Specialist irritating x-ray radiation. Radiation therapy bern. Personal and collective protective equipment in x-ray diagnostics

X-ray therapy is one of the types of radiation therapy, where active substance short-wave X-ray radiation appears. The method belongs to the external category, since the radiation source is located outside the human body.

Concept of method

For irradiation in medicinal purposes X-rays with an energy of 60–250 square meters are used. Depending on the power, the penetrating ability of the waves varies from 2–3 mm to 8–10 cm. In this way, both superficial organs - the skin, for example, and deeply located ones can be irradiated.

Application of the method is based on action x-ray radiation. Radiation has a detrimental effect on cells, causing mutations leading to death. But if you apply ionizing radiation locally, directing the beam of waves only to the lesion, you can achieve amazing success. In this case, cells atypical for the human body die. Unfortunately, normal healthy cells also die, so treatment with this method is accompanied by unpleasant consequences and complications, but in some cases, for example, when cancerous tumors, the healing effect significantly exceeds the severity of the consequences.

X-ray therapy is used to solve the following problems:

radical therapy– the highest possible doses are used in order to achieve the destruction of the source of the disease;
palliative– irradiation with lower doses is carried out to suppress the development of tumors and metastases. If necessary, palliative treatment can become radical;
symptomatic therapy– carried out to relieve symptoms: pain, squeezing blood vessels and so on. According to medical statistics X-rays relieve pain in 50–90% of cases.

X-ray therapy is also effective for less severe diseases. Thus, with the help of dosed irradiation, joints, arthrosis, and some skin diseases. The intensity of radiation and duration entirely depend on the purpose of the procedure and the condition of the patient. The course is selected individually for each patient and is constantly adjusted.

The therapeutic effect of the method is determined by the dose of radiation that the tissue in the affected area can absorb. Different histological structures have different sensitivity to radiation, so X-ray therapy is far from universal.

Types of X-ray therapy

Radiation therapy is classified according to several criteria. Thus, according to the time distribution of radiation doses, 3 methods are distinguished:

single irradiation– Typically used with other types of radiation therapy. Involves a single procedure using the intracavitary or application method of exposure;
fractionated - fractional. This is the main method for external remote exposure. Irradiation is carried out in certain doses. Fractional irradiation is safer than one-time irradiation. In addition, the method allows one to assess the differential sensitivity of tissues and more correctly distribute doses. There are several main modes:
- fine fractionation - or classical. 1.8–2.0 Gy per day up to 5 times a week;
- average – 4.0–5.0 Gy per day 3 times for 7 days;
- large – from 8.0 to 12.0 Gy per day, 1–2 procedures per week;
- intensive – 4.0–5.0 Gy per day for 5 days in a row. This is a common method for preoperative preparation;
- accelerated - the dose corresponds to average fractionation, that is, 4.0–5.0 Gy, but 2–3 times a day;
- hyperfractionated - the dose is reduced to 1.0–1.5 Gy, but the procedure is repeated every 4–6 hours;
- dynamic – each stage of treatment has its own fractionation scheme;
- split course is a regimen in which there is a break for 2–4 weeks in the middle of the course or upon reaching a certain radiation dose. The break may be shorter - 10–14 days, which depends on the rate of mutations;
continuous irradiation– required at a high rate of repopulation.

It is known that large fractions are more effective than small ones. However, as the dose increases, a reduction in the number of procedures and a decrease in total dose irradiation.

Based on the depth of penetration, X-ray therapy methods are divided into 2 groups:

telephoto or remote– with a natural length of 60–250 kV, the waves penetrate 30–60 cm under the skin. Indicated for lymphosarcoma, lymphoepithelial tumors. The remote method is also used in the treatment of large joints - for arthrosis, for example;
short throw– waves with a length of less than 60 kV penetrate no deeper than 7 cm. This method is used for skin cancer, primary melanoma, and mucosal cancer. Short-focus radiotherapy is also used in the treatment of osteomyelitis and thrombophlebitis.

Remote radiotherapy, in turn, is divided into 2 methods:

static radiation– the patient and the X-ray tube are motionless;
mobile irradiation– during the session, either the patient or the X-ray machine moves.

X-ray therapy is used and how independent species treatment, and in combination with surgical intervention or . Treatment is usually accompanied by therapeutic procedures such as blood transfusions, hormone therapy in order to minimize the side effects of exposure.

Advantages and disadvantages

As already mentioned, X-ray radiation has an equally destructive effect on both healthy and diseased cells. Accordingly, the method makes sense to use only in cases where this rather dangerous intervention is justified.

The advantages of the method include:

in the treatment of malignant tumors, radiotherapy may be the only in an effective way treatment;
for non-tumor ailments, X-ray therapy allows you to achieve a very quick and lasting effect and completely restore the affected organ;
the procedure does not last long – from 1 to 9 minutes;
Hospitalization is not always required. For example, when treating heel spurs or arthrosis, the patient can stay at home and visit the clinic only for sessions;
the procedure is completely painless;
Irradiation with short-wave radiation relieves pain by 50–90%.

