Radiology room. Design of x-ray rooms (roentgen project). What is included in the design services of medical x-ray rooms

The placement of the X-ray room and equipment in it is carried out on the basis of a project carried out by an organization that has a license for the placement of sources of ionizing radiation (generating) and the design of radiation protection equipment.

The X-ray room, unlike other rooms of medical institutions, is not one room, but several rooms (rooms isolated from each other), each of which has its own purpose and corresponds in area to the established regulatory requirements and also meets all other sanitary and hygienic requirements. We will focus on the latter in detail.

The X-ray room includes at least 3 isolated rooms, one of which serves as a treatment room (a room in which work is directly carried out using ionizing radiation sources), the second is a control room (a room in which the equipment that controls the IRS is located) and the third is an office doctor. Depending on the purpose of the x-ray equipment or the specifics of the activities of the medical institution, the x-ray room may include a photo lab, waiting room, dressing room, staff room, etc. ( detailed information about the types of X-ray rooms is described in the article "").

Appendix 5 to SanPiN 2.6.1.1192-03 establishes the composition and area of the X-ray rooms. So, based on the information in Appendix 5 to SanPiN 2.6.1.1192-03, we give below in table 1 the area of the procedure room with different x-ray machines, in table 2 the composition and area of the premises of the x-ray diagnostic room, in table 3 - the composition and area of \u200b\u200bthe rooms of the radiotherapy room.

Table 1

Treatment room area with different x-ray machines

X-ray machine	Area, sq. m (at least)
X-ray machine	The use of a wheelchair is envisaged	Wheelchair use not included
X-ray diagnostic complex (RDC) with a full set of racks (PSSH, imaging table, imaging rack, imaging rack)	45	40
RDK with PSSH, rack of shots, tripod of shots	34	26
RDK with PSSh and universal stand-tripod, X-ray diagnostic apparatus with digital image processing	34	26
RDK with PSSh having remote control	24	16
Apparatus for X-ray diagnostics by X-ray method (image table, image stand, image stand)	16	16
Apparatus for X-ray diagnostics with a universal stand-tripod	24	14
Apparatus for close-range X-ray therapy	24	16
Apparatus for long-distance radiotherapy	24	20
Mammography machine		6
Apparatus for osteodensitometry		8

table 2

The composition and area of the premises of the X-ray diagnostic room

The name of a room	Area, sq. m (at least)
General premises of the department (office)
Department manager's office	12
staff room	10 (+3.5 sq. m. for each additional employee)
Results Review Room (Snapshots)	6
Barium Cooking Cabin	3
expected	6
Material	8
Spare parts pantry	6
Storage room for cleaning items	3
Temporary storage room for x-ray film (no more than 100 kg)	6
Staff personal hygiene room	3
Restrooms for staff and patients	3 per cab
Computer	12
Engineering	12
X-ray room
Fluorography room for mass examinations – procedural - dressing room - expected — photo lab** - staff room	14 6 6 6 9
Fluorography room for diagnostic images – procedural - control room (in the absence of a protective cabin) — photo lab** – dressing room* — doctor's office (for devices with digital image processing)	14 6 6 3 9
X-ray diagnostic room using fluoroscopy and radiography (1,2 and 3 r.m.) – procedural 1 – procedural 2 - control room – dressing room* — photo lab** - doctor's office	According to the table one according to the table one 6 3 8 9
Room for X-ray diagnostics of diseases of the gastrointestinal tract (1 r.m.) – procedural - control room — photo lab - toilet for patients - doctor's office	According to the table one 6 8 3 4 9
Room for X-ray diagnostics using X-ray and / or tomography (1, 2 and 3 r.m.) – procedural 1 - control room – dressing room* — photo lab** - staff room	According to the table one 6 3 8 9
Room for X-ray diagnostics of breast diseases using mammography – procedural - procedural spec. methods (if necessary) – dressing room* — photo lab** - doctor's office	6 8 3 8 9
Room for X-ray diagnostics of diseases of the genitourinary system (urological) – treatment room with drain - control room — photo lab** – dressing room with a daybed* - doctor's office	According to the table one 6 8 4 9
Cabinet (box) for X-ray diagnostics of infectious departments - vestibule at the entrance to the box (gateway at the entrance to the box) - expected - restroom at the expected – procedural - control room — photo lab** - doctor's office	1,5 6 3 according to the table one 6 8 9
Topometry room (radiotherapy planning) – procedural - control room – barium preparation cabin — photo lab** - doctor's office - restroom	According to the table one 6 3 8 9 3
X-ray operating unit
1. Block for diagnosing diseases of the heart and blood vessels – X-ray operating room - control room — preoperative – sterilization* – room for temporary stay of the patient after the study* — photo lab** - doctor's office	48 8 6 8 8 8 9
2. Block for the diagnosis of diseases of the lungs and mediastinum – X-ray operating room - control room — preoperative – sterilization* – cytological diagnostics* — photo lab** — picture viewing room* - doctor's office - nurses' room* — staff personal hygiene room* - storage room dirty laundry*	32 8 6 6 6 8 6 9 13 4 4
3. Block for diagnosing diseases of the urogenital system – X-ray operating room - control room — photo lab** - doctor's office – Contrast preparation room* - toilet for patients	26 6 8 9 5 3
4. Block for diagnosing diseases of the reproductive organs (mammary gland) – X-ray operating room - control room — photo lab** - doctor's office	8 4 6 9
X-ray computed tomography room
1. CT room for head examination – procedural - control room — generator/computer — photo lab** - doctor's office	18 7 8 8 9
2. CT room for routine examination – procedural - control room — generator/computer — photo lab** - doctor's office - dressing room - viewing	22 8 8 8 9 4 6
3. CT room for X-ray surgery – procedural — preoperative - control room — generator/computer — photo lab** - doctor's office - viewing - room for the preparation of contrast agents - toilet for patients - nurse's room - engineer's room	36 7 10 8 8 9 10 5 3 12 12

* Not necessary.
** Not needed when using digital radiography and fluorography devices.

Table 3

The composition and area of the premises of the radiotherapy room

The name of a room	Area, sq. m (at least)
1. Near-distance radiotherapy room
– treatment room with 2-3 emitters	16
– treatment room with 1 emitter	12
- control room	9
- doctor's office (examination)	10
- expected	6
2. Room for long-range radiotherapy
– procedural	20
- control room	9
- doctor's office (examination)	10
- expected	6

The use of premises of a smaller area or a reduced set of premises is possible in cases where the equipment used, the organization of work, the number of personnel, etc. ensure compliance with general hygiene requirements (microclimate, bacterial contamination, sanitary and epidemiological regime, etc.).

According to the hygienic requirements of SanPiN 2.6.1.1192-03, it is advisable to place X-ray rooms centrally, as part of the X-ray department, at the junction of the hospital and the clinic. Separately, X-ray rooms of infectious diseases, tuberculosis and obstetric departments of hospitals and, if necessary, fluorography rooms of emergency departments and outpatient departments can be placed.

As a general rule, the X-ray department (office) is not allowed to be placed in residential buildings and children's institutions. The exception is dental X-ray rooms (devices), the possibility of placing them in residential buildings is regulated by a special chapter of the rules SanPiN 2.6.1.1192-03, as well as the "Basic sanitary regulations ensuring radiation safety (OSPORB-99/2010" SP 2.6.1.2612-10 and Amendment 1 to SP 2.6.1.2612-10. It is not allowed to place dental X-ray machines with a film image sensor in residential buildings.

In dental and X-ray dental offices adjacent to residential apartments, it is allowed to place X-ray diagnostic devices with digital image processing, the total rated workload of which does not exceed 40 mA-min / week. (detailed information on this issue is set out in the article "Placement of X-ray equipment in a dental clinic").

