ASIAN MEDICAL INSTITUTE NAMED AFTER

S.TENTISHEV
Medical Faculty
The Department of Therapeutic Sciences

«approved» «approved»

Chief of study-methodical dept. chief of department

______________________ ___________________

«__»____________20__. «__»____________20__.

Discipline –"Internal diseases and Radiological diagnostics"

____________________________________________________________________

(title of discipline)

Direction-Medical Business

______________________________________________________________________

The composer – Emiroslanova Safiiat Suleymanovna- teacher of Department of Therapeutic

science

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 Kant 2017

Сontent

1. Explanatory notes………………………………………..3

2. Working programm ……………………………………..5

3. Methodicalmatherials……………………………………8

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1.

Explanatory note

This program directed on giving of qualitative services in sphere of high and middle medical
occupational education by extensive spectrum of specialties for implementation of Mission of
AzMI:

- Preparation of specialists corresponded to contemporary requirements in medical care

service

- Creation of good conditions for realization of education export and guarantee of

education

- Assistance for development of scientific potential of Kyrgyz Republic

- Mutual enrichment and interaction, penetration of cultures

- Achievement of international admission and supporting of AzMI image as one of leading

universities in Kyrgyz Republic

Preface

Modern approaches to the study of radiology are based on the latest ideas about the etiology,
anatomy, physiology, pathological anatomy and physiology of various diseases, as well as on the
latest achievements of science and technology in the field of medical imaging.

The subject matter of the discipline is considered in accordance with the modern scientific
definition of the development of radiation diagnosis in combination with other methods of
diagnosis and treatment of diseases.

The author's concept involves the study of the current state of radiation diagnosis, the definition
of its role and possibilities in the complex of other basic methods of diagnosis and treatment of
various diseases and its importance for clinical practice.

In addition to radiology, great importance is attached to the study of other diagnostic methods
(computed tomography, magnetic resonance imaging, ultrasound, radionuclide diagnostics) and
treatment (X-ray surgery).

Methods of radiation diagnosis are now widely used in therapy, surgery, orthopedics, oncology,
neurosurgery and neurology for the detection of various diseases.

The goals of programm

Prevention of many functional diseases and profilaxis of complication of diseases of human

should start with the early diagnosis with using of modern technology in Radiology. The
methodics of different radiological investigations have some specific features in practice include
the protection of human from radiologic hazards and over special moments.

• Very important part of program is forming of basic research skills of collection

information about new scientific discoveries in Radiology (new methods of diagnosis, treatment,
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prevention and rehabilitation of internal diseases), primary abilities of analysis of morbidity and
mortality in region.

• The big part in program take process of supporting development of moral and
cultural/spiritual values in students, striving for constant self-education and self-improvement,
careful attitude to national and world cultural traditions and values skills of critical thinking,
readiness to observe the principles of medical ethics and deontology. The programm
contemplate development of skills of critical thinking, readiness to keep principles of medical
ethics and deontology.

The purpose of teaching the course of internal diseases and radiology:

To teach students of medical faculty to prevent, diagnose on time and treat the most common
diseases. Form a doctor's behavior based on ethical and deontological principles and norms.

The objectives (results) of teaching the course of internal diseases and radiology:

1. The ability to apply basic knowledge of Radiology for diagnosis with using of
modern methods of radiological examination of treatment within self-competence
limits.

Student must know:

 - principles of image acquisition for radiation diagnostic methods
 (X-ray, ultrasound, radionuclide methods, computer
and magnetic resonance imaging);
-physical fundamentals of methods of radiation diagnostics;
 -diagnostic capabilities of various methods of radiation diagnosis;
-properties of sources of ionizing radiation, basic methods of dosimetry and
clinical dosimetry;
- tactics and expedient sequence of application of beam
research in the most common diseases;
- to know the basic principles of radiotherapy of tumors, indications and
contraindications
to its conduct, the physical and biological basis of the method of radiation therapy;
- modern methods of radiation treatment of malignant neoplasms and
Non-tumor diseases;
- radiation reactions and damage in radiation therapy, methods of their prevention;
- deontological aspects in radiology.
- the main clinical manifestations of radiation reactions and damage;
- terminology used in radiotherapy and diagnosis.

