Bone x-ray is a set of methods of radiological examination of the morphology of the musculoskeletal system in normal and pathological conditions. Due to the high content of calcium and phosphorus salts, bone tissue contrasts well against the background of surrounding soft tissues. Various parts of the skeleton can be subjected to X-ray examination: the bones of the skull, chest, upper and lower extremities, pelvis. Radiography is indicated for the diagnosis of bone fractures and monitoring their treatment, infectious and inflammatory processes, osteoporosis, primary and metastatic bone tumors, flat feet, etc. For greater information, bone x-ray is performed in two projections, often with functional tests.

Bone x-ray is a classic non-invasive diagnostic technique that allows you to quickly, inexpensively and with minimal inconvenience for the patient to diagnose traumatic injuries and diseases of bone tissue. It is the oldest and most common visualization method. X-ray radiation was discovered at the end of the XIX century by the German scientist Wilhelm Conrad Roentgen. In medicine, bone x-ray has been used since the 30s of the XX century. Provides for the effect of a small dose of ionizing radiation on the human body.

Thanks to numerous scientific studies, the use of modern equipment and protective equipment, as well as strict standards that determine the permissible dose of radiation and contraindications to bone x-ray, this study does not pose a danger to the health of patients suffering from injuries and diseases of the skeleton. In the presence of contraindications and the threat of exceeding the dose of ionizing radiation, other methods are used. At the same time, due to the convenience, accessibility, low price and high information content, bone x-ray remains the gold standard of instrumental diagnostics for traumatic injuries and diseases of the musculoskeletal system.

Indications

X-rays have the ability to pass through various objects. At the same time, part of the radiation is absorbed by these objects. The denser the tissue through which the radiation passes, the stronger the absorption. The highest absorption coefficient is in bone tissue, therefore, during bone x-ray, bone structures look very light, almost white. Muscles, internal organs and fatty tissue absorb X-rays less intensively, therefore they are displayed on radiographs in the form of gray formations. When passing through the air cavities, radiation is practically not absorbed, so they are black spots in the pictures.

Bone x-ray is widely used in traumatology for the diagnosis of fractures, determining the type of damage, direction and degree of displacement of fragments (necessary for active reposition, correct application of skeletal traction and surgical intervention planning), as well as for evaluating the effectiveness of treatment. Bone x-ray is prescribed upon admission, after repositioning, applying the Ilizarov apparatus, fixing with a plate, screws, spokes and other metal structures. In addition, bone x-ray is performed during the circulation of a plaster cast (to make sure there is no repeated displacement), before removing the plaster and skeletal traction (to determine the degree of fracture consolidation).

Along with traumatologists, bone x-ray is prescribed by orthopedists, oncologists, rheumatologists and some other specialists. The results of this study play a crucial role in the diagnosis of osteomyelitis (when detecting and assessing the severity of this pathology, both conventional and contrast studies are carried out), benign and malignant neoplasms of bone tissue. Bone x-ray is used to detect metastatic lesions of bone structures in oncological lesions, as well as to assess the condition of bone tissue, the presence of its changes and growths in diseases caused by metabolic disorders.

Contraindications

There are no absolute contraindications to bone x-ray without the use of contrast agents. Relative contraindications are pregnancy, childhood and multiple X-ray examinations in the anamnesis. In these cases, the attending physician assesses the level of risk and determines the required volume of the procedure. Contraindications to bone x-ray using contrast agents are hypersensitivity to iodine preparations, the patient’s serious condition, cardiac arrhythmias, arterial hypotension, hypertension, active tuberculosis, severe liver and kidney dysfunction, severe cardiac pathology and increased blood clotting.

Preparation

This study does not require special training. Before conducting an X-ray of the patient’s bones, they are asked to expose the area under study (the damaged segment should be clearly visible and sufficiently free in movement to give the desired position) and remove metal objects from it that prevent the passage of X-rays. Women should inform the doctor about pregnancy in advance so that he can either prescribe another study, or, if bone x-ray is vital (for example, in severe injuries), reduce the dose of X-ray radiation by reducing the number of projections or limiting the area of the image.

Methodology of conducting

A radiologist or an X-ray technician helps the patient to take the right position on a special table. In some cases, pillows, sandbags and other devices are used to maintain the desired position of the body or its segment. The pelvic area and mammary glands are covered with a lead apron. During the radiography of the bones, the patient must remain completely motionless. After laying, the specialist goes to the next room, takes a picture, returns and helps the patient to take a different position, after which the procedure is repeated.

In most cases, radiography of bones in two projections (straight and lateral) is sufficient to assess the condition of bone tissue. Less often, three or more projections are used. Sometimes a doctor needs a comparative radiography of the bones of the same segment of a healthy limb. After the end of the study, the radiologist asks the patient to wait until the pictures are developed. If additional radiographs are not required, bone x-ray is considered completed. The duration of the procedure is usually about 10 minutes. When using a contrast agent, the duration of bone x-ray increases, before starting the study, the attending physician injects a contrast agent into the area under study, and then the radiologist takes pictures.

In emergency situations (in case of fractures), after the bone X-ray, the image is immediately transferred to the attending physician, who determines the need and scope of therapeutic measures: reposition, surgical intervention, plaster dressing or skeletal traction, and then carries out these measures. In other cases, the X-ray remains with the radiologist. The radiologist studies the results of bone x-ray, draws up a conclusion and passes the document to the attending physician. Sometimes the pictures along with the description are given to the patient so that he can contact the right specialist on his own.

Limitations of the method

Bone x-ray is a highly informative method in the study of bone structures, but it does not allow to study in detail the condition of the surrounding soft tissues: fiber, muscles and tendons. With skeletal trauma accompanied by soft tissue damage, for example, with a bone fracture in combination with a tendon rupture, along with bone x-ray, an MRI of the affected limb segment may be required, which makes it possible to visualize soft tissue formations. In some pathological conditions, the informative value of bone x-ray decreases. Thus, a fracture of the femoral neck without displacement in elderly patients with osteoporosis is sometimes not visible or poorly visible on radiographs. In such cases, a CT scan of the bone is additionally prescribed to clarify the diagnosis after bone x-ray. CT and MRI increase the price of the examination, so they are carried out if there are sufficient indications.

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