It is allowed to operate X-ray rooms in polyclinics built into residential buildings, if the vertically and horizontally adjacent premises are not residential. It is also allowed to place X-ray rooms in an extension to a residential building, as well as in basement floors, if the entrance to the X-ray department (office) is separate from the entrance to the residential building.

As stipulated in clause 3.3 of SanPiN 2.6.1.1192-03, an X-ray department serving only a hospital or only a clinic should be located in the end parts of the building. In this case, the branch should not be through. Entrances to the X-ray department for inpatients and outpatient departments are separate.

Important: by virtue of clause 3.4 of SanPiN 2.6.1.1192-03, it is not allowed:

Place X-ray rooms under rooms where water can flow through the ceiling (pools, showers, latrines, etc.);
Place the procedural X-ray room adjacent to the wards for pregnant women and children.

According to paragraph 2 of Appendix 7 to SanPiN 2.6.1.1192-03, the choice of premises that make up the X-ray room (department) is carried out by the administration of the medical institution together with the X-ray department (RRO) (or another organization similar in function to the RRO) of the region and is consistent with institution of sanitary and epidemiological supervision. At the same time, in relation to individual rooms of the X-ray room, the medical organization must comply with the special requirements established by SanPiN 2.6.1.1192-03. However, in practice, there is no longer such approval of the selected premises with Rospotrebnadzor, and applications for approval of the location of the X-ray room are no longer submitted.

Treatment room - a specially equipped room in the X-ray room, in which an X-ray emitter is located and X-ray examinations or X-ray therapy are carried out.

According to paragraph 3.11 of SanPiN 2.6.1.1192-03, the height of the X-ray treatment room should ensure the functioning of technical equipment, for example, a ceiling mount for an X-ray emitter, a tripod, a television monitor, a shadowless lamp, etc. requires a room height of at least 3 m (2.6 meters according to the newer SanPiN 2.1.3.2630-10). The height of the X-ray treatment room in the case of rotational irradiation should be at least 3 m. ×1.8 m.

Requirements for the area of the procedure room, including depending on the X-ray machine, are given in tables 1, 2 and 3 above. At the same time, as stipulated in paragraph 3.9, the area of the procedure room can be adjusted in agreement with the body exercising federal sanitary and epidemiological supervision, taking into account the following requirements:

The distance from the workplace of the personnel behind a small protective screen to the walls of the room is at least 1.5 m;
The distance from the workplace of the personnel behind a large protective screen to the walls of the room is at least 0.6 m;
The distance from the swivel table-tripod or from the image table to the walls of the room is at least 1.0 m;
The distance from the photo rack to the nearest wall is at least 0.1 m;
The distance from the X-ray tube to the viewing window is at least 2 m (for mammography and dental devices - at least 1 m);
Technological passage for personnel between the elements of stationary equipment - at least 0.8 m;
The area for placing a gurney for a patient is at least 1.5 × 2 m;
Additional area in case of technological need to bring a wheelchair into the treatment room - 6 m 2.

In accordance with clause 3.30 of SanPiN 2.6.1.1192-03, in the procedural room, in addition to the procedural room for fluorography and X-ray surgery, it is planned to install a sink with a supply of cold and hot water. In the treatment room, designed for urological examinations, a viduar should be installed.

In the procedural room for the study of children, the presence of toys (which are washed in a soap and soda solution and disinfected) and distracting design is allowed.

Important: It is not allowed to place equipment in the procedural room that is not included in the project, as well as to carry out work that is not related to X-ray examinations.

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The arrangement of a modern X-ray room includes several stages, starting with the preparation of the room itself. The planning of the office, the calculation of parameters and the technological arrangement are carried out by special services, preferably in tandem with an experienced radiologist.

The equipment of the X-ray room includes:

arrangement of radiation protection,
treatment room equipment
photo lab equipment,
equipment for the workplace of a doctor and laboratory assistant.

It is also desirable to have a separate room for storing film archives.

Arrangement of radiation protection

To provide protection against penetrating x-ray radiation, the treatment room is finished with special X-ray protective materials over the entire area: walls, ceilings and floors, doors and windows. Barite plaster for walls or special X-ray protective gypsum panels, leaded materials with a certain lead equivalent - glass and metal sheets to protect doors and windows.

Procedural equipmentrooms

The list of basic equipment for the procedure room of the X-ray room:

x-ray machine stationary for 2 or 3 workplaces (radiography, fluoroscopy, linear tomography),
ward mobile device,
dental x-ray machine for intraoral images or orthopantomograph,
digital radiovisiograph (on request).

According to sanitary standards, the installation of one X-ray diagnostic complex for 2 or 3 workplaces requires an area of at least 6 square meters. m, including the installation of an aiming dental apparatus. For additional installation orthopantomograph requires more than 8 sq. m area. For the installation and operation of the second apparatus, a room of 12 square meters is required. m.

In modern X-ray diagnostics, both film and digital X-ray systems with highly sensitive receivers are used, which improve the quality of studies and reduce the radiation load. Remote-controlled systems are used for remote fluoroscopy, which does not require light adaptation, and also reduces the radiation load on personnel.

A digital radiovisiograph is a wireless flat panel detector in cassette format that allows you to acquire a digital image using an analog X-ray machine.

Required additional equipment:

mobile (screens) and personal protective equipment made of leaded rubber, the set of which includes: aprons, collars, gloves, skirts and aprons, hats, a set of protective plates and goggles. All personal protective equipment must have a factory marking and a lead equivalent of at least 0.3 mm,
individual wearable dosimeters-radiometers for individual monitoring of personnel, they are periodically changed and sent to a special laboratory (to determine the possible radiation dose received),
screw Chair,
fixing chair for examination of children (on request).

If there are two X-ray machines, a special interlock must be installed to prevent the simultaneous activation of all the equipment.

X-ray complexes are placed in such a way that the main radiation beam is directed to the main wall.

In the absence of a specially allocated room, the control panel is located behind a B-40 type protective screen.

The X-ray room must be equipped with autonomous supply and exhaust ventilation with an air exchange rate of at least 3 per hour.

The front door must be closed on the inside with a latch, and on the outside it must have signal lamp for patients.

Equipment for a photo lab and a doctor's workplace

The photo laboratory of the X-ray room should be equipped with the following equipment:

installation for manual film processing (tank tanks) or processing machine for automatic X-ray film processing,
non-actinic developing lights with red (for green-sensitive film) or green (for blue-sensitive film) light,
negatoscopes for viewing pictures,
photo lab clock with timer,
multiple cassette set standard sizes for film exposure
electric cabinet for drying the developed film,
x-ray film storage cabinet,
expendable materials: x-ray film, photoreagents, barium for fluoroscopy.

The photo laboratory should have cold and hot water supply, supply and exhaust ventilation.

The workplace of a radiologist is located in a separate room or combined with a control room. Equipped with:

personal computer with application software package,
fluoroscope (for viewing fluorograms),
negatoscope,
laser printer for printing digital images,
an intercom for transmitting commands to the patient, a video device for monitoring the patient or a viewing window with X-ray protective glass.

To additional equipment includes furniture: chairs and tables, filing cabinets.

LLC SK Olimp offers to use the services of designing X-ray medical offices"turnkey" in Moscow. Our experts will do everything necessary work for the creation and commissioning of the X-ray room, including the preparation of a full package of documents and obtaining licenses, conclusions and permits.

Find out the cost of the service - send a request for a project

What is included in the design services of medical X-ray rooms?

The creation of an X-ray room begins with the choice of a room and an X-ray machine. At this stage, it is already necessary to know some of the features that will be presented by Rospotrebnadzor in the future when putting the X-ray room into operation and obtaining a sanitary and epidemiological conclusion (SEZ).