The disadvantages of the method are very significant:

X-ray therapy can be used only when treating relatively shallow lesions;
the procedure requires very careful localization, since the harm from irradiation of healthy tissue is great;
compared to sources of higher energies, the body’s reaction during X-ray irradiation is more pronounced, so the side effects can be so strong that the sessions will have to be abandoned;
Radiation itself can cause disease. Greatest danger represents the possibility of developing leukemia.

Indications for testing

X-ray therapy is most often used as a remedy. So, for appropriate indications, the method is used, regardless of age or gender. Contraindications are associated with a certain state of the body, but not with these parameters.

The exception is infants: X-ray therapy is replaced by chemotherapy. When treating slightly older children, X-ray irradiation is used to suppress the development of not only cancer, but also embryonic tumors. The latter are often found in early age and has high radiosensitivity, so the treatment is very effective.

In general, children are more sensitive to the effects of ionizing radiation, so much lower doses are used and the child's condition is carefully monitored. As a rule, the initial reaction to radiotherapy is not pronounced, but a change in the child’s behavior indicates an effect: loss of appetite, decreased tissue turgor, lethargy. indicates dysfunction of hematopoiesis. Developmental defects may occur in the future bone tissue, decreased vision.

During pregnancy, X-ray therapy is excluded. On early stages During pregnancy, functional tissues are being formed, so ionizing radiation will most likely lead to fetal death and miscarriage. In the second semester, internal organs are formed: irradiation will cause developmental anomalies, for the most part incompatible with life outside the womb. Radiation exposure in the third semester often leads to developmental anomalies that last a lifetime.
If a pregnant woman is diagnosed with cancer and radiotherapy is necessary, an abortion is performed, artificial birth is provoked, and so on. If it is possible to replace radiation with surgery, which will not affect the condition of the fetus, then the latter solution is preferable.

Indications for remote X-ray therapy for men and women are:

oncological disease - sarcoma, lymphosarcoma, etc. Moreover, treatment is allowed only based on the results clinical trials and only if the disease is absolutely proven;
arthrosis of the knee or hip joint– X-ray therapy stimulates the recovery process and eliminates pain;
epicondylitis and periarthropathy of the shoulder joints, arthritis, osteomyelitis, osteochondrosis and other degenerative diseases of the musculoskeletal system;
inflammatory purulent ailments - carbuncles, thrombophlebitis, ;
complications after surgery - fistulas, mumps, inflammation in the wound area;
inflammatory and hyperplastic disorders at work nervous system– , ganglionitis, radiculitis;
benign neoplastic changes – , ;
dermatological diseases– chronic dermatoses including;
, plantar warts, Dupuytren's contracture – no higher than stage 1;
eye diseases - iridocyclitis, keratitis, retinopathy.

Indications for the use of close-focus radiotherapy are:

obligate and facultative skin cancers – keroderm pigmentosum, cutaneous horn;
skin cancer, basilioma;
– in this case, radiotherapy acts as a palliative method if the patient refuses surgery;
, oral mucosa, penis;
skin lymphomas;
benign and malignant vascular formations– hemangiomas;
non-tumor skin diseases – .

Contraindications

There are absolute and conditional contraindications for a course of radiotherapy. The absolute ones include:

the patient’s serious condition, severely weakened immunity;
exhaustion - the correspondence of weight to the height and age of the patient is calculated using formulas. The destruction of atypical cells and the subsequent restoration of unhealthy tissue require a certain energy food resource. In their absence, the procedure cannot be carried out;
dangerous accompanying pathologies– defeats of cardio-vascular system, kidneys, liver in the stage of decompensation;
leukopenia – less than 3500 in 1 cubic meter. mm, thrombocytopenia – less than 15 thousand, anemia. Treatment can be carried out if these factors can be eliminated and the blood composition can be restored;
existing radiation sickness or radiation damage received previously.

Relative contraindications include:

pregnancy and childhood. In the first case, they resort to surgical methods. If this is impossible, an abortion is performed or early labor is provoked, since radiation has an extremely negative effect on the fetus. IN childhood X-ray therapy is used according to vital signs;
acute infectious and those observed in the area of focus of the main disease.

Preparation for the procedure

The main preparatory work before the x-ray therapy session is carried out by the doctor.

The task of preparation comes down to precise definition location of the focus of the disease - depth, localization, structure. This can be done using computed tomography.
Using CT images, markings are made on the patient’s body using a laser guidance system. A surgical marker indicates the area of irradiation and reference points - they allow you to place the patient in the required position. Under no circumstances should the markings be washed off.
Based on research data, the radiologist and other specialists calculate the total dose and radiation regimen.
The X-ray equipment is adjusted immediately before the session.
The patient himself does not need to carry out any special measures before irradiation. If necessary, the patient can be consulted by a psychotherapist.

The only condition is sufficiently loose and comfortable clothing. Despite the short duration of the procedure, you must remain completely still during the session, which is not easy in tight or uncomfortable clothing. In addition, only certain areas of the body are exposed to radiation. The rest should be hidden by clothing.

A prerequisite is T-shirts, dresses and sweaters with a neckline, the neck area must remain open.

How is the treatment carried out?

