This is a simple and safe technique that makes it possible to detect pathological changes even at the early stages of their development. The only and main drawback of the procedure is the negative effect of electromagnetic radiation on the human body.
X-ray of the lumbar spine allows you to make an accurate diagnosis, determine the localization of the pathology, as well as the degree of its severity and the nature of pathological changes. With its help, you can identify the accumulation of fluid, deformation of the intervertebral discs, changes in the shape of the vertebrae. The procedure is prescribed for suspected various diseases of the spine and is considered the initial diagnosis.
Indications
Radiography of the lumbar and sacral region may be recommended in such cases:
- in the presence of pain in the back;
- if you suspect a tumor, hernial protrusion, curvature of the spine;
- in case of chronic weakness;
- with numbness of the limbs;
- before surgery, in the postoperative period;
- in case of complications after traumatic injuries of the back;
- with congenital defects of the spinal column.
The decision to conduct X-rays of various departments is made exclusively by the doctor based on the complaints presented by the patient.
Training
An x-ray examination of the lumbar and lumbosacral region requires special preparation, which will help ensure that a reliable result is obtained, on the basis of which an appropriate treatment can be selected.
Referring the patient to an x-ray of the lumbar spine, the doctor should tell him about the rules for preparing for the procedure
Preparation for a lumbosacral x-ray includes the following recommendations:
- A patient who has been scheduled for an x-ray should exclude foods that provoke an increase in gas formation from the diet three days before the procedure. These include: vegetable legumes, black bread, potatoes, cabbage. In chronic bloating, activated charcoal may be recommended in addition.
- In some cases, the patient is prescribed the use of valerian root. As a rule, a drop is prescribed three times a day.
- The last meal before the x-ray should be no later than 7 pm. In addition, in order to cleanse the intestines from feces, it is advisable to make an enema a few hours before bedtime. Similar activities should be repeated in the morning before the diagnosis.
On the day of the X-ray examination, the patient is forbidden to eat and drink, and you should also refrain from smoking.
Why are preparations needed?
The main purpose of the preparatory measures is to cleanse the intestines, since the presence of undigested food residues and waste products in it greatly complicates the study.
When receiving low-quality images, the specialist will not be able to make an accurate diagnosis, so you will need to undergo an examination again, and therefore, expose the body to additional radiation.
The principle of the procedure
An x-ray of the lumbosacral spine has practically no restrictions on performance. The only exception is the period of pregnancy and lactation, which is associated with the negative effects of x-rays. Also, such activities are undesirable in childhood. In rare cases, a diagnostic procedure may be prescribed for children in order to exclude the development of a pathological process.
X-rays are done fairly quickly, the procedure does not cause any particular discomfort
To ensure that the images are not blurry, the patient must take off his clothes, jewelry and be motionless in a lying or sitting position on the x-ray table. If a person is worried and moving, the pictures will be fuzzy. In the case of a poor-quality radiograph, a second procedure may be prescribed, which is undesirable due to the harmful effects of radiation.
A protective plate made of a special shielding material is placed on the chest and neck area, which is designed to reduce the level of radiation. For a more accurate examination, the specialist takes several pictures at once. The procedure itself takes about 15 minutes.
Deciphering the results
Normally, the vertebrae should be placed one above the other vertically, match in size, shape and number. There should be no swelling of the soft tissues around the bones, curvature, pathological formations, foreign objects.
The specialist makes the interpretation of the x-ray image immediately after the procedure.
A deviation from the norm is the presence of bone spurs on the spinal column, deformation and curvature of the spine, slipping of the vertebrae forward or backward, fracture. In addition, the picture may show stenosis of the lumbar, which manifests itself in the narrowing of the spinal canal. Displacement of disc structures beyond the anatomical framework, hernial protrusion, sciatica can also be observed.
Is x-ray examination harmful?
X-ray radiation is a stream of electromagnetic waves, the length of which ranges from 0.06-20 A. They have a high penetrating power, as well as a photochemical effect, which makes it possible to take pictures from different parts of the human body.
X-ray radiation has a biological effect on the body, causing changes in cells, tissues and organs.
The principle of operation of x-rays is that from the source of radiation, a beam of x-rays, passing through a certain area of the patient's body, is directed to a special receiver, which transforms it into a visible image. However, some of the rays are absorbed by various organs and soft tissues of the human body.
In addition, a small amount of energy is also dissipated in the environment, which is dangerous for the specialist performing the procedure. And although the dose of radiation exposure is relatively small, it can still be enough to harm human health.
Benefits of the procedure
Up to 70% of diagnoses are confirmed thanks to X-ray examination, and in some cases this is the only way to determine the disease. In addition, regular examinations help to identify the disease in the early stages, which makes it possible to prevent its further development in a timely manner.
This type of study makes it possible to detect fractures, dislocations, the presence of dystrophic processes. Radiography of the spine allows not only to detect the presence of pathology, but also to determine the stage of its development, which helps to choose the most appropriate therapy and monitor its effectiveness. This feature distinguishes X-ray from ultrasound.
It is also worth noting that the x-ray of the sacro-lumbar region is relatively inexpensive, which is an undoubted advantage and makes the procedure affordable even in paid clinics. In public institutions, such events are held free of charge.