The next step is the design of an X-ray room with the obligatory calculation of X-ray protection. Our company carries out the development of a technological project for an X-ray room, both as part of the complex preparation of a turnkey X-ray room, and as a separate independent service. More information about X-ray room design can be found

The design of an X-ray room begins with a survey of the structural elements of the building and internal existing engineering systems. Then a package of documents is created, which includes text and graphic parts as part of:

Explanatory note.
Technological part (with the provision of calculation of protection from sources of ionizing radiation and radiation safety). Perform the calculation of radiation protection in accordance with the current standards (SanPiN 2.6.1.1192-03).
Architectural and construction solutions.
Structural and space-planning solutions.
Estimated documentation.
Information about engineering equipment, about networks of engineering and technical support, a list of engineering and technical measures:

subsection "Power supply system";
subsection “Water supply and sanitation system”;
subsection "Heating, ventilation";
subsection "Communication networks";
subsection "Automation".

Based on the design of the X-ray room, all subsequent repair and construction work is carried out, including the installation of X-ray protective structures and elements. LLC "SK "OLIMP" offers the whole set of construction, repair and installation work, including the creation of X-ray protection on the basis of a technological project agreed in the RFW and the availability of a license for the placement of sources of ionizing radiation (IRS), design and manufacture of radiation protection means of RRS (License No. 77.99.15.002.L.000059.08.14).

What data and requirements are taken into account when designing X-ray rooms?

Design documentation for medical rooms with X-ray equipment is developed in accordance with the Government Decree No. 87 of February 16, 2008 and the letter of the Ministry of Regional Development of the Russian Federation of June 22, 2009 No. 19088-sk / 08; RMD 11-08-2009. The composition and areas of the premises are designed on the basis of the results of measurement work and surveys (including an examination of the supply and water supply systems, ventilation, heating power supply), taking into account the planned functional purpose premises and parameters set by the equipment manufacturer, and the requirements of SanPiN 2.1.3.2630-10, SNiP 31-06-2009, SNiP 21-01-97, SP 2.6.1.2612-10, SanPiN 2.6.1.1192-03, TSN 31- 330-2005, SP 31-110-2003, SNiP, SanPiN, PUE. The project must take into account the requirements of the Guidelines for the design of healthcare institutions, SanPiN 2.1.3.2630-10, SNiP 41-01-2003. Decree of the Government of the Russian Federation of April 25, 2012 N 390 "On the fire regime" and other applicable regulatory documents.

The planning solution for the re-equipment of the premises is carried out in accordance with the standards technical regulations, SaNPiN, taking into account the location of the premises for the installation of the X-ray apparatus.

Sections of the working documentation of architectural and planning and architectural and construction solutions are developed taking into account the state load-bearing structures buildings in accordance with current rules operation of the premises.

Procedure for commissioning X-ray rooms

1 Our company carries out "on a turn-key basis" the whole complex of works on design and repair and construction work with subsequent commissioning and obtaining a free economic zone. In cases where there are activities that involve not only the use of medical equipment for personal purposes, we provide a service for accompanying and obtaining a Rospotrebnadzor License for sources of ionizing radiation. More information
The procedure for commissioning X-ray rooms is regulated by SanPiN 2.6.1.1192-03, as well as SP 2.6.1.1283-03, SanPiN 2.1.3.2630-10. According to SanPiN 2.6.1.1192-03, the documented commissioning process is as follows:
2
Purchase of an X-ray machine and receipt of documents provided by the equipment manufacturer:
- Sanitary and epidemiological conclusion for the X-ray machine;
- Registration certificate of the Ministry of Health of Russia for an X-ray machine (certified copy);
- Operational documentation for the X-ray machine.
You should be aware that not all types of dental x-ray machines can be used in clinics located in residential buildings. It depends on the purpose of the device, its workload and on the nominal value of the anode voltage. Restrictions on these parameters are specified in SanPiN 2.6.1.1192-03 "Hygienic requirements for the design and operation of X-ray rooms, apparatus and X-ray examinations."
3
Obtaining a license of an institution for medical activities.
4
Please note that there are several options for placing the X-ray machine:
- in a separate room, the area of \u200b\u200bwhich must be at least 6 m2;
- in room dental office at the dental chair. In this case, the cabinet area must be at least 14 m2;
- 2 X-ray machines in one room - the area of the office must be at least 12 m2.
The room where the X-ray machine will be placed will be called the X-ray room.
7
Obtaining a ventilation examination protocol. Based on the availability of the necessary approvals from the SRO (Certificate No. this species works.
8
Obtaining a sanitary and epidemiological conclusion (SEZ) for the X-ray room project.

Obtaining a sanitary-epidemiological conclusion for the installation of an X-ray machine is mandatory. On the basis of the Federal Law of 09.01.96 No. 3-FZ "On Radiation Safety of the Population" and the Federal Law of 30.03.99 No. 52-FZ "On the Sanitary and Epidemiological Welfare of the Population" without the permission of the State Sanitary and Epidemiological Service to install X-ray equipment, the office is closed , and its owner is subject to administrative liability in the form of a fine.
9
Obtaining an act to hide the work. The document is provided by the construction organization that put the facility into operation.
10
Registration of documents that are formed in the process of obtaining a SEZ:
- Technical passport for X-ray room;
- Instruction on labor protection, including requirements for radiation safety, for the prevention and elimination of radiation accidents;
- Control and technical journal for the X-ray machine;
- Order on the assignment of employees to the personnel of groups "A" and "B";
- Order on the appointment of persons responsible for radiation safety, accounting and storage of X-ray machines, industrial radiation control;
- Document on personnel training in radiation safety;
- The conclusion of the medical commission on the passage of personnel of group "A" preliminary and periodic medical examinations;
- Journal of registration of briefing at the workplace;
- Accounting cards for individual exposure doses of personnel;
- Documents confirming the accounting of individual radiation doses of patients.
The X-ray room is taken into operation by a commission consisting of representatives of the medical institution and the X-ray department, specialists of the sanitary and epidemiological service.

The sanitary-epidemiological conclusion is a permission for the right to operate an X-ray room.

SanPin describes Medical and Dental X-Ray Units

X-ray equipment	Price, rubles
1. X-ray fluorography apparatus with a fluorescent screen and optical image transfer, film and digital
2. X-ray fluorography low-dose apparatus with a scanning line of detectors and digital image processing
3. X-ray fluorography low-dose device with URI, CCD-matrix and digital image processing
4. X-ray diagnostic apparatus with digital information processing
5. X-ray diagnostic complex with a full set of stands (1st, 2nd and 3rd workstations)
6. X-ray apparatus for fluoroscopy (1st workplace - turntable-support PSSh)
7. X-ray machine for radiography (2nd and 3rd workstations - table of pictures and rack of pictures)
8. Angiographic complex
9. X-ray computed tomography
10. Surgical mobile device with URI
11. Ward X-ray machine
12. X-ray table
13. X-ray machine for lithotripsy	on request
14. Mammography X-ray machine
15. X-ray machine for radiotherapy planning (simulator)	on request
16. Apparatus for close-range X-ray therapy	on request
17. Apparatus for long-range radiotherapy	on request
18. Whole body osteodensitometer	on request
19. Bone densitometer for extremities	on request
20. Osteodesitometer for the whole body and its parts using a wide beam of radiation and a two-dimensional digital detector	on request

Dental units

It is not allowed to use X-ray machines and carry out work not specified in the sanitary and epidemiological conclusion.