To carry out X-ray therapy, a special device is required. The dimensions of the device vary widely depending on the nature of the disease. So, when irradiating the knees or elbow joints, neurodermatitis use mobile X-ray machines, compact and lightweight. When treating tumors, stationary devices are used, usually designed to irradiate a significant part of the body.

Not every clinic can afford to install the appropriate equipment. Sometimes patients have to come from other regions for radiotherapy sessions.
The procedure itself takes a minimum of time - up to 10 minutes, is painless and does not require any special actions.
The patient lies on the couch and takes a certain position. This is necessary in order to achieve the most accurate irradiation of the source of the disease and not injure healthy tissue. The accuracy of the position affects the depth of penetration, so the position should be maintained throughout the entire session. Nurses help you get into the correct position.
In some cases, the patient must move in a certain way during radiation. To do this, the doctor first accurately describes his actions to the patient.
If necessary, if the patient is a child, for example, they use restraints - a mask, a headrest, a mattress.
During the session, the patient is alone: the medical staff leaves the room where the equipment is installed. You can talk to the patient over a microphone, which is especially important when children are being treated.

After the session, the patient returns to his room or home, if the treatment does not require constant medical supervision.

Consequences and possible complications

Whichever high classification whatever the doctor had, with even a long course of x-ray therapy side effects cannot be avoided. No matter how precise the setting, unfortunately, the doctor is forced to irradiate some of the surrounding healthy cells in order to remove all cancerous ones. In the treatment of arthritis, arthrosis and neurodermatitis, this can be avoided, and the dose during irradiation is noticeably lower.

The most known side effects include:

– is connected not so much with the procedure itself, but with the body’s desire for recovery. To synthesize a sufficient amount of substances, large energy and material resources are spent when building cells. It's not surprising that after long course the patient feels very weak, lethargic, apathetic;
hair loss – focusing on restoration internal organs and tissues, the body “saves” on everything else. When irradiated, the condition of nails, skin and hair noticeably worsens until they are completely lost;
high temperature - explained by the actual effect of radiation on the body, the appearance of secondary infections, but in general is considered a sign of effectiveness if it does not exceed 37.5–38 C;
During irradiation, if the skin is sensitive, darkening, irritation, redness of the skin, even the appearance of blisters, may occur. Symptoms disappear 1–2 weeks after completion of the course;
Radiation therapy may cause problems with menstrual cycle. Signs of menopause are also often observed - sweating, hot flashes, vaginal dryness;
in men, irritation of the urethra is possible, which leads to painful ejaculation. Symptoms usually resolve within 2–3 weeks;
Very often, irradiation causes diarrhea, thathemes, and constipation. In this case, appropriate medications are prescribed;
– irradiation can cause damage to lymph vessels. In this case, swelling appears, mainly in the legs.

In addition, X-ray therapy is fraught with complications that do not disappear after completion of the course and require additional treatment:

fistulas are pathological channels that open from a hollow organ to the outside or into another hollow organ. If left untreated, they turn into ulcers and gradually destroy the walls of organs. During X-ray therapy, fistulas often appear between bladder and skin, for example, between the rectum and bladder;
long-term exposure can cause pneumonia. If left untreated, over time this leads to the replacement of lung tissue with fibrous tissue and respiratory dysfunction;
darkening and decay of teeth often occurs during the treatment of tumors of the oral area;
impaired hematopoiesis - a decrease in leukocytes and hemoglobin in the blood is an inevitable consequence of x-ray therapy. Normalization of indicators occurs over several months and in many cases requires drug therapy;
Irradiation has virtually no effect on a man's reproductive functions. In women, problems with pregnancy arise when the uterus, ovaries, pelvic organs, and brain are irradiated.

Recovery and care

X-ray therapy is a serious test for the body. Destruction of cells requires not only the fastest restoration of damaged tissue, but also the equally rapid removal of cell decay products. All this forces the human body to literally work for wear and tear.

Rehabilitation after radiotherapy, with the exception of the simplest cases - treatment of neurodermatitis, eczema, where minimal doses are used, includes a number of mandatory measures:

high-calorie diet - the body requires much more energy, proteins and fats than in normal life. But an almost constant side effect of radiation is nausea and vomiting. As a result, the patient is asked to eat small, but high-calorie foods;
foods are processed and easily digestible. Often, especially with irradiation of the oral cavity, esophagus, and stomach, the mucous membrane becomes inflamed and thinned, becoming extremely sensitive. It is recommended to consume food in the form of porridges and purees, since the damaged esophagus and stomach simply cannot process hard and coarse fibers;
sufficient amount of water - at least 2.5–3 liters of water, which is the norm for healthy person. Water – not juices and tea – allows you to get rid of toxic breakdown products as quickly as possible. This rule is not followed in cases where there are serious contraindications: disturbances in the functioning of the heart, the appearance of severe edema;
Carcinogens are excluded from the diet - it is almost impossible to completely prevent their entry into the body: most substances are a normal component of ordinary pollution or are formed when fertilizing the soil or treating plants and products with insecticides, fungicides, and so on. However, you can reduce their intake by giving up smoked, canned, fried foods - especially deep-fried;
during radiation therapy, A, C, E are prescribed to reduce the activity of free radicals. The latter are synthesized during irradiation and are very aggressive.

