giáo trình kỹ thuật chụp x quang

PGS.TS PHAM MINH THONG
chu bien

CHl)P X-Q
Ky thuat vien chan doan hinh anh

NHA XUAT BAN Y HQC
HA NOI

G
.

.

,


XU'O'ng dui

I. CIAl PHAU XUONC DUI
Ul xirong dai nhf'l cua bQ xuong, gl~l(nco mot than va hai dftu. Than xucng gorn 3 mfit
(xau ngoai, sau trong V~lsau truoc) vii 3 bo (ngoai, trong va saul.
I )frU trcn xucng dui g6m co CClvi, chom xirong. Cham

xuong

Ch~IU

tao thanh khop hang. l lai mau chuycn

xirung ti~p khop vdi

6 c0i

Ion va be, giC(a hai mau chuycn

I~l

.tuong lien mau.
Dftu duoi xuong dui hoi cong va ra sau. L6i cftu trong va ngoai ti~p khop voi rnam
chfty tuong Crng. I)i~n khop rang

J'<)C

d tnroc tiep khop voi xuong banh che.

II. CHi D!NH CHl)P

A. Chan thuonq
1. Gay than xuung dui
Xirong dui nhm trong kh6i co Ian diroc nhi~u mach mau nuoi duong nen li~n
nhanh nhirng trai lai g~y xl(lIng dui thUdng chay nhif:u mflu co th~ gay s6e milt
mall.
Cae cd mong kho\.: bam vao milu ehuy~n

Ion lam dftu Iren d~mg, cd th~t lung

eMu bam VilO mAu chuy~n hl~lam dh tren g~p ra trvoc. Di~u nay giai thich g~y
xUdng dui

I'D!

hay di l~eh. Klli ehl:lP X-quang

phai h~1 s,'(e nhl;! nhang, tranh lho

b~IO. Tu tht- clWP xU0ng uui Ihing la cAn IhiGI, khong d;.11 viln d~ clwp nghieng
n~u nhU th{.y dnh tr?ng lam s:lng kh,'mg chu phep.


Bai 1. Xuong dui 5
,..

:;:::

;:...

2. Gay tren lot

).

'~1I11xlidng

,

.

elm

G~y tren 16i c~u xuong dui thirong do tai nan C) to, do nga cao, day 1a rEm tlurun];
it g~p, Khi thiim kham can phat hien d~u hi~lI thirong rEmth~n kinh hong khco V~I

t6n thirong mach mau.
Tham kh[1I11X-quang cling chup hai nr Ih~ Ih~ng va nghicng d~ xac dinh /1 g~y
va mire dQ b] lcch,

B. Chup xuonq dul phuc vu eho dieu tr]
G~y xirong dui c() chi dinh di~u tri dong dinh n0i tuy: Vai Il'll cua X-quang luc nay
13 xac dinh vung. lily rong hay hep d~ chon 11inhnQi tlly phi: he,Jp,
Danh gia tinh trang li~n xuong sau di~u tr]:

_ Phuong phap di~u tri dong dinh noi tllY nguQc dong cho k~t qua t61. Sau
mot th('li gian (2-3 tu~n), ch\1p X-quang xlfdng dui ltrlnh gia tlnh tr"l1lg lien
xudng llC' co hlfdng di~u tr\ thleh h<,lp,
_ N~ll nlH( g5y xt(ong Ulli khong co chi l1jnh ph~u thu01. chi bo b0t sat! khi uil th('li gian (kho~mg 6 tu~n), Tnttfc khi lhao bQt lit'n hanh Ch~IPl<;li:\I(lng
Ulli, nh:)11a\nh so bQ v~ s~ li~n Xlt<1llg.can XltClng6 g~y,

c. Cae ton

thU'O'I1gkhac
Ch~n aoan vi011lxltOng, u xllong, 10ang XI(<1ng..,
M~c du da ut(,le thay th~ chin doan btng chl,lp dt IdP vi tinh nhung X·quang
thudng quy v;n) con nguyen gia tr\ VI
li~n. cI~ th~tc hi~n, vtta giup chAn ,111;lnV~I
theo d6i trong qua trlnh di~u tri, Trong nhCtng trudng hQP nay, tham kham X-quang

re

. b~t bUQc phai clwP 2 tu th~: th~ng va nghi0ng,

III. KY THuAT CHUP XUONG DUI

A. Ky thu~t chl;lP xU'O'I1gdui th~ng (H1nh 1-1)
_ B~nh nhfll1 n~m ngva tren ban X-qllang, Chan ben c~n chl,lp du6i thfll1g, h;\ll
chan x(1ay nh~

VaG

trong (n~u g§.y khong hoan toan),

_ Phim ~Ox40 em, d~t dQc dudi ,11'li,"hlnh ai~m gilta xltdng alii

V;ll)

giL("

phim. kllu tru chLlm tia ho~c che 11't ch~n chI theo ehi~u dQc.
_ Tia trllng Hlm: ehi~u vuong goc Itf 11'011
xu6ng qua di~m gilfa (1lli vito Irung

lam pllim.
_ Thong s6 ch9p: 60-65 kY, 40 m:\s. kho?mg each 100 cm.
Lliu

y:
_ N~ll h~nh nhan to beo ho~c bo h(ll Ihl phai dung IUdi ch6ng mel

V;I

I:ing

6 Ch 1. Ky thu~t chup X-quang xuonq khop chi dU'O;

htng s(J .hup (k V, m/vs).
- Trong truung h9P g§y XL,dllg dui duoc cti~u tri bftng Ul'lIlg ctinh noi tLIY, din
danh gia kich thuoc th~lt cua ong tuy, thi phai ct~t phim sat vao dui, bong Xquang ctC'khoang each xa Ii', 1,5 ct~n 2 m.
- Phai Uly dLI<_:jC mot doan g?1 Y hoac mOL khop gfll1 nh~t ncu chup khu tru.

