Roentgen himself happily avoided this because, when experimenting with the rays he discovered, in order to prevent the blackening of photographic plates, he was placed in a special cabinet lined with zinc, one side of which, facing the tube located outside the box, was also lined with lead.

The discovery of X-rays also meant a new era in the development of physics and all natural science. It had a profound influence on the subsequent development of technology. According to A.V. Lunacharsky, “the discovery of Roentgen gave an amazingly subtle key that allows one to penetrate into the secrets of nature and the structure of matter.”

Personal and collective protective equipment in x-ray diagnostics.

Currently, to protect against X-ray radiation when used for medical diagnostic purposes, a set of protective equipment has been formed, which can be divided into the following groups:

· means of protection against direct unused radiation;

· personal protective equipment for personnel;

· patient personal protective equipment;

· means of collective protection, which, in turn, are divided into stationary and mobile.

The presence of most of these products in the X-ray diagnostic room and their main protective properties are standardized by the “Sanitary Rules and Norms SanPiN 2.6.1.1192-03”, put into effect on February 18, 2003, as well as OSPORB-99 and NRB-99. These rules apply to the design, construction, reconstruction and operation of X-ray rooms, regardless of their departmental affiliation and form of ownership, as well as to the development and production of X-ray medical equipment and protective equipment.

In the Russian Federation, about a dozen companies are engaged in the development and production of radiation protection equipment for X-ray diagnostics, mostly new ones that were created during the perestroika period, which is associated, first of all, with fairly simple technological equipment and stable market needs. Traditional production of protective materials, which are the raw materials for the production of X-ray protective agents, is concentrated in specialized chemical enterprises. For example, the Yaroslavl Rubber Products Plant is practically a monopolist in the production of X-ray protective rubber of a whole range of lead equivalents, used in the production of stationary protective products (finishing the walls of small X-ray rooms) and personal protection (X-ray protective clothing). Sheet lead used for the manufacture of collective protective equipment (protection of walls, floors, ceilings of X-ray rooms, as well as rigid protective screens and screens) is produced in accordance with GOST standards at specialized factories for processing non-ferrous metals. Barite concentrate KB-3, used for stationary protection (protective plaster for X-ray rooms), is produced mainly at the Salair mining and processing plant. The production of X-ray protective glass TF-5 (protective viewing windows) is practically owned by the Lytkarino Optical Glass Plant. Initially, all work on the creation of X-ray protective equipment in our country was carried out at the All-Russian Research Institute of Medical Technology. It should be noted that almost all modern domestic manufacturers of X-ray protective equipment still use these developments to this day. For example, in the late eighties, VNIIMT for the first time developed a complete range of lead-free protective equipment for patients and personnel based on mixtures of concentrates of rare earth element oxides, which, as waste, accumulated in sufficient quantities at the enterprises of the USSR Ministry of Atomic Energy. These models were the basis for the development of numerous new manufacturers, such as X-ray-Komplekt, Gammamed, Fomos, Gelpik, Chernobyl Defense.

The basic requirements for mobile radiation protection equipment are formulated in the sanitary rules and regulations of SanPiN 2003.

Protection from the direct radiation used is provided in the design of the X-ray machine itself and, as a rule, is not produced separately (an exception may be aprons for screen-imaging devices, which become unusable during operation and must be replaced). Stationary protection of offices is carried out at the stage of construction and finishing works and is not a product of medical equipment. However, SanPiN provides standards for the composition of the area of ​​premises used (Table 1,2) .

Table 1 . Treatment room area with different x-ray machines

Table 2. Composition and area of ​​premises for X-ray dental examinations

At the stage of finishing the X-ray room, based on SanPiN, the level of additional protection of the walls, ceiling and floor of the treatment room is calculated. And additional plastering of the calculated thickness is carried out with radiation-protective barite concrete. Doorways are protected using special X-ray doors of the required lead equivalent. The viewing window between the treatment room and the control room is made of TF-5 X-ray protective glass; in some cases, X-ray protective shutters are used to protect window openings.

Thus, independent products for protection against x-ray radiation (mainly scattered by the patient and elements of the office equipment) are wearable and mobile means of protecting patients and staff, ensuring safety during x-ray examinations. The table shows the range of mobile and personal protective equipment and regulates their protective effectiveness in the anode voltage range of 70-150 kV.

X-ray rooms for various purposes must be equipped with protective equipment in accordance with the types of x-ray procedures performed (Table 3) .

Table 3. Nomenclature of mandatory radiation protection equipment

Depending on the adopted medical technology, adjustments to the nomenclature are allowed. When performing X-ray examinations of children, protective equipment of smaller sizes and an expanded range are used.

Mobile radiation protection equipment includes:

· large protective screen for personnel (one-, two-, three-leaf) - designed to protect the entire human body from radiation;

· small protective screen for personnel - designed to protect the lower part of the human body;

· small protective screen for the patient - designed to protect the lower part of the patient’s body;

· protective rotating screen - designed to protect individual parts of the human body in a standing, sitting or lying position;

Control check of the patient's position is a prerequisite for the production of x-rays, if the patient’s condition allows. Of course, a minimum of time should be spent on this, especially in cases where the patient is in a forced position. Particular attention should be paid to the correct relationship between the central beam of the working X-ray beam, the plane of the cassette and the main planes of the human body. After checking the placement, the area to be examined is secured using sandbags, bandages, compression belts, etc.