Student should be able to:

 - To choose optimum technical modes of use of various methods of beam
diagnostics;
- Use methods to obtain a high-quality diagnostic image;

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 - the ability to identify and assign the most informative method of radiation diagnosis
(ultrasound, roentgenogram, computer tomogram, etc.);
- identify the image of human organs and indicate their main anatomical structures on
the results radial examinations (tomograms, roentgenograms, etc.);
- analyze the quality of images obtained using various methods of radiation
diagnostics.
- independently identify images of all human organs, indicate their anatomical
structures on X-ray photographs, X-ray computer and magnetic resonance
tomograms, ultrasonic scans, scintigrams, angiograms.

 Student must own:

 physical and biological bases, technical support of various methods of radiation
diagnostics and radiotherapy, methods of clinical dosimetry, terminology used in
radiation diagnostics and radiation therapy.

 Must demonstrate ability and readiness: to apply the knowledge gained in

practice.

The thematic plan of lectures for XI semester:

1 Introduction to radiation diagnostics. History of radiology. 8h

General and specific radiology issues. The modern methods of radiology
investigations: US, CT, MRI, RND, intervention radiology
2 Introduction to radiology. Radiotherapy department. Sources of ionizing 4h
radiation. Radiation protection and clinical dosimetry.
3 Indications and contraindications to radiation diagnosis. Methods and planning 4h
radiation diagnosis. Radiation Reactions and Damage
4 Methods of radiation diagnosis in diseases of the respiratory system. 8h
Interpretation of the data. Differential diagnostics. Indications and
contraindication to investigations.
5 Methods of radiation diagnosis in diseases of the organs of the digestive system. 8h
Interpretation of the data. Differential diagnostics. Indications and
contraindication to investigations.
The thematic plan of lectures for XII semester:
1 Methods of radiation diagnosis in diseases of the cardiovascular system. 8h
Interpretation of the data. Differential diagnostics. Indications and
contraindication to investigations.
2 Methods of radiation diagnosis in diseases of the osteo-articular system. 8h
Interpretation of the data. Differential diagnostics. Indications and
contraindication to investigations.
3 Methods of radiation diagnosis in diseases of the genitourinary system. 8h
Interpretation of the data Differential diagnostics. Indications and
contraindication to investigations.
4 The main methods of radiological examination of central nervous system. 8h
Radiological examination of scull and vertebral column. Radiological examination
of cerebral circulation. Radiological diagnosis of brain tissue pathology.

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The thematic plan of practice lessons of XI-XII semester for VI year Medical faculty

XI semester
1. introduction to 1. Introduction to radiology. History of developments radiology. 2h
radiology 2. Radiation department. Sources ionizing radiation. Facilities 2h
radiation protection and clinical dosimetry
3. X-ray and fluoroscopy. The basis of the method, the 2h
advantages and disadvantages of the method. Indications and
contraindications to this study. Methods to protect the patient
and medical staff. 2h
4.CT scan
The basis of the method. Indications and contraindications to this
study. Preparing the patient for the study. 2h
5.Positron emission tomography. The basis of the method.
Indications and contraindications to this study. Preparing the
patient for the study.
6. Ultrasound procedure. The basis of the method. Preparing the 2h
patient for an ultrasound examination of the abdominal organs,
organs of the urinary system. Indications and contraindications.
The use of ultrasound diagnosis with minimally invasive
procedures (puncture of a cyst, abscess, pleurisy, ascites). 2h
7. MRI. The basis of the method. Indications and
contraindications to this study. Preparing the patient for the 2h
study.
8. Echocardiography. The basis of the method, the advantages
and disadvantages of the method. transesophageal
echocardiography.

2. Lung disease 1. X-ray image acquisition mechanism. Normal chest on 2h

semiotics. radiograph. Correct patient placement during the investigation.
2. Radiological diagnosis of pneumonia. Classification of
pneumonia. Radiological diagnosis of focal, lobar, total
pneumonia. Clinical options. Treatment of acute pneumonia 2h
depending on the etiology. Emergency treatment of severe
pneumonia.
3. Radiographic diagnosis and ultrasound of lung abscess, 2h
echinococcal lung cyst.
4. Radiological diagnosis and ultrasound of emphysema, 2h
bronchiectasis, asthma. Modern principles of treatment of COPD
and asthma. Emergency treatment for asthmatic status 2h
5. Radiological diagnosis and ultrasound of pneumothorax,
hydropneumothorax, pyopneumothorax, fibrotorax, pleuritis. 2h
6. Radiological diagnosis of congenital diseases of lungs.