111111).

Hinh 1-1.

'CJ(J(J

Ky thu$t ch~p xuCjngQuith~ng, tia trung tam vuong goc a Qi~mgiO'aQuivao giO'aphim.

B. Ky thuat chup xuonq dui nghieng
1. Ky thuat chup nghicng Ilgmil (Hinh 1-2)
- Benh nh.in ntm nghicug hoan roan tren ban X-quang,

\'~ phi a ben c~n chup,

Chan ben khong chup co len dira ra tnroc ho~c dira ru sau t6i cta. C6 chan ke
g6i ct~m ml,lc ctich ct~ xudng ctui sat phim. Chan ben ch\lp g~p l~i d~ng ra
m~l ngoili ctui sflt philll.
- Cling ell th~ b~nh nhflll niim nghieng khong hO:ll1 to;II1, xudng c!ui cftn-ch\1p
g?P nht,: va xoay ra nguili sao cho m~t ngoai ap vilo phim. Chan ben c!6i
di~n g?P g6i ct~t ban chan thing goc xu6ng ban Hun ui~m ti c6 ctinh cho tll
th~.

Bai 1. XU'011g dui 7

- Phim 30x40 em, d~t doc diroi dui, chinh di~m gili'a xirong dui

VaG

giira

phim, khu tru chum tia hoac chc If1 ch~n chi thea chien doc.

Hlnh 1-2.

Ky thu$t

chuo xLidng aUi, ur the nqhieng ngoai hoan toan (A) va khong hoan toan
(8), tia trung tam chieu vuong qoc qua ai§m giu'a aui va van trung tam phim.

- Tin tnmg Him: chi~u vuong gl'w Ilf tren xuong LIlia diem giC(auui vao trung
tam phim.


8 Ch 1,

Ky thu~t chyp X-Quang

xU'O'I1g khop chi dU'Qi

- Thong so chup:

-----------------------------------

GO k V.

mAs, khoang each

-I( I

100

1.'1"11,

co th0 dung liroi

chong I11ll.
2. Ky thu~t chup IIghicng trong (l linh 1-3)
- Duoc ap dung trong nhirng uucng hop chan tlnrong n~lIg,
- Bcnh nhfin ntm ngLca, hai chan uuCli thing
Inr(1c

(hojic chan hi'll khong dau dua ra

])ui hen cftn chup UU'(_1C ~l' cao btng mQt g6i

co 111~1 sire len b()II~),

u~m,
- Phim 30x,IO cm, c.!(tt lh'~IIIt!- dirng doc c.!U\jC cCl dinh IH'!i kcp gitra hai dui
(hoiic

ULCl.k·c5 djnh

quang chi0u ngang,
chum

b[lIlg 11,1\) cut n011 chan hen khollg chup co), Bong X-

chinh (ti~m giira xirong dui van giira phim, khu tru

tia h. )(IC chc 1[1 Ch;[11 chi thco chi~u doc.