Estimated cost of services for putting an X-ray room into operation (development of a placement project, licensing activities in the field of using IRS)

*Name of service*	*Price*
Standard (basic) project for an x-ray room with one x-ray machine	from 30 000 rub.
Project for an x-ray room with 2 or more x-ray machines in one room	+50% of the base price for each x-ray machine
Coordination of the project in the authorized body* or Expert opinion on the project for placement of inspection equipment**	from 10 000 rub.
Construction and installation works for the Republic of Belarus (on the basis of an agreed project)	individually
Technical report of the electrical laboratory (contains the protocols of all tests and measurements of the electrical network and equipment)	from 15 000 rub.
The act of inspection of ventilation with the calculation of the level of air exchange in the room	from 15 000 rub.
Protocols for taking parameters by the radiation monitoring laboratory	from 20 000 rub.
Expert opinion on activities in the field of the use of IRS (EZ).	from 60 000 rub.
Sanitary and epidemiological conclusion (SEZ) for medical activities (additional complex service)	from 80 000 rub.
License for medical activity (additional complex service)	from 80 000 rub.
State fee for granting a license for medical activities> (additional complex service)	7 500 rub.
*Additionally, specialized services provided by our CA:*
Advanced training of your specialists in the programs: "Radiation Safety", "Radiation Control" and others	from 7 000 rub. / person

* - authorized body: Moscow - GORRO, Moscow region - MONIKI, Regions - the relevant regional X-ray and radiological departments (RRO) or other organizations similar in function to the RRO of the region.

** - inspection body - FBUZ "Center for Hygiene and Epidemiology" on a territorial basis (at the location of the X-ray room.

The cost of design, testing and measurement services is calculated individually based on preliminary assessment room configuration, and depends on the amount of X-ray equipment placed, as well as the type, power and security of this equipment.

The cost of services for obtaining licenses, certificates and conclusions is calculated individually, based on the availability of a basic package of documents, the desired time frame and the complexity of the tasks. .

The X-ray room should have:

Stationary means of protection for the procedural and control room, providing attenuation of ionizing radiation (walls, floor, ceiling, protective doors, viewing windows, screens, etc.);
Protective measures to prevent scattered radiation from entering other rooms;
Bactericidal installations for air disinfection;
Closed decorative panels for radiators, providing free air convection and the convenience of wet cleaning;
Autonomous supply and exhaust ventilation system;
Light board (signal) "Do not enter!" white-red color at the entrance to the treatment room at a height of 1.6-1.8 m from the floor or above the door, automatically lighting up.

According to SanPiN 2.6.1.1192-03 (Appendix No. 7), in order to obtain an Expert Opinion (EP) and a Sanitary and Epidemiological Conclusion (SEZ) for a project and for the implementation of X-ray diagnostic activities, the Technological Design for an X-ray room must be approved by the SPC of Meradiology ( city radiological department (GORRO+] and in Rospotrebnadzor.

Sanitary and epidemiological rules and regulations

SanPiN 2.6.1.1192-03 "Hygienic requirements for the design and operation of x-ray rooms, apparatus and x-ray examinations"

There are many different types of x-ray machines, so the design of x-ray rooms can vary in detail, especially now - in the age of high technology. But all devices, in principle, are divided into stationary, mobile and portable. Mobile allow you to take pictures in the ward, operating room. There is also special equipment for imaging in dentistry, cardiology (operating rooms, angiography, etc.). Ideally, at least 4 rooms are required to accommodate an X-ray room:

1. The X-ray room itself, where the apparatus is located and the patients are examined. The area of the x-ray room must be at least 50 m 2, otherwise the sanitary and epidemiological station will not allow the operation of the device.

2. Control room, where the control panel is located, with the help of which the X-ray laboratory assistant controls the entire operation of the apparatus.

3. A photographic laboratory where cassettes are loaded with film, images are developed and fixed, they are washed and dried.

4. Doctor's office, where the radiologist analyzes and describes the radiographs taken.

Stationary X-ray machines often have 2 jobs:

1) The stand of the X-ray machine, on which the X-ray tube and the screen for transmission are mounted (it is possible to perform fluoroscopy and radiography). AT modern devices an X-ray image intensifier is attached to the screen, which makes it possible to improve the images obtained on the screen by 1000 times. From here, the image is transmitted to the monitor. Before the advent of URI, one looked directly at a fluorescent screen. Its glow is relatively weak, so we looked in the dark, we had to waste time adapting to the dark (minus 10-20) and small details of the image were poorly visible. Now fluoroscopy without URI is prohibited. The stand of the X-ray machine makes it possible to examine the patient in a vertical, in horizontal position, sitting position and Trendelenburg position. There is a device for sighting images, which allows you to take pictures of the departments of interest to us during transillumination.

2) Imaging table (only pictures are taken, without transillumination). It has its own X-ray tube. A screening grid is mounted in the table, which "removes" the scattered rays and thereby improves the image quality. An attachment for conventional, linear tomography is attached to the table. There is also a "transformer tank" in the X-ray room, in which a generator device is placed - step-up and step-down transformers, as well as current rectifiers. Here comes the current high voltage, from here it goes to the tubes through well-protected high-voltage cables.

In the control room there is a control panel for X-ray machines, here the X-ray laboratory assistant selects the technical conditions necessary for the images of each patient (current strength in milliamps, voltage in kilovolts, shutter speed in seconds or fractions of a second).

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

X-ray tube and obtaining 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 power - the ability to pass through dense volumes

Protective measures against the harmful effects of X-rays
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 prin

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

Radiography (images)
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 image features
1. X-ray image is planar. To get a three-dimensional view of the organ, you have to take pictures in at least 2 projections - direct and lateral (or oblique).

IX. Assessment of the quality of the obtained radiographs
1) Informative image. The doctor should be able to judge the presence or absence of pathological changes on the x-ray. 2) Completeness of coverage of the study area. So, in the picture

Methods of x-ray examination of the lungs
The methods of radiation diagnostics most commonly used in the study of the lungs are fluoroscopy and radiography, FOG, conventional (linear) tomography, angiopulmonography, bronchography. At

Blackout
The most common symptom, it happens with any compaction of the lung tissue: with pneumonia, tumors, tuberculosis, the presence of fluid in the pleural cavity, with the growth of connective tissue, etc. Behind

Changes in lung pattern
Most often, when describing x-rays, we meet with the term enhanced pulmonary pattern. There is also a poor pulmonary pattern, a deformed pulmonary pattern, the absence of a pulmonary

enlightenment syndrome
Pneumothorax is the presence of air between the parietal and visceral pleura. The causes of pneumothorax are different: there may be a traumatic pneumothorax, or air enters the pleural cavity.

Syndrome of extensive dimming
An extensive darkening is called, occupying the entire lung field or most of it (more than half of the lung). It can be caused by various pathological processes. Most frequently encountered

Staphylococcal and streptococcal pneumonia
They make up about 10% of the total number of pneumonias in adults. Basically, this form of pneumonia occurs in children, especially newborns and infants. Distinguish between primary and secondary pneumonia. By

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

Legionnaires' disease
This type of acute pneumonia has been recently discovered and studied. 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, ornithosis, adenovirus, etc. Viral pneumonia is a group of more or less similar diseases caused by various

Pneumonia with adenoviruses
Some of the 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 basal regions. On this f

Ornithosis or psitaccos pneumonia
The causative agent of ornithosis 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 has been isolated relatively recently. The causative agent of pneumonia, Micoplasma pneumonia, is the smallest known microorganism, occupying an intermediate

Infarct pneumonia
The number of LA thromboembolism is increasing. Thromboembolism of LA branches contributes to the development of secondary infarct pneumonia. In most cases, pulmonary embolism is the result of phlebitis of various

Pneumonia in violation of bronchial patency
If the patency of the bronchi is disturbed, hypoventilation of the segment, lobe or lung occurs and thereby creates favorable conditions for the development of secondary pneumonia. Great practical knowledge

Aspiration pneumonia
When various substances are aspirated into the bronchi, favorable conditions are created for the reproduction of microbes and the occurrence of pneumonia. The causes of aspiration are different - a violation of the act of swallowing (with a tumor of the pharynx

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Brief description of previous work activity

I, Liliya Yagfarovna Musina, born in 1980, graduated from Nizhnekamsk Medical College in 2006 with a degree in Nursing.