After completion of the course, the patient continues to be monitored. To record the results of radiotherapy, CT or CT is prescribed. With satisfactory results of treatment of non-dangerous diseases - heel spurs, for example, the patient is observed once every six months, if no complaints arise. Cancer patients undergo MRI examinations constantly; the examination schedule is developed according to the patient’s condition.

During and after X-ray therapy, antibiotic therapy is prescribed to prevent the development of bacterial infections: after all, during irradiation, the body's defenses are greatly reduced. After completing the course of antibiotics, it is recommended to take medications to restore the intestinal microflora.

Price

The cost of the procedure is determined by the nature of the disease, and, more precisely, the area of irradiation, depth, method used and duration of the course. Unfortunately, there are no standard methods in X-ray therapy; each course is calculated individually for each patient and adjusted depending on the intermediate result.

On average, the price in Moscow for 1 session of long-focus irradiation is 2000–3000 rubles. The cost of intracavitary is from 3500 to 7000 per session.

ID: 2013-11-977-A-3109

Original article (loose structure)

Komleva Yu.V., Makhonko M.N., Shkrobova N.V.

GBOU VPO Saratov State Medical University named after. IN AND. Razumovsky Ministry of Health of Russia Department of Occupational Pathology and Hematology

Summary

Ionizing radiation, exposure to which is possible if safety rules in the workplace are not followed, is considered the most common factor leading to the development of leukemia. One of the forms of pathology from exposure ionizing radiation(X-rays, γ-rays, neutrons) workers in X-ray rooms also suffer from radiation sickness, radiation cataracts, and skin cancer. Diseases caused by exposure to ionizing radiation and associated long-term consequences for the health of medical personnel require special attention to conduct preventive measures from the management of the medical institution.

Keywords

Ionizing radiation, medical workers, occupational diseases, prevention

Article

Relevance of the problem. The International Commission on Radiation Protection has introduced the concept of a single category of occupational exposure - this is exposure to ionizing radiation of any worker in the process of his work. professional responsibilities. The most exposed to radiation are medical personnel serving X-ray rooms, radiological laboratories, specialists in angiography rooms, as well as some categories of surgeons (X-ray surgical teams), and employees of scientific institutions. At frequent execution procedures in which x-ray control is associated with the nature of the surgical intervention, radiation doses may exceed permissible limits. The radiation dose to medical workers should not exceed 0.02 Sv (Sievert) - a dose of any type of ionizing radiation producing the same biological effect as a dose of X-ray or γ-radiation equal to 1 Gray (1 Gy = 1 J/kg) per year ; 1 Sv is equal to 100 rem.

Target. To study the impact of ionizing radiation on medical workers.

Research objectives. To identify diseases among medical personnel that arise during the work performed from ionizing radiation and measures to prevent them.

Materials and methods. An analysis of literature data and research materials on medical workers exposed to ionizing radiation was carried out.

Results. Ionizing radiation, exposure to which is possible if safety rules in the workplace are not followed, is considered the most common factor leading to the development of leukemia. According to statistics, leukemia occurs 7 times more often among radiologists aged 25-39 years, and 2-3 times more often among radiologists aged 40-70 years than among the rest of the population. In 2002, 8,150 cases were identified in Russia of this disease. The connection between emerging leukemia and exposure to an occupational factor is evident in cases where, for several years preceding leukemia, hematological symptoms characteristic of this nosology when exposed to harmful factors are observed. Clinical, morphological and cytogenetic studies suggest that chronic lymphocytic leukemia is a heterogeneous disease, having many forms with different clinical picture, the rate of increase in signs of progression, the duration of the disease and response to therapy. This is characterized by varying degrees of severity of cytopenic blood parameters. They are often small, but they are characterized by a rather long presence (from 2 to 10 years). According to clinicians, among the cytological variants of occupational leukemia, the most common are acute leukemia, in particular its myeloblastic variant, erythromyelosis and undifferentiated forms, as well as chronic myeloid leukemia. Acute leukemia is a blood disease in which blast cells accumulate in the bone marrow, in the vast majority of cases found in the peripheral blood. Found in all age groups, men and women get sick with the same frequency. If leukemia occurs several years after the cessation of contact with the leukemic factor, then this does not contradict its professional etiology. In a general blood test initial stage disease, there may be no manifestations of anemia, but in the advanced phase its severity increases. The number of red blood cells decreases sharply to 1-1.5*10¹²/l. With such indicators, anemia is normochromic in nature. The number of reticulocytes usually decreases significantly; in acute erythromyelosis, their content is 10-27%, and ESR increases significantly. The number of leukocytes in this type of blood cancer in the analysis can range from low (0.1*109/l) to high (100-300*109/l) numbers. It depends on the form (subleukemic, leukopenic, leukemic) and the current stage of the disease. In the advanced stage of leukemia, young bone marrow cells and a certain amount of mature elements are detected in the peripheral blood. Hematologists call this condition “leukemic failure” - the absence of transitional forms in cells. In the blood test of patients, basophils and eosinophils are completely absent. Any changes in blood counts in acute and chronic leukemia indicate the presence of thrombocytopenia (up to 20*109/l and below). A number of publications emphasize that in megakaryoblastic leukemia the number of platelets most often significantly exceeds the norm, while in aleukemic forms there are no malignant cells in the blood. During remission, the picture of cellular analysis of peripheral blood stabilizes. Final conclusion about subsidence acute process, prescribing therapy can only be done with a bone marrow examination and a detailed deciphering of the type of leukemia. In the advanced phase of the disease, blast cells in the bone marrow make up 20-80%, in remission - only about 5%. The number of granulocytes should be at least 1.5*109/l, platelets - more than 100*109/l. IN terminal stage Anemia, severe leukopenia, an increase in the number of immature eosinophils and basophils, and a decrease in the number of neutrophils are observed. At this stage of the disease, a blast crisis is possible. A general analysis of blast cells does not allow them to be classified as one or another lineage of hematopoiesis, but this has great importance to begin rational therapy. Therefore, patients with acute leukemia undergo immunological and cytochemical reactions to establish the cell phenotype; enzymes (peroxidase, alkaline phosphatase, nonspecific esterase), lipids, glycogen and others are determined. In acute lymphoblastic leukemia, cytochemical reactions are positive for terminal deoxynucleotidal transferase and negative for myeloperoxidase. In patients with acute myeloid leukemia, the reaction to myeloperoxidase is always positive. In the patient's blood serum, the activity of AST, LDH, the level of urea, uric acid, bilirubin, γ-globulins increases and the content of glucose, albumin, and fibrinogen decreases. The severity of biochemical changes in blood tests is determined by changes in the functioning of the kidneys, liver and other organs. Immunological blood tests are aimed at identifying and determining specific cell antigens. This allows you to differentiate subtypes and forms acute leukemia. In 92% of patients, genetic damage is determined. Therefore, it is very important to conduct a complete, detailed blood test for any form of leukemia.