TITRn2000
OI(;I/,\j 1:.1/1(1),;"".11'/0

TIA

x £)1.............
NG~f1J,.~
~~~~.

"""<"~

Ky thuat chup xU'ong Qui, tu Ih6 nghieng trang, tia trung tam di ngang giu'a Qui (chi
lay QLfc;c2/3 dLfOiQui),

Hlnh 1·3.

- Tia trung

tam: di ngang

V:I

vuong goc qua di~m giU'a xvong dui van trung

tam phim.
- Thong

s6 clll}P:

60 kV, --lOmAs, khoang

dlch

100

ch6ng md.

Lu'u

y: TLt th~ cht,lp nay

chithjy

dL(<;!C

2/3 dvai xLtong dLli,

CIll,

co th~ dLlIlg lLfdi

)

XU'O'ng cang chan

I. GIAI PHAU XUONC CANG CHAN (Hlnh 1-4)
II. cAc CHi D!NH CHl,JPXUONG CANG CHAN
- Phat hien llilCfng 16n thirong gfty xtronj; c:~ll1gchan.

- Theo d6i l1hnh gia Ii~n xirong sau be h()l ho(tc phi'iu thuat.
- Tim nhirn]; tAn thirong benh ly: viern.

II x irong.

III. KY THU,~T CHl,JPXUONG CANG CHAN

A. Ky thuat chup th~ng (Hinh 1-5)
- Benh nhan n~m ngira tren ban Xvquang, chan cAn Chl.IP du6i th~ng,
chan xoay nhe vao trong (d~ tach dVc;1Ct6i da hai xuong chay mac).

him

- Phim 30xdO ern, l1~t doc dlfdi dng

1;'1111

('11;111.

chinh dng

('han

V;lO

trung

phirn, khu II'll churn tia hofic chc 1&ch:,il1 ('hi thea chi~ll doc.
- Tin trung

film: chi0u th;1ng tir trcn Xlll:'llg vuong gee vtli phirn, khu tru

"ill)

di~m giira xlfdng dng chan, d phia n)!.11;'1i ('ilch h,'j tnroc xuong chay kho.ing
2 em va Vil11(rung tam phirn.

- Thong

s6 chup:

50 kV, 20 mAs, 100

('111.

khong dung ILf{1ichong md.

B. Ky thu~t ch~p nghieng (Hlnh 1-6) ,
- B~nh nhilll Ilfllll nghicng

vt phia

chall ('IIIl chl,lp, chan Ilily du6i th~ng, nl(~(

ngoai dng L'han S{lt phim sao cho gej Infl'le ella xlfCng l'ilay song song "l~ji
m?t phim. Chan ben d6i di~n co len va chfa ra phI a trvdc.
9


10 ChI.

Ky thuat

chup X-quang

xuono khop chi dU'O;
Nhin sau
,----Go

Nhin truce
,,---Go glan 101cau ~

91"r', 101cau --~

Cu gian

\twn tan cua
cnau chay)

d;iI

bam t~n gan co
ban mang
Eluongco dep--\---Mat nqoai ---

,

,~

Lo".,;, '"""9 ~

Bo tru'Oc---

Be gian cot

eo 91ancot ~

:

Mat trong --41

Mat sau

Matsau---

\.

_-"--

Mao trong

Botrong--,
I

\,"
Xu'dng mac --

-~..l

X"""' ,hay

~

I

Mat ngoai

l

Xu'cng mac

\.
.1

,

\

Bd sau

I

~\

T
"
:,

~ 0,

Milt ca ngoal -.

_,

DI~nkhop mat ca

Hlnh 1-4.

~

;),

-,,:...~.

~ t

'y

duol

,
I

tMl1ca trong

•
MatcatrOng~\

'-

"
DI(!11khdp mat ca

- Khuyet mac

tf

,,/'

,",r.

,;,:'n DI$n khop (:..,
'..J

Ranh cno eo' chay sau
& co gap cac og6n dal~

\ '
Dien khop mat ca

Hlnh anh giai phau xudng c~ng chan phai nhln trLiOC va nhin sau.

Mat ca ngoai

Ho mat
ca ngoai


------

Bal 2. XU'011gdng chan 11

~ ...... Phlrn

Ky thu$t ch~p xU'angdng

chan th~ng, ban chan xaay nhe vao trang, Tia trung tam
chieu vu6ng g6c Wi di~m giCfac~ng chan, (j phia ngoai cacb ba trU'oc XU'angchay
khoang ;:> cm, VaG trung tam phim.

Hinh 1-5.

- Phim 30x,W em, u~t doc dirdi dng

Ch:"lI1, chinh dJ\g chan VaG trung tflm

phim, khu tru chum tia hoac che la chftn chi thea chitu doc,
_ Tia trung

tilm: chi6u vuong g6c tl'li di0m giLra dng

chan d m~t sau xirung

chay "il( \ trung tam phim.
_ Thong 'ici chup:

Liru

y:

4)-4R kY, 20 mA:-.. I ()O em. khong

dtll1g llr(Ji chong

111(!.

Chup ph:ii l~y duoc mot khop tCI~' thco vi tri 16n ilurong rna ta l~y khrtp

g~n do. N~l1

('II

ncp boc kim loai 1h1 bo

1':1.

N0u bo h(lt thi t~ng thong

s6 chup.

12 ChI. Ky thu~t ch~p X-quang xU'ong kh61~_c_hi_d_u'_6i

Hlnh 1-6.

_

Ky thu$t chup xLidng c~ng chan nghieng, tia trung tam th~ng goc toi ai~m giCtac~ng
chan (j mat sau xU'ongchay.


Khop hang

I. GIAI PHAU KH()'P HANG
