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Types of Chest X-ray

Discuss About The Medical Field As Applied Treatment Regimen?

The latest development in medical technology has placed patients in a position where diagnosis of medical conditions is far easier and accurate. One such diagnostic tool is X-ray that is highly useful for detecting complex medical conditions. It is however to be noted that unnecessary exposure to radiation can bring about harmful impacts to individuals. The present paper discusses the usefulness of X-ray as applied as a diagnostic tool for assessing conditions of the chest. Special attention is given to the diverse types of X-ray works and the strategies which could  implemented for  reducing the diverse effects of the radiation. The impacts of X-ray on human body, both adverse and common ones, make up a significant section of the paper.

There exist several X-ray tests that can be carried out on a patient depending on the problem in question. Such X-ray range from abdominal x-rays and intraoral x-ray to chest x-rays among others (Cole et al., 2016). ‘Chest x-ray’ is a type of imaging test that uses very minimal radiation amounts in the picture production of organs, bones or body tissues focused near the chest of the patient.  Through this diagnosis test aids physicians in the identification of abnormalities, diseases of the blood vessels, heart, lungs and even bones (Resnick et al., 2014). Besides, these chest x-rays are used in the determination of presence of fluids in the lungs or even in the air that surrounds the lungs. Ionizing radiation is any type of electromagnetic or particle wave that carries enough energy to ionize or remove electrons from an atom (Neroladaki, et al., 2013). The radiation has sufficient energy that can remove electrons from their orbital shells which can either be present in the atomic or molecular orbital of the cells of the tissues which they penetrate (Cook et al., 1998). A common ionizing subatomic particle arising from radioactivity is made up of alpha particles, beta particles and neutrons. Almost all products of radioactive decay are ionizing due to the fact that the energy contained in the radioactive decay is typically much higher than what is required to carry out the ionization. When humans are exposed to ionization from x-ray radiation over a long period of time in sufficient quantities, the exposure can result into body tissues being damaged, and also a disruption of the cellular functions at the molecular level, all of which are conditions that cannot be corrected. The ionization effect on the deoxyribonucleic acid [DNA] is of particular interest (Martin & Sutton, 2015). There exist three interactions describing photon absorption in tissues: the first effect is known as the Campton effect (here a photon does collide with an electron not bonded to the atom, known as “free electrons”), the second is known as the photoelectric effect {the process where an incoming proton undergoes collision with a tightly bound electron}, lastly is an interaction known as the pair production {in this process a pair production photons interacts with the nucleus of the atom. Through this they are able to create a pair of both positively and negatively charged electrons in the process. The positive electrons then ionize until it is able to combine with free electrons, hence generating two photons that do move irregularly in opposite directions}. Under the influence of electromagnetic radiation, there are changes brought about in the living organism’s life structure [x rays or gamma rays] or the charged particles fluxes [beta radiation, protons and alpha particles] and neutrons (White et al., 1991).

Ionizing Radiation and its Impact on Body

The initial effects of any type of radiation on biological objects start with the body absorbing energy during irradiation. This is then accompanied by molecule excitation and their ionization. There exist various principles that characterize the biological effects of ionizing radiation; for instance, there is the profound disturbance of human activities which are brought about by small energy quantities absorbed by the body. Thus, the energy absorbed is irradiated with a lethal dose upon heat conversion to energy, hence raising the body temperature by 0.001 degree Celsius (Morgan & Sowa, 2015). Secondly “the biological impacts of ionizing radiation are not limited to those particular organisms that are subjected to irradiation, as this kind of limitation may spread to the succeeding generations. This theory is explained in details by the effects on the hereditary apparatus of the organism (McDonald et al., 1996). The last theory talks about the slow observation made on the development of radiation sickness.     