In 2001, I got a job at the Municipal Unitary Enterprise "NGMB No. 3" as a medical registrar at the Mammological Center.

At the end of the NMC, she was transferred to the position of a nurse in the same department.

From January 22, 2008 to April 22, 2008, she specialized in KMC in the cycle "Laboratory work in radiology", was transferred to the position of X-ray laboratory assistant and to polyclinic No. 2. In 2009 temporarily worked (for the period of study) in the fluorography room in the prevention department.

From October 1, 2009, to the present, I have been working as an X-ray laboratory assistant in the X-ray room of the Radiation Diagnostics Department of the Consultative and Diagnostic Polyclinic of the State Autonomous Institution "NTsRMB".

General medical experience - 12 years.

Special experience - 5 years

Brief description of the medical institution

In 2009, the health care of Nizhnekamsk has undergone major changes. Since October 1, all adult medical institutions in Nizhnekamsk have merged into a new legal entity - GAUZ "Nizhnekamsk Central District Multidisciplinary Hospital". The rural part of the Central District Hospital was connected with the district hospital of the river. n. Kamskiye Polyany.

The population of the city is served by two official medical institutions: the Children's City Hospital with a perinatal center (combining the Women's Consultation, the maternity hospital, the children's city hospital) and the Nizhnekamsk Central District Multidisciplinary Hospital, which now includes the former MBUZ "Dental Polyclinic No. 1 and No. 2", MBUZ "City Hospital No. 2", MBUZ "Nizhnekamsk Ambulance Station", the city part of the Central District Hospital, MUE "NGMB No. 3".

The structure of the GAUZ "Nizhnekamsk Central District Multidisciplinary Hospital":

1) The outpatient part includes:

Polyclinic No. 1 (attached population 101467 people)

Polyclinic No. 2 (attached population 86246 people)

Dental clinic (350 visits per shift)

· Consultative and diagnostic polyclinic (500 visits per shift).

In polyclinics No. 1 and No. 2, general practitioners conduct appointments.

Doctors of narrow specialties conduct appointments at the KDP. The Department of Radiation Diagnostics is part of the consultative and diagnostic polyclinic, has firmly taken an authoritative place in the hospital and plays a very important role in the treatment, diagnostic and preventive process.

The structure of the consultative and diagnostic polyclinic includes:

department of narrow specialists No. 1 (therapeutic profile),

department of narrow specialists No. 2 (surgical profile),

department of narrow specialists No. 3

department of radiation diagnostics

Department of functional diagnostics (FGDS, ultrasound, neurophysiology and other functional studies),

clinical diagnostic laboratory,

bacteriological laboratory,

department of medical examinations,

Uro-andrology department

Medical genetic consultation

breast center,

department of prevention

trauma center

2) The stationary part includes 30 divisions. The hospital consists of several buildings, interconnected by elevated passages, which allow transporting patients.

3) The administrative and economic part includes 20 divisions.

The regular number of beds in the hospital is 1110.

Today, 2572 employees work in the hospital. Including: doctors - 432; paramedical workers - 1344; junior medical staff - 480; other personnel - 316.

Department of Radiation Diagnostics

The quality of medical care for the population is determined not only by the adequacy of the forms of its organization, the state of the material and technical base of the healthcare institution, but, first of all, by the availability of qualified specialists. This can have a positive significance only if their work is well organized, materially equipped, and they are economically interested in the results of their work.

Table No. 1. States of health workers in the department of radiation diagnostics

no./p.	Position	By state
	Head of department
	Senior X-ray Technician
	Medical Registrar
	Sister is the owner
*X-ray room*
	Radiologist
	X-ray laboratory assistant
	Nurse
*X-ray computed tomography room*
	Radiologist
	X-ray laboratory assistant
	Nurse
*Cabinet of nuclear magnetic resonance imaging*
	Radiologist
	X-ray laboratory assistant
	Nurse

	*TOTAL for the Department of Radiation Diagnostics:*
	*w.h. medical staff:*
	*average staff*
	*junior staff*
	*other personnel*

Table No. 2. List of X-ray diagnostic devices of the Department of Radiation Diagnostics

№ p/p	Name of equipment	Type, brand	Factory number	Year of issue

	X-ray machine with a remotely controlled stand-table "Baccara"
	X-ray apparatus with digital radiological FLASH 2000 system with subtraction
	Device for fluorography	Renex-Fluoro
	Mobile x-ray machine	"Mobi-Ren-MT"
	X-ray mammograph
	Computerized X-ray mammograph	Mammo-4-MT
	X-ray diagnostic complex. stationary
	X-ray complex diagnostic teleoperated	"KRT-electron"
	X-ray CT scanner	Aguilion 16,
	X-ray diagnostic complex	"KRD 50/7-Reneks"
	X-ray unit diagnostic mobile
	Mobile x-ray diagnostic machine	Mediroll
	X-ray diagnostic portable
	Film fluorograph
	Film fluorograph
	Wall-mounted dental x-ray machine
	X-ray machine dental apparatus
	X-ray machine dental orthopantomograph	"Odontorama RS 100"
		"Electron"
	X-ray fluorographic digital apparatus	Renex-Fluoro
	X-ray diagnostic complex
	Mammography x-ray machine with stereotaxy	Mammo-MT
	Tomograph medical magnetic resonance	"Image-1"

Mobile ward X-ray machines Medirol and Mobi Ren-MT are located in the departments of anesthesiology and resuscitation No. 1 and No. 2. In the trauma department there is an X-ray mobile device "10 L-6". These mobile devices allow seriously ill patients to be X-rayed directly on the spot.

The operating block contains mobile unit OKO RTS-612 (“C-arm”) is used for R-examination in any projection without moving the patient. Designed for clinical use in vascular surgery, endoscopy, urology, traumatology, orthopedics, general surgery.

In its activities, the department of radiation diagnostics is guided by the regulatory legal acts of the Ministry of Health and Social Development Russian Federation, the Republic of Tatarstan, the requirements of the Federal Law "On Radiation Safety Standards" (NRB-99) and "Basic Sanitary Rules for Ensuring Radiation Safety" (OSPORB-2000).

The list of basic documentation that is available in the department:

Sanitary rules and regulations SanPiN 2.6.1.1192-03.

Basic sanitary rules ensuring radiation safety (OSPORB-2000).

Sanitary rules SP 2.6.1.799-99.

Hygienic requirements for the design and operation of X-ray rooms, apparatus and X-ray examinations

・Alert scheme when various types disasters

Intra-hospital orders

· Journal of familiarization with orders

・Safety Log

Folders with instructions on labor protection

Folders with safety instructions

· Folder with exposure dose cards for group A personnel

Folder with job descriptions

· Folders with technical documentation for operating X-ray diagnostic rooms and X-ray diagnostic equipment.

· Magazine Maintenance medical equipment.

Goals and objectives of the radiology department

The main goal of the radiology department is:

Providing the population of the city of Nizhnekamsk and the Nizhnekamsk region with emergency and planned qualified, the most affordable and guaranteed X-ray diagnostic care for patients in a hospital and polyclinic;

Provision of timely preventive fluorographic and mammographic assistance to the population;

Carrying out medical examination of working citizens and timely detection of probable diseases of the chest and mammary glands in the early stages, to prevent an increase in the number of complications and disability;

Conducting constant monitoring of radiation exposure of patients.

