Kỹ thuật viên chuẩn đoán hình ảnh thông qua chụp X-Quang: Phần 1

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Phần 1 Kỹ thuật chụp X-Quang - Kỹ thuật viên chuẩn đoán hình ảnh giới thiệu tới người đọc các kỹ thuật chụp X-Quang không chuẩn bị (thường quy) bao gồm: Kỹ thuật chụp X-Quang xương khớp chi trên, kỹ thuật chụp X-Quang xương khớp chi dưới, kỹ thuật chụp X-Quang phổi và khung xương lồng ngực,... Mời các bạn tham khảo.

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Nội dung Text: Kỹ thuật viên chuẩn đoán hình ảnh thông qua chụp X-Quang: Phần 1

C a o D S n g Y ti P h u T h o - T h it v i $ n lit IIII 1111111111 L KM.I008200 GS.TS PHAM MINH THONG C h ii b ic n KY THUAT CHUP X-QUANG KY THUAT VIEN CHAN DOAN HINH ANH iiim n m u n i n h A x u Xt b A n Y HQC ■I II
K? THUAl O CHyP X-QUAIM(G Ky thuat vien chan doan hir
CAC SACH CUNG TAC GIA SIEU A m TONG QUAT, C h u b i e n . N h a x u a t b a n Dai h o c H u e . 2 0 1 1 . 6 0 4 t r a n g . k h o sacli 19 x27 c m . BAl GIANG CH AN DOAN H I N H AN H, Viet c u n g c a c t a c gia k h a c . N h a x u a t b a n V Hoc, 2 0 07 .
PGS.TS PHAM MINH THONG chu bien KY THUAT CHUP X-QUA Ky thuat vien chan doan h NHA XUAT BAN Y HOC hA noi
© 2 0 1 2 . h\ C a o T ra n .ISC and P h a m M in h T h o n g cl al Han q u \ c n c u o n sach nay dUtic g iu bdi C o n g t\ c o p h an C a o T ra n \ a cac tac gia. N g h ic m c a m m oi hinh lhue sao chcp. nhan ban k inh d o a n h dUifi bat k\ hinh thuc nao. M oi \ c u can tho ng tin \ i n gifi \ c C o n g tv co p h a n C a o T r a n , 2 7 /1 0 p h o \ " i n h T u \ . q u a i l H a i B a T r i f n g . t h a n h p h o H a N oi, \ iel N a m . D ic n th o a i : (M3 9 87 0 5 8 0 . 094) 4 52 8 0 0 1 . K.mail: c a o t r a n inc(£ v a h o o . c o m
CHU BIEN P g s .T s P ham M inh T hong BAN BIEN SOAN P g s .T s P ham M inh T hong Ts P ham H ong Due T hs L e T huy L an C n N guyen T uan D ung THU KY BAN BIEN SOAN Ts P ham H ong Due
M y c L y c Lofi noi dau PHAN I. KY THUAT CHUP X-QUANG KHONG CHUAN BI (THUCfNG QUY) Chu’tfng 1. KY THUAT CHUP X-QUANG XUONG KHCJP CHI DUOl Bai 1. Xuong d u i ............................................................................................................................ 4 Bai 2. Xao'ng cang c h a n ................................................................................................................9 Bai 3. Khop h a n g .........................................................................................................................13 Bai 4. Khop g o i .............................................................................................................................21 Bai 5. Xtfo'ng b an h c h e ................................................................................................................26 Bai 6. Xuong klio'p co chan, xuo'ng g o t .................................................................................. 29 Bai 7. Xuo'ng khop ban ngon c h a n ......................................................................................... 37 Chtfo’ng 2. KY THUAT CHUP X-QUANG XL^ONG KHOP CHI TREX Bai 8. Xuo'ng canh tay................................................................................................................. 44 Bai 9. Xuo'ng cang t a y ................................................................................................................. 49 Bai 10. Kho'p v a i ...........................................................................................................................53 Bai 11. Ivliuyu t a y ........................................................................................................................ 60 Bai 12. Co tay.................................................................................................................................(58
viii M u c luc Bai 13. Xuong klidp ban t a y .....................................................................................................74 Chtfdng 3. KY THUAT CHUP X-QUANG PHOI VA KHUNG XUONG LONG NGl/C Bai 14. P h o i ..................................................................................................................................S4 Bai 15. Xuo'ng s u o n ..................................................................................................................... 92 Bai 16. Xirong d o n ...................................................................................................................... 96 Bai 17. Khop Uc d o n ................................................................................................................ 