patient supine and the hips and knees flexed at 90 degree, the legs abducted 15 to 20 and the femur in the neutral rotation - SOME SPECIAL VIEWS IN X RAY

28. ---MODIFIED DUNN VIEW:- This view is the slight modification of DUNN view, where the hip is flexed to 45 degree --Dunn view and modified Dunn view is mainly to see the asphericity of the femoral head, which is the cause of premature arthritis - SOME SPECIAL VIEWS IN X RAY

29. -Cross table lateral view is the lateral projection radiography of a supine subject using a horizontal X Ray beam - SOME SPECIAL VIEWS IN X RAY -This is Mainly used to detect neonatal pneumo – thorax hairline fracture in the neck of the femur

30. ---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 ? -At what level is the fracture ? Weather he fracture is in the Upper, Middle, or Lower third -What is the pattern of the fracture ? =Is the fracture displaced =Is the fracture expended to nearby joints -Does the underlying bone appear Pathological ? Example a Cyst, abnormal texture of the whole bone etc. -is it a fresh or an old fracture -READING AN X RAY

31. -SOME SAMPLES OF X RAY PLATES -Fracture Shaft of Ulna

32. -OSTEO – ARTHRITIS KNEE

33. -CRUSHING INJURY LAFT FOOT

34. -SCOLIOSIS

35. -THORACIC KYPHOSIS

36. -POSTERO – LATERAL -Subluxation of knee joint

37. -LOBECTOMY

38. -CALLOUS FORMED at fracture site

39. -FRACTURE OF BOTH BONES OF FOREARM

40. -ADVERSE EFFECTS OF X RAY ---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 organization’s international agency for research on cancer and U.S. government. --It is estimated that 0.4% of current cancer cases in the United States are due s to diagnostic X Rays and CT Scans --That’s why when it comes to perform an X Ray on a pregnant woman Proper women, proper assesment of benefit versus risk is done