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X-ray of the lumbosacral spine
The wide spread of spinal diseases among the population requires accurate diagnosis of these pathologies. And, despite the emergence of new informative diagnostic methods, radiography remains the most common examination of the musculoskeletal system, including the spine. This procedure can be applied to all parts of the spinal column. X-ray of the lumbosacral spine needs to perform preparatory procedures in compliance with simple rules.
What is the purpose of radiography
The method is based on the ability of tissues to varying degrees to transmit X-rays, which are fixed on a special film located behind the patient's body. In front there is a source of radiation - an x-ray tube. Bone structures transmit less rays, so the film opposite them has a whitish color. Soft tissues and organs containing air (intestines, lungs) give a darker tint on the film. Since an x-ray is an image negative, radiologists call light elements on it blackouts, and dark ones - enlightenments.
- availability;
- cheapness;
- ease of implementation;
- information content in the assessment of bone structures.
Disadvantages of the X-ray method:
For the prevention and treatment of DISEASES OF THE JOINTS, our regular reader uses the method of non-surgical treatment, which is gaining popularity, recommended by leading German and Israeli orthopedists. After carefully reviewing it, we decided to offer it to your attention.
- rather low information content when visualizing muscles, discs, ligaments, soft tissues;
- difficulties in assessing the state of the structure of intervertebral discs;
- harmful effects of x-rays.
Intervertebral hernias are difficult to diagnose using a classic X-ray, so it is better to perform an MRI diagnosis.
When is a spinal x-ray needed?
Indications for x-ray of the lumbosacral spine are:
- traumatic injuries;
- deformation of the spinal column;
- pain in the lumbar region and sacrum;
- feeling of numbness, paresthesia in the lower extremities, leg muscle cramps;
- primary or secondary (metastatic) malignant processes in the bones of the spine;
- benign neoplasms of the vertebrae;
- suspicion of rheumatological diseases affecting the spine (for example, Bechterew's disease);
- infectious lesions of the spine (tuberculosis, syphilis, osteomyelitis);
- diagnosis before and after surgery;
- control of the dynamics of the disease during treatment;
- congenital pathologies of the development of the spine.
The indications are determined by the local therapist, neurologist, orthopedic traumatologist or vertebrologist. To undergo an x-ray, these specialists issue a direction, where they indicate the area of \u200b\u200bthe spine and the projections necessary for performing the study.
Contraindications for x-ray
Despite the many advantages of this method, radiography of the lumbosacral spine has a number of contraindications:
- pregnancy;
- lactation period;
- children under 14 years of age (strict doctor's indications);
- movement disorders;
- mental states with a sharp excitement;
- high degree of obesity;
- barium x-ray performed the day before.
These contraindications can be relative, especially when there is no other way to diagnose. If we are talking about excess body weight or the inability to achieve a stationary position of the body during an X-ray examination, it is unlikely that it will be possible to obtain a high-quality image. In such a situation, alternative diagnostic methods should be considered.
How to Prepare for an X-ray of the Lumbar Spine
Radiography of the lumbar and sacral spine needs careful preliminary measures, unlike other parts of the spinal column. Their implementation is necessary in order to obtain high quality and informative images. If you do not follow the rules, the doctor will not be able to reliably evaluate the results of the study, therefore, the patient did it in vain. In this case, a second x-ray is necessary, and this is additional radiation. Therefore, it is better to learn how to prepare for an x-ray of the lumbar spine immediately upon receiving a referral from a doctor. The specialist will determine the set of necessary procedures.
You can use the following rules:
You need to start preparing for an X-ray 3 days before the examination.
You should follow a diet that excludes the use of legumes, raw vegetables and fruits, rye bread, sweets, soda, milk. The diet is necessary in order to reduce the formation and accumulation of gases in the intestines, which make it difficult to visualize the spine.
During the next meal, drink a single dose of an enzyme preparation (Creon, Mezim, Pangrol) according to its instructions to improve digestion.
The last meal on the evening before the X-ray is allowed no later than 19 hours. The procedure itself is carried out in the morning on an empty stomach.
12 hours before the proposed study, a cleansing enema is performed in the evening, which is desirable to repeat in the morning.
If it is not possible, a single dose of a laxative (Guttalax, Bisacodyl) should be taken in the evening.
On the day of the procedure, you must stop smoking.
In order to reduce anxiety and muscle tremors, some experts recommend taking sedatives (Valerian extract, Alora, Persen) 3-4 days before taking an x-ray.
Research methodology
The procedure itself is painless and lasts about 10-15 minutes. To begin with, the patient needs to remove all jewelry and metal objects, bare above the waist. The chest, as well as the neck area, is covered with a shielding material in order to reduce the negative effect of radiation on the internal organs.
Important! During the examination, the patient should remain still. This allows you to achieve high quality images and will help the doctor in interpreting the results.
The study is performed when the patient is sitting or lying on the x-ray table. In this position, an x-ray of the lumbar spine is taken in two projections: lateral and direct. In any case, the correct position is determined by the X-ray laboratory technician or radiologist.