100 Bai 18. Xirong irc....................................................................................................................... 102 Bai 19. Xirong ba v a i ................................................................................................................ 105 Chtfdng 4. KY THUAT CHUP X-QUANG BUNG - TIET NIEU - KHUNG CHAU Bai 20. He tiet nieu (khong chuan bi)................................................................................. 110 Bai 21. Bung (khong chuan b i ) .............................................................................................114 Bai 22. Khung c h a u ..................................................................................................................120 Chtfdng 5. KY THUAT CHUP X-QUANG COT SONG Bai 23. Cot song c o ................................................................................................................... 127 Bai 24. Cot song l u n g .............................................................................................................. 138 Bai 25. Cot song that l ung...................................................................................................... 145 ChUo’ng 6. KY THUAT CHUP X-QUANG XUCNG SO MAT Bai 26. Dai cuo'ng ve chup so m a t ........................................................................................ 158 Bai 27. So (thang n g h i e n g ) .................................................................................................... 162 Bai 28: Xoang - B lon de au....................................................................................................... 170 Bai 29. Nen so - Hirtz ...............................................................................................................175 Bai 30. Tang giua va sau ne n so - Worms Bre tton...........................................................182 Bai 31. Ho y e n ............................................................................................................................185 Bai 32. Ho ma t - xuo'ng go m a .............................................................................................. 189 Bai 33. Cung tiep xuo'ng go m a ............................................................................................. 192 Bai 34. Lo thi giac......................................................................................................................194 Bai 35. Xuo'ng c h u m (tu the Sc h u ll e r) ................................................................................ 197 Bai 36. Xuo'ng da (tu the S te n v e rs )...................................................................................... 201 Bai 37. Tai xuo'ng c h u m (tu the M ay e r).............................................................................. 206 Bai 38. Tai xuo'ng c h u m (tu the Chausse III).....................................................................209
Bai 39. Mom chain (tu the N ad eau ).................................................................................... 212 Bai 40. Xuong chinh m u i ........................................................................................................216 Bai 41. Loi cau xuong h a m du6i va khop thai duong h a m ........................................... 219 Bai 42. Ham dudi chech (ham c h e c h ) ............................................................................... 222 Bai 43. R a n g ..............................................................................................................................227 PHAN II. KY THUAT CHUP X-QUANG CO CHUAN BI Chu’dng 7. THUOC CAN QUANG, TAI BIEN VA CACH XLT TRI Bai 44. Thuoc can quang, tai bien va cach xu t r i .............................................................238 Chtfdng 8. KY THUAT CHUP X-QUANG HE TIEU HOA Bai 45. Thuc q u a n ................................................................................................................... 248 Bai 46. Da day - ta t ra n g .........................................................................................................259 Bai 47. Ruot n o n .......................................................................................................................278 Bai 48. Dai t r a n g .......................................................................................................................287 Bai 49. Duong ma t - tui m a t .................................................................................................305 Chtfdng 9. KY THUAT CHUP X-QUANG HE TIET NIEU Bai 50. UIV (Urographie Intra Veineuse)............................................................................ 322 Bai 51. He tiet nieu nguoc d o n g .......................................................................................... 