One of the forms of pathology from exposure to ionizing radiation (X-rays, γ-rays, neutrons) in X-ray room workers is also radiation cataract. Experts describe that repeated irradiation with low doses of neutrons is especially dangerous in terms of cataractogenic effects. Cataracts usually develop gradually, the duration of the latent period depends on the dose received and averages from 2 to 5 years. The clinic has many common symptoms with thermal cataracts. Cloudiness first appears at the posterior pole of the lens under the capsule in the form of fine grains or vacuoles. The granularity gradually takes the form of a disk (or “doughnut”), sharply demarcated from the transparent part of the lens. At this stage, cataracts do not affect visual acuity. Subsequently, the cloudiness takes on the shape of a bowl or saucer. In the light of a slit lamp, the cloudiness in its structure resembles tuff with a metallic tint. In a later period, vacuoles and belt-shaped opacities appear under the anterior capsule. Gradually, the entire lens becomes opaque, vision drops to light perception. In most cases, radiation cataracts progress slowly. Sometimes initial cloudings last for years without causing a noticeable decrease in vision. Signs of radiation sickness are not necessary.

Radiation sickness is a fairly rare manifestation of the effects of ionizing radiation on medical workers, but when a certain dose level is reached, chronic radiation sickness can develop. For medical workers, when in contact with the relevant equipment, the likelihood of negative effects of X-ray and γ-radiation increases in the case of poor tube protection, neglect of personal protective equipment or their wear.

Persons who work in direct contact with X-ray equipment are susceptible to developing skin cancer. Mostly these are doctors, technicians, X-ray room nurses, and X-ray factory workers who work for long periods near X-ray tubes without appropriate protection. The period before the onset of diseases is called latent. It lasts on average from 4 to 17 years and directly depends on the dose of radiation received. According to studies, experts have found that the latent period for the development of x-ray cancer among radiologists is an average of 26 years. The predominant site of cancer of this etiology is the skin of the hands, and the skin of the left hand is most often involved. The nail phalanx is affected, then the middle and main folds, interdigital folds, and less often the dorsum of the hand. The appearance of cancer is preceded by chronic, developing over a period of several months to several years, difficult to treat x-ray dermatitis, characterized by persistent focal thickening of the skin, especially on the palms, with the appearance of deep grooves and cracks, areas of atrophy, hyper- and depigmentation. Hair falls out in scalp areas. Nails become brittle, with grooves and recesses. With a long-term course, hyperkeratosis can be accompanied by the development of dense warts, calluses, and subungual hyperkeratosis occurs. According to some authors, these changes are precancrosis, and their progression can lead to the appearance of x-ray ulcers. On the spot chronic dermatitis with hyperkeratosis and ulceration, cancer most often develops. By histological structure The epidermis in chronic x-ray dermatitis in the late stage is a layer of cells of unequal thickness; acanthosis with hyperkeratosis is noted in some areas, while atrophy occurs in others. In some places, the epithelium grows in the form of long strands into the dermis, especially around blood vessels that are sharply expanded in the upper layers (telangiectasia). In the cells of the Malpighian layer the phenomena of atypia are expressed: they are revealed incorrect location, different sizes of cells and their nuclei, a significant number of division figures. Histological changes in the epidermis resemble those of Bowen's disease, an intraepidermal squamous cell carcinoma. Characteristic is the presence of edema in the dermis, sclerosis, especially around blood vessels. There is partial destruction of collagen fibers, determined by basophilic staining. In the deep layers of the dermis, the walls of blood vessels are thickened, their lumen is narrowed, and sometimes closed by blood clots that organize with recanalization. Atrophy of hair follicles occurs and sebaceous glands; sweat glands last longer, disappearing only at an advanced stage of the process; in some places, elastic fibers are destroyed. There are reports stating that in especially severe cases, ulcers occur, in the depths of which they become obliterated. blood vessels. Against the background of all the processes described above, the emergence and formation of squamous cell carcinoma with varying degrees of keratinization occurs. Sometimes it has a spindle cell appearance and resembles a sarcoma, being malignant. Rarely does basal cell carcinoma develop after exposure to X-rays. Metastasis of skin cancer from X-ray irradiation primarily depends on the malignancy of the tumor.