3. Diseases of 1. Diseases of the esophagus: polyp, diverticulum, Barrett's 4h

gastrointestinal trackt esophagus, chemical burns of the esophagus. Clinic, radiation
diagnosis. Therapy.
2. Gastroesophageal reflux, hiatal hernia, paraesophageal 4h
hernia
3. Stomach ulcer, gastric perforation. Clinic, radiation 2h
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 diagnosis. Therapy. Complications.
4. Diseases of the duodenum: ulcer, atresia. Clinic, radiation 2h
diagnosis. Therapy. Complications.
5. Bowel obstruction: high intestinal obstruction, low 2h
intestinal obstruction. Causes, Symptoms, methods of
radiology. Treatment.
6. Gastrointestinal bleeding. The reasons for the differences 2h
in bleeding from the upper and lower gastrointestinal
tract. Diagnostics. Treatment.
7. Foreign body digestive tract. Radiology diagnosis. 2h
Treatment. X-ray contrast and non-x-ray contrast foreign
bodies.
8. Diseases of the small intestine: diverticula congenital 2h
(true), acquired (false); terminal ileitis. Causes,
Symptoms, methods of radiology. Treatment.
9. Diseases of the large intestine: polyps, ulcerative-necrotic
esterocolitis, Crohn's disease, Dolichocolon. 2h
Dolichosigmoid Megacolon. Causes, Symptoms, methods
of radiology. Treatment.
10. Diseases of the large intestine: Hirschsprung disease, 2h
atresia of the anus. Causes, Symptoms, methods of
radiology. Treatment.
11. Liver diseases: Hepatitis, liver cirrhosis, cysts, liver 2h
abscess, liver amyloidosis, liver tumors.
12. Diseases of the biliary system: cholecystitis, cholangitis, 2h
gallstone disease, cyst of the bile duct.
4. Mediastinum 1. Mediastinal volume mass: cysts, benign and malignant 4h
tumors. Clinic, Radiology.
XII semester
1. Heart disease 1. Myocarditis. Definition Etiology and pathogenesis. 4ч
semiotics Classification. Clinical picture. Radiological diagnosis of
myocarditis. Principles of treatment. Complications.
2. Pericarditis. Definition Etiology. Dry and exudative
pericarditis. Classification. Instrumental diagnostics: X-ray,
EchoCG, MRI, radionuclide methods, myocardial biopsy. Drug
and surgical treatment. Complications. Forecast.
3. Cardiomyopathy. Definition Etiology. Pathogenesis of 4h
intracardiac hemodynamic disorders in dilated, hypertrophic,
restrictive cardiomyopathy and right ventricular arrhythmogenic
dysplasia. Classification. Secondary cardiomyopathy. The main
clinical syndromes. Instrumental diagnostics: X-ray, EchoCG,
MRI, radionuclide methods, myocardial biopsy. Drug and
surgical treatment. Complications. Forecast. 4h
4. Acquired heart defects. Mitral valve insufficiency. Mitral
stenosis. Aortic valve insufficiency. Aortic stenosis. Etiology of
valvular defects. Pathogenesis of hemodynamic disorders in
acquired heart defects. 4h
2. Clinical manifestations, direct and indirect signs of heart
disease. The value of instrumental methods in the diagnosis of
heart defects. Combined and combined heart defects: clinical
features, determination of the predominance of the defect,
diagnosis, course, complications, prognosis. Relative and
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 absolute valve insufficiency.

3 Urinary system 1. Methods of radiation diagnosis with contrast: 2h

cystography, urography. Indications and
contraindications to these types of studies. Preparing the
patient for the study. Interpretation of the data.
2. Radiological diagnosis of diseases of the urinary system: 4h
hydronephrosis, vesicoureteral reflux. Definition,
classification, diagnosis, treatment.
3. Radiological diagnosis of diseases of the urinary system: 4h
urolithiasis, pyelonephritis. Definition, classification,
diagnosis, treatment.
4. Radiological diagnosis of diseases of the urinary system: 4h
benign and malignant tumors. Definition, classification,
diagnosis, treatment.