Khop hang dlfC.1('tao hCi chorn xircng dLli ti,~p khop VC1i6 e6i cua xirong chau. Ch()111

xuong dlli hinh 2/3 kh6i du,

htrong len trcn vno trong va ra tnroc, chom co

.~~111 chc

phil tnr h6111 chorn dui, la noi bam ella day chang chorn dui.
D~u tren xuong (ttd co du

true di,ie biet:

- LC1p vi", xuong d~e C than xirong lC'1I (10n tan e6 kh/rp ,'I phia trong
- Cac h0 xirong tu lai C phan
voi dL(l'1ng giap.

- Giira

el, va m§u

vo XL(!ng

d,le ella c6 xirong dui va

tv do ti0p

n6i

chuyen co 1119t h~ (hAng eung nhon rna chom ella cling 11,Ia

vito v,\ xirong di,ic C than xirong vii .linh eung hirong len tren, GiG';1 hui h¢
th6ng niiy co 1119teh6 y~u tl e6 la 11(1id~ g~y, d~ bi tl',~1khop,
II. cAc CHi 8!NH CHl,JP KHOr HANG

A. Tr~t kh6'p hanq
Day la m9t (/111 thudng

khcp

thudng

g;)p ('1 ngudi

lcn dll ehftn thudng,

do 1119t

Il,fe l11~lIlh tile ll(lng gi{lIl ti~p vaa d§.u cit((Ii xL(dng dui V;l vung g6i khi (ll'li gftp,
xoay trong

V:'I

kltcp va khdp g6i C tLf th0 '!:~I'.

Tr?t khdp h(lll!! baa gid eGn~(tr~t
quang

ta thny d§.u xudng

ngang

XLtdng

11111

bi

(tr~t ra mice),

dh

xu6n!! dl(li ho~c ra saLi l~ khdp. Tren pltil11 xxu6ng

hc~ ch~u (tr?t

ra sau) ho~e lci nganh

thLfdng I/lil Ihu(Jng gd h<"1111
khcp,

va h6rn khAp

13


14 Chi.

Ky thu~1

chyp X-quang

Xll'Ol~!)::....__kh_6p--=--c_h_i
_du_,61_'

_

hoac miu L'I1Lly~n ICJn,

B, Gay c6 xuonq dui
C6 hai IOt,1i:
- Gft)'

J) - mttu

chuyc»

\'j

nguo: cao tu6i.

- Gfty c6 chinh danh g~ip(J ngiroi tre,

Gay c6 xuung dui 13. Illt,li 1111)' g?P (J nguoi cao tuoi, p"~n 16n tv 60 tu6i trl'j len,
clo loang xuong.

- 1)0 Il:(vong

Day

Ii" 11Ii,Ii g~y

xuong n~ng vi:

cao JI) L';Wbi0n chirng sau gAy xirong.

- Rjl kho li~n XL((!llg ncn thirong d~ lai cac Ian phl: nang n~.

Trcn phim chup thing

vii Ilghi0ng

chung ta co Lh6 thay cac hinh anh lem thirong

sau:
- CC) lllQt v~t c!~lm hdll ('j vung c6 XL(Ong gay cai vito nhau. V~t nay thuong

0

phia tren Sill chom.
- DCli khi Ihfty mot l.lL((tllg ran mrt nhe (J be diroi

Cl\ xuong

dui.

- C[IC be th6 xuong cuu h~ quat bi g~y khoa, ch6 gay dti van nhau.

C. B~nh Perthes - Legg - Calve
B~nh nay hay g~p 0 tre L'Ill (,-8 tu6i. Tre trai g~p nhiGli hon Ire gai. Nguyen

nhan:

chL(a r6 r~lIlg co th~ do dli 1()(11l tufrn hO~ll1chom xLWng dili bj thi~u mau nu6i dL(Clng
va ho~i tL( v6 khufrn. K0t qU~1la chom xudng dui bi hE;)l va bi~n d~ng.
Chl}p X-quang th5ng nghicng th5y
- KI1L' khop r(lllg Illl~t III khc khop phla trong.
::._Thlla veli, teo Chl')nl xlMng ULli.
- Nh;111 chom c!~c vii I1IH')I~li, bi~u hi~n btng c!~m \,\,i han binh thvdng.
- Ng\l:li chom XUt~tlli~11 cac 6 sang hinh nang tr011 Il~n xvong d?c.
- C6 xLWng dui dflY

V~I

rQng ra han blnh thVdng.

D, Kh6'p hang t6n thu'Ong, viem kh6'p hang

Khop h[lng Iii m()1 kh6p d~'hi 16n thL(Ong nen cCl Ih~ qua cac giai do~n (xt:m bai ky
thu~t ch~lp khung ch~u).
III. KY THUAT CHljP KHOP HANG

A, Ch~p kho'p hang th~ng
1. Chl!P Idl('lp hang th~ll~

1l~1l1

ngli'a (Hinh

1-7)

- B~llh nhan 115m ngl(il ngay ng~n tren b~ll1 chyp, Tay du6i th~ng ho~c d~t


Bili 3. Khop hang 15

tnroc nguc. C6 th~ d?t dern g6i d5u
mai d nr Ih~ nhm ngira.

V;I

vung khop g0i giup benh nhan li1o;'li

A

Gai c'iau

Cl10m

Khdp rnu
Xlid/19 cfui.
..
xudng cfUI
Ban ell;)" xoay vilo trong

- .::':-:-:-:-,~,~
..~~~~

--~-

B
Hlnh 1-7.

'"

..

Chup khdp hang th~ng, B~n chan xoay vao trong mot qoc 15-20° (A). tia trung tam
th~ng goe vai phim (j di~m giO'anep ben neu ehup mQtben (8).


16 (II], Kythu~t ch~p X-quang xu'ong kho? chi duo;

--------------------