Conclusions. Diseases caused by exposure to ionizing radiation and the associated long-term consequences for the health of medical personnel require special attention to preventive measures on the part of the management of the medical institution. Prevention of occupational cancer in medical workers consists of primary and secondary measures. Primary prevention provides for the prevention of cancer and includes hygienic regulation of carcinogens, development and implementation of measures aimed at reducing contact with them, control of pollution of the working environment. The entire range of measures to protect against the effects of ionizing radiation is divided into two areas: protection from external exposure and prevention of internal exposure. Protection from external radiation comes down to shielding that prevents certain radiation from reaching medical workers or other persons within the radius of the radiation source. For this purpose, various absorbing screens are used. The basic rule is to protect not only the medical worker or workplace, but to shield the entire radiation source as much as possible in order to minimize the possibility of radiation penetrating into the area where people are present. Hygienists have proven that the materials used for shielding and the thickness of the screens are determined by the nature of the ionizing radiation and its energy: the greater the severity of the radiation or its energy, the denser and thicker the shielding layer should be. Most often, lead aprons, brick or concrete walls are used for this purpose to protect radiologists, radiologists and radiation diagnosticians. Special formulas and tables have been developed to calculate the thickness of the protective layer, taking into account the amount of energy of the radiation source, the absorption capacity of the material and other indicators (SanPiN 2.6.1.1192-03 “Hygienic requirements for the design and operation of X-ray rooms, devices and X-ray studies"). There are various designs of devices, irradiators and other devices for working with sources of γ-radiation, which also provide for maximum shielding of the source and a minimum open part for certain work. All operations for moving sources of γ-radiation (removing them from containers, installing them in devices, opening and closing the latter) must be automated and performed using remote control or special manipulators and other auxiliary devices that allow the medical worker involved in these operations to be at a certain distance from the source and behind an appropriate protective screen. Premises where radiation sources are stored or where work is done with them must be ventilated using mechanical ventilation. Skin cancer from exposure to X-rays is now rare due to effective X-ray prevention and protection measures in the workplace.

The basis of the system for the prevention of occupational diseases is mandatory preliminary and periodic medical examinations of workers whose work activities are associated with harmful and dangerous production factors. According to the Order of the Ministry of Health and Social Development of the Russian Federation dated April 12, 2011 No. 302n “On approval of lists of harmful and/or dangerous production factors and work, during which preliminary and periodic medical examinations (examinations) are carried out, and the procedure for conducting mandatory preliminary and periodic medical examinations(examinations) of workers engaged in heavy work with hazardous and (or) dangerous conditions labor" medical workers exposed to ionizing radiation must undergo medical examinations once a year with consultation the following specialists: ophthalmologist, dermatovenerologist, neurologist, otorhinolaryngologist, surgeon, oncologist. Laboratory and functional studies: expanded general analysis blood, reticulocyte count, spirometry, radiography chest in two projections, biomicroscopy of the eye media, fundus ophthalmoscopy, visual acuity with and without correction. On the recommendation of medical specialists, ultrasound examinations of organs are prescribed abdominal cavity, thyroid gland and mammography for women. Persons with a hereditary predisposition to tumor diseases, as well as those with chromosomal instability, should not be allowed to work with ionizing radiation. It is important to identify people with immunological deficiency and carry out measures among them to normalize the immune status, the use of drugs that prevent the blastomogenic effect (methods of hygienic, genetic, immunological and biochemical prevention). Clinical examination of persons working with sources of ionizing radiation, early detection, treatment of chronic background and precancerous diseases, that is, timely and high-quality medical examinations are essential. Contraindications to working with ionizing radiation are: hemoglobin content in peripheral blood is less than 130 g/l in men and less than 120 g/l in women; leukocyte content less than 4.0*109/l and platelet count less than 180*109/l; obliterating vascular diseases, regardless of the degree of compensation; Raynaud's disease and syndrome; radiation sickness and its consequences; malignant neoplasms; benign neoplasms that interfere with wearing overalls and using the toilet skin; deep mycoses; corrected visual acuity of at least 0.5 D in one eye and 0.2 D in the other; skiasscopic refraction: myopia with a normal fundus up to 10.0 D, hyperopia up to 8.0 D, astigmatism no more than 3.0 D; radiation cataract. Monitoring the health status of persons working with carcinogenic factors should be carried out even after their transfer to another job, as well as retirement, throughout their lives.