Interaction with other medical and preventiveinstitutions and medical schools

The Department of Radiation Diagnostics interacts with polyclinics No. 1, No. 2, the Department of Laboratory Diagnostics, Functional Diagnostics, departments of the hospital, the epidemiological service, and the territorial center for sanitary and epidemiological surveillance. Provides consultative assistance to doctors of other departments of the hospital on X-ray diagnostics of patients with various diseases. MUP "NTsRMB" cooperates with other hospitals of our republic, transfers information about identified patients with suspected oncopathology to the cancer center in Kazan. After a complete examination, patients with an unclear diagnosis or with difficulty in choosing a treatment are sent to the Republican Clinical Hospital for further in-depth examination and treatment.

Radiologists and X-ray laboratory assistants of the department undergo specialization and advanced training at the Kazan State Medical Academy and at the Kazan Medical College.

General organizational measures

All rooms of the department of radiation diagnostics correspond to " hygiene requirements to the arrangement and operation of X-ray rooms, devices and X-ray examinations”. (SanPin 2.1.6.1192-03). All offices have technical data sheets and sanitary and epidemiological conclusions for the operation of X-ray machines. There are orders: on the assignment of working persons to the personnel of group "A"; on the admission of personnel to work with sources of ionizing radiation (IRS); on the appointment of a person responsible for radiation safety. For all rooms there are acts of checking the grounding of X-ray machines and ventilation of rooms. All X-ray machines are equipped with X-ray clinical dosimeters DRK-1 to measure the radiation doses of patients during research. The measured radiation doses of patients are recorded in the patient register, in the medical history and in outpatient cards.

The department conducts individual quarterly dosimetric monitoring of group A personnel with registration of the results in the "Charts of Accounting for Individual Exposure Doses of Personnel". All offices of the department have individual protective equipment for medical personnel and patients: protective screens, aprons, skirts, aprons, collars, hats, gloves, glasses, lead rubber plates, in accordance with the requirements of SanPiN 2.6.1.1192-03, which are 1 time at 2 years they are tested for lead equivalent.

The department collects and delivers silver-containing waste: x-ray film and used fixer. After the merger of all adult medical institutions in the city into MUE "NTsRMB" in the Department of Radiation Diagnostics, a centralized X-ray archive was created for X-rays in a separate isolated room, taking into account all the requirements of SanPiN and fire safety. X-rays archived for 5 years

The X-ray room where I work is located in Polyclinic No. 1 on the ground floor and is equipped with a RADREX device. X-ray diagnostic complex, designed to work on a table with a grating with a floating upper section FBT-10A and radiography on a stand with the patient in a standing position. The table of the FBT-10A series is intended for performance of all types of radiographic researches. For ease of patient positioning, it is facilitated by a floating top section mechanism. The horizontal movement of the table top is controlled by a foot pedal.

In combination with the X-ray table, a floor-to-ceiling X-ray tube stand is used. Movement or control of all its components is carried out manually, all components are fixed by means of electromagnetic brakes. Click-stops in end position for moving the X-ray tube closer/further and turning the X-ray tube in the vertical direction facilitates positioning for tabletop exposures, for exposures with grating/rack, for exposures with grids and ensures reproducible positioning.

Movement or control of each section can be done using a control box with control handles.

Also in the X-ray room there is a mammography device MAMMOGRAPH. With the help of this device, we perform mammography of the mammary glands in women over 40 years old. This is an X-ray system with exposure control by protective devices, with a high-frequency generator, with a double focus of the X-ray tube, a grating with a removable carbon fiber mesh, an effective magnification device.

The X-ray room consists of the following rooms:

Treatment area 46.3 m 2 ;

Console 15 m 2;

Photo lab 12.5 m 2;

Ordinatorskaya 18 m 2;

Nursing 18 m 2;

The walls, floors and ceilings of each treatment room are covered with a protective layer of barite (plaster), the doors are made of leaded rubber. There are protective shutters on the windows of the treatment room. A viewing window with leaded glass was installed in the wall between the X-ray treatment room and the control room for observing the patient during X-rays. Near the entrance door to the treatment room, at a height of 1.6 meters from the floor, a light board was installed: “Do not enter”, automatically turns on during R-graphy. The walls of the rooms in the R-office are covered with light-colored oil paint. The floors are covered with linoleum. The floor in the darkroom is covered ordinary tiles, and walls up to 2 meters high with glazed tiles.

The lighting of the R-cabinet is artificial. The photo lab additionally has non-active flashlights with a green light filter.

All cabinets are equipped with: supply and exhaust ventilation providing 3-fold air exchange; central heating. There is sewerage, hot and cold water supply.

Organization of work of the X-ray room

The tasks of X-ray diagnostics are performed by an X-ray team consisting of a radiologist, an X-ray laboratory assistant and a nurse.

In his activities, the laboratory assistant reports to the head of the department, and during work - to the radiologist, and is responsible to him for the technical and economic condition of the R-office.

The X-ray laboratory assistant simultaneously supervises the work of the nurse in the R-office and the middle junior medical staff of the medical departments.

At the workplace, the X-ray laboratory assistant acts as three specialists: an average medical worker, an X-ray technician and a photo laboratory assistant, performing alternately the duties of each of them. The workplace of the X-ray laboratory assistant during the working day is constantly changing.

The working day of the X-ray laboratory assistant begins with planning, taking into account the volume and content of the upcoming studies. The time is being specified for participation in medical manipulations during R-scopy and complex special studies, as well as for independent work. An approximate order of patients referred for conventional radiography is drawn up. During the working day, it is implemented by contacting the sisters on duty by telephone. All studies are carried out strictly according to the indications and directions of the attending physicians.

The decision on the need for an X-ray examination is made by the radiologist and puts his signature on the referral.

X-ray laboratory assistant maintains medical accounting and reporting documentation in accordance with approved standards and within the established time limits;

1. Journal of diagnostic work of R-graphy (full name, age, diagnosis, address, place of work, film size and quantity, radiation dose and conclusion - the result of the image description).

2. Diary of R-research (preparation for the annual report).

3. Maintenance log of the R-device.

4. Journal of health education.

5. Safety magazine.

Records of the doses received by patients are recorded in the journal of R-graphy and R-scopy, as well as the medical history with the signature of the radiologist.

A daily record of work on surveys and departments is maintained.

I draw up a monthly report, where, in addition to all this, a record is kept of patients who are on a day hospital, referred from the military registration and enlistment office, and non-resident. From 8 o'clock I accept patients prepared for examination: for survey urography, radiography of the lumbosacral spine, irrigography. From 10:00 to 13:00 the rest of the examinations: images of the chest, skull, PPN, spine, limbs.

Before starting work, I conduct a visual inspection of the X-ray room and the X-ray machine. I check the integrity of cables, grounding. I do a trial run and then work according to the plan.

radiation radiological complication patient

Stages of radiography

1. I get acquainted with the patient's medical history, I conduct a brief briefing with the patient. I check the referral with the signature of the radiologist. Above the front door I turn on the "Do Not Enter" sign.

2. I turn on the desired workplace. I set the X-ray mode appropriate for this patient. I insert the cassette into the cassette holder.

3. I put the patient on the table deck, center the central beam on the center of the cassette through the area under study and diaphragm the working beam in strict accordance with the size of the area under study.

4. Protect from unused rays open areas bodies, especially critical organs: gonads, mammary glands, thyroid gland, which are not the object of study.

5. I check the correct laying and centering x-rays on the monitor.

6. I give a command to the patient and turn on the high voltage.

7. I release the patient from protective equipment, take the cassette.

8. Photochemical processing of X-ray film through the AGFA processing machine.

9. Marking.

Photochemical processing of exposed X-ray films

Photo processing includes several successive stages:

Preparation of photo solutions;

Manifestation;

Intermediate flush;

fixing;

final flush;

Photo solutions are prepared strictly according to the manufacturer's instructions.

I dilute the developer and fixer in enameled jars. The developer must stand for at least 12 hours. Then I filter and pour into tanks-tanks.