The adverse effects of X-rays differ in every individual and are dependent upon the body conditions of the patients. In this context, some of the patients undergoing radiation therapies do not develop any contradictory signs at the very beginning. However as argued by  Corne & Kumaran (2015), a number of side effects may arise later along with the development of autoimmune disorders. Thus, of the some of the notable autoimmune disorders is Rheumatoid Arthritis. In this context, the immune system of the body fails to differentiate between its own cells and foreign tissues. This triggers the synthesis of macrophages, which have necrotic actions.However as commented by Hart et al. (2000), the autoimmune disorders are not always triggered by exposure to radiations. The response may also be elicited by a series of metabolic disorders in the human body. For example, presences of conditions such as diabetes result in tissue necrosis of the arms and legs due to excessive sugar deposition.

After a chest x-ray has been done to a patient, the results are interpreted by a radiologist who analyzes the images and then sends the results to referring physicians who then interpret the results. These results are available almost immediately for review by the physicians. Patients are advised on the importance of the second test after the fast result is out. It is necessary for a patient to go for follow up examinations for detecting potential abnormality that can be highlighted through further evaluation through special imaging techniques (Corne & Kumaran, 2015). However as commented by Adam et al (2014), the lack of sufficient support from the  medical and health care professionals often hinder the success of the process. The second test is also necessary since any occurring change in the form of abnormality can be observed over time. Follow-ups are also important as it helps the physician to determine whether the finding is stable or changing over time and whether the treatment is working (Lowe et al. 1999.). However, as argued by Corne & Kumaran (2015), the lack of motivation in the patients and lack of peer support often challenge meeting the health requirements through follow up. There are both benefits and risks of being exposed to chest x-rays. After the x-ray test is done, there are no traces of radiation remaining in the body of the individual; x-rays are not known to cause any side-effects to the individual in the typical diagnostic range; the x-ray imaging has been found not only to be fast but also easy (Adam et al., 2014).

Adverse Effects of X-ray

Modern x-ray systems, as compared to the old system, have  implemented dose control method and  helpful in minimizing the scattered radiation. However as commented by Adam et al. (2014), lack of sufficient infrastructure often prevent the patient from demanding required services. This then ensures that the patient’s body parts that are not being imaged always receive minimum exposure to radiation. There are limitations to in-chest radiography (Kessel & Robertson, 2016). In the last few decades have witnessed increased application of technology in the medical sector. It has been found that chest x-ray is very useful besides having its disadvantages. This is because there are some chest conditions whose identification is not possible on a conventional chest x-ray image; hence the mentioned kind of examination is not able to rule out all chest problems. For instance, on a chest x-ray small traces of cancers are not shown. Also, “pulmonary embolism” a condition of a blood clot in the lungs is not visible in a chest x-ray (Richardson, 2017). According to medical research we see that X-rays interacts with tissues in two ways; ‘photoelectric effect’ – this is an interaction where the proton uses all of its energy “in order to get rid of an electron from an atom”, and the ‘Compton scatter’ - here the photon hits an atom, hence ionizing the electron without using up its energy content. The photon then scatters un-uniformly with a little energy with the free electrons going about causing damage (Cotes et al., 1993).

Though the contribution of X-rays in the medical field is undisputable, however, the Compton scattering is associated with a number of perils. In this context, the free radicals have been found to cause point mutations. Some of the point mutations can be lethal and may have adverse effects in the current or the upcoming generations. The point mutation could be regarded as an alteration in the normal base pairing of DNA leading to transition and tranversion effects. As argued by Cotes et al (1993), depending upon the immunity of the human body the SOS response might be failed resulting in the development of malignancy.