Forced fixation Children of preschool age and seriously ill patients are not eligible if the latter’s condition does not allow this. When radiography of preschool children and seriously ill patients, the area under study is recorded with the participation of an adult who accompanies the patient. It goes without saying that it must also be reliably protected from X-rays by the protective equipment available in the X-ray room.

Calm patient's position is ensured by the styling itself, if it does not cause him pain. In addition, during the installation process, various devices are used (rollers, pads, stands, etc.) that help ensure a calm position for the patient.

Protecting the patient from x-rays. Protecting the patient from X-rays refers to measures aimed at ensuring that the dose of X-ray radiation received by the patient is extremely reduced.

Security issues X-ray studies Patients are treated by both a radiologist and a radiographer, who need to know all the basic radiation protection measures when performing certain X-ray procedures.

Direction patients for X-ray examinations must be strictly limited and performed only for justified indications. In the referrals, the attending physicians must indicate the purpose and area of ​​the examination, the diagnosis and, in cases where there is no card, the date of the last x-ray examination.

Purpose sick for special complex methods of X-ray examination (bronchography, urography, angiography, etc.) should be carried out only according to strict clinical indications, after agreement with a radiologist.

Repeated ones, especially complex x-ray examinations, which are associated with a large radiation dose to the patient, are allowed to be carried out no earlier than 15 days after the last study. This is due to the fact that skin changes caused by exposure to X-rays can usually appear during this period. If reactions occur, repeated studies associated with high radiation exposure are not recommended. However, the timing of repeated X-rays may be changed when the patient's condition requires emergency or urgent care.

X-ray studies of women in childbearing age, if the study involves irradiation of the abdominal area or high radiation exposure, it is recommended to perform it in the first week after menstruation.

X-ray examination of pregnant women can only be performed according to strict clinical indications. In this case, preference is given to radiography. Examination of the abdominal cavity during pregnancy is strictly prohibited. If there are vital indications, then the issue of termination of pregnancy is decided.

At carrying out X-ray examinations optimal physical and technical conditions should be used under which the radiation dose would be minimal, namely: studies should be carried out at increased voltages on the tube, in the shortest possible time, with a minimum value of the anode current, with strict observance of radiation filtration, with maximum limitation of the irradiation field , at the greatest distances between the focus of the X-ray tube and the film.

For X-ray studies Particular attention should be paid to protecting the genital organs of patients, especially during childbearing years. In addition, other parts of the body that are not the object of research are also subject to protection. For example, when X-raying teeth and fingers in a sitting position, the patient should wear a leaded rubber apron; when radiography of the skull, the rest of the gel must be protected from x-rays, etc. During x-ray examinations, children are completely protected, except for the area that is to be examined. In most cases, protection of patients is ensured by covering adjacent areas of the body with lead rubber; in this case, the rubber is placed directly on the patient or on a special frame.

After exposure X-ray film, first of all, the patient should be freed from all protective or other devices and given the opportunity to take a free position; then you can begin chemical-photographic processing of the exposed film.

It is strictly forbidden to produce repeated x-ray examinations for the purpose of obtaining duplicates of x-rays for research or other purposes, except for the purpose of clarifying the diagnosis.

Protection from ionizing radiation of a reactor is based on its shielding and weakening with protective materials (creation of biological protection). The choice of materials for biological protection depends on the type of radiation. Thus, a-particles are completely absorbed by clothing and rubber gloves. To protect against P particles, operations with radioactive substances must be carried out behind special screens (screens) or in protective cabinets. X-ray and y-radiation are most completely absorbed by substances with high density (lead, steel, and concrete). To protect against neutrons, substances with a low atomic number are used, for example water, polyethylene.[...]

For the construction of stationary means of protecting walls, floors, ceilings, etc., brick, concrete, barite concrete and barite plaster are used (they contain barium sulfate - Ba804). These materials reliably protect personnel from exposure to gamma and x-ray radiation.[...]

When listing anthropogenic sources of radiation, only those that pose a danger to the entire population should be indicated. Here we should especially note medicine that uses X-ray radionuclide radiation for diagnostic and therapeutic purposes. In the 1980s, many older X-ray machines were replaced with modern equipment that uses lower radiation doses, reducing radiation exposure to patients. Protection from radiation is also provided by reliable shielding of those parts of the body that are not exposed to radiation for medical purposes. The effectiveness of these measures depends both on the quality of work of medical personnel and on the frequency of patient contact with radiation sources. Yet, despite the advances achieved in the field of radiology and radiology, medicine remains the main source of artificial exposure to radiation on the body.[...]