_ Chan

d\l1 chup

duoi th~ng, b:1I1 chan xoay nhe vao troug theo phuong thttng
I "O_201l, Tir th~ nay giup e6 XUl111g dui tir huong ra

dirng mOt )!l\e kho;mg

truoc duoc way thco hlr"!11t: IlrlJ11 ngang' song song v{Ji Ilhim,Chlnh
chau truoc trC:n song

SOil!! \"Ii rn(lt

han, n~u benh nhiin hi g~y

thi d0 theo cd th~ co nang,
__ Nen d~t dlln chin b~lOv~ vLlllg sinh due ngoai cua narn

\,;1

hai gai

e6 xuong

dui

vung buong tnrng

ella nC(.
-- Tia trung t[lIn
+ N0u chup m()t ben U(lt phim 24x30 em duoi mong hC'n chup sao cho khop
hang bC'11chup

"~IO

trun];

t;-1I11phim,

tia trung tflm vuoug goc voi voi phim

d cti~m giCia nep ben.
+ N~u chup hai khop lr~n (;ung mOt phim phai dung phim 30x40 em, tia
trung tilm di vuong glll' "Cji phim d di~m giG'a uudng n6i di~m gifra hai
n~p bt;n,
_ Thong s6 ch~p: 70 kV, ,~) mAs, 100 cm, co llcoi ehtmg md,
2. Ch~p khdp hang th5ng nfim sap (it up d~ng)
_ B~nh nhflll n1m s~p tl'011 hill1 clWp sao cho m~t phftng llrng so voi phL(C)ng
:?
A'
~'kl'goc ' 11 Ian g _1<=50,
tang
ulill
g mQt
h
_ Phim 18x24 em u~t trC:ll billl sao cho khdp hfmg vao gilra phim.

_ Tia trung Him: ch~eh lSI) len phia d~u so vdi phuong

th~ng c1ung tdi tren

di~m gi[ra mong 5 cm ";ll) phim,
_ Thong s{) ch~p: 70 kV, 4" mAs, tOO cm, colu(Ji l<)e,

B, Ky thu~t chl;lPkho'p hang nghieng
DGi voi b~nh nhfll1 cLr uQng

------40...~~

feb

uLCI,k'

khdp hang, co th~ chl;lP tu th~ ni~u d~lO ho?c

CQn UOi vC!i hl:Jlh nhan __khong cLr dOng Ultl,lC khop hfll1g cCl th~

ch\lp tu' th~ tia X di ngang ILrtrong ra,
i. 'I'll' th~ nieu <.lao(!-linh I-X)
_ B~nh nhiil1 nrlm eh0ch Il~!,udi v~ phia dm clWp vLJi Iltng 1<,10 voi m(ll ban
khoanlJ to ,ISO'
oOi dl~11ldil
Dui ben c~n ehup' b,
aap '"
"eli nhe' va dana
ra naO~li
'"
'
,'"
b

co

sao cho m~t ngoai ctui S[lt m~t ban, Dui ben khong cll~lp du6i th~ng c1ua v0phia sal! ho?c g?P g{)i V~\ II b~m chan xu6ng ban d~ dl l1jnh tu th~.
_ Phim

IXx24 em d~t

JI,)e

theo trl;lc cua xVdng uui

~ill)

,..,

eho khop hang

gWa phirn,
_ Tia trung Him: di th~ng goe voi phim d c1i~m giLi'a n~p b<;n,

V~IO


Bai 3. Kh6V hang 17

- Thong s~ chup: 70 kY, 45 mAs, II)() ern, co Il((li ch/lIlg mo.
2. Tlfth~ chfin ~ch (Hlnh 1-9)

- Bcnh nhfm n~m ngira ngay ngiln rrcn han. Tay cluoi th~ng hoac a0t trl('lC
ngirc.

+

D(Ji \'I'li ur th~ chan ~ch hai bell:
•

Hmh 1-8.

Ky

Hai ban chan co len
t(~i eta va long ban chan ap J~(a vao nhau. D'.lI1g ca hai dui 1"<1 ngoa:
kl1rhco hirong nhm ngang song ~()ng \'di phim.

C'I

kh(lp hang va khop g6i

UI(I.lC

g,~p khoang

thudl chup khop hang nghieng ur the nieu
trung lam th~ng gee (j oi~m giO'aben.

0(:10,

l)()II.

narn nghieng khoang 45°, tia

..

'


18 ChI.

Ky thu~t chl,lp X-quang xU'ong kho'P~----------------------------------chi du'o;
• Chinh hui gui ch.u: In(0c trcn song song y(ji 1ll;~11
han. Tin trung

lh:1I1g gee voi phim

+ D6i vlji
• Nhu

\'1

tam

ui~m gi[(a oU0ng nC)i l1i~mgiC(a hui ncp ben.

IL(

lh~ chan ~ch 1l19t ben:

IL(

Ih0 tren Illl;il' chan kh6ng cfm chup JU(li \h~ng. Ben din chup

g{lj) khop hang \·il I-.h('jpg6i, r6i xoay (lui ra ngllili khoang 45° so y{ji
plll((jng th{mg dirng, h~tnchan duoc ap dua vao kll{jp g6i ben o6i dien .
• Tin trung
oL(ng tci

_ Thong

Hlnh 1-9.

sri

tam ch0ch

len tren mot gee

IOU-IS(I thco phuong lh~ng

e6 XU(jng lIili d di~m gilia n~p ben.

chup: 70 k V, ·1') m/vs, 100

C111,

ell lL((li Chl\llg mil

Ky thu?t cnup khap hfmg nghieng tu the chan ech mot ben, tia trung tam chech len
iren 100-15°thea phu'dng th~ng dung Wi c6 xttdng dui a di~m giG'anep br;ln.