Functional radiography of the lumbar spine: how is it done
Sometimes radiography is required using functional tests to assess the mobility of individual segments of the spinal column. A functional type of radiography is performed after a conventional x-ray. The provisions for this may be different. The most commonly used position is on the side with the maximum possible extension and flexion for the patient. You may need to take sitting and standing shots. It is important to accurately and correctly choose the position of the patient and the tilt of the X-ray tube itself.
How X-rays are made for bedridden and elderly patients
Despite the general availability of the method (it can be performed in a clinic with an X-ray room, in a hospital), some patients do not have the opportunity to take an X-ray in a medical institution. In this case, mobile (or portable) devices are used, which are delivered directly to the house, and an X-ray examination is already carried out there. However, the quality of images obtained by this method is inferior to stationary devices.
X-ray results
What the picture shows, only a specialist in the field of radiology can adequately answer, although often a doctor of any specialty is able to draw preliminary conclusions. After the examination, an X-ray image (film) in conventional radiography or a file with an image on an electronic medium in a digital technique is sent to a radiologist. He assesses the state of the bone tissue of the vertebrae, joints of the lumbosacral region, determines the degree of deformation, describes additional formations and osteophytes. When x-rays are clearly visualized bone structures, in contrast to ligaments and soft tissues. The patient is given a description of the picture, the conclusion of the doctor. With them, he goes to his treating doctor, who makes the final diagnosis and prescribes treatment.
The safety of the method and the frequency of its implementation
X-rays are absorbed by the tissues and cause photochemical reactions in them, which leads to disruption of the cells. Therefore, there are limitations on the frequency of the survey. For different areas of the body, the radiation exposure is different. So, for radiography of the lumbar spine, the radiation dose is 0.7 mSv with a film technique, and 10 times less with a digital one. The allowable dose is 1 mSv/year, and the maximum dose is 5 mSv.
After a single examination, there will be no direct harm, but if the permissible norms are systematically exceeded, long-term effects are possible: oncological processes, developmental anomalies in the offspring.
Thus, radiography of the spine is a very valuable method for diagnosing diseases of the musculoskeletal system. A qualified specialist will help to correctly interpret the picture. And on the part of the patient, only one thing is needed - high-quality preparation for an x-ray of the spine in the lumbosacral region, which is of great importance for an accurate assessment of the result of the study.
Do you often experience back or joint pain?
- Do you have a sedentary lifestyle?
- You cannot boast of a royal posture and try to hide your stoop under your clothes?
- It seems to you that it will soon pass by itself, but the pain only intensifies.
- Many methods have been tried, but nothing helps.
- And now you are ready to take advantage of any opportunity that will give you the long-awaited good health!
Expert advice: how to prepare for a lumbosacral x-ray
To date, X-ray of the lumbosacral spine is considered the most common procedure. With its help, you can diagnose various diseases and pathologies. This procedure is quite fast and completely painless. It is carried out using modern equipment. Since the minimum dose of X-rays is used during the diagnosis of the lower back, the procedure is safe for health. You can take an x-ray of the lower back at any medical institution.
When is a spinal x-ray taken?
It is necessary to go to the hospital in order to make an x-ray of the spine if the patient has:
- back pain appeared;
- numbness of the limbs of the arms and legs;
- there was a curvature of the spine;
- there are suspicions of a tumor;
- there were complications after fractures.
What can be seen on an x-ray of the lumbosacral spine
When diagnosing the lumbosacral region, doctors will identify:
- rachiocampsis;
- lumbosacral sciatica;
- herniated discs;
- infectious diseases of the vertebra;
- postoperative complications.
Preparation for x-ray of the lumbosacral spine
The procedure for diagnosing the lumbosacral spine is quite simple, but requires special training. Before writing out a referral for an x-ray, the specialist is obliged to tell the patient in detail how to prepare for the x-ray.
If you take an x-ray without preparation, the pictures will be fuzzy, and it will be difficult for doctors to determine the cause of your complaints. In case of unsuccessful shots, you will have to do the procedure again after 4-5 days.
Experts advise patients a few days before the x-ray to remove from their diet products such as dairy products, vegetables and fruits, beans, black bread. After all, they contribute to an increase in flatulence and can adversely affect the quality of x-rays.
Before going to the clinic for an x-ray of the lower back, you need to take several tablets of activated charcoal three times a day three days before the procedure. To make the patient feel more relaxed and remain still during this procedure, experts recommend drinking valerian root a couple of days before the x-ray. It is necessary to take sedatives three times a day, 15 drops at a time.
Do not eat before the X-ray. The last meal should be at least 19 hours before the x-ray. Also, experts strongly recommend doing two enemas before an x-ray of the lumbosacral spine, one in the evening and the second in the morning before visiting the hospital. On the day when the patient is scheduled for an x-ray, you can not drink, eat, smoke. Even if you are a heavy smoker, you will have to be patient if you do not want to redo the x-ray several times.
If you follow these simple recommendations of specialists, then the diagnosis and X-ray of the lumbosacral spine will be clear, and doctors will be able to determine from the first time what exactly worries you from the picture. Also, if there are good pictures, doctors will be able to immediately begin treating patients.