Various materials are used to create mobile screens. Protection against alpha radiation is achieved by using screens made of ordinary or organic glass several millimeters thick. A layer of air of several centimeters is sufficient protection against this type of radiation. To protect against beta radiation, screens are made of aluminum or plastic (plexiglass). Lead, steel, and tungsten alloys effectively protect against gamma and X-ray radiation. Viewing systems are made from special transparent materials, such as lead glass. Materials containing hydrogen (water, paraffin), as well as beryllium, graphite, boron compounds, etc., protect from neutron radiation. Concrete can also be used to protect against neutrons.[...]

Lead, its oxide and salts are used for the manufacture of batteries, for protection against x-rays and y-rays, for the manufacture of printing alloys, bronze, in the rubber industry, etc.[...]

However, prolonged or too intense exposure to x-rays, especially hard ones, on the body causes severe diseases similar to those that occur with y-irradiation. For this reason, protective measures against x-ray radiation are similar to those used against y-radiation.[...]

The first category includes work where radioactive substances are used in a closed form - sealed sources. Only external radiation is possible here, so protection from X-rays and gamma radiation is necessary.

The radiologist is responsible for the protection of patients, as well as staff, both inside the office and people in adjacent rooms. There may be collective and individual means of protection. In principle, protective measures are the same as when exposed to any type of ionizing radiation (including α, β, γ rays).

3 main methods of protection: protection by shielding, distance and time.

1 .Shielding protection:

Special devices made of materials that absorb X-rays well are placed in the path of X-rays. It can be lead, concrete, barite concrete, etc. The walls, floors, and ceilings in X-ray rooms are protected and made of materials that do not transmit rays to adjacent rooms. The doors are protected with lead-lined material. The viewing windows between the X-ray room and the control room are made of leaded glass. The X-ray tube is placed in a special protective casing that does not allow X-rays to pass through and the rays are directed at the patient through a special “window”. A tube is attached to the window, limiting the size of the X-ray beam. In addition, an X-ray machine diaphragm is installed at the exit of the rays from the tube. It consists of 2 pairs of plates perpendicular to each other. These plates can be moved and pulled apart like curtains. This way you can increase or decrease the irradiation field. The larger the radiation field, the greater the harm, so aperture- an important part of protection, especially in children. In addition, the doctor himself is exposed to less radiation. And the quality of the pictures will be better. Another example of shielding is that those parts of the subject’s body that are not currently subject to filming should be covered with sheets of leaded rubber. There are also aprons, skirts, and gloves made of special protective material.

2 .Time protection:

The patient should be irradiated during an X-ray examination for as little time as possible (hurry, but not to the detriment of diagnosis). In this sense, images give less radiation exposure than transillumination, because Very short shutter speeds (time) are used in the photographs. Time protection is the main way to protect both the patient and the radiologist himself. When examining patients, the doctor, all other things being equal, tries to choose a research method that takes less time, but not to the detriment of diagnosis. In this sense, fluoroscopy is more harmful, but, unfortunately, it is often impossible to do without fluoroscopy. Thus, when examining the esophagus, stomach, and intestines, both methods are used. When choosing a research method, we are guided by the rule that the benefits of the research should be greater than the harm. Sometimes, due to the fear of taking an extra photo, errors in diagnosis occur and treatment is prescribed incorrectly, which sometimes costs the patient’s life. We must remember about the dangers of radiation, but do not be afraid of it, it is worse for the patient.

3 .Protection by distance:

According to the quadratic law of light, the illumination of a particular surface is inversely proportional to the square of the distance from the light source to the illuminated surface. In relation to x-ray examination, this means that the radiation dose is inversely proportional to the square of the distance from the focus of the x-ray tube to the patient (focal length). When the focal length increases by 2 times, the radiation dose decreases by 4 times, and when the focal length increases by 3 times, the radiation dose decreases by 9 times.

During fluoroscopy, a focal length of less than 35 cm is not allowed. The distance from the walls to the X-ray machine must be at least 2 m, otherwise secondary rays are formed, which occur when the primary beam of rays hits surrounding objects (walls, etc.). For the same reason, unnecessary furniture is not allowed in X-ray rooms. Sometimes, when examining severely ill patients, the staff of the surgical and therapeutic departments helps the patient stand behind the X-ray screen and stand next to the patient during the examination, supporting him. This is acceptable as an exception. But the radiologist must ensure that nurses and nurses helping the patient wear a protective apron and gloves and, if possible, do not stand close to the patient (protection by distance). If several patients come to the X-ray room, they are called into the treatment room one person at a time, i.e. There should be only 1 person at the moment of the study.

End of work -

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Physical foundations of radiation diagnostics

Topic: physical foundations of radiation diagnostics.. plan, concept of radiation diagnostics.. X-rays and their properties..

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All topics in this section:

The concept of radiation diagnostics
Radiation diagnostics is a diagnostic discipline that combines a number of diagnostic methods, namely: 1. The classical x-ray method, which has existed for 113 years,

X-rays and their properties
X-rays were discovered in 1895 by German physicist Wilhelm Conrad Roentgen. In foreign (English-language literature) they are often called X-rays (X-ray).

X-rays
X-rays are produced in an X-ray tube. An X-ray tube is a glass container with a vacuum inside. There are 2 electrodes - cathode and anode. Cathode - thin tungsten

Properties of X-rays
We will analyze only those properties that are important in the practical work of a radiologist.