Bai 3. Kh6'p hang 19

J. T\ith~ tia X di ngang (it dung) (Hinh 1-1(l)
_ Ri;nh nhfin ll~m nglta tren ban chup, chan dau d~ thea nr th~ co nang, ch~n
khong dau nang cao va dang ra ngoai hhng hai tay keo giCf dui.
_ Phim 24x:'() em, dl(.jC ap sat vao h()lIg

h('11

chup san ella khdp hang

VIIO

giua phim.
_ Tia trung Him: di ngang thea dirong It.IO hl'ji hai m?l rh~ng dung doc giLril
dui va n6r hen vao phim.
_ Thong sf, chup: 70 kV, 45 mAs, 100 ern. co Iudi chong md.

··rn_-TII\ X 01NGI\N(

Hinh 1-10.

Ky thu$1chup khap hang nghieng vai till

X eli ngang tu' phia trang thea nep bon vao

phim.
IV. G1A1PHAu lINC DI.)NG PH1M CHI.)P Kll(),P I-lANG
A. Giai phau phim khop hang th~ng (Hinh I-I I)
B. Giai phau phim kh6-phang nghieng (Hinh

1·12)


20 ChI.

Ky thu~t ch~lpX-QuangxU'Ollg khop----------------chi du'oi

Hlnh 1-11.

Hlnh 1-12.

Giai phau phim chup khop hang th~ng.
1. Xu'dng canh chau 2. Gai chau tru'dc dLiOL3. Gai chau 4. Tdm khop '6 coL 5. Khe
khop, 6. Ba sau 7. Ba tnroc. B. l) X-quang (qiot 1$X-quang). 9. La bit 10. Cham
xudng duL 11. Ndi bam day ch~ng iron. 12. c'6 giai phau, 13. MEIUchuy~n Ion. 14.
Mau chuy~n nho. 15. c'6 phllU thu?t 16. BLiang lien rnau chuy~n.

Giai phau phim cbup khop hang nghieng.
1. Xudng mu. 2. Xu'dng chau, 3. XLidng ngoi. 4. cOL5. Ba trLioc '6 cOi. 6. Ba sau '6
cOi. 7. Cham xudng dui. U. C6 giai phau, 9. Mau chuy6n lon, 10. Mau chuy~n nha.

6

11. C6 phau thu?t


Khop g6i

. '. 'v -

mliG tj~u hgG t?P ..,~'..

• Neu ctu'9C 3 C~L~!n~;~,h~P
kh~P g61.:
: , , <,
• Trlnh bay ctU'9c'ky tli'u?t chup khCJpgoi th~ng, nghi~ng.
• MOt'a &V~c'gi~r
X-quang khcp g6i th~ng, nghieng. '

pli~~

I.

" ,.

" -:"'::.:' .0;,,:, '" ",:' :'

.i . ,

G!AI PHAU KH(JP GO!
- Khop g~i

la khdp

phirc hQPcua co Ih~ gflm 2 khop.

_ Khop gllfaXl(dng dui va xirong chav Ihlll~)eloai kh{lp ll\i diu.
_ Khop !!llfCl xircng ltlli va

xirong banl: rhi' thuoc IO':1iklt{lp ph~ng.

Phuong li9n n6i khi'lp g6111hao khop va day rl1hllg.
_ Bao kh(lp g6i mong, v~ phia

xuong dui ban khop ham tren dicn rong roc

trcn hai I(\i diU va h5 gian 16i d,u \,~,phia XL((lngch~y, bao khop ham ('j phla
JL(Ciih:1i di~n kh(lp.
_ UI dlC
ehtng

d.ly chtng (kh6p g5i ell 4 h" Ih(\llg Jfly chftng): dfly chftng Irl(I'II'. d'-IY
~;tLl,

Jily ehtng hen

V~I

Jay l'h(ln!~ chen.

Nhu v~y khdp gl Ii (h(c,lecoi nhL( hai khdp I;li

C(III

eLta xl(lng dlli, I11Qtdi¢n kh,''1) ci'ICI

xUdng ehflY. Khl'lp (1L(<;le
giL( eho khoi tr~t s:lI1g hen b(ii dily chi',ng ben va khoi 11';11
ra
trude bdi Jay ehtng eheo.

Trong lllQI S(~bl\llh Iy kh(lp g0i: ngoai vi~e ell/In doflll htng

Ci1I,IP

X-quang thl('lng qllY

va e1wp dl l(lp ,i llnh, nglfdi ta con clWP Cl'l1g 111(t'ing11"r,ng()ili ra

co lh~ lal11Sit':11;1I11

n0u nghi ngd trilll ujeh khcp g6i.

II. cAc CHi B!NH CH(jP KHOP

GO!

A. Chan thu'011g kh6'jJ g6i
Kh(ip g6i Idn I1I1:il do

do d~ bi

ehl;lm thUdll!!. ('iWP kh(lp ~(:'i kh6ng kho nhl(ll~ u()i

21 __
'
,-


22 (111. Ky th~~t chyp X-quang XU'011gkhop chi duo;
Ill'lI "-)'

111lI:1III !l11

u0

X[IV

dinh cC, 16n 111l(dllg hay kh6ng.

Moi chin

ilurong vung

.\L(llllg dill gell1 hay xa khup g5i cling h.iy t.~i,IPtrau djch khop g6i i'lI1h IIl(i'lng tci co

nang,
B. Benh ly khop g6i
I)' kh0p g6i nttm 1I'\1I1gbcnh 15' L'lllIllF cuu xuong khop, Cac tCm ihuong nhu

Iknh

vicrn xu.rng, lao xuong, 1I sun dew Xlidllg hi~u hi~n d khop khac thi khop g6i
cling c() th~ g~p.
VI v.iy, Ilgo~li die xet nglli~'m sinh lW;I, Illly~l hQC va d~e biet co 3 k)' 111Ll~tI~l
noi
sui k hup. chup c5t lop vi rinh

V;I