I start processing the film with development. I lower the film, tucked into the frame of of stainless steel, into the developer and hold for 6 minutes, then rinse with water and dip into the fixer. I continue fixing until the milky white coating disappears. Then I rinse with clean water. Then I label the x-ray. I stick a strip of paper on the raw picture, where I indicate the date, full name, age, case history and department number. As the depletion of the solutions change. I collect the used fixer solution in canisters. Further, the medical technician delivers silver-containing waste to a centralized collection point in Kazan. At present, I am processing films in a Kodak processing machine.

When performing radiography, I strive to limit the radiation exposure to the examined patients and the staff of the R-room:

1. I control the technical condition of X-ray diagnostic equipment.

2. I constantly improve the methodology and technique of research.

3. I apply the optimal physical and technical conditions of the study, contributing to the reduction of radiation exposure to the subjects without loss of diagnostic information:

a) I carefully block the working beam of R-radiation.

b) I use additional filters to optimize the output exposure dose;

c) try to use optimal modes appropriate for a particular object being examined.

4. I use a highly sensitive X-ray film with intensifying screens.

5. I use protective equipment that limits the area of irradiation of the area under study.

I cover the most vulnerable parts of the body with leaded rubber plates: gonads, mammary glands, thyroid gland, etc.

The x-ray room also has protective equipment for personnel: aprons, skirts, gloves, glasses, collars and headgear made of lead rubber. When conducting R.-study using a portable ward apparatus (in the ARC department), radiation protection is carried out by distance.

All employees are equipped with individual dosimeters, which are monitored quarterly. The control of protective equipment is carried out once every two years by specialists of the NEC "Proton". Carry out annual preventive medical examinations employees to identify contraindications to work with radiation sources.

Documents regulating the work of the X-ray room

Sanitary rules and regulations SanPiN 2.6.1.1192-03.

Hygienic requirements for the design and operation of X-ray rooms, apparatus and X-ray examinations.

Basic Sanitary Rules for Ensuring Radiation Safety (OSPORB-2000).

Sanitary rules SP 2.6.1.799-99.

Journal of Safety Engineering.

Hospital orders.

Alert scheme for various types of disasters.

Instructions for the actions of medical personnel in case of fire.

Number of X-ray examinations in 2012

R-graphy of the chest 2357/2707

R-examinations of bones 1032/3238

Irrigography 86/258

R-graphy of bones and joints 3097/5019

Skull R-graphy 85/159

R-graphy of the paranasal sinuses 1174/1174

Plain urography 14/15

Specialist. styling 23/49

Mammography 1428/5706

Total: 9296/18325

Description of more complex X-ray examinations

1. Excretory urography (excretory) - X-ray examination of the urinary tract after intravenous administration of a water-soluble contrast agent and its excretion by the kidneys.

This research technique allows you to study the morphological and functional state of the kidneys, ureters and bladder. This study is based on the ability of the kidneys to absorb, concentrate and excrete an intravenous iodine-containing substance.

The study is carried out on an empty stomach after cleaning the body enema. Preliminary test for sensitivity to contrast is performed. At least 40 ml of 60-76% solutions of triiodinated substances are used: urotrast, verografin, omnipaque, urografin and others. Indications - all organic diseases and kidney damage.

Radiography is carried out in the position of the patient on the back using R-film 30x40 cm. The laying is performed in such a way that the kidneys, ureters and bladder are displayed on the radiograph. If the shadow of the bladder is cut off due to the patient's high growth, then it is filmed separately on a film of 18x24 cm. Four radiographs are usually performed during urography. The first picture is taken before the introduction of a contrast agent to review the shadow picture of the abdomen and identify possible radio-positive shadows in it (concrements, calcifications, foreign bodies). After the introduction of a contrast agent, as a rule, three pictures are taken - after 7, 15 and 45 minutes.

In some cases, with sufficient contrasting of the urinary tract on them, the doctor will cancel the 3rd image, or, conversely, prescribe additional urograms later in 1-3 hours if pathological changes are noticed.

X-ray stacking instony bone according to Stanvers

During this examination, the patient lies face down on the table top, the chin is pressed to the chest. The head is turned so that the sagittal plane makes an angle of 45 degrees with the plane of the cassette. Under these conditions, the long axis of the investigated pyramid is located in a plane parallel to the deck of the imaging table. The plane of the physiological horizontal is perpendicular to the cassette. The central beam is directed cranially at an angle of 10 degrees to the center of the cassette. Stenvers stacking X-ray is used to assess the structure of the pyramid of the temporal bone and determine the condition of the internal auditory canal, as well as the inner ear.

Mammography in two projections

The purpose of the image is to study the structure of the mammary gland in cases where any induration is found in it during palpation, as well as during a screening examination of women over 40 years old. During the exposure, the patient is facing the x-ray machine. The height of the cassette holder must be adjusted so that the mammary gland is comfortably located on its surface in the center and the nipple is brought to the contour. The mammary gland should be tightly compressed and we take a picture.

Correctness criteria: nipple on the breast contour, medial or lateral region, skin in the inframammary zone.

Irrigography (colonography).

X-ray examination of the colon after filling its lumen with a contrast medium. The patient comes to the study on an empty stomach with the colon thoroughly cleaned of the contents (for this purpose, cleansing enemas are made the night before and in the morning before the study). To introduce a contrast mass into the large intestine through the anus, the Bobrov apparatus is used. This is a device consisting of a balloon for suspensions of barium sulfate, a rubber tube with an enema tip and a rubber bulb for blowing air into the balloon.

The patient is placed on the table. Insert the tip into the anus behind the sphincter of the rectum. Then the large intestine is gradually filled with a contrasting mass under pressure. When it passes into the descending intestine, the patient turns to the left side. Following the introduced contrast suspension, the volume of which is 400-450 ml, air is injected into the intestine. A suspension of barium sulfate envelops the mucous membrane of the colon, and the air inflates its lumen. The resulting double contrasting of the colon creates optimal conditions for the detection of organic changes in it. After radiography of all parts of the colon, the patient is sent to the toilet for maximum bowel emptying from the injected contrast media. A repeated x-ray examination of a partially collapsed intestine supplements information about its condition.

The described simultaneous double contrasting of the colon allows in the best way to study its position, contours, displacement and straightened mucous membrane over a large area. It creates best opportunities for the detection of neoplasms of the intestine.

The main clinical symptoms of complications and the tactics of medical personnel when they occur are as follows:

In R-studies with intravenous administration of iodine-containing R-contrast agents, due to their individual intolerance during the study, dangerous complications are possible that require urgent medical care. For this purpose, the R-office has a first aid kit, which includes:

Adrenaline 0.1% - 1.0.

Norepinephrine 0.2 - 1.0.

Mezaton 1% - 1.0.

Suprastin 2% - 1.0.

Tavegil 0.1 - 2.0.

Prednisolone 30 mg.

Dexamethasone 4 mg.

Ephedrine 5% - 1.0.

Atropine 0.1% - 1.0.

Eufelin 2?4% - 10.0.

Strofantin 0.025% - 1.0.

Cardiamin 2% - 2.0.

Glucose 40% - 20.0.

NaCl 0.9% - 20.

NaCl 0.9 - 400.

Glucose 5% - 400.

Penicillinase 1,000,000 units

Polyglukin 400.0.

Soda 4% - 200.0.

Air duct.

Kornzang.

Language holder.

Gag.

In cases of syncope, cardiovascular collapse, acute respiratory distress, Quincke's edema, anaphylactic shock, the R-room staff begins to provide medical care, followed by a call to the resuscitation team.

The main clinical symptoms of complications and the tactics of medical personnel when they occur are as follows:

Cardiovascularcollapse - acute vascular insufficiency.

It is caused by a drop in the tone of small vessels, and develops with massive blood loss, trauma, myocardial infarction, poisoning, and anaphylactic shock.