1. Great penetrating ability - the ability to pass through dense volumes
X-ray room design

There are many different types of X-ray machines, so the design of X-ray rooms can be different in detail, especially now in the age of high technology. But all devices in principle
X-ray examination methods

A lot of them. All of them are divided into basic and special. The main ones include fluoroscopy (transmission and radiography). X-ray examination of the patient is always
X-ray (pictures)

Most often, pictures are taken on X-ray film (we talked about it above). They can also be performed on fluorographic film (FOG) and on selenium plates - electroradiography
X-ray imaging features

1. The X-ray image is planar. To get a three-dimensional view of an organ, you have to take pictures in at least 2 projections - frontal and lateral (or oblique).
IX. Assessment of the quality of the obtained radiographs

1) Information content of the image. The doctor must be able to judge the presence or absence of pathological changes on the radiograph.
2) Completeness of coverage of the study area. So, in the picture d

Methods of X-ray examination of the lungs
Radiation diagnostic methods most often used in the study of the lungs are fluoroscopy and radiography, FOG, conventional (linear) tomography, angiopulmonography, bronchography.

At
Blackout

The most common symptom, it occurs with any compaction of the lung tissue: with pneumonia, tumors, tuberculosis, the presence of fluid in the pleural cavity, with the proliferation of connective tissue, etc. Behind
Changes in pulmonary pattern

Most often, when describing X-ray images, we come across the term enhanced pulmonary pattern. There is also a poor pulmonary pattern, deformed pulmonary pattern, absence of pulmonary
Extensive is a darkening that occupies the entire lung field or most of it (more than half of the lung). It can be caused by various pathological processes. Most common meeting

Staphylococcal and streptococcal pneumonia
They make up about 10% of the total number of pneumonias in adults. This form of pneumonia mainly occurs in children, especially newborns and infants.

There are primary and secondary pneumonias. By
Friedlander's pneumonia

This is a type of lobar pneumonia. One of the most severe forms of pneumonia. It occurs more often in weakened people, children and the elderly. Caused by Friedlander's bacillus (Klebsiella pneumoniae). Stable
Legionnaires' disease

This type of acute pneumonia was discovered and studied recently. It is caused by a gram-negative bacterium that does not belong to any known species (Legionella pneumophilia).
For this

Viral pneumonia
These include acute interstitial pneumonia, influenza pneumonia, psittacosis, adenovirus, etc. Viral pneumonia is a group of more or less similar diseases caused by various

Pneumonia due to adenoviruses
Some adenoviruses can cause pneumonia. These pneumonias are characterized by a pronounced reaction of the lymph nodes of the roots of the lungs and an increase in the pulmonary pattern, especially in the hilar regions. On this f

Ornithosis or psitacosis pneumonia
The causative agent of psittacosis is a filterable virus. A person becomes infected most often through contact with domestic or wild birds on poultry farms, at home from parrots, canaries, etc.

Contagion
Mycoplasma pneumonia

As an independent nosological form, this pneumonia was isolated relatively recently. The causative agent of pneumonia - Micoplasma pneumonia - is the smallest known microorganism, occupying between
Infarction pneumonia

The incidence of pulmonary embolism is increasing. Thromboembolism of the branches of the pulmonary artery contributes to the development of secondary infarction pneumonia.
In most cases, pulmonary embolism is a consequence of phlebitis of various types.

Pneumonia due to obstruction of bronchial obstruction

If bronchial patency is impaired, hypoventilation of a segment, lobe or lung occurs, thereby creating favorable conditions for the development of secondary pneumonia.

ABSTRACT

X-ray radiation in medicine and protective measures
staff and patients

Performer: Repin K.V. 304 gr.

Teacher: Zelenov V. A.

Syktyvkar, 2007

History of the discovery of X-rays. 3

Personal and collective protective equipment in x-ray diagnostics. 6

Dose loads on the population and personnel during medical X-ray examinations and the main ways to optimize them.. 11

History of the discovery of X-rays.

On the threshold of the 20th century, two important discoveries were made that restructured our knowledge in many branches of science and technology - the discovery of X-rays on November 8, 1895, and Becquerel's subsequent discovery of radioactivity in 1896.

The impression that Roentgen’s discovery made on the world community is evidenced by the following statement by Moscow physicist P. N. Lebedev, who wrote in May 1896: “Never before has any discovery in the field of physics met with such universal interest and been so thoroughly discussed.” discussed in periodicals as Roentgen’s discovery of a new, hitherto unknown type of ray.”

Wilhelm-Conrad Roentgen was born on March 27, 1845 in Leniep, a small town in Germany. Already in one of the senior classes of the gymnasium, he was expelled from it because he refused to hand over a friend who had drawn a caricature of an unloved teacher on the blackboard. Without a matriculation certificate, Roentgen could not get into university and entered first the mechanical engineering school and then the Zurich Polytechnic Institute.