Why do I need to prepare for an x-ray of the lumbosacral spine
Preparation for an x-ray of the spine is needed in order to completely clear the intestines. A significant accumulation of gases and feces will negatively affect the quality of the images, and it will be difficult for specialists to make a correct diagnosis and prescribe competent treatment to the patient. Otherwise, a low-quality picture will have to be redone. And this is both a waste of time and additional exposure to X-rays, even in a small dose.
How is the examination
The procedure for examining the lumbosacral spine is quite fast and without any discomfort. The only unpleasant moment in this procedure may be a table that is cold to the touch. Before an X-ray is taken, the patient will need to remove all upper body clothing and jewelry. During the procedure, it is necessary to maintain a fixed position of the body. The procedure can be performed both sitting and lying down. This is where your doctor decides.
Contraindications for x-ray of the lumbosacral spine
It should be noted that X-ray of the lumbosacral spine is strictly forbidden to do:
- pregnant and lactating women;
- preschool children;
- nervous people;
- obese people.
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X-ray of the spine
X-ray of the spine is a diagnostic method that allows you to evaluate the structure, condition of the spine and, to some extent, its function.
The spine consists of individual vertebrae (24), the sacrum and the coccyx. Allocate the cervical, thoracic, lumbosacral spine, which have their own characteristics. The X-ray diagnostic method allows you to evaluate both the entire spinal column and certain sections and individual vertebrae.
The X-ray image first assesses the shape of the entire spine, the presence of physiological curvatures (lordosis in the cervical and lumbar regions, kyphosis in the thoracic and sacral regions), pathological curvatures (scoliosis), and the presence of fractures. The integrity of the vertebral bodies, their processes and arches, and symmetry are also specified.
Radiography of the spine allows us to evaluate the features of the structure of the bone tissue of the vertebrae, the thickness and density of its cortical layer, to identify signs of osteoporosis, tumor changes, damage to the articular surfaces, destructive-dystrophic and metabolic changes.
X-ray of the spine helps in identifying the following diseases:
- Fractures and wedge-shaped compressions;
- Curvature (scoliosis, lordosis, kyphosis);
- Spondylolisthesis (displacements);
- Osteochondrosis;
- osteoporosis;
- Degenerative changes (osteoarthritis, decrease in the height of the intervertebral discs, osteophytes);
- Tumors (benign and malignant);
- Confirmation of congenital anomalies (lumbarization, sacralization);
- Systemic diseases (Bekhterev's disease, rheumatoid arthritis, Paget's disease, Charcot's disease);
- Infectious diseases (tuberculosis of the spine);
- Changes in the spine in arthritis and metabolic syndrome.
Radiography of the spine for a more objective picture is performed in two projections: direct (with the patient in the supine position) and lateral or oblique. No additional preparation is required. Only for x-rays of the lumbosacral spine and coccyx, bowel cleansing (enemas or laxatives) is necessary.
The study can cover the entire spinal column, and can be performed selectively, for example:
- X-ray of the cervical spine;
- X-ray of the thoracic spine;
- X-ray of the lumbosacral region;
- X-ray of the coccyx.
The appointment of a particular type of study, as well as the interpretation of images, is carried out taking into account the clinical picture and the history of the disease.
Radiography of the spine with functional tests, that is, when performing special exercises and shifting the center of gravity, is carried out for a deeper assessment of the state of the spinal column and its functionality. This allows you to more accurately diagnose and assess the severity of pathological changes.
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X-ray with functional tests
Modern medicine very often resorts to such a research method as radiography, because thanks to it, many diagnoses can be confirmed or refuted. This diagnostic method is based on the use of x-rays. The flow of particles passes through organs and tissues, and some of them are projected onto special paper or film.
There are organs and tissues that:
- easily pass X-rays;
- poorly transmit rays (tissue, light muscles);
- do not allow x-rays to pass at all (bone tissue).
On paper, they are distinguished by dark and light zones. However, sometimes it is required to check with X-ray those organs that, during their normal functioning, do not transmit X-ray beams. It is for such cases that functional tests were invented.
What is a functional test?
A functional test is any auxiliary element or criterion that makes it possible to extract more data about internal organs, the analysis of which, without their presence, provides insufficiently reliable information. Distinguish:
- Functional tests of the digestive system, liver and kidneys. A chemical analysis of fluids (blood, urine) is carried out to study the level of performance by organs of their functions, as well as an ultrasound scan or other more informative study.
- Functional tests of the respiratory tract. Since breathing directly depends on the cardiovascular system and the brain, this type of study is combined with a check of these organs.
- X-ray of bone and joint structures with functional tests. It is prescribed for the purpose of examining the spine and joints, it involves flexion and extension of the limbs and joints of the spine to the maximum possible poses.
How is an x-ray with a functional test performed?
This type of x-ray can be performed in different cases and in several ways, but ideally, when prescribing it, the following should be taken into account:
To obtain an X-ray with functional tests, it is necessary to make 3 radiographs of the spine, which in turn require the patient to perform special exercises:
- In the rear projection (in a standing, sitting or lying position).
- In the lateral projection in a state of maximum extension.
- In lateral projection in a state of maximum flexion.
In the case of a study of the lumbar part of the patient, they are placed on their back on a laterographic attachment. However, if he is not able to move independently, and he was brought to the X-ray room on a stretcher, then there is no need for such a prefix. Also of no small importance is the slope of the X-ray tube, which should be at the same angle with the segment or section of the ridge under study.