344 Bai 52. Dan luu be t h a n .......................................................................................................... 347 Chtftfng 10. KY THUAT CHUP X-QUANG HE SINH DUC Bai 53. Buong tu cung - voi trUng........................................................................................352 Bai 54. Tuven vu (mamography).......................................................................................... 363 ChUdng 11. KY THUAT CHUP X-QUANG TUY SONG c An QUANG (Myelography) Bai 55. Tuv song can quang (Myelography)...................................................................... 380 Chtfofng 12. KY THUAT CHUP X-QUANG TUYEN NU6C BOT (SIALOGRAPHY) Bai 56. Tuven nuo'c bot (Sialography)................................................................................. 392 ChUong 13. KY THUAT CHUP X-QUANG KHOP c An QUANG Bai 57. Khop can q u a n g ..........................................................................................................402 T H l / M U C THAM KHAO............................................................................................................. 413 CHI MUC (INDEX)........................................................................................................................ 415
x Muc luc
Lfr n 6 i t>Au Cun g vai sir phat trien nhir vu bao cua khoa hoc cong nghe, nganh Bien quang d u a c thira hirong cac tien bo do, cac trang thiet bi tr o n g cac khoa Dien quang t r u a c dav chi co X- quang thi gia dav da co th e m sieu am, cat lop vi tinh, cong hirong t u va X-quang mach mau. T u kv thuat analogue thi ngav nav tat ca cac mav m oc tr o n g khoa B ie n quang deu du ng kv thuat so (digital). Voi nhieu cac trang thiet bi hien dai da giiip cac bac si B ien quang co the chan doan chinh xac lion va chuven sau hon tr o n g nhieu benh lv tuv nhien kv thuat X-quang kinh dien van dirac sir dung nhieu nhat va la nhu ng th a m kha m ban dau tr o n g tat ca cac khoa Dien quang tre n the gicri. C ung chinh vi lv do do ma chung toi bien soan cuon "Kv thu a t chup X-quang" voi m u c dich lam tai lieu giang dav va tham khao tr o n g dao tao kv thuat vien B ie n quang tr o n g cac t r u o n g tr u n g cap, t r u o n g cao dang va dai hoc kv thuat; tai lieu tham khao cho cac bac si chuven nganh Bie n quang. Sach bao gom hai phan:
xii Loi noi dau Phan I la cac cac kv thuat chup X-quang khong chuan hi. cac kv thuat du qc phan chia theo giai phau bao gom : cac kv thuat chup X-quang xuong khop chi duoi, cac kv thuat chup X-quang xuong khop chi tren, kv thuat chup phoi va long nguc, kv thuat chup bung - tiet nieu - khung chau; kv thuat chup X-quang cot song; kv thuat chup X-quang so mat. Phan II la cac kv thuat chup dac biet va kv thuat chup co chuan bi bao gom : T h u o c can quang; kv thuat chup X-quang he tieu hoa; kv thuat chup X-quang he tiet nieu; kv thuat chup X- quang he sinh due; kv thuat chup tuv song can quang; kv thuat chup tuven nirac hot; kv thuat chup khop can quang. Sach du qc ke thua cac an pham tr o n g va ngoai nu oc ve kv thuat chup X-quang cung n h u dua vao kinh nghiem tr o n g thuc hanh lam sang cua cac bac sT, kv thuat vien khoa Chan doan hinh anh benh vien Bach Mai va bo m o n Chan doan hinh anh tr u o n g Cao dang v te Ha Noi. Tu v nhien chac chan chung toi khong tranh khoi m o t so thieu sot tr o n g qua trinh bien tap ve noi dung cung n h u hinh thuc, kfnh m o n g cac quv dong nghiep dong gop v kien de chung toi co dieu kien bo sung va hoan thien, de noi dung cuon sach cluoc tot hon va cap nhat hon. PGS.TS P h a m M inh T h o n g Pho G ia m D o c Benh Vien Bach Mai T r u o n g Khoa C ha n D o a n H in h A nh Benh Vien Bach Mai Pho T r u o n g Bo M o n C h i n D o a n H in h Anh Dai H o c Y Ha Noi
Lin G ift THlgU N a m 1895, W . C Rontgen da tim ra tia X n h a thi nghiem pho ng dien qua m o t bong chan khong va hinh chup X-quang dau tien la anh x u on g ban tav cua ba Ron tgen. Ho n m o t the kv da troi qua, nhieu p h u o n g phap tao anh moi da d uqc phat minh va ung dung tr o n g v khoa nhun g chieu, chup X-quang van giu nguven gia tri va van luon luon la kham xet c o ban dau tien cho hau het cac kham xet be nh lv cua moi chuven khoa lam sang. Nhieu loai hinh kv thuat vien chan doan hinh anh da du qc dao tao qua cac t r u o n g tru ng hoc, tr u o n g cao dang va dai hoc tr o n g nu oc nhung chuven nganh chan doan hinh anh van rat can m o t cuon sach h u o n g dan thuc hanh chup X-quang, vi chi co the xac lap du q c chan doan dun g dua tre n m o t phim X-quang chup dung kv thuat va dat veu cau. Ben canh do, kv thuat \i e n X- quang can n h o phai lam sao de dam bao veu cau an toan buc xa cho benh nhan va nhung nguoi xung quanh, dac biet la phu n u mang thai va tre e m la hai doi tu o n g rat nhav cam voi buc xa ion hoa.