4 Methods of 1. Angiography. Interventional radiology. 4h

diagnostic Diagnostic and therapeutic vascular and extravascular
interventions under the control of radiation techniques
visualization

2. Radionuclide diagnostics.
The principle of obtaining the image. Types of radionuclide 4h
diagnostics (radiometry, radiography, gamma topography,
emission computed tomography (single-photon and positron).
Diagnostic capabilities of the method.

5. Radiation signs of 8h
diseases of the
musculoskeletal system

СРС

1. Infective endocarditis in patients with acquired 4h

heart defects.
Flaws tricuspid valve
2. Diseases of the nervous system: craniocerebral and spinal hernias. Clinic, radiological 4
diagnostic methods, treatment. h
Concussion, brain injury. Clinic, radiological diagnostic methods, treatment. 4h
Cerebral stroke for children. Clinic, radiological diagnostic methods, treatment 4h

TOPICS OF LECTURES.

Topic #1

Organization and technology of radiation research. Methods of research. Radiological diagnosis

is a clinical discipline that develops the theory and practice of applying radiation in the diagnosis
of diseases. History of development and the physical basis of X-rays. Fundamentals of radiation
protection. Subjects studying radiation diagnosis. X-ray diagnostics, computed and magnetic
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resonance imaging, radionuclide diagnostics, ultrasound diagnostics, angiography and
interventional radiology. Sources of radiation used for diagnostic purposes. Regulation of
radiation diagnostic studies. Principles of protection against ionizing radiation. The main
methods of obtaining medical diagnostic images. Image analysis, computer processing of
medical images. Digital imaging technologies. Methods of artificial contrasting of internal
organs. Contrast media and their scope. Possible complications. Radiation safety in X-ray and
osteological studies.

Topic #4

Methods of radiological examination of the lungs. The use of computed and magnetic resonance
imaging, radionuclide studies. Radiation anatomy of the lungs. The division of the lungs into
fields and zones. Share and segmental structure of the lungs. Radiation syndromes of the lung.
Identification of the main indicators of pulmonary pathology: darkening or enlightenment of the
pulmonary field or its part, change in pulmonary and root pattern.

Topic#6

Osteo-articular system in the radial image. Normal radial anatomy of the osteo-articular
apparatus. Radiation methods for studying the osteo-articular system. Radiation age anatomy of
the osteo-articular system.

Topic #7

Radiation anatomy and semiotics of diseases of the gastrointestinal tract. Methods of radiation
diagnosis of the esophagus, stomach, duodenal ulcer, small intestine, large intestine. Methods
and techniques of artificial contrasting of the digestive organs. Radiation anatomy of the
esophagus, stomach, intestines. Radiological diagnosis of diseases of the gastrointestinal tract.

Topic #8

Methods of radiation diagnosis of diseases of the urinary system. Pielonefritis, hydronephrosis,

urolithiasis, kidney tumors.

Any doctor, regardless of his profile, must deal with an objective radiological examination
document - X-rays, CT scan and others. It should be understood that the interpretation of the X-
ray is a difficult matter. To understand the shadow image you need to perfectly know the
anatomy and function of the test organ and possible pathological changes in it.

History.

The era of obtaining visual information about the living human body began on November 8,
1895, when Professor of the University of Würzburg, Wilhelm Conrad Roentgen, conducting
experiments with cathode tubes, opened the X-rays, which were later named after him as X-rays.

The moment of opening X-rays is usually described as follows. Experimenting with cathode
tubes, Wilhelm K. Roentgen, once leaving in the evening from his laboratory, saw the
inexplicable glow of a screen covered with platinum cyanide barium. Many would have left
conducting refining experiments for the future, but Professor Roentgen returned to the
laboratory, and over the next few weeks, after conducting a whole series of experiments,
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established the nature of the new rays. Already on December 22, 1895, Roentgen carried out a
15-minute exposure to the X-rays of the hand of his wife Bertha and received pictures of the
bones of the hand with rings on the fingers. This date is considered the "birthday" of a new
medical specialty.

The announcement of the discovery of Wilhelm K. Roentgen caused a sensation in the scientific
world. During 1896, X-rays were taken in the leading clinics and laboratories of Vienna, Paris,
London, St. Petersburg, Moscow. In Russia, the first X-ray image was performed by the famous
scientist Alexander Stepanovich Popov, and his wife, Raisa Sergeyevna, became one of the first
Russian radiologists.