Symptoms: pallor of the skin, anxiety, feeling short of breath, cold clammy sweat, bluish extremities, loss of consciousness, weak thready pulse, rapid breathing, lowering blood pressure, the degree of which characterizes the severity of the collapse.

The patient is laid on a couch with an elevated foot end; loosen buckles and straps, create fresh air.

Call the resuscitation team;

Make injections of cordiamine or caffeine;

2. Acute respiratory distress.

May be due to: laryngospasm, bronchospasm, laryngeal edema, pulmonary edema.

Symptoms: shortness of breath, shortness of breath, agitation, tachycardia, cyanosis, foamy sputum.

Avoid retraction of the patient's tongue;

Call the ARC brigade;

In / injected 5-10 ml of a 2.4% solution of aminophylline per 20 ml of 40% glucose, 60 mg of prednisolone, 20 ml of a 30% solution of sodium thiosulfate, 4 ml of a 1% solution of diphenhydramine;

Breathe pure oxygen

Artificial ventilation of the lungs through a mask.

3. Quincke's edema.

Symptoms: the sudden appearance of extensive hyperemic blisters on the skin of the face and a plaque-like rash throughout the body, a rapidly growing swelling of the face and tongue, a feeling of fear, shortness of breath, runny nose, lacrimation, itching.

0.5 ml of a 0.1% solution of adrenaline per 20 ml of NaCl 0.9%, 2 ml of a 1% solution of diphenhydramine, 90 mg of prednisolone, 20 ml of a 30% solution of sodium thiosulfate, 5 ml of a 2.4% solution of eufillin per 20 ml of 40% glucose solution;

If the condition worsens, call the ARC brigade.

4. Anaphylactic shock is the most severe manifestation of an allergic reaction that occurs with the introduction of drugs, radiopaque substances.

Symptoms: rapidly developing pallor of the skin, a feeling of tightness in the chest, severe weakness, dizziness, headache, shortness of breath, nausea, vomiting, urticaria, Quincke's edema, cyanosis, cold sweat, loss of consciousness, convulsions, involuntary urination and defecation, rapid decrease in blood pressure.

Lay the patient on a couch with a raised leg end, create an influx of fresh air

Immediately call the ARC brigade;

Intramuscularly inject 10% -1.0 caffeine or cordiamine 2.0 ml;

In / inject 120 mg of prednisolone per 20 ml of saline, 0.5 ml of 0.1% adrenaline solution per 20 ml of 0.9% NaCl, 4 ml of 1% solution of diphenhydramine or suprastin 2% -2.0.10 ml 10% calcium chloride solution;

In case of respiratory disorders, inject 1.0 ml of 1% solution of lobeline;

To establish breathing with pure oxygen;

Artificial lung ventilation, closed heart massage according to indications.

When rendering emergency care in anaphylactic shock, speed and accuracy of the appointments are required.

Prevention of these complications:

1. Preliminary testing for patient tolerance of a contrast agent;

2. Patients taking antihistamines (diphenhydramine, pipolfen, suprastin, tavegil) in the evening on the eve of the study and in the morning on the day of the study;

3. Prohibition of drinking liquids in the evening on the eve of the study and eating on the day of the study.

Work on professional development

During her work in the X-ray service, she learned to operate a fluorograph, X-ray machines: Prestige, RUM 20, KRD-50/7-Reneks, KRT Electron, Medirol, RTS-612.

Worked out all the used styling and modes. I pass on my practical skills in radiology to beginner radiologists.

I work closely with radiologists. Discuss current topics on X-ray diagnostics. I keep accounting records. Every year I prepare a report of X-ray examinations, a report of R-examinations by departments. I work systematically to improve my skills. I attend conferences, nursing classes.

In his practical activities I use special literature: "Atlas of styling" (authors: Kishkovsky, Tyunin, Esinovskaya). "Medical X-ray technology" (author: Kishkovsky, Tyunin), "Guide for X-ray laboratory technician" (author: V. Yakovets), "Physico-technical foundations of radiology" (author: Monich).

I conduct health promotion and disease prevention work. I conduct explanatory work among patients about the need for this or that X-ray examination, about radiation protection. I conduct conversations with patients, medical staff about the expediency of a healthy lifestyle.

Conducted lectures and discussions on the following topics:

"The role and importance of fluorography in the early diagnosis of tuberculosis and oncological diseases"

"The need for an X-ray examination"

"Movement is life"

"Smoking is injurious to health"

"Alcoholism is a disease"

"Prevention of AIDS infections"

"Prevention of venereological diseases"

“Influenza Prevention. The Importance of Influenza Vaccination

"Healthy lifestyle".

San. dez. mode in x-ray room e

In the X-ray room, disinfection is carried out in a timely manner and sanitization. Ventilation for 10 minutes every 1-2 hours, especially after fluoroscopy. Sanitary day - once a month. Treatment of the entire R-cabinet - 2 times a month, with a solution of vinegar (for lead dust). Wet cleaning of the R-cabinet - 2 times a day.

Processing of the shooting table is carried out by wiping with a 1% solution of chloramine after each patient.

Processing of rags - by soaking in a 1% solution of chloramine for 1 hour, then rinse under running water, dry, store in a closed container for clean rags.

Treatment of enema tips. Soaking in a 3% solution of chloramine, then immersed in a 0.5% washing solution heated to 50C, washed with a brush, then with running water, dried and sent for sterilization to a centralized sterilization department. Currently, disposable enema tips are used.

After use, the Bobrov apparatus is soaked in a 1% solution of chloramine in an appropriate container for 1 hour, then washed, dried, and stored in a clean container.

All utensils for storage, processing are marked and used strictly for their intended purpose. In addition to chloramine, other disinfectants are also used. means: purzhavel, deochlor, calcium hypochlorite.

In the event of a disaster, fire, there are schemes for notifying employees during working and non-working hours, indicating the responsible persons, their addresses and telephone numbers.

San. dez. we carry out the mode on the basis of these orders:

Order No. 720 dated July 31, 1978 "On improving medical care for purulent surgical diseases and strengthening measures to combat nosocomial infections."

Order No. 408 of July 12, 1989 "On measures to reduce the incidence of viral hepatitis in the country."

Order No. 806 dated October 7, 1992 "On strengthening the organization of measures to combat HIV infection."

Order No. 770 dated 06/10/95 "Sterilization and disinfection of medical devices".

SanPiN 2.1.7.728-99 "Rules for the collection and disposal of waste from healthcare facilities."

M.U. No. 287-113 of the Ministry of Health of the Russian Federation 12/30/98. “On disinfection, pre-sterilization cleaning and sterilization of medical devices”.

findings

During the period of work she mastered the basic and special methods of X-ray examination. I independently compiled a table of technical parameters for the study of various organs and systems for the RADREX apparatus, I know photolaboratory processing of exposed films. I know the safety rules (anti-radiation protection of patients and staff, fire and electrical safety). I can take pictures in standard and atypical projections in a gentle mode, avoiding additional trauma to patients during the examination. I have good clinical training, I know how to provide emergency first aid, including the simplest methods of resuscitation.

It is important to know the basics of dosimetry of ionizing radiation and radiation biology, knowledge of the physical foundations, means of protection and features of the interaction of X-rays with body tissues.

Offers.

Improve the material and technical bases of X-ray rooms.

Improve the quality of maintenance of X-ray equipment and conduct repair work in a shorter time frame.

Achieve a reduction in radiation exposure by: choosing the optimal technical parameters taking into account the characteristics of the patient, using a highly sensitive film and intensifying screens, preventing defects in the process of photo processing of the removed materials, monitoring the preparation of the patient for the study, etc.

To improve the qualifications of the staff of the X-ray room in order to reduce the duration of examinations and defects in work.

X-ray laboratory assistant: __________________ Musina L.Ya.

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