Contraindications
X-ray with functional tests is of great benefit in determining the diagnosis, choosing further treatment and its success. However, do not neglect the contraindications, in which case it is better to refrain from providing this procedure.
Functional radiography is contraindicated:
- with intolerance to physical activity or individual elements of the drug, if the study can worsen the patient's health;
- in case of excessive sensitivity to radiation or an excess of received radiation exposure, it must be taken into account that the received portion of radiation can accumulate;
- with perforation or ulcer of the stomach, duodenum, bleeding is possible, especially when the need for the introduction of fat-soluble contrasts;
- during pregnancy, any x-ray radiation will have an undesirable effect on the fetus.
X-ray with functional tests is one of the safest and most effective ways to study the patient's condition. Due to the simplicity and accessibility of this procedure, it has become very popular, and in some cases even necessary.
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An X-ray of the spine is mandatory in the diagnosis of such severe injuries as fractures. Thanks to X-ray, it is possible to determine the exact location of bone fragments and, based on this, choose the method of reposition. X-ray examination is highly informative in assessing the degree and nature of the displacement of the vertebrae relative to each other, so it is used in the examination of all types of curvature of the spinal column. Bone, cartilage and soft tissues have different densities, so they appear differently on an x-ray. This makes it possible to include diagnostics of diseases of the joints, including the formation of cartilaginous bodies in the joint fluid, into the scope of X-rays. Often it is an x-ray that allows you to detect tumors in the region of the spine. The study itself speaks only of the presence of a tumor, in order to accurately determine its nature, a biopsy is used. To make the X-ray examination more reliable, it is carried out in 2 projections: lateral and posterior.
As prescribed by the attending physician, an image can be used in the position of flexion or extension of the spine at a certain angle. For each part of the spine, a separate x-ray can be performed in 2 projections.
There is a restriction on the X-ray of the spine in pregnant women at an early stage. Only in emergency situations can an X-ray be used, for example, if a fracture is suspected or if other equipment is not available. In people with severe obesity, X-rays are also not used, since it is impossible to obtain a sufficiently informative image through the thickness of soft tissues. Usually the restriction applies to patients weighing more than 200 kg. Sometimes a preliminary preparation of a person for an x-ray is required. If the patient is unable to remain still even for a short time (for example, with strong psychomotor agitation), tranquilizers are first taken, and only after that a picture is taken.
What does a spinal x-ray show? In the picture you can see:
- structural disorders of each vertebra, complete and incomplete fractures;
- distances between individual vertebrae, dislocations, subluxations;
- the location of the vertebrae relative to the normal trajectory of the spinal column, curvature, displacement;
- formation of bone processes, osteophytes.
In order to get a complete picture of the clinical picture of each disorder, it may be necessary to use other diagnostic methods:
- ultrasound procedure;
- CT scan;
- Magnetic resonance imaging;
- myelography.
Injuries and deformities of soft tissues are not displayed on the x-ray or their display is not clear enough. In some cases, the tumors may look like dark areas, which does not give a complete picture of their size. Frequent injuries of the spine are dislocations and subluxations, as a result of these injuries, the integrity of the ligaments and blood vessels is violated. An x-ray can only exclude a fracture of the vertebrae, but does not provide practically any data on the condition of the ligaments or muscles.
To cover the clinical picture in a complex, 2 (or more) examination methods are usually used. Each x-ray of the spine has its own characteristics.
X-ray of the cervical spine is shown when:
- skull injuries;
- bruises, dislocations and fractures of the cervical vertebrae;
- headaches of unknown origin;
- curvature and deformation of the spinal column in the cervical region;
- with complaints of dizziness, visual impairment;
- if the victim has neurological symptoms, numbness of the upper limbs or neck, difficulty with coordination of movements.
An x-ray allows you to specify the location of each vertebra, but does not provide detailed data on intervertebral discs or herniated discs. How is x-ray done for multiple spinal injuries? First of all, a study of the cervical region is carried out, because fractures and hematomas in this area can provoke a fatal outcome within a short period of time. For the cervical region, a picture is often taken in 3 projections: oblique, straight and through an open mouth.
Studies of all departments, except for the cervical, require preliminary preparation. In order not to complicate the study, foods that promote flatulence should be excluded from the diet in advance:
- cabbage;
- legumes;
- carbonated drinks;
- white bread and pastries.
For an x-ray of the thoracic spine, the condition of the stomach is more important than the intestines, therefore, in order to prepare for the study, you need to stop eating 8-12 hours in advance. Modern equipment has different requirements, so no specific training may be needed. First you need to consult with your doctor, and he will give recommendations on how best to take an x-ray. Before the picture on any equipment, the patient removes all clothing and jewelry from the upper body. An entry is made on the personal card about the radiation dose received during the x-ray.
When conducting multiple studies, the data are summarized so that the total dose does not exceed the safe limit for humans.
A chest x-ray is prescribed for:
- chest injuries (for example, ribs);
- diseases of the heart and blood vessels;
- inflammatory processes in the lungs and pleura;
- ingress of foreign objects into the gastrointestinal tract and respiratory tract;
- suspected pulmonary tuberculosis;
- injuries and curvature of the spinal column.