Literature

1. Artamonova V.G., Mukhin N.A. Occupational diseases: 4th ed., revised. and additional - M.: Medicine, 2004. - 480 pp.: ill.

2. Hygiene: 2nd edition, revised. and additional / Ed. acad. RAMS G.I. Rumyantseva. - M.: GEOTARM ED, 2002. - 608 p.: ill. - (Series “XXI Century”).

3. Zhevak T.N., Chesnokova N.P., Shelekhova T.V. Chronic lymphocytic leukemia: modern concepts of etiology, pathogenesis and features clinical course(review) // Saratov scientific and medical magazine. - T.7, No. 2. - P.377-385.

4. Izmerov N.F., Kasparov A.A. Occupational medicine. Introduction to the specialty. - M.: Medicine, 2002. - 392 p.: ill.

5. Kosarev V.V. Occupational diseases of medical workers: monograph. - Samara, “Perspective”, 1998. - 200 p.

6. Kosarev V.V., Lotkov V.S., Babanov S.A. Occupational diseases. - M.: Eksmo, 2009. - 352 p.

7. Kuchma V.V. Hygiene of children and adolescents. - M.: Medicine, 2000. - 187 p.

8. Makhonko M.N., Zaitseva M.R., Shkrobova N.V., Shelekhova T.V. Conducting medical examinations of workers in the conditions of modern legislation (Orders No. 302n, 233n of the Ministry of Health and SR of the Russian Federation). XVI International Scientific Conference “Family Health - XXI Century”: Sat. scientific works. - Budapest (Hungary), 2012, part II. - pp. 21-23.

9. Order of the Ministry of Health and Social Development of the Russian Federation dated April 12, 2011. No. 302n “On approval of lists of harmful and/or dangerous production factors and work, during the performance of which preliminary and periodic medical examinations (examinations) are carried out, and the procedure for conducting mandatory preliminary and periodic medical examinations (examinations) of workers engaged in heavy work with hazardous and (or) hazardous working conditions.”

10. Radiation. Doses, effects, risks: Transl. from English - M.: Mir, 1990. - 79 p.: ill.

11. SanPiN 2.6.1.1192-03 “Hygienic requirements for the design and operation of X-ray rooms, devices and the conduct of X-ray examinations.” Approved on February 14, 2003 and put into effect by decree of the Chief State Sanitary Doctor of the Russian Federation G.G. Onishchenko dated February 18, 2003 No. 8.

12. Therapist's Handbook / Comp. A.V. Topolyansky. - M.: Eksmo, 2008. - 544 p. - (Newest medical reference book).

13. Human ecology: Dictionary-reference book / Author-comp. Agadzhanyan N.A., Ushakov I.B., Torshin V.I. and others. Under general. ed. Agadzhanyan N.A. - M.: MMP "Ecocenter", publishing company "KRUK", 1997. - 208 p.

Your rating: No

Offers patients all kinds of disease diagnostics. An accurate diagnosis of the disease is very important and helps diagnose. X-ray technicians gain specialized knowledge and work using x-rays to diagnose diseases and injuries. They work in a variety of settings, including hospitals, doctors' offices, rehabilitation centers, nursing homes and radiology clinics. Diagnostic centers may also employ x-ray technicians. If you want to become an X-ray specialist, it is recommended that you study science and mathematics in school, which can provide a good foundation for future study. Today, X-ray machines can be seen in clinics in big cities and, if desired, you can undergo an MRI examination in Novosibirsk http://mrt-gid.ru/mrt/novosibirsk/

There are official radiological learning programs, designed to prepare people for the advent of x-ray technicians. You must obtain a high school diploma or GED before applying to one of these programs. Most programs last between one and four years, depending on the type of training provided and how often classes are offered. You can graduate from a radiology program with a PhD, which requires about two years of study. While this is a common choice for many who pursue this career, it is not the only route to work; There are also training programs that provide certificates of completion and bachelor's degrees.

In some cases, people who are already working in the medical field decide to pursue a career as an x-ray technician. In this case, a person can choose an accelerated program that allows him to become an x-ray machine in about a year. Often, those who choose programs at the undergraduate level do so because they have a desire to apply for management or administrative jobs.

X-ray technology must work well with others and be detail oriented.

After completing your training, you typically pursue certification, such as through the American Registry of Radiologists. You must complete an accredited training program and pass an exam before receiving certification, but it is entirely voluntary. To maintain your US certification, you must complete 24 continuing education credits every two years.

X-ray technicians use equipment such as X-ray machines to take images of bones or other internal parts of a patient's body.

In addition to formal training, you should consider whether you perform well on the job. Typically, a person in this field must work well with others—both other health care professionals and patients—and pay close attention to detail. You must have a lot of physical stamina as you may have to stand for long portions of the work day. Physical strength is another requirement, as you may need assistance in moving and transforming patients in need of assistance.