The discovery of Wilhelm K. Roentgen gave a start to a whole series of amazing discoveries.
Studying one of the X-rays in Paris in 1896, Antoine Henri Becquerel became interested in the
mechanism of X-ray formation, in particular, their connection with fluorescence. After 2 months,
he proved that similar rays emit the natural element uranium.

Initially, these rays were called Becquerel rays - by analogy with X-rays. However, later it was
found that such rays emit many natural substances. It was this discovery of natural radioactivity
that resulted in the first appearance of radium, isolated by Pierre Curie and Maria Sklodowska-
Curie in 1898, and then the discovery of possibilities for its medical use. From that moment
began an in-depth study of the atom, the development of radiochemistry, the emergence of
artificial isotopes, and, finally, atomic energy.

In 1929, the German doctor Werner Forsmann was the first in the world to perform right heart
catheterization. In 1956, he, along with other scientists (A. Kurnan, D. Richards) received the
Nobel Prize in Medicine for the creation of angiography. the first angiographies were performed
before World War II by E. Monitz and I. Dos Santos (1927 and 1929)

During the Second World War, angiography and radionuclide diagnostics began to develop
rapidly. In 1953, the Swedish scientists I.Edler and K.H. Hertz received the first ultrasound
image of the heart. In 1964, the American doctor Charles Dotter and his assistant M. Jadkins for
the first time in the world were able to pass through a conductor (a special metal string for
catheterization of vessels according to the technique of S. S. Seldinger proposed in 1953), which
gave rise to a new iliac artery. medical diagnostics - interventional radiology.

The success of the Swiss physician Andreas Grüntzig, who in 1977 performed the first coronary
artery balloon angioplasty. In 1963, J. Anger developed a scintillation chamber, laying the
technical basis of the radionuclide imaging method - scintigraphy.

In 1971, a prototype of an X-ray CT scanner was installed in London. It was created by the
engineer Godfrey Hounsfild, who worked in the recording company EMI (hence the first name
of the device EMI-scanner). For technical reasons, this device could only be used for brain
research, but even this, despite the poor (according to modern concepts) image quality, caused a
sensation comparable to the discovery of X-rays. Scientists, having overcome serious technical
difficulties, in 1975 created an X-ray computed tomography scanner to study the whole body.
For the creation of a method of computed tomography Gondri Hausfield and Alan Cormac in
1979 was awarded the Nobel Prize in Medicine.

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The basis of another tomographic technique - magnetic resonance imaging (MRI) - is the work
of two Nobel laureates of physicists F. Bloch and E. Parcell (1952), who discovered the effect of
nuclear magnetic resonance (NMR).

In 1973, physicist Paul Lauterbur created a method for the spatial localization of the MR signal
and obtained the first images of test objects. In 1977, the American doctor R. Damadian received
the first MRI scans of animals and humans. From this period began the rapid introduction of
magnetic resonance imaging in the diagnosis. In 1979, the Swiss researcher R. Ernst received the
Nobel Prize in Chemistry for the development of methods for MR-spectroscopy, and in 2003 the
Nobel Prize in Medicine was awarded to P. Lautherbur and P. Mansfield for the introduction of
MRI.

Radiology (roentgenology) is the science of the use of all types of radiation and waves to study
the structure and functions of organs and tissues for the purposes of screening, preventing and
diagnosing diseases.

Radiation therapy is the science of using various types of ionizing radiation to treat diseases
(mostly malignant neoplasms).

The methods of radiation diagnostics combine to use for obtaining images of various
electromagnetic radiation (ionizing and non-ionizing) or waves (ultrasound), magnetic field and
radio-frequency oscillations (magnetic resonance imaging, spectroscopy), artificial radioactive
drugs (radionuclide diagnostics) acting on or through object under study or emitted by it.

In this case, the interaction of radiation (attenuation, absorption, reflection, scattering) with the
human body is recorded and studied. Processing of the material obtained allows to obtain an
image suitable for diagnosis.

Scheme of the device for radiation diagnosis:

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 1. radiation source; 2. investigation object; 3. radiation detector; 4. signal processing unit; 5.
Computer

Methods of radiation diagnosis are divided into 2 categories: ionizing (X-ray, fluoroscopy,
angiography, CT, radioisotope examination) and non-ionizing (ultrasound, MRI). To expand the
diagnostic capabilities of some methods, it is necessary to inject intravenous contrast agents.
Such techniques are called minimally invasive, and in contrast to the introduction of various
instruments and contrast agents into the ural body vessels (invasive methods). From a technical
point of view, images of the body can be obtained by projection (X-ray, fluoroscopy,
angiography, planar scintigraphy) and tomographic (layer-by-layer) methods (ultrasound, CT,
MRI).

