Head x-ray

The most accessible and sufficiently informative method for visualizing the bones of the skull is head X-ray or craniography. This study is usually prescribed if there is a suspicion of pathology of bone structures, however, even from a general X-ray image, one can assume the presence of a brain tumor, hematoma or an area of ischemia, even intracranial hypertension, and then search in a specific direction.

Craniography has been used for diagnostic purposes for more than a decade and has not lost its relevance to this day.

Indications for the procedure

X-rays of the skull bones are always indicated in patients with head injuries. [1]

The basis for such a study may be a suspicion of congenital and acquired pathologies of the cranium - a visible violation of symmetry, size and shape, patient complaints of tremors of the limbs, impaired coordination of movements, frequent and painful headaches, dizziness, nausea, blurred vision and hearing, pain with movements of the maxillofacial structures.

Preparation

There is no special preparation for the X-ray of the head. You do not need to follow a diet, carry out any procedures, take medications. Already in the X-ray room, the patient removes metal objects from the head and neck, including glasses, earrings and removable dentures.

Technique

Head X-ray is done depending on the required angle and the equipment used in a sitting or lying position, sometimes standing. The patient must remain motionless for several minutes at the time of the X-ray, as warned by the radiologist. To ensure comfort when holding the head in the desired position, foam pads, pads, fixing straps can be used. Lead vests and aprons are used to protect body parts that are not subject to examination.

An X-ray of the child's head is done only for health reasons. During childhood, doctors try to use alternative and safer imaging techniques, such as ultrasound or MRI. However, the condition of the bone structures can best be assessed by radiographs. Therefore, if the child hits his head, it is better to exclude the possibility of damage to the bones of the skull.

An X-ray of the head of a child under one year old is also done for head injuries, including those received during childbirth, as well as for suspected congenital pathologies, since without diagnosis, time can be lost for effective treatment.

Children are carefully screened for parts of the body that are not subject to examination. The most difficult thing when taking an X-ray of a child is to keep him still. The smallest is usually given an X-ray of the head under the influence of sedation; older children are tried to persuade, calm and fix in the desired position. For this, they resort to the help of parents. [2]

Pregnancy is a contraindication for X-ray examination. However, there are circumstances (blows, falls, accidents) when an X-ray of the head during pregnancy is necessary. In this case, cover the body and especially the abdomen with capes that do not allow X-rays to pass through.

Contraindications to the procedure

Absolute contraindications for routine examination by radiation methods are:

• the presence of a mental illness, which makes it impossible for the patient to adequately perceive the requirements for the procedure - he does not understand the need to sit or stand in a certain way, remain motionless for a short time, etc.;
• the examination is also prohibited for pregnant women and children under 15 years of age, since radiation can have a teratogenic effect and negatively affect the development of bones in a child.

In emergency cases, when an X-ray of the head is necessary for health reasons, it is carried out for all categories of patients, carefully observing preventive measures, immobilizing people who cannot be motionless with medication.

Examination by means of X-ray radiation is not performed for people with metal or electronic implants in the diagnostic area. [3]

A temporary recommendation is to postpone the planned procedure until a more favorable period for people with a reduced immune status.

Is x-ray of the head harmful?

The diagnostic procedure is practically harmless, the radiation dose is low and the exposure time is very short. Even a few X-ray examinations of the skull bones per year will not cause significant harm. On average, the radiation dose for x-rays of the head is 0.12 mSv. For comparison, epidemiological studies in humans indicate that the minimum cancer-hazardous radiation dose received in childhood starts at 50 mSv. The same indicator averages over 100mSv.

The radiation dose received during X-ray examinations is 1 mSv or six to seven X-rays annually. Therefore, even if in one year you had to go through, for example, eight procedures of radiation diagnostics, then in the next one there may not be one. 

And if we compare the danger of radiation from x-rays of the head with the danger of losing life or being disabled, then it is possible to exceed the norm recorded in reference books, since an accurate diagnosis increases the guarantee of successful treatment.