cong Ill(I'lllg tir, nhung X-guang

thl(lllf

quy kh6ng

the. hI') qlla bi'ji VI day Ul IlH}1tham kham di truce.

C. Tran dich khop g6i
Tr~1I1 LliL'11khop g6i la h:)u qua ella C:ll' h~lIh 15' khop nhl( eh~n thVlIllg kh(jp g5i,
viem kh,'fp nhi~m lrung, Ch~n dofm trim Llieh khdp ngoai,

tham kh[11ll lam sang,

khClIlg Ih0 kh6ng noi d~l1 ky lhu~ll sieu am. sicu am khdp noi chung va khdp g5i noi
ril:llg r:~1 u~e hi~u trong h~nh 15' Ir~m djl'1l khdp. Vai tro X-quang
"hC)llg phi'li dC: ch~n dO;lIl Ir~lI1 dieh klllip

dich.

M(ll khflC clwp X-quang

111.KV TI-HJAT CHl)P KHOP

ilia

Ihl((fng guy ia

dtnh hVdng tim nguyen nh5n trim

giup thell Lltll va danh girl sau di~ll tri·

GOr

lYlu6n eh~lp dung ky thu~t, trVde h~t phai dimll d~u m5e khe khdp:
I >0 U~lll g5i hoi g:)P I1h<;. Nin tl( pllia l;ltrong xvong chflY len pllia tren thay
11l9l

ranh nh6 hoi Itim (khc khlJp). I )[lI1h dau bhng butnWc

m0 tr0n da.

_ Trang thVe l~ khl' khdp ngang v(li Ill) dVdi xvong banh ehe.

A. Ky thu~t chl;lP kh6'p g6i th~ng CHinh 1-11)
1. 'fl( th~ ngii'a

_ I{~nh nhan n~m ngiia hO~ICng(\i 11'011ban X-quang,

chan ben

l'illl

eh~lp Ju6i

th~ng va b~tn chiln xoay nh<; viiI) tJllllg.
_ Phiml8x24

em Jell dV(.1ikheo, ui011l~hlnh khdp VaG trung tam pilim.

_ Tia trung Him: ehi~u th~ng g6c vCli phim VaG khe khdp c1a d[lI1h d~lI ho?e

110dVdi xvong b['l1h ehe, tia ra Irung lam phim.
Thong
LU'lJ )':

['hill!.

n~u

s6 chl!p:
cfll1

50 kV, 25 mAs, 100 em, kh6ng lVdi ch6ng

ehl;lp khdp g6i c1~

Sl)

I1l\f,

si'l1h thi d?t d hai khdp g6i ll"011eung mOt


Bai 4. Kho-p g6i 23

r&:,
~

~

':

-,

...,""~--",,."!'....-r.
,

•

Hmh 1-13.

,..,,..'

.. :1 __

..

Ky lhuM chup khop goi th~ng voi

lin lrung tam th~ng qoc voi phim a bo du'Oi xu'dng

oann che (khe khop).
,

,(

2. Ttl the sap
_ H~'nh nhar: ntm sftp tren ban xquang,
vil() g()i d~m sao cho true cua ci,ng chan

c~ng ch,ln co len
1~1()vCli m~lt han

V~I

ciL(c;JrI)'

L'(\

diuh

mot g6c \)-4({

_ Phim 18x24 em dat dudi g5i, c1i0u chinh khc khClp vao trung t[lm phim
_ Till trung HIm: chech xu5ng phin chan mot g(lC 40° so vdi phl(clng th~llg

ltlrl1g, qua vung khe kh(lp c1A(11(1,k' d(ll1h d~l1, vii V;IO trung tam phim.
_ Tltiing

s5 chup:

50 kV. 25

ll\/\S.

I()O em, khon]; lLCdichong mo.

B. Ky thu~t rhup khop g6i nghieng (Hinl: \ - \·1)
Thlfdng ap dung ky ihuat chup khl'lp gl:li nghieng
_ B~'nh nhan n~m nghieng

ng():li,

v~ hi:n ll\n thl(dng. Dflll g5i ben dn chllp g(lp I1hl "

hll;~\(, (1~ theo tlf tht cd nang
Cllil khdp g(~i th~lt nghieng,

1\0l1

h~nh nhan uau ho~c cLrng khl'lll· Ml1()n di:

L~ltFJI Xl(lng chhy song song v{ji milt han. Cl'

I

chiln dU(.lC kc b5ng g5i d~m. C\t;'11l bcn kh6ng c1wp du6i th~n)! !'a sau

1l();I(

ra tnC(lc.
_ \'him 18x24 cm d~t dlC(li m~lt Il)!llili kh(lp g6i. diC:u chlnh kh(lp ~~l~iV~I() trll1l)!.
1:lln phirn.


?:I__ Chl..:_~y' lhu~t chl;lP X-quang
Tin trung

tfllu:

)(.U'Ol1g

khiYp chi d~?'_i

---

l'hiQu vuo 1I1(;11l)!khc khiJp d~1 (bnh

ern nhung ehc-ch nhc v~ phi.:

d~11I 'ill

utlU sau

)·...in banh chc I

(VI 16i c~u trong lhr,p 1\1111 leli

diu ngD~li,

nhu vay phim s~ eho 111nh2 ICli cilLl xudng dui chong len nl1au).
Thong 56 chup: )() kv, 25111/\,.100

em, khong Il(lJi ehClI1)! 1111\

y:

Dbi voi bi'nil nhan chi", lil,,"ng n(mg ho~c bo b,)1 khi,n~ nhlll nghieng
,hide Ihi co thi; clwp ur Ih&ngil icng uong. B"nh nhan ntm np'r:.. Jal philTIphi"
uong va nang C(lO drill gCli len, lia irung trim di ngang Ill' ngoiu Villi.

L,(u

Hinh 1-14. KY thu~t ehu p khap go; nghiimy va; tia trung tam th~ng g6e VOlphim i:J a;~m giao