xiv Loi gioi thieu Cuon kv thuat chup X-quang cua tac gia Pham Minh T h o n g va Cong su du q c bien soan cong phu, ke thira nhun g an pha m tro n g nu oc va nu o c ngoai nen co the coi la m ot giao trinh tu o n g doi hoan chinh hien nav va dap ung du q c veu cau cua cac dong nghiep cung n h u cua cac co so dao tao kv thuat X-quang tr o n g ca nude. Toi tran tr o n g gioi thieu cuon sach nav toi doc gia chuven nganh Chan doan hinh anh va nhiet liet chuc m u n g cac thanh \ ien Ban bien soan cuon sach da hoan thanh m ot cong viec rat co v nghia thuc tien cho chuven nganh. GS. TS. H o a n g D i r e K i £ t Chii tich Hoi Dien qua ng va Y ho c hat nhan Viet N a m
Lfr nh A xu At ban Noi dung "Ky thua t chup X-quang, Ky thua t vien chan doan hinh anh" gom hai phan, kv thuat chup X-quang khong chuan hi (th uong quv) va kv thuat chup X-quang co chuan hi, du q c trinh bav lan luqt qua 1 3 chu ong tro ng 57 bai. Phan " T u luo n g gia" du qc soan cho tun g bai. T r o n g no luc nang cao chat luqng sach, chung toi cho in sach bon mau tren giav tot. N h a m lam giam gia thanh cho cuon sach, toan bo phan "Tur luqn g gia" duqc tach roi khong in cung tr o n g sach. Phan nav se duqc cung cap cho nguoi hoc bang m o t file PDF. D oc gia can dung phan " T u lu qn g gia" cua cuon "Kv thu a t chup X-quang, Ky thu a t vien chan doan hinh anh" xin vui long gdi email veu cau ve dia chi: c a o tr a n _ in c @ v a h o o .c o m se du o c nhan tile nav (mien phi). Nha xuat ban Y Hoc m o n g quv doc gia \ u i long don nhan. N H A X U A T BAN Y H O C xv
xvi Loi nha xuat ban
K? THUAT CHyP X-QUAWG khong chuan 1 (thircmg qr
Chirong K? THUAT CHIjJP x -quang xirong khop chi duoi
Xirong dui 171uc tidu hoc t$p • N£u (JiiOc cac chi dinh chup xuong dui. •Trlnh bdy tfuoc ky thuat chup xutfng dui thing, nghieng. I. g i A i p h a u x u q n g d u i / ^ v V V La xtfdng dai nhat cua bo xtfdng, gom co mot than va hai dau. Than xtfdng gom 3 mat (sau ngoai, sau trong va sau trtfdc) va 3 bd (ngoai, trong va sau). Dau tren xtfdng dui gom co co va chom xtfdng. Chom xtfdng tiep khdp vdi o cdi * "f S xtfdng chau tao thanh khdp hang. Hai mau chuyen ldn va be, gitfa hai mau chuven la dtfdng lien mau. Dau dtfdi xtfdng dui hdi cong va ra sau. Loi cau trong va ngoai tiep khdp vdi mam chay ttfdng tfng. Dien khdp rong roc d trtfdc tiep khdp vdi xtfdng banh che. II. CHI DINH CHUP A. Chan thirong 1. Gay than xtfdng dui V . w ' . v Xtfdng dui nam trong khoi cd ldn dtfdc nhieu mach mau nudi dtfdng nen lien nhanh nhtfng trai lai gay xtfdng dui thtfdng chay nhieu mau co the gay sdc mat mau. Cac cd mdng khoe bam vao mau chuyen ldn lam dau tren dang, cd that ltfng / I V y V __ chau bam vao mau chuyen be lam dau tren gap ra trtfdc. Dieu nay giai thich ga\ xtfdng dui rat hay di lech. Khi chup X-quang phai het stfc nhe nhang. tranh iho bao. Ttf the chup xtfdng dui thang la can thiet. khong dat van de chup nghieng neu nhtf thay tinh trang lam sang khong cho phep. 4