Next, we consider the methods of radiation diagnosis.

Brief X-ray Characteristic

X-ray radiation is electromagnetic radiation, which is a stream of quanta (photons) that propagate in a
straight line at the speed of light(300 000km\s). These quanta have no electric charge and cause
ionization. In the tissues of the human body, ionization can cause damage to DNA and cells, and, in
addition, it provides non-invasive visualization of internal anatomical structures.

Quanta have no charge and have a very small mass. The main properties of x-rays, which determine their
use in practical medicine, are penetrating ability, fluorescent, photochemical and biological effects.

The penetrating power significantly depends on the wavelength of radiation, which ranges from tens to
hundredths of an angstrom. The shorter the wavelength, the "tougher" the radiation and the more
penetrating power it has. In turn, the x-ray wavelength depends on the magnitude of the voltage applied to
the poles of the x-ray tube. The higher the voltage on the tube, the greater the speed and energy of the
flow of electrons in the vacuum space of the tube and the shorter the wavelength of the resulting x-rays.
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When X-rays interact with a substance, quantitative and qualitative changes occur in the latter. The
degree of X-ray absorption by the tissues is different and is determined by the density, thickness and
atomic mass of the elements that make up the object under study. The higher these indicators, the more,
ceteris paribus, absorbed x-rays. The structural features of the human body, the presence of organs of
different physical density (lungs, bones, soft tissues and others) in it cause unequal absorption of x-rays in
them, which is the basis of visualization of internal organs and structures.

The subject of radiology

Medical radiology (as defined by L. D. Lindenbraten and I. P. Korolyuk) is a field of medicine

that develops the theory and practice of using radiation for diagnosis and treatment.

Radiology (radiology, diagnostic radiology) - the science of using "radiation" to study the
structure and function of normal and pathologically changed organs and systems of a person for
the prevention, diagnosis and determination of the prevalence of diseases.

The specialty "radiation diagnosis" includes the study of the following methods:

. X-ray diagnostics (roentgenology) - a method of radiation diagnosis based on the registration

of X-rays passing through the body (X-rays).

It includes:

1.1 Radiography - obtaining X-rays of various parts of the body.

1.2. fluoroscopy - the study of organs and their functions by X-ray screening.

1.3 Angiography - X-rays after the introduction of contrast agents into the arterial, venous or
lymphatic system.

1.4 Computed tomography (X-ray CT) - obtaining transverse (axial) sections of the body.

2. Radionuclide diagnostics (nuclear medicine) - a method of radiation diagnosis, based on the

registration of radiation introduced into the body of artificial radioactive substances
(radiopharmaceuticals).

These include:

2.1 Radiometry and radiography

2.2 Planar (flat) scintigraphy

2.3 Positron Emission Tomography

3. Ultrasound diagnosis (sonography) - methods of radiation diagnosis, based on the analysis of

the reflection of ultrasonic waves (elastic waves) from the tissues.

These include:

3.1 Ultrasound examination (ultrasound), including echocardiography

3.2 Dopplerography (assessment of the speed, direction and nature of the movement of blood
and other biological fluids).
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3.3 Other methods of processing and recording ultrasonic waves.

4. Magnetic resonance - methods of radiation diagnostics, based on the phenomenon of

resonance of atomic nuclei in a magnetic field.

These include:

4.1 Magnetic resonance imaging

4.2 Magnetic resonance spectroscopy

5. Interventional radiology (endovascular surgery) is a field of medicine based on the use of

radiation diagnosis methods for performing minimally invasive interventions for the purpose of
diagnosis and treatment.

In terms of their ability to cause tissue ionization, all methods of radiation diagnosis are divided
into 2 large categories: ionizing (X-ray, fluoroscopy, angiography, CT, radionuclide studies) and
non-ionizing methods (ultrasound, MRI).

If necessary, intervention in the internal environment of the body distinguish between invasive
and non-invasive research methods.

Invasive methods include interventional radiology methods, when the application of the method
requires the introduction of instrumentation into the body, for example, the introduction of
catheters into the central (arterial, venous) vessels for injection of contrast preparations.