The fear of radiation has taken root in our minds, especially after Chernobyl disaster. Many people even refuse to undergo X-ray and fluorographic examinations for fear of radiation exposure. But for some diseases and injuries, such diagnostics need to be done several times a year. How dangerous is medical radiation In fact?

Of course, ionizing radiation is of little use to the human body. Radiologists themselves do not argue with this. It is prohibited to conduct X-ray radiological examinations on children under 15 years of age, pregnant women and nursing mothers, unless there are direct medical indications for this.

Children have a growing body, which means their cells divide much more often than adults. And the greater the number of divisions - mitoses - the greater the percentage of their mutations under the influence of ionizing radiation and the higher the likelihood that these mutations can provoke a particular disease.

After all, it’s not for nothing that radiologists and laboratory technicians receive additional vacation days, cash bonuses, and even milk for their work. A clear indication of “harmfulness”!

They give us milk not because of radiation, but because of lead, which is included in the cabinet’s protective equipment,” says the head. X-ray department of one of the Moscow clinics, candidate medical sciences Andrey Vasiliev. – But free radionuclides are best removed from the body by Cabernet wine. Although it is right to be afraid of ionizing radiation.

You just need to approach the problem carefully. An X-ray examination of the chest alone makes it possible to detect both tuberculosis and peripheral lung cancer in time, when the lymph nodes have not yet been affected and the person can be absolutely saved.

An annual examination of the mammary glands (mammography) should generally become mandatory for women after 40 years of age. The Japanese are a nation of radiophobes - everyone undergoes X-ray examination of the gastrointestinal tract, because stomach cancer is their main risk factor. And in our country, judging by the statistics on the incidence of tuberculosis and cancer, there are frankly few X-ray examinations.

But it happens that a person is forced to undergo fluorography three times within a month (either there is a problem with the machine, or the film is defective). Isn't this harmful?

I assure you, even the most primitive film, if it is normally exposed and developed, produces normal image quality. “Defective film is an excuse. If the device emits rays, if the modes are selected correctly, the chest can be removed in any case. The reason for repeated X-ray examinations is not in the film or in the “bad” apparatus, but in bad doctors and laboratory assistants.

- What dose of radiation can a person receive per year without harm to his health?

All people are divided into three groups. The first is preventive, that is, a practically healthy contingent. The second is those who x-ray studies prescribed for diseases of internal organs other than cancer. And the third are cancer patients and victims of multiple injuries.

So, for the first group the annual dose is set at one millisievert. This is approximately one study per year. But increasing the dose even to five millisieverts also does not pose a direct health hazard.

You work inside the X-ray room, and we are talking right behind the wall in the resident’s room. Aren't you afraid to constantly be in the irradiated area?

The sanitary and epidemiological service checks us once a year. Dosimetry of all walls, floors, ceilings, windows, doors is carried out. Checking protective equipment. I am present at this, and when I sit in my place, I am sure that the dose here is zero. For the readers, I will say that no one needs to have an X-ray unless necessary, but fluorography should be done once a year to exclude more serious illnesses and more serious radiation, say, for oncology.

Now let's look at how dangerous X-ray irradiation is.

X-rays are a type electromagnetic radiation, whose other forms are light and radio waves. The peculiarity of this radiation is its short wavelength, which allows it to carry enormous energy and gives high penetrating ability. The high penetrating power and energy of X-ray radiation makes it especially dangerous for humans. The degree of danger from x-ray exposure depends on how much time people spend near x-ray equipment, i.e. The contingent is divided into 2 groups. The 1st group consists of radiologists, researchers working with X-ray equipment and personnel servicing this equipment. Group 2 are patients. For the 2nd group, there are methods for monitoring national and international standards, which are strictly observed by doctors. Accordingly, the risk of radiation exposure is minimized. Let us assume that the dose of X-ray radiation used for a chest X-ray does not cause any side effects. There is accurate medical evidence regarding the risks associated with high doses of radiation. So you don’t have to worry about patients, doctors are responsible for them.

Now let's discuss the 1st group - radiologists, researchers, personnel servicing this equipment. How dangerous is it for this group to work in this direction?

Scientists from the Italian National Research Institute studied this issue. Their opinion is that such radiation exposure initiates rather positive changes that were noted at the cellular level. A study was conducted in which 10 people took part. The subjects were exposed to a year's equivalent of radiation. Studies have shown that hydrogen peroxide was observed in the blood of such doctors, which showed cell damage. The peroxide level was 3 times higher than normal. White blood cells were also a concern. This raises the question, why did scientists come to a positive result? The answer was the following: in addition to hydrogen peroxide, the doctors noted that the level of glutathione, an antioxidant that is responsible for protecting cells, was twice the normal level in the blood, i.e. The chances of cells dying become higher, but at the same time the body easily gets rid of cells if they are seriously damaged.

It is impossible to objectively answer the question about the dangers of radioactive radiation, but proven facts inspire optimism.

Nowadays, medicine has reached a new level, and accordingly, equipment must ensure safety for patients and doctors. As for X-ray equipment, patients need to choose clinics that have the latest equipment, and doctors need to update and provide quality service more often