The duration of the study is on average about 20 minutes. Without professional training, it is impossible to correctly interpret the image, so a specialist should deal with decoding.
Radiography of the lumbar and sacral
Sometimes, to improve the quality of the results, especially if the study is performed on old-style equipment, the patient is pre-prescribed enemas or laxatives so that the accumulation of gases and feces does not appear in the picture. Study preparation includes:
- diet to prevent flatulence;
- taking absorbent agents (for example, activated charcoal) a few days before the study;
- immediately before the study, bowel movements naturally with a laxative or enema.
The interpretation of the image is significantly influenced by the cognitive abilities of the doctor, so you should take care of choosing a truly competent specialist. What disorders are indicated for x-rays? This is:
- bruises, fractures and dislocations in the lower part of the spinal column;
- pain and numbness in the lower extremities, loss of sensation and muscle control;
- pain in the back, especially localized in the lower back, coccyx and sacrum;
- structural deformations of the vertebrae in shape, height, location relative to each other.
To conduct an X-ray of the lumbar region, a person takes a horizontal position on a special hard table. It is very important to remove piercings and jewelry, including from intimate areas. In order to select the best and clearest image, several shots are taken in succession. In this case, the patient can not move, talk, breathe. To reduce the potentially harmful effects on the body, special aprons are used with a lead insert fixed inside. Metal allows you to protect certain parts of the body from x-rays. If necessary, you can take a picture of only one part of the spine in isolation, for example, an x-ray of the coccyx. This study is mandatory assigned in the diagnosis of bruises, fractures or dislocations of the last 5 vertebrae.
Functional trials
In some cases, it is required to take an X-ray of the spine when performing flexion or extension at a certain angle in order to assess the nature of the displacement of the vertebrae relative to each other not at rest, but under load. For some types of scoliosis, studies with forward and backward deviation of the body are required. The exact list of movements that a person makes is selected by the doctor on an individual basis, depending on the objectives of the study. Most often, maximum flexion and extension of the spinal column is used in standing, sitting and lying positions.
Pictures are taken in 3 projections: 2 side and back. Functional studies are very rarely used for the thoracic region, usually used for the lumbar and cervical regions, because the range of motion in them is wider. Modern equipment allows you to save an image in very good quality immediately on a digital medium. This allows you to enlarge individual fragments of pictures. Old-style equipment can only reproduce a picture on film, which creates a lot of inconvenience for doctors, especially when it is necessary to diagnose incomplete fractures of individual vertebrae. When ordering a study in any private laboratory, the patient can receive a disk or USB flash drive with all the data in order to then provide them to the attending physician for interpretation.
In the diagnosis of spinal pathology, the leading place is still occupied by radiography. New equipment with minimal radiation exposure allows you to get an x-ray of the lumbosacral spine in the shortest possible time and completely painlessly. Yes, and you can take pictures in several projections, unlike MRI, in any medical institution. Mobile devices allow you to get x-rays without getting out of bed, which is very important if a person is in serious condition or is forbidden to get up.
Why is it necessary
X-ray of the lumbosacral spine is indicated if there is pain. The reason for it may be different: in children - developmental anomalies or signs of instability, in adults - a herniated disc. X-rays should be taken if the pain extends to the legs or there is numbness. In children, x-rays are shown with a curvature of the spinal column. For adults, an image is prescribed for suspected cancer or a herniated disc, but an MRI is the best option for this pathology.
It may seem paradoxical, but x-rays are recommended for chronic fatigue and constant weakness. An indisputable indication is a fracture or complications after it, as well as monitoring the dynamics of consolidation. Often, the patient passes through the X-ray - the office before the surgical intervention, and then after it. That's just with the help of a picture it is impossible to diagnose the pathology of soft tissues, as well as a herniated disc, but MRI can easily solve this problem.
What can be seen
In the picture, which is necessarily taken in several projections, the doctor can see everything that happens to the bones in the region of the lumbosacral spine. Indirectly, with the help of an image, a hernia can be detected, but to confirm and establish its exact dimensions, an MRI is shown, in the conclusion of which you can read all the information about it, and it is clearly visible in the image.
It is noteworthy that X-ray of the spine in the lumbosacral region shows pathological curvature, wear of cartilage tissue, again indirectly, because only MRI can show completely soft tissues. In addition, the picture shows oncological processes or osteoporosis, pathological thinning of the bone, which results in a fracture.
In children in the lumbosacral region, as in adults, listhesis or instability of the vertebrae may occur. Signs of instability are visible in the form of a violation of the longitudinal axis of the vertebrae.
Training
Very often, especially if the picture is taken with functional tests, serious preparation is required. It starts about three days before the expected date of the study. If you do not properly prepare, this will cause a poor-quality image and an incorrect diagnosis.
They all start with nutrition, for a few days, foods that contribute to increased gas formation are excluded from food, especially legumes, black bread and milk. Additionally, activated charcoal is taken in the amount of two tablets for three times a day. If there is a nervous strain, a daily intake of 15 drops of Valerian per day will help to cope with it.
You will have to prepare in a day.
