The practical Applications of X-rays

Radiography is probably one of the most common medical techniques (you just have to think about its use in dental care to be convinced.) If it is not a new technique, it turns out to be still of great topical and very useful. Indeed, even if many other very sophisticated medical imaging techniques have appeared in recent decades (ultrasound, scanner, MRI, PET scan, scintigraphy, X-rays, etc.), radiography is far from obsolete because it has been able to evolve. Examples include the trend to replace the photographic film used to reveal radiographic images with digital sensors, which opens the door to image processing and sharing via the Internet. Today, we will discuss the practical applications of X-rays. Let’s get into it!

Imaging using X-rays

1: Bone, joint and spinal radiology

a) Simple x-rays: 

All parts of the body can be x-rayed at different angles to examine the bones and joints of the different limb segments, the spine (cervical, dorsal or lumbar spine), the skull and sinuses of the face, the teeth (dental pan), the number of incidences depending on the part of the body to be examined.

b) Arthrography: 

Any joint can benefit from an intra-articular injection of an opaque X-ray contrast product. The joints most often affected are the shoulder, the knee, but also the elbow, wrist, hip, or ankle.

- shoulder

- Knee

- Elbow

- Wrist

- Ankle

2: Pulmonary radiology

It remains the primary exploration of any pulmonary or pleural pathology. It is also often used in cardiology assessments to assess heart shape and pulmonary vascularization.

3: ASP

This x-ray of "Abdomen without Preparation" always precedes explorations of digestive or urinary clouding, but can be used alone or in combination with other examinations, in particular, ultrasound for the initial assessment of acute abdominal pain (intestinal obstructions, nephrotic colic, etc.).

4: Digestive radiology

a) Transit of the small intestine

This examination consists of opacifying the small intestine (small intestine) after the oral ingestion of an opaque product with X-rays. It allows you to examine the internal walls of the small intestine up to the colon (large intestine). A fast is essential to allow the product to adhere to the digestive walls. Its performance is sensitized by the use of an enteroclysis technique, which consists in positioning a probe in the duodenum (initial part of the small intestine after the stomach), the air insufflation coming to complete the clouding. The small intestine remains an intestinal portion difficult to explore, and a technique using) may be offered. 

b) Pharyngo-esophageal transit (TPO)

Again, this is an x-ray technique after oral ingestion of an X-ray opaque product (baryte), which makes it possible to study the part used during swallowing (pharynx) which precedes the esophagus. Fasting is essential to allow the product to adhere to the pharyngeal walls. It remains widely used for the study of ENT pathologies.

c) Opaque enema

This examination consists of opacifying the large intestine (colon) rectally in order to assess the condition of its internal walls. This enema can be performed in simple contrast using an opaque X-ray material called barium ("Barium Enema"), or a water-soluble product (water-soluble enema) when a perforation of the colon is suspected or when the 'we are in a situation at risk of perforation. A technique called "double contrast" uses both barytes and air blowing, which improves its performance. Preparation is necessary to empty the large intestine of feces (residue-free diet, water enema, and laxative).

5: Urinary radiology

a) UIV

This "Intravenous Urography" is a simple examination intended to visualize the kidneys and the cavities where the urine is evacuated to the bladder, by using a contrast agent opaque to X-rays injected intravenously which eliminates by the kidneys. This exam remains used because it can be quickly and easily scheduled. It is nevertheless more and more often replaced by a CT scan of the urinary tract (uroscanner).

b) Cystography

This examination consists of filling the bladder with an opaque X-ray contrast medium, either with a small sterile disposable probe lubricated with a local anesthetic (“retrograde” cystography) or much more rarely after direct puncture above the pubis ("suprapubic" cystography). It remains widely used in the context of repeated urinary tract infections to look for reflux of urine from the bladder to the kidneys (vesicoureteral reflux), which can ultimately compromise good kidney function.

c) Retrograde Urethrography

This examination is only carried out in men, consists of this time of opacifying the urethra (conduit which evacuates urine at the exit of the bladder), the opaque contrast agent to X-rays being introduced by a small probe at the end of the rod. It remains used in the balance of urethral strictures.

6: Various

a) Hysterosalpingography

This examination consists of filling the uterus with an opaque X-ray contrast product. It is almost no longer used for the study of the uterine cavity, but remains very useful and is still often practiced in the context of infertility for assessing the permeability of the fallopian tubes in case of pregnancy.

b) Galactography

This examination consists of filling a canal that opens up through a fine orifice in the nipple of a breast with an opaque X-ray contrast medium. It is only used in the event of unichannel nipple discharge. 

c) Sialography

This examination consists of filling the salivary glands (submaxillary or parotid) with an opaque X-ray contrast product. It remains prescribe in addition to ultrasound for the exploration of salivary pathologies (lithiasis, chronic infections, or other).

d) Saccoradiculography and Myelography

This examination consists of filling the dural sac contained in the spine with an opaque contrast agent with X-rays. This dural sac contains the spinal cord and the origin of the nerve roots. This clouding is done by lumbar puncture (saccoradiculography), more rarely by a cervical puncture for the study of the cervical or dorsal cord. Saccoradiculography, formerly widely used for sciatica and narrow lumbar canals, have seen its indications diminish with the development of Computed tomography (CT) and MRI. However, it is still prescribed in some situations because it is the only examination that can be practiced in a standing or sitting position, which sometimes unmasks compressions of nerve roots that are overlooked by other examinations such as CT or MRI, which can only be performed on a patient lying.

Author: Vicki Lezama