1.1 1.2 Roentgenography and Roentgenoscopy

Roentgenoscopy and Roentgenography are the strategies of X-ray examination.

Roentgenoscopy (Greek "scopeo" - examine, observe) - a study in which the x-ray image is
projected on a fluorescent screen (or a system of digital detectors).

The method allows for static, as well as dynamic, functional study of organs (for example, x-
ray of the stomach, a tour of the diaphragm) and to monitor the conduct of interventional
procedures (for example, angiography, stenting). Currently, when using digital systems,
images are obtained on the screen of computer monitors.

The main disadvantages of fluoroscopy include relatively high radiation exposure and
difficulties in differentiating the “subtle” changes.

Roentgenoography (Greek "Greapho" - to write, to depict) - a study in which receive an x-

ray image of an object fixed on film (direct X-ray) or on special digital devices (digital X-
ray).
Traditional radiography using radiographic film or digital radiography remains one of the
main and widely used research methods. This is due to the high efficiency, simplicity and
informativeness of the obtained diagnostic images.
Ultrasound diagnosis (sonography, ultrasound) is a method of radiation diagnosis based on
imaging of internal organs using ultrasound waves.

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2. Ultrasound is widely used in diagnosis. Over the past 50 years, the method has become
one of the most common and important, providing fast, accurate and safe diagnosis of
many diseases.
Ultrasound is called sound waves with a frequency of more than 20 000 Hz. This form of
mechanical energy is of a wave nature.
Ultrasonic waves propagate in biological media. The speed of propagation of ultrasonic
waves in tissues is constant and is 1540 m / s. The image is obtained by analyzing the signal
reflected from the boundary of two media (echo).
In medicine, the most frequently used frequencies are in the 2-10 MHz range.
Ultrasound is generated by a special sensor with a piezoelectric crystal. Short electrical
pulses create mechanical vibrations of the crystal, as a result of which ultrasonic radiation is
generated.

The greater the acoustic impedance, the greater the reflection of ultrasound. The air does not
conduct ultrasonic waves, therefore, to improve the penetration of the signal at the air / skin
interface, a special ultrasound gel is applied to the sensor. This eliminates the air gap
between the patient’s skin and the sensor. Strong artifacts in the study may arise from
structures containing air or calcium (lung fields, bowel loops, bones and calcinates.
Modern ultrasound machines are sophisticated digital devices. They use real-time sensors.
Images are dynamic, they can observe such rapid processes as breathing, contraction of the
heart, pulsation of blood vessels, movement of valves, peristalsis, movement of the fetus.
The position of the sensor connected to the ultrasonic device with a flexible cable can vary
in any plane and at any angle. The analog electrical signal generated in the sensor is
digitized and a digital image is created.

Doppler sonography (Doppler sonography) is an ultrasound technique based on the use of

the Doppler effect. The essence of the effect is that ultrasound waves from moving objects
are reflected with a changed frequency. This frequency shift is proportional to the speed of
movement of the structures being located — if the movement is directed towards the sensor,
the frequency increases, if away from the sensor, it decreases.
Doppler described the physical effect, according to which the frequency of the sound
generated by a moving object changes when it is perceived by fixed receivers depending on
the speed, direction and nature of the movement. The method of doplerography is used to
measure and visualize the speed, direction and character of the movement of blood in the
vessels and chambers of the heart, as well as the movement of any other fluids.

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In the Doppler study of blood vessels, continuous wave or pulsed ultrasonic radiation passes
through the area under investigation. When an ultrasound beam crosses a vessel or chamber
of the heart, ultrasound is partially reflected by erythrocytes. For example, the frequency of
the reflected echo from blood moving in the direction of the sensor will be higher than the
original frequency of the waves emitted by the sensor. The difference between the frequency
of the received echo signal and the frequency of the ultrasound generated by the sensor is
called the Doppler shift. This frequency shift is proportional to the speed of blood flow.
The modern development of duplex technology has led to the emergence of the method of
color Doppler blood flow mapping. Within the control volume, the stained blood flow is
superimposed on the two-dimensional image. At the same time, blood is displayed in color,
and immobile tissues in a gray scale. When blood moves to the sensor, red-yellow colors are
used, while moving from the sensor - blue-blue.