Having received a diploma in mechanical engineering in 1868, Roentgen accepted the offer of the physicist Kundt and became his assistant, devoting his entire life to scientific and pedagogical activities. In 1869 he received the degree of Doctor of Science, and in 1875, at the age of thirty, he was elected professor of physics and mathematics at the Agricultural Academy in Hohenheim. In 1888 At the invitation of the oldest university in Germany in Würzburg, Roentgen holds the position of ordinary professor of physics and head of the physics institute.

During more than fifty years of scientific activity, Roentgen published about 50 works devoted to various branches of physics. Already a world-famous scientist, he does not give up teaching and continues to lecture on experimental physics. Only at the age of 70 did Roentgen leave the department, continuing his scientific activities almost until the last days of his life as head of the Institute of Physics and Metrology in Munich.

The characteristic features of Roentgen as a person were his exceptional modesty, restraint and isolation. Thus, in his laboratory, until his death, he forbade calling the rays he discovered X-rays, but only “X-rays” (X-Rays), despite the decision of the First International Congress on Radiology in 1906 to give them the name Roentgen rays.

Demanding and strictly principled in scientific research, he was straightforward and principled also in life, regardless of whom he met. At the same time, simplicity and modesty did not leave him even when he became one of the greatest people in the history of mankind. Roentgen’s attitude towards students was exceptional.

Roentgen had a hard time experiencing the first imperialist war and the attitude of the whole world towards the Germans, recognizing the wrongness of official German circles. At the beginning of the war, Germany's opponents crossed out his name from the list of world scientists. Roentgen himself found consolation in the fact that his discovery greatly contributed to mitigating the suffering of many wounded, and saved the lives of many, which became even more apparent during the Second World War.

Roentgen died on February 10, 1923, at the age of 78. Over a hundred awards and honorary titles in all countries of the world were awarded to him for his discovery, including from the Society of Russian Doctors in St. Petersburg, the Society of Doctors in Smolensk, and from the Novorossiysk University in Odessa. In many cities streets were named after him. The Soviet government, recognizing Roentgen's great services to science and humanity, erected a monument to him during his lifetime in front of the building of the Radiological Institute in Leningrad; The street on which this institute is located was named after him.

Roentgen made his discovery in the process of studying a special type of rays, known as cathode rays, which arise during an electrical discharge in tubes with a highly rarefied gas.

Observing in a darkened room the glow of a fluorescent screen - cardboard coated with platinum sulfur barium - caused by a stream of cathode rays emerging from the tube through the window, Roentgen suddenly noticed that when a current passes through the tube, crystals of platinum sulfur barium located at a distance on the table also glow. Naturally, he assumed that the glow of the crystals was caused by the visible light that the tube emitted. To test this, Roentgen wrapped the tube in black paper; however, the glow of the crystals continued. To solve another question - whether cathode rays cause the screen to glow or other, hitherto unknown rays, Roentgen moved the screen a considerable distance; the glow did not stop. Since it was known that cathode rays can travel only a few millimeters in the air, and in his experiments Roentgen far exceeded the limits of this thickness of the air layer, he concluded that either the cathode rays he obtained had such a penetrating power that no one had ever seen before. received, or it must have been some other, still unknown rays.

During the research, Roentgen placed a book along the path of the rays; the glow of the screen became somewhat less bright, but still continued. Passing rays in the same way through wood and various metals, he noticed that the intensity of the screen’s glow was either stronger or weaker. When platinum and lead plates were placed in the path of the rays, no glow from the screen was observed at all. Then the thought flashed through his mind to place his brush in the path of the rays, and on the screen he saw a clear image of bones against the background of a less clear image of soft tissue. To record everything that he saw, Roentgen replaced the fluorescent cardboard with a photographic plate and received on it a shadow image of those objects that were placed between the tube and the photographic plate; in particular, after 20 minutes of irradiation of his hand, he also received its image on a photographic plate.

Roentgen realized that this was a new, hitherto unknown natural phenomenon; abandoning all other activities, after two months of work he was able to give him such a comprehensive explanation, confirmed by a number of facts he collected, that over the next 17 years nothing fundamentally new was said in thousands of works devoted to his discovery. Roentgen formulated almost all the properties of the rays he discovered in three works dating back to 1895, 1896 and 1897. He also developed the technique for producing these new rays.

Academician A.F. Ioffe, who worked with Roentgen for many years, writes: “50 years have passed since X-rays were discovered. But from what Roentgen published in the first three messages, not a single word can be changed "Many thousands of studies could not add one iota to what Roentgen himself did under the most elementary conditions with the help of the most elementary instruments."

Roentgen's first message appeared in the scientific press in early January 1896. In a short time it was translated into many foreign languages, including Russian. Already on January 5, 1896, information about Roentgen’s discovery penetrated the general press. The whole world was stunned and excited by the news of this discovery. Both scientific journals and general magazines and newspapers were full of reports about X-rays.

In Russia, Roentgen's discovery was received with enthusiasm not only by specialist scientists, but also by the entire public. A.M. Gorky wrote in 1896 that X-rays are “the greatest creation of human genius.”

Roentgen understood perfectly well what material benefits his discovery promised him. However, he refused to derive any material benefits from it for himself and rejected a number of very profitable offers from American and German companies, answering them that his discovery belonged to all of humanity.