Normal performance

Based on the patient's complaints, anamnesis and clinical manifestations, an X-ray examination of the skull bones in one or more projections may be prescribed. Sometimes a targeted study of a specific area of the head is prescribed.

In case of injuries, congenital abnormalities, complaints of the patient about headache, dizziness, lack of coordination, an overview X-ray of the skull is performed. In this case, fractures and cracks in the bones, displacement of bone fragments are found; developmental anomalies; curvature of the nasal septum and diseases of the paranasal sinuses.

In addition, on the roentgenogram, one can suspect the presence of osteomyelitis of the bones of the skull by the presence of foci of calcification (white areas, impervious to rays), osteoporosis - by areas of bone rarefaction. Intracranial foci of calcification are interpreted as signs of chronic subdural hemorrhage; about the same, only with a more distinct rounded shape, oligodendromas and meningiomas (tumor calcification) look. [4]

On the X-ray, you can also see the vascular changes characteristic of high intracranial pressure; disorders specific to metabolic disorders with excessive secretion of growth hormone (acromegaly) and softening of bones in Paget's disease. It is not always possible to draw a final conclusion about the disease from the radiograph alone, but it can indicate the direction of the subsequent diagnostic search.

Quite often, people are prescribed a targeted X-ray of the sella turcica to detect prolactinoma, clarify the presence of osteoporosis and better consider the features of the vascular pattern if intracranial hypertension is suspected.

A popular study using an X-ray of the temporomandibular joints, which shows arthritis or arthrosis of the joint of the same name, a violation of its functions. Such a picture is taken in two positions: in one the patient's mouth is open, in the other it is closed.

With purulent mastoiditis, an X-ray of the temporal bone is prescribed, a targeted X-ray of the zygomatic bone can determine the cause of pain when chewing and other movements of the jaws.

With craniocerebral traumatic lesions, fractures in the orbit area are often found. With this study, you can also detect the presence of a foreign body in the eye. [5]

Sighting through the bones of the nose, which often suffers from facial injuries, as the most prominent part of it. A popular prescription is mandibular x-ray. Basically, they are prescribed for suspected fractures, however, in this way, tumors and some inflammatory diseases can be detected.

Complications after the procedure

When x-rays of any area of the body are exposed to low-intensity sources of ionizing radiation occurs immediately at the time of the procedure. Electromagnetic waves, which are used in X-ray equipment, do not accumulate in the body. Therefore, there is nothing to "remove" from the body after the procedure. Even with repeated x-rays of the head, no immediate complications can arise after the procedure. Therefore, when people complain that they feel bad after an X-ray of the head, this is due to other factors. Firstly, it is unlikely that they were well before the study, there were necessarily any complaints, since radiation diagnostics are not carried out just like that, out of a whim. Secondly, suspiciousness, excitement, expectation of complications also do their job.

Nevertheless, it is recommended to do an X-ray of the head only as directed by a doctor, in addition, if this is not a one-time event, then it is advisable to monitor the dose of radiation received during diagnostic procedures throughout life. Because the main consequence after the procedure is the excess of the permissible average annual dose of radiation, but this requires more than twenty examinations per year. So you shouldn't be afraid of complications.

But refusal to diagnose can cause serious consequences, associated with a risk to life.

Head x-ray reviews are the most favorable. The procedure is short-term, does not cause any preliminary hassle and does not cause any discomfort. Advice on improving the efficiency of examination and reducing the radiation dose - if possible, choose an office equipped with a digital X-ray machine.

It happens, of course, that after X-ray there is a need for computed tomography (if the patient has a high bone density, layer-by-layer examination is more informative) or magnetic resonance imaging (when the presence of vascular pathologies or brain matter is assumed).

For the study of damage to bone structures, X-ray remains the method of choice, due to the low cost and the presence of X-ray rooms in almost all polyclinic departments.