In most cases, for the purpose of ultrasound it is enough to use sensors for percutaneous
examination. However, in some cases it is necessary to bring the sensor closer to the object.
For example, in large patients, sensors placed in the esophagus (transesophageal
echocardiography) are used to examine the heart; in other cases, intrarectal and intravaginal
sensors are used to obtain high-quality images. During the operation resort to the use of
operating sensors.
In modern clinical practice, the method of ultrasound is widespread. This is because when
using the method there is no ionizing radiation, it is possible to carry out functional and load
tests, the method is informative and relatively inexpensive, the devices are compact and easy
to use.
3 Computed tomography is an x-ray method based on the receipt of layer-by-layer images in
the transverse plane and their computer reconstruction.
Creation of devices for CT is the next revolutionary step in obtaining diagnostic images after
the discovery of X-rays.
CT does not have absolute contraindications to its use (except for the limitations associated
with ionizing radiation) and can be used for emergency diagnostics, screening, and also as a
method for specifying diagnostics.
At first, computer tomographs were divided into generations, depending on how the X-ray
tube - detectors system was arranged. Despite the numerous differences in the structure, they
were all called "stepper" tamographs. This is due to the fact that after each cross-section, the
tomograph stopped, the table with the patient took a “step” a few millimeters, and then
performed the next cut.
In 1989, spiral computed tomography (SCT) appeared. In the case of SCT, an X-ray tube
with detectors constantly rotates around a moving table with a patient. This allows not only
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to shorten the time of the study, but also to avoid the limitations of the “step-by-step”
technique - skipping the plots in the study due to the different depth of breath held by the
patient.
It was possible to synchronize the introduction of a contrast agent with the beginning of the
movement of the table in the CT, which led to the creation of CT angiography.
In 1998, multispiral CT (MSCT) appeared. Systems were created with not one (as in the
MTS), but with 4 rows of detectors.
Since 2002, tomographs with 16 rows of digital elements in the detector have been used, and
since 2003, the number of rows of elements has reached 64.
In 2007, MSCT with 256 and 320 rows of detector elements appeared.

4 Magnetic resonance imaging (MRI) is a medical imaging technique used in radiology to

form pictures of the anatomy and the physiological processes of the body in both health and
disease. MRI scanners use strong magnetic fields, magnetic field gradients, and radio waves
to generate images of the organs in the body. MRI does not involve X-rays or the use of
ionizing radiation, which distinguishes it from CT or CAT scans and PET scans. Magnetic
resonance imaging is a medical application of nuclear magnetic resonance (NMR). NMR
can also be used for imaging in other NMR applications such as NMR spectroscopy.

While the hazards of X-rays are now well-controlled in most medical contexts, an MRI scan
may still be seen as a better choice than a CT scan. MRI is widely used in hospitals and
clinics for medical diagnosis, staging of disease and follow-up without exposing the body to
radiation. However, MRI may often yield different diagnostic information compared with
CT. There may be risks and discomfort associated with MRI scans. Compared with CT
scans, MRI scans typically take longer and are louder, and they usually need the subject to
enter a narrow, confining tube. In addition, people with some medical implants or other non-
removable metal inside the body may be unable to undergo an MRI examination safely.

MRI was originally called NMRI (nuclear magnetic resonance imaging), but the use of
'nuclear' in the acronym was dropped to avoid negative associations with the word. Certain
atomic nuclei are able to absorb and emit radio frequency energy when placed in an external
magnetic field. In clinical and research MRI, hydrogen atoms are most often used to
generate a detectable radio-frequency signal that is received by antennas in close proximity
to the anatomy being examined. Hydrogen atoms are naturally abundant in people and other
biological organisms, particularly in water and fat. For this reason, most MRI scans
essentially map the location of water and fat in the body. Pulses of radio waves excite the
nuclear spin energy transition, and magnetic field gradients localize the signal in space. By
varying the parameters of the pulse sequence, different contrasts may be generated between
tissues based on the relaxation properties of the hydrogen atoms therein.

Since its development in the 1970s and 1980s, MRI has proven to be a highly versatile
imaging technique. While MRI is most prominently used in diagnostic medicine and
biomedical research, it also may be used to form images of non-living objects. MRI scans
are capable of producing a variety of chemical and physical data, in addition to detailed

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spatial images. The sustained increase in demand for MRI within health systems has led to
concerns about cost effectiveness and overdiagnosis.

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