Fluorography is a preventive and diagnostic method of X-ray examination of the chest cavity and lungs. Fluorography is a screening study for the detection of cancer, tuberculosis and occupational lung diseases, recommended for healthy individuals once a year. Fluorograms are images of 70×70 or 110×110 mm in size, less informative compared to standard radiographs, but their receipt is accompanied by a lower radiation load. Now digital low-dose fluorography is being widely introduced, accompanied by an even lower dose load, which gives a better image, the ability to archive and store images for a long time.
Types of fluorography
Film fluorography
In the process of film fluorography, a shadow image of the chest is reproduced from a fluorescent screen on a particularly sensitive small-sized fluorographic film. After X-ray imaging, the fluorographic film is processed using a development complex.
In recent years, fluorography has undergone qualitative improvements. Starting with small-format images with a frame size of 24 ×24 and 32 ×32 mm, today fluorography has become medium- and large-format, allowing you to take images with a size of 70×70 mm or 110×110 mm, which facilitates the X-ray interpretation of the image. The technical disadvantage of film fluorography is the probability of obtaining defective images, which are detected only after developing the film.
Interpretation and analysis of fluorograms is performed by a radiologist using a fluoroscope – a device that magnifies the image by 1.5-3 times (images with a size of 100×100 mm are usually studied without magnification). To exclude subjectivity and errors in the interpretation of fluorography, it is recommended to view the images by two specialists or one doctor twice at intervals of a day.
Digital fluorography
The fundamental transformation of the technique is associated with the development of low-dose digital fluorography. With the introduction of digital fluorography, the radiation dose has significantly decreased, as well as the capabilities of a diagnostic doctor have significantly expanded. Now the image in the form of a digital photo is transmitted to a computer monitor, can be printed on paper, adjusted using various filters (adjusting contrast, brightness, size), as well as archived and stored on electronic media for a long time. Devices for digital fluorography are of matrix and scanning type; they differ in the quality and time frame of the study.
The results of digital fluorography are visible to the doctor immediately after the X-ray, which eliminates the possibility of delayed detection of an uninformative image. The limitation of digital fluorography is its high price compared to film.
Indications
Fluorography as part of the annual medical examination is recommended for all practically healthy people. A conclusion on the results of fluorography is required at the initial visit to the therapist, hospitalization, employment, admission to study, registration of a sanatorium card, registration in sports clubs and swimming pools, obtaining a driver’s license, before planning pregnancy. If there is a prolonged cough, shortness of breath, weight loss, weakness, the patient is sent for fluorography immediately.
The purpose of fluorography is a targeted mass examination of the population, revealing latent lung diseases (tuberculosis, pneumoconiosis, nonspecific inflammatory diseases and lung tumors), lesions of the pleura and mediastinum, diaphragm, large vessels, ribs, heart. When changes are detected, a clarifying chest X-ray is performed.
Methodology of conducting
By the fluorography room, you should undress above the waist and remove metal jewelry from your chest to exclude artifacts. A protective lead apron is attached to the patient’s belt. To take a picture, the subject enters the cabin and is positioned vertically between the X-ray tube and the fluorographic film or digital recording plate.
When performing fluorography in the frontal projection, the patient presses his chest against the screen, raising his hands behind his head or placing them on his belt and pushing his shoulders forward. At the same time, the chin rests on a special stand. When removing the fluorogram in the profile projection, the patient is turned sideways to the screen. At the command of the X-ray technician, you should inhale and not breathe for a few seconds while the picture is being taken.
When performing fluorography, dosed X-ray radiation is directed to the upper part of the body, which passes through the tissues and captures their image on a film or digital plate. Since X-rays penetrate tissues in different ways, the shadows of the structures depicted in the image differ in color. Dense bone tissue, which delays most of the rays, looks white; the heart also delays some of the radiation and is displayed as a light spot; lungs filled with air look darker on the film.
Interpretation of results
When evaluating the result of fluorography, the radiologist evaluates the condition of the pulmonary pattern, the roots of the lung, the pleural sinuses and the mediastinal shadow. Enhanced pulmonary pattern, determined by fluorography, occurs with acute inflammation in the lung of any genesis. The presence of fibrous tissue in the lung indicates a penetrating trauma, surgery, an acute infectious process with an outcome in fibrosis (tuberculosis, pneumonia). Focal shadows in the middle and lower lobes more often indicate focal pneumonia, in the upper sections – tuberculosis. Calcinates detected on fluorography serve as evidence of an isolated, undeveloped focus of infection (tuberculosis, helminthic, bacterial) and do not pose a danger.
The compaction, expansion and heaviness of the roots of the lung allows you to think about pneumonia or bronchitis, bronchiectatic disease. Adhesions and pleural layers indicate a transferred inflammatory process. The condition of the sinuses during fluorography is important for determining the presence of pleural effusion in pleurisy. The expansion of the mediastinal shadow primarily indicates changes in the heart, but has no serious diagnostic significance. If the mediastinum is displaced, according to fluorography, an accumulation of effusion or air in the pleura, large lung neoplasms should be suspected and the patient should be immediately referred to a thoracic surgeon.