The photons that are scattered then travels back towards the tube passing through the patient hitting the detector from any odd angle or scattering again with the patient. X-ray penetration has been found to be an “exponentially” decreasing function of thickness of the patient’s body part being tested. As the beam x-ray penetrates tissues, there is less energy since protons are absorbed. The photoelectric absorptions probability is roughly proportion to “(Z/E)3”, where Z is the atomic number of tissue atoms and E becomes the photon energy. As E gets larger in amount the interaction drops rapidly; as seen from the ‘Beer-Lambert equation’ the protons amount going through an object does drop exponentially as illustrated in the middle of the panel simulation. Note that a particular number of protons are always needed in the production of the x-ray image. In case the x-ray is not able to penetrate the body due to blockage by any tissue, there is no generation of images. Instead, there will be a grey blob visible on the screen. In the soft tissues, the dominant elements namely are Carbon, Hydrogen, Oxygen and Nitrogen that do have low K-edges in the range of Kev (Mettler, 2013).

Interpretation of Chest X-ray Results

There is not a justified K-edge with a substantial change in attenuation as the elements do make a contribution to the photoelectric effects and the attenuation of low x-ray energies. The K-edge value for iodine is 30 Kev to 40 Kev, while that of barium is the same. This is found right in the centre of the x-ray’s beam spectrum. Absorption due to Compton scattering is not dependent of the x-ray energy, though Compton is dependent on the electron density. However, as compared by Paganetti (2014), in order to obtain low energy beams low kV needs to be used. Also, it should be ensured that there is no filtration taking place. Traditionally the production of low-kV x-rays was done by the use of molybdenum of tungsten anode. It is important to note that at the K-edge of a given material photo electric effects become accentuated. “Linear energy transfer (LET) is the measurement of the ionization in which radiation causes per unit distance as it transverse a cell or a living tissue”. Most of the natural background radiation including medical x-rays are said to be low LET, while on the other hand alpha particles do pose high LET. Ionization radiation can seriously disrupt the cell’s chemistry, hence killing or either causing a permanent change to the cells (Paganetti, 2014). After the cells are damaged it is always difficult for the cell to repair.  In the modern world of medicine, medical imagery has been seen to have undergone major advancements.

Therefore, it has become possible and very easy for the technicians and other medical practitioners to achieve information regarding the human body. However, as argued by Mettler (2013), maintenance of the medical equipments often demands a greater amount of investment. In this respect, lack of sufficient knowledge often prevents in attaining the required standards of health and care services. The recognized methods used in medical imagery include the conventional x-ray, computed tomography, Magnetic Resonance Image (MIR) and mammography (Adam et al., 2014).

The use of MRI possesses a number of health hazards such as a 1.5 T magnet generating a magnetic field 21,000 greater than the normal magnetic field produced due to the gravitation force of the Earth. As mentioned by Neroladaki et al. (2013), the magnitude of the magnetic field in huge to attract any paper, clips and other small objects present in the room. The application of the method comes with a huge number of medical disclaimers. Mathematical principles have assisted in the facilitation of treatment with x-ray radiations in the medical field, giving us both the effects and the advantages of the later. The increasing human demand is affecting our health standards with both the requirements and optimization of the radiation protection principles (Sherer et al., 2014). However, as argued by Wraith et al (1995), the increasing population puts a demand for the development of more effective medical intervention policies.

Benefits and Risks of Chest X-ray

A radiologic medical procedure that is justified should be supported by the national health authorities and the professional societies, for instance the recommendation on producing procedures for individuals who are at an increased risk of developing a particular health condition. The imaging referral guidelines are found to be helpful to health-care professionals for making informed decisions in the provision of providing clinical decision-making tools emerging from evidence based criteria (Wraith, et al., 1995). Always, a justification for an examination should depend on the professional evaluation of comprehensive patient information which includes; imaging taken in prior, the clinical history that is regarded to be relevant, laboratory, and treatment information among others. “Ultrasonography” or MRI (radiofrequency and electromagnetic waves) are preferred especially to the pregnant mothers and the children, whenever available (Fletcher et al., 1986).