The last meal should be 19 hours before the proposed study. In the evening and 12 hours later in the morning on the day of the examination, two cleansing enemas are prescribed. Do not eat, drink or smoke before the examination. It is especially important to observe all these rules when x-raying children, if there are recommendations from a specialist.
Survey progress
Diagnosis of the lumbosacral spine is necessarily carried out in two projections, so then it is easier to read radiographs. The procedure passes quickly, the only thing that can bring discomfort is a cold table. Before the examination, the upper half of the body is exposed, jewelry is removed, then you need to take a fixed position, which is very important for diagnosing curvature or instability. Open areas of the body and genitals, especially in children, are covered with a protective screen.
Functional trials
The technique in some cases is able to replace MRI and diagnose a hernia. In the lumbar region, images are necessarily taken in several projections, which helps in the diagnosis of instability. Children can have difficulties, so an adult is present during the procedure in the office.
Most often, the study is performed in projections of maximum flexion and extension. To diagnose instability or, if there is a suspicion of a hernia, a picture is shown in a standing position, maximum sitting. Three projections are made: one direct and two lateral at maximum flexion and extension. It is very important to choose the angle at which the x-rays are directed. This is necessary when diagnosing instability, otherwise the result may be distorted.
Depending on the position
Each position of the patient has its own functional tests. Lying down - maximum flexion can be achieved by pulling the knees and head to the stomach. The extension is performed in the opposite direction. In children, an adult (parent or relative) helps to maintain the necessary position.
Sitting - knees are covered with hands, and the back is leaning against a vertical surface, the body is tilted forward as much as possible. When unbending, it is necessary to try to lean back as much as possible and bend the chest forward.
Standing, signs of instability are diagnosed, it is also possible to indirectly determine a hernia. An MRI can complete the picture by showing complications, if they occur. The person bends down as much as possible, hands should strive to touch the floor, knees are straight. Unbending back, the body describes an arc with its back, and the hands are located at the back of the head.
Contraindications
There is a category of persons to whom X-rays will only harm. These are, first of all, pregnant women; pictures are not recommended for small children. The danger may be mental overexcitation or an acute period of mental illness. Excessively large weight, X-ray is also not recommended if barium contrast was previously used.
There are more advanced diagnostic methods, but for a long time it is X-ray that has been the "gold" standard in diagnostics. It is with him that a full-fledged examination and preliminary diagnosis begins.
The site provides reference information for informational purposes only. Diagnosis and treatment of diseases should be carried out under the supervision of a specialist. All drugs have contraindications. Expert advice is required!
What is a spine x-ray?
Radiography ( x-ray ) is a method of radiation diagnostics widely used in modern medicine. It is based on the use of X-rays, which have the ability to penetrate human tissues and organs. The source of such rays is an x-ray tube. X-rays are of the same nature as sunlight, without which human life is impossible. These rays are electromagnetic waves that are invisible to the human eye because they are outside the optical frequency spectrum.Specifications
Film dimensions: 18 x 43 cm (7 x 17"), 20 x 40 cm, cassette positioned longitudinally. Film speed 400, compensation filter ± FR: 115 cm (40"). A screening grid is used. Big focus. Exposure at 90 kV is automatically set according to the central field by an X-ray exposure meter.
Patient preparation
Take off your shoes.
- The patient becomes strictly in profile to a vertical stand.
- Legs are straight and parallel, feet slightly apart.
- Arms extended forward (may supported by something) or raised above the head.
- Maximum flexion and extension.
- The center of the cassette is located 2 PP above the iliac crest.
Centering
- The X-ray beam is directed perpendicular to the film.
- The central beam is directed 2 PPs above the iliac wing crest, stepping back from the posterior surface of the back to the width of an arm, to the center of the cassette.
- Centering, diaphragming, marking of the side facing the film.
- One radiograph is taken at maximum flexion and another at extension.
Options
It is possible to study the functional state with an inclination to the right and to the left (film sensitivity 400, then see above, as for the picture of the lumbar spine in the anteroposterior projection).
Wishes
If left-sided scoliosis is present, rotate the Patient's left shoulder to an upright position.
Spine
Criteria for a correctly performed radiograph
- The entire pelvis is represented completely and symmetrically, including the hip joints, trochanters of the femur, and wings of the ilium (1).
- On both sides, (2) the outer edge of the greater trochanter is clearly visible.
Centering
- The X-ray beam is directed perpendicular to the film.
- The central beam is directed to the center of the cassette.
- Centering, aperture, side marking.
- Hold your breath after exhaling.
Pelvis: anteroposterior view, standing
Specifications
Film dimensions: 35 x 43 cm (14 x 17"), cassette positioned lengthwise. Film speed: 200 (400). FR: 115 cm (40"). A screening grid is used. Big focus. Exposure at 77 kV is automatically set in two or three fields by an X-ray exposure meter.
Patient preparation
- Remove all clothing except underwear.
Take off your shoes.
- The patient stands with his back to the vertical stand, hands. omitted.
- The legs are straightened, the feet are slightly turned inward (thumbs touch, heels are 4 cm apart).
- Eliminate, if any, the difference in leg length as indicated on the film.
- Compression of the abdomen with a wide belt (in the absence of anes
abdominal aortic rhysms!)