It will not be an exaggeration to say that radiology in medicine, in a relatively short period of its development, has done as much as no other branch of our knowledge has done. What was previously available only to individuals, brilliant masters and experts in their field, thanks to X-rays, has become available to ordinary doctors. In many areas of medical knowledge, our ideas have been radically changed under the influence of the new things that X-ray research has provided, and not only in the field of recognizing diseases, but also in the field of their treatment. During the last war, radiology greatly contributed to the rapid restoration of the health of wounded soldiers and commanders of our army and navy, as well as the development and implementation of operations that would have been unthinkable without it.

The biological effects of X-rays were unknown to Roentgen. Unfortunately, it became known later at the cost of many lives of doctors, engineers and x-ray technicians, who, not anticipating the damaging effects of x-rays, could not take preventive measures in a timely manner. Due to chronic and prolonged irritation by X-rays, X-ray burns of the skin and chronic inflammation in it developed, which later turned into cancer, as well as severe anemia.

So in our country, doctors S.V. Goldberg, S.P. Grigoriev, N.N. died from occupational x-ray cancer. Isachenko, Ya.M. Rosenblat, X-ray technician I.I. Lantsevich and others, abroad - Albers-Schönber, Levi-Dorn (Germany), Goltsknecht (Austria), Bergonier (France) and many other pioneers of radiology.

Roentgen himself happily avoided this because, when experimenting with the rays he discovered, in order to prevent the blackening of photographic plates, he was placed in a special cabinet lined with zinc, one side of which, facing the tube located outside the box, was also lined with lead.

The discovery of X-rays also meant a new era in the development of physics and all natural science. It had a profound influence on the subsequent development of technology. According to A.V. Lunacharsky, “the discovery of Roentgen gave an amazingly subtle key that allows one to penetrate into the secrets of nature and the structure of matter.”

Personal and collective protective equipment in x-ray diagnostics.

Currently, to protect against X-ray radiation when used for medical diagnostic purposes, a set of protective equipment has been formed, which can be divided into the following groups:

· means of protection against direct unused radiation;

· personal protective equipment for personnel;

· patient personal protective equipment;

· means of collective protection, which, in turn, are divided into stationary and mobile.

The presence of most of these products in the X-ray diagnostic room and their main protective properties are standardized by the “Sanitary Rules and Norms SanPiN 2.6.1.1192-03”, put into effect on February 18, 2003, as well as OSPORB-99 and NRB-99. These rules apply to the design, construction, reconstruction and operation of X-ray rooms, regardless of their departmental affiliation and form of ownership, as well as to the development and production of X-ray medical equipment and protective equipment.

In the Russian Federation, about a dozen companies are engaged in the development and production of radiation protection equipment for X-ray diagnostics, mostly new ones that were created during the perestroika period, which is associated, first of all, with fairly simple technological equipment and stable market needs. Traditional production of protective materials, which are the raw materials for the production of X-ray protective agents, is concentrated in specialized chemical enterprises. For example, the Yaroslavl Rubber Products Plant is practically a monopolist in the production of X-ray protective rubber of a whole range of lead equivalents, used in the production of stationary protective products (finishing the walls of small X-ray rooms) and personal protection (X-ray protective clothing). Sheet lead used for the manufacture of collective protective equipment (protection of walls, floors, ceilings of X-ray rooms, as well as rigid protective screens and screens) is produced in accordance with GOST standards at specialized factories for processing non-ferrous metals. Barite concentrate KB-3, used for stationary protection (protective plaster for X-ray rooms), is produced mainly at the Salair mining and processing plant. The production of X-ray protective glass TF-5 (protective viewing windows) is practically owned by the Lytkarino Optical Glass Plant. Initially, all work on the creation of X-ray protective equipment in our country was carried out at the All-Russian Research Institute of Medical Technology. It should be noted that almost all modern domestic manufacturers of X-ray protective equipment still use these developments to this day. For example, in the late eighties, VNIIMT for the first time developed a complete range of lead-free protective equipment for patients and personnel based on mixtures of concentrates of rare earth element oxides, which, as waste, accumulated in sufficient quantities at the enterprises of the USSR Ministry of Atomic Energy. These models were the basis for the development of numerous new manufacturers, such as X-ray-Komplekt, Gammamed, Fomos, Gelpik, Chernobyl Defense.

The basic requirements for mobile radiation protection equipment are formulated in the sanitary rules and regulations of SanPiN 2003.

Protection from the direct radiation used is provided in the design of the X-ray machine itself and, as a rule, is not produced separately (an exception may be aprons for screen-imaging devices, which become unusable during operation and must be replaced). Stationary protection of offices is carried out at the stage of construction and finishing works and is not a product of medical equipment. However, SanPiN provides standards for the composition of the area of ​​premises used (Table 1,2) .