Conclusion and further analysis

In this respect, the medical practitioners in the application of the radiation guidelines and principles face a number of ethical challenges. The practicing radiologists often have to encounter a moral dilemma regarding the applicability of the radiation guidelines. This is because providing effective treatment in severe and lethal conditions such as Cancer calls for sophisticated scanning and imaging processes. Most of which are dependent in the application of hard x-rays or other imaging process. As argued by Chapple et al (1994), the same might generate free radicals in the human body, which shows severe oxygen scavenging properties. The activity of the free radicals is however debatable, though they have been seen to prevent abnormal tissue growth I the body. On the contrary, as argued upon White et al. (1991), some of the activities of the free radicals are expressed in the form of additional health symptoms such as fatigue, weakness and lowered immunity.

The most frequently done diagnostic X-ray examinations include radiographs of the chest and the abdomen. These tests are commonly considered in neonatal intensive care units. The images that are generated are obtained as two different exposures; one of abdomen of the patient and one of chest. They can also be obtained as a single exposure in order to include both anatomical regions on one film. Observed variations the medical field size does give various uncertainties in DAP and hence the effective doses estimated from it. Hence there are no significant differences in effective dose observed between the radiographic techniques. Infants, who are born prematurely with a gestational age of as low as 23 weeks, do survive due to the continual advancements witnessed in neonatal intensive care practices (Faulkner et al., 1989).

Limitations of Chest X-ray

According to the information given by the international journal of radiology, radiation oncology and all related science, “some infants might require various radiographic examinations throughout their neonatal care, however the radiation exposure to an individual’s life for 10 years in life might have an attribute to that particular individuals lifetime risk that are three times or four times greater than that after the age of 30. Besides, due to the fact that long life expectancy of children, as compared to adults, tends to have a greater period for the potential expression for the delayed effects of radiation, the methods of reducing radiation dose to the young children for a diagnostic radiography are of paramount importance (Chapple et al., 1994). For a single child, both chest and abdominal radiographs are to be requested simultaneously, for example in order to localize an umbilical artery. Besides, the findings of a small survey that was conducted at the outset of the study revealed that there was no general agreement between different hospitals as whether these images should be obtained as two separate exposures or as a single exposure including both anatomical regions on one film. Consideration was given to the use of thermoluminescent dosimeters to record entrance surface dose (ESD)” (Quality criteria for diagnostic radiographic images in paediatric, 1992).

According to physicians, "medical exposure is justified through the weighing of the expected diagnostic or the therapeutic benefits found to be against the potential radiation detriment. Hence the procedure is judged in doing more good than bad." The justification principles do apply to the three medicine levels (ICRP, 2007a) as described below. What lay at the primitive level is how proper radiation used in health sector has been approved to be causing more harm than good. At the secondary level there is a specific procedure justified for a certain patient population showing relevant symptoms or even a group of individuals at a clinical conditions risk for a clinical condition is that it’s able not only to be detected but also to be treated. Also on the third level, a justification for the application of a specified procedure to an individual patient is provided in case a particular application is judged to do more good to an individual as compared to the harm caused (Mettler, 2013)From the above discussion it can be concluded that chest X-ray in a noninvasive medical diagnostic tool effective in identifying different conditions. This form of radiology technique uses ionizing radiation in small amounts. This method is easy and fast, making it the priority when an assessment is to be done. The exposure to ionization radiation has drawn much attention of researchers in relation to the harmful impacts it has on the patient, such as deformation of nervous systems and others. Among the risks that a patient might experience are the existence of a minor chance of developing cancer due to unnecessary exposure to radiations. This is particularly noticed in the case of pregnant women where the physicians should apply necessary amendment strategies in order to protect the fetus from the harmful effect of the radiations. In this regard, adoption of a patient centered approach would help in meeting the required safety standards. Thus, adopting such strategies would help in ensuring that an interactive interface is established between the patient and the proactive care team.  A number of precautionary methods need to be considered while using the radiation technology. With advent of future research, new milestones would surely be achieved in this section of radiology.

Application of Technology in Medical Sector


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