- The position is lying on the back, the legs are turned inward, the knees are at the same level, straightened (if one of the knees cannot be straightened, then a soft roller is placed on the opposite side for support).
- The upper edge of the cassette is located 4 cm above the iliac crest.
- For men, the genitals are shielded.
Options
Radiography of the lower pelvis
- The upper edge of the cassette is located at the level of the anterior superior iliac spine.
Taz. Laying Pennal I
- The X-ray beam is directed at an angle of 40° craniocaudally.
- The central beam is directed at the level of the anterior superior iliac spine to the center of the cassette.
Taz. Laying Pennal II
- The X-ray beam is directed at an angle of 40° caudocranial.
- The central beam is directed 4 cm below the upper edge of the pubic symphysis to the center of the cassette.
Radiation diagnostics is currently the safest and most accessible means for the patient to visualize the anatomical structures of the spine and their degenerative changes.
Methods such as multislice computed tomography (MSCT) and magnetic resonance imaging (MRI) make it possible to objectively evaluate, in addition to bone, also connective tissue and neuromuscular structures of the spine and spinal canal (SC). At the same time, the peculiarity of the design of standard devices allows examinations to be carried out only in the prone position. This somewhat discredited high-tech methods, since without direct data on the presence of instability in the structures of the spinal motion segments (SMS), the study becomes inferior, and its diagnostic efficiency is significantly reduced. Moreover, the introduction of MRI and MSCT into practice in some cases did not allow us to exclude functional techniques from the diagnostic algorithm for standard radiography.
The importance of visualization of the spine under the influence of a functional (axial) load is confirmed by experimental work. This is due to the structural features and properties of the PDS. Even normal intervertebral discs (IVDs) respond to stress by reducing their height by 1.4 mm and increasing their width by 0.75 mm. At the same time, it should be taken into account that a normal IVD can withstand up to 12,000 N of axial load, while a spine with signs of degenerative changes and instability can withstand only 100 N. height and increase in width of stenosis of the lumbar spine largely depend on the posture. All this points to the need to introduce a study of the spine during exercise into the diagnostic algorithm in order to determine the true relationship between the structures of the PDS, PK and intervertebral foramina (IFO), as well as to identify signs of instability.
The first technique capable of evaluating the signs of instability of the lumbar spine was functional load radiography - in a vertical position, which was further expanded by functional tests, i.e. examination in the position of maximum flexion and extension. The introduction of functional radiography made it possible to partially solve the problem of diagnosing instability, especially when detecting displacements of the vertebrae. At the same time, standard radiography with functional tests has its drawbacks: [ 1 ] in case of suspected (only) PDS instability, the use of this study everywhere does not lead to a significant increase in the diagnostic efficiency of radiography with a significant increase in radiation exposure; [ 2 ] radiography does not allow answering a number of important questions due to significant limitations:
First of all, the technique is projection, and therefore, it has a pronounced summation effect, which makes it difficult to evaluate all structures of the PDS;
Secondly, on radiographs, due to the relatively low contrast resolution, it is practically impossible to assess connective tissue structures;
third, the study in extreme positions allows to detect instability, mainly associated with the passive system, which led to a large number of false positive results.
To solve this problem, 2 options for conducting functional studies using high-tech diagnostic methods are proposed. [ 1 ] The first option is MRI scanners capable of conducting research in a vertical position. [ 2 ] The second option - devices dosed axial load, allowing to simulate verticalization in the study in the supine position.
In the first case, physiology comes to the fore, but this also leads to technical difficulties in creating tomographs, and, accordingly, severe restrictions on the quality, duration of the study and the versatility of these devices. In the second case, the use of devices for creating a dosed load requires determining the adequacy of the simulation of the vertical position.
video
The introduction of the above methods into clinical practice over the past 10 years has significantly changed the understanding of spinal instability and clarified its diagnostic criteria. These studies (functional MRI techniques) make it possible to visualize all structures of the SMS during functional loading. This makes it possible to assess the true relationship with neural structures, to determine the signs of dynamic and latent stenoses, as well as the degree of participation in these processes of various PDS structures. Definitely, this led to a change in the tactics of treating degenerative changes in the lumbar spine. In particular, the volume and type of neurosurgical interventions have shifted from IVD removal to the installation of various devices that compensate for the function lost during surgical treatment.
Currently, in order to objectify the clinical picture, and, consequently, a more adequate choice of the nature and scope of medical care for patients with chronic pain syndrome in the lumbar region, it is necessary to introduce functional MRI techniques into the diagnostic algorithm ... more in the article"Functional magnetic resonance imaging of the lumbar spine (literature review)" A. V. Bazhin, E. A. Egorova, Moscow State University of Medicine and Dentistry. A. I. Evdokimova" of the Ministry of Health of Russia, Department of Radiation Diagnostics (journal "Radiology - Practice" No. 4, 2015) [read].
read also the post: Multiposition MRI(at mri-russia.livejournal.com) [read]
read also the dissertation for the degree of Ph.D. "Possibilities of functional radiation techniques in the study of degenerative changes in the intervertebral discs of the lumbar spine" A.V. Bazhin, Moscow, 2015 [read]
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