Table 1 . Treatment room area with different x-ray machines

Table 2. Composition and area of ​​premises for X-ray dental examinations

At the stage of finishing the X-ray room, based on SanPiN, the level of additional protection of the walls, ceiling and floor of the treatment room is calculated. And additional plastering of the calculated thickness is carried out with radiation-protective barite concrete. Doorways are protected using special X-ray doors of the required lead equivalent. The viewing window between the treatment room and the control room is made of TF-5 X-ray protective glass; in some cases, X-ray protective shutters are used to protect window openings.

Thus, independent products for protection against x-ray radiation (mainly scattered by the patient and elements of the office equipment) are wearable and mobile means of protecting patients and staff, ensuring safety during x-ray examinations. The table shows the range of mobile and personal protective equipment and regulates their protective effectiveness in the anode voltage range of 70-150 kV.

X-ray rooms for various purposes must be equipped with protective equipment in accordance with the types of x-ray procedures performed (Table 3) .

Table 3. Nomenclature of mandatory radiation protection equipment

Depending on the adopted medical technology, adjustments to the nomenclature are allowed. When performing X-ray examinations of children, protective equipment of smaller sizes and an expanded range are used.

Mobile radiation protection equipment includes:

· large protective screen for personnel (one-, two-, three-leaf) - designed to protect the entire human body from radiation;

· small protective screen for personnel - designed to protect the lower part of the human body;

· small protective screen for the patient - designed to protect the lower part of the patient’s body;

· protective rotating screen - designed to protect individual parts of the human body in a standing, sitting or lying position;

· protective curtain - designed to protect the entire body, can be used instead of a large protective screen.

Personal radiation protection equipment includes:

· protective cap - designed to protect the head area;

· safety glasses - designed to protect the eyes;

· protective collar - designed to protect the thyroid gland and neck area, should also be used in conjunction with aprons and vests that have a cutout in the neck area;

· protective cape, cape - designed to protect the shoulder girdle and upper chest;

· one-sided protective apron, heavy and light - designed to protect the body from the front from the throat to the shins (10 cm below the knees);

· double-sided protective apron - designed to protect the body from the front from the throat to the shins (10 cm below the knees), including the shoulders and collarbones, and from the back from the shoulder blades, including the pelvic bones, buttocks, and from the side to the hips (at least 10 cm below belt);

· protective dental apron - designed to protect the front part of the body, including the gonads, pelvic bones and thyroid gland, during dental examinations or examination of the skull;

· protective vest - designed to protect the front and back of the chest organs from the shoulders to the lower back;

· an apron to protect the gonads and pelvic bones - designed to protect the genitals from the side of the radiation beam;

· protective skirt (heavy and light) - designed to protect the gonads and pelvic bones on all sides, must have a length of at least 35 cm (for adults);

· protective gloves - designed to protect the hands and wrists, the lower half of the forearm;

· protective plates (in the form of sets of various shapes) - designed to protect individual areas of the body;

· protective equipment for male and female gonads is intended to protect the genital area of ​​patients.

For the study of children, sets of protective clothing are provided for various age groups.

The effectiveness of mobile and personal radiation protection equipment for personnel and patients, expressed in lead equivalent, should not be less than the values ​​specified in table 4.5.

Table 4. Protective effectiveness of mobile radiation protection equipment

Table 5. Protective effectiveness of personal radiation protection equipment

Dose loads on the population and personnel during medical X-ray examinations and the main ways to optimize them

Irradiation for medical purposes, according to UNSCADAR, ranks second (after natural background radiation) in terms of contribution to population irradiation on the globe. In recent years, radiation loads from the medical use of radiation have shown an increasing trend, which reflects the increasing prevalence and availability of x-ray diagnostic methods throughout the world. At the same time, medical use of radiation sources makes the largest contribution to anthropogenic exposure. Average exposures due to medical use of radiation in developed countries are approximately equivalent to 50% of the global average exposure from natural sources. This is mainly due to the widespread use of computed tomography in these countries.

Diagnostic radiation is characterized by fairly low doses received by each patient (typical effective doses are in the range of 1 - 10 mSv), which in principle is quite sufficient to obtain the required clinical information. Therapeutic radiation, in contrast, involves much higher doses precisely delivered to the tumor volume (typical prescribed doses in the range of 20-60 Gy).

In the annual collective radiation dose of the population of the Russian Federation, medical exposure accounts for about 30%.

The adoption of the Federal Laws of the Russian Federation: “On Radiation Safety of the Population” and “Sanitary and Epidemiological Welfare of the Population” fundamentally changed the legal basis for the organization of State Sanitary and Epidemiological Supervision over the use of medical sources of ionizing radiation (IRS) and required a complete revision of sanitary rules and regulations governing the limitation of exposure of the population and patients from these sources. In addition, there was a need to develop at the Federal level new organizational and methodological approaches to determining and accounting for dose loads received by the population from medical procedures using radiation sources.

In Russia, the contribution of medical exposure to the integral radiation dose of the population is especially large. If, according to UNSCEAR data, the average dose received by an inhabitant of the planet is 2.8 mSv and the share of medical exposure in it is 14%, then the exposure of Russians is 3.3 mSv and 31.2%, respectively.

In the Russian Federation, 2/3 of medical exposure comes from X-ray diagnostic studies and almost a third from preventive fluorography, about 4% from highly informative radionuclide studies. Dental examinations add only a small fraction of a percent to the total radiation dose.