nhau giu'a khe khop ail du'9Cdtlnh dtw voi bo sau gan banh el\(3 1 em.

IV. GIAI PHAU ONG DUNG PHIM CHI)P KHOP GOI

A. Giai ph~lUphim chl;lP kh6'p g6i th~ng (Hlnh 1-15)
B. Giai phau phim chl;lP kh6'p g6i nghieng (Hlnh 1-16)


Bai 4. Khop g6i 25

J

8

9

(
,f

:1
I

Hlnh 1-15.

Giai phau phim chup khap goi th~ng.
1. Than xU'dng dui 2. XU'dng banh cho. 3. L6i cau trang. 4. Loi cau nqoai 5. Hanh

lien loi cau 6. Gai chay. 7. Mam chay. 8. Loi CLltru'ac, 9. Than xU'o'ngchay. 10. Bau

tren XUD'ngmac. 11. XU'o'ngmac. 12. Khap chay mac. 13. Khe khop.

2

6

I

10

I
Hlnh 1-16.

Giai ph,;u phim chup khcp goi nghienq.
1. XU'dngdui. 2. Loi cau trang. 3. Loi cau nqoa! 4. Ba tren loi cau 5. XU'o'nq banh
che. 6. Mam chay. 7. Gai chay. 8. Loi clio 9. XU'o'ngmac. 10. XU'dngchay.
;'


XU'O'ng banh (he

m LjC tieu h9C t~p

• Trinh bay dU'9cky thu?t chup )(u~ng b'~.nhch~: .

I.

Ml)C DICH CHl,J1l XUONG nANl1 CHE
_ Tim ti\n thuong va XtCdn):', hanh che do ehfrn thuong.
_ Cac tim thuong bcnh

Iy, I1I1Utla

do thoai khop.

11.KY THUAT CH~JP XUONG BANI I CHE
Ch~IP xuong banh che thang hi dhu JUdi xuong dui va d~u tren xuong chay che khuat,
do vay chup xuoug banh che gClIl1ur lh~ nghicng va chup banh che thco true.

A. Chup nghieng
_ Nhir L'1!~IPkhop g6i nglucng:

Benh nhan nam nghii'ng v~ ben t6n thuong.

DUu g/)i ben cfll1 chup g(lp nhc, hoac dG thco tv lh0

l:
nang n~u benh nhiin

dau hU(IC cung khcip. Mu6n d~ cho khop g6i lh~l nghieng, di;it gej xucng
chay ~l)ng song v(li 111(11 ban, e6 chan duoc kc btllg gf>i d~m. Chan bcn

khang Ch~IPJuoi tlll~lng 1'1\ sau hoi;ie ra truoe.
_ Phim

13x 18 em d~l Ul(lii m~t ngoai khap g6i, di~ll ehlnh xuong b[ll1h ehe

.vao trung lam phim.
_ Tia trllllg t[II11: lhflllg t" Ie voi phim d bd lrong XlC(lllg banh ehe.

_ Thollg

sG clll}P: 4()·)()).. V,

15 mAs, 100 em, khang

Itcoi ch6ng md.

B. Chl:lP theo trl:lc xU'011gbanh che
1. Til th~ s5p
_ B~nh nhfll1 ntm

26

sflp

IrC'l1 ban dwp. cfrng chan bell

dill Ch~IPco

len sao cho


Bai 5. XU'ong bfmh (he 27
vuong gl'll' \'(1i xirong dui, long ban ch:ln hirong len trcn,

- Phim llx 18 cm d?t dUC1idui sao cho xlwng banh chc vao gifra phim.
tam: ch6ch mot goc 15(1 so vt'li plu(eing

- Tin trung

th/lng dirng hl(dn~ IC'n

phia c1~u. qua ui~m giC(a hd dlt(1i XU(ll1l:!banh chc vao giC(a phim.
- Thong sci chup: 50 kV, 20 mAs, Ion ern. khong Il(cii chong mo.
2. Til th~ quy g(~i
- Benh nhan quy g5i tren han chup. Chan hen dn chup g~p t6i da, m?t tn(l'je
c5ng chfin silt phim.
- Phim I_h I H em kc chcch xuong dl(c'li hhng g(~i l191ll thco mat dng

chan [II'

len, Xl(cllll:!11[lI1hchc vao giira phim.
- Tin trung

tam: tuy theo uO chech

('I'la

XI(1ng hanh chi.', thirong khoanj; ,!O-

50° thco plurong th~ng dirng, qua di~m giil'a hei trcn xucng banh chc

V;lO

gi il'a ph i Ill.
- Thong
3. Til th~

n5m

s6 c1u}p: 50 kV, 20 mAs,

IOn cm, kh6ng lueji cll(~ng md.

IIJ!lfn CHinh 1-17)

- B~nh nhfln n5m nglfa tren ban ch~lp. Chan bcn
dng

cfll1

chl,lp g?P 1?i sao cho

chill1 va Xl(ong c1ui t?O mOt go(' kho1ll1g 90°.

- Phim 1.lx 18 em U?t th~ng goe
hfll1h chi·

V;IO

V[\o

XI(llll:! dui hen kh()J)g g?P sao cho

x\(t1ng

gina phim.

- Tin trllllJ! tam: ui ngang giG'a m?t

SIIII

xl(dng himh chi, va vao giil'a philn.

- Thong s~ ch~p: 50 kV, 20 mAs, lOO em, kh6ng Il(Clich6ng md.

Llru

y: N611 ('1l~lp so

sfll1h xuong bfll1h elll' thl ta dung co philll to han, va di'lt sao

eho 2 xltdng h[lnh ehe cfll1 d6i va ngang h(llll! nhall. Tia trllng tam di ngan)!. qua
di~1ll nfli gil(;1 2 xl(dng himh ehe.