The population of the Russian Federation is still one of the most exposed due to medical exposure and, unfortunately, this situation does not yet have a downward trend. If in 1999 the population dose of medical exposure to the population of Russia was 140 thousand man-Sv, and in previous years it was even less, then in 2001 it increased to 150 thousand man-Sv. At the same time, the country's population has decreased. In Russia, an average of 1.3 x-ray examinations per year are performed per year for each resident. The main contribution to the population dose comes from fluoroscopic studies - 34% and preventive fluorographic studies using film fluorographs - 39%.

Some of the main reasons for high doses of medical radiation are: low rates of renewal of the fleet of outdated X-ray machines with modern ones; unsatisfactory maintenance of medical equipment; lack of financial resources to purchase personal protective equipment for patients, highly sensitive films and modern auxiliary equipment; low qualification of specialists.

A random check of the technical condition of the X-ray equipment fleet in a number of territories of the constituent entities of the Russian Federation (Moscow, St. Petersburg, Bryansk, Kirov Tyumen regions) showed that from 20 to 85% of operating devices operate with deviations from the modes specified in the technical specifications . At the same time, about 15% of the devices cannot be adjusted, the radiation doses to patients are 2-3, and often more times higher than during their normal operation, and they must be written off.

The strategy for reducing dose loads on the population during X-ray procedures should include a phased transition in radiology to digital information processing technologies and, above all, in the conduct of preventive procedures, the share of which in the total volume of X-ray studies is about 33%. Calculations show that the dose load on the population will decrease by 1.3 -1.5 times.

An important component of reducing dose loads on the population is the correct organization of the darkroom process. Its main elements are: selection of the type of film depending on the location of the examination area and the type of x-ray procedure; Availability of modern technical means for film processing. The use of an optimal set of modern technologies when working in a “dark room” allows, due to a sharp reduction in duplication of images and optimization of screen-film combinations, to reduce the dose load on patients by 15-25%.

The introduction of radiation-hygienic passports into the practice of the Central State Sanitary and Epidemiological Service and health care institutions, with the correct methodological approaches to measuring, recording, recording and statistical processing of doses, already today makes it possible to make management decisions that give the maximum effect of reducing individual and collective radiation risk while maintaining the high quality of medical care to the population . At the present stage, a detailed analysis of the dynamics of dose loads is the basis for justifying the need to revise medical technologies using radiation sources in favor of alternative research methods with optimization based on the benefit-harm principle. This approach, in our opinion, should be the basis for the development of standards for radiological diagnostics.

A large role in solving the above problem is given to the personnel of radiology departments. Good knowledge of the equipment used, the correct choice of examination modes, precise adherence to patient positioning and the methodology of its protection - all this is necessary for high-quality diagnostics with minimal radiation, guaranteeing against defects and forced repeated examinations.

It is generally accepted that radiology has the greatest reserves for justified reduction of individual, collective and population doses. UN experts have calculated that reducing medical radiation doses by only 10%, which is quite realistic, is equivalent in effect to the complete elimination of all other artificial sources of radiation exposure to the population, including nuclear energy. For Russia, this potential is much higher, including for most administrative territories. The medical radiation dose to the country's population can be reduced by approximately 2 times, that is, to the level of 0.5-0.6 mSv/year, which is the level of most industrialized countries. On the scale of Russia, this would mean a reduction in the collective dose by many ten thousand man-Sv annually, which is equivalent to preventing every year several thousand fatal cancers induced by this radiation.

When performing X-ray procedures, the personnel themselves are exposed to radiation. Numerous published data show that radiographers currently receive an average annual occupational dose of about 1 mSv per year, which is 20 times lower than the established dose limit and does not entail any significant individual risk. It should be noted that it is not even the workers of X-ray departments who may be exposed to the greatest radiation, but doctors of the so-called “related” professions: surgeons, anesthesiologists, urologists involved in performing X-ray surgical operations under X-ray control.

Currently, legal relations related to ensuring the safety of the population during X-ray and radiological studies are set out in more than 40 legal, organizational and administrative documents. Since patient exposure levels in medical practice are not standardized, compliance with their radiation safety must be ensured by compliance with the following basic requirements:

* conducting X-ray and radiological examinations only for strict medical reasons, taking into account the possibility of conducting alternative studies;

* implementation of measures to comply with current norms and regulations when conducting research;

* carrying out a set of measures for radiation protection of patients aimed at obtaining maximum diagnostic information with minimal radiation doses.

At the same time, production control and state sanitary and epidemiological supervision must be fully implemented.

Full implementation of the proposals of the Russian State Sanitary and Epidemiological Service to optimize dose loads during X-ray diagnostic procedures based on the results of the annual radiation-hygienic certification of medical institutions will make it possible in the next 2-3 years to reduce the effective average annual radiation dose per person to 0.6 mSv. At the same time, the total annual collective effective radiation dose to the population will decrease by almost 31,000 man-Sv, and the number of probable cases of malignant diseases (fatal and non-fatal) will decrease over this period by more than 2200.