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

C a o D S n g Y ti

P h u T h o - T h it v i $ n

lit IIII 1111111111
KM.I008200

GS.TS PHAM MINH THONG
C h ii b ic n

KY THUAT

CHUP X-QUANG
KY THUAT VIEN CHAN DOAN HINH ANH

iiim n m u n i

L

n h A x u Xt b A n
■I

Y HQC
II


K? THUAl
O

CHyP X-QUAIM(G
Ky thuat vien chan doan hir

CAC SACH CUNG TAC GIA
SIEU A m TONG QUAT, C h u b i e n . N h a x u a t b a n Dai h o c H u e . 2 0 1 1 . 6 0 4 t r a n g . k h o
sacli 19 x27 c m .
BAl GIANG CH AN DOAN H I N H AN H, Viet c u n g c a c t a c gia k h a c . N h a x u a t b a n V
Hoc, 2 0 07 .


PGS.TS PHAM MINH THONG
chu bien

KY THUAT

CHUP X-QUA
Ky thuat vien chan doan h

NHA XUAT BAN Y HOC

hA noi


© 2 0 1 2 . h\ C a o T ra n .ISC and P h a m M in h T h o n g cl al
Han q u \ c n c u o n sach nay dUtic g iu bdi C o n g t\ c o p h an C a o T ra n \ a cac tac gia. N g h ic m c a m m oi hinh
lhue sao chcp. nhan ban k inh d o a n h dUifi bat k\ hinh thuc nao.
M oi \ c u can tho ng tin \ i n gifi \ c C o n g tv co p h a n C a o T r a n , 2 7 /1 0 p h o \ " i n h T u \ . q u a i l H a i B a
T r i f n g . t h a n h p h o H a N oi, \ iel N a m . D ic n th o a i : (M3 9 87 0 5 8 0 . 094) 4 52 8 0 0 1 . K.mail:
c a o t r a n inc(£ v a h o o . c o m

CHU BIEN

P g s .T s P ham M inh T hong
BAN BIEN SOAN

P g s .T s P ham M inh T hong
Ts P ham H ong Due
T hs L e T huy L an
C n N guyen T uan D ung
THU KY BAN BIEN SOAN

Ts P ham H ong Due


M y c L y c

Lofi noi dau
PHAN I. KY THUAT CHUP X-QUANG KHONG CHUAN BI (THUCfNG QUY)
Chu’tfng 1. KY THUAT CHUP X-QUANG XUONG KHCJP CHI DUOl
Bai 1. Xuong d u i ............................................................................................................................ 4
Bai 2. Xao'ng cang c h a n ................................................................................................................9
Bai 3. Khop h a n g .........................................................................................................................13
Bai 4. Khop g o i .............................................................................................................................21
Bai 5. Xtfo'ng b an h c h e ................................................................................................................26
Bai 6. Xuong klio'p co chan, xuo'ng g o t .................................................................................. 29
Bai 7. Xuo'ng khop ban ngon c h a n ......................................................................................... 37
Chtfo’ng 2. KY THUAT CHUP X-QUANG XL^ONG KHOP CHI TREX
Bai 8. Xuo'ng canh tay................................................................................................................. 44
Bai 9. Xuo'ng cang t a y ................................................................................................................. 49
Bai 10. Kho'p v a i ...........................................................................................................................53

Bai 11. Ivliuyu t a y ........................................................................................................................ 60
Bai 12. Co tay.................................................................................................................................(58


viii M u c luc

Bai 13. Xuong klidp ban t a y .....................................................................................................74
Chtfdng 3. KY THUAT CHUP X-QUANG PHOI VA KHUNG XUONG LONG NGl/C
Bai 14. P h o i ..................................................................................................................................S4
Bai 15. Xuo'ng s u o n ..................................................................................................................... 92
Bai 16. Xirong d o n ...................................................................................................................... 96
Bai 17. Khop Uc d o n ................................................................................................................ 100
Bai 18. Xirong irc....................................................................................................................... 102
Bai 19. Xirong ba v a i ................................................................................................................ 105
Chtfdng 4. KY THUAT CHUP X-QUANG BUNG - TIET NIEU - KHUNG CHAU
Bai 20. He tiet nieu (khong chuan bi)................................................................................. 110
Bai 21. Bung (khong chuan b i ) .............................................................................................114
Bai 22. Khung c h a u ..................................................................................................................120
Chtfdng 5. KY THUAT CHUP X-QUANG COT SONG
Bai 23. Cot song c o ................................................................................................................... 127
Bai 24. Cot song l u n g .............................................................................................................. 138
Bai 25. Cot song that l ung...................................................................................................... 145
ChUo’ng 6. KY THUAT CHUP X-QUANG XUCNG SO MAT
Bai 26. Dai cuo'ng ve chup so m a t ........................................................................................ 158
Bai 27. So (thang n g h i e n g ) .................................................................................................... 162
Bai 28: Xoang - B lon de au....................................................................................................... 170
Bai 29. Nen so - Hirtz ...............................................................................................................175
Bai 30. Tang giua va sau ne n so - Worms Bre tton...........................................................182
Bai 31. Ho y e n ............................................................................................................................185
Bai 32. Ho ma t - xuo'ng go m a .............................................................................................. 189

Bai 33. Cung tiep xuo'ng go m a ............................................................................................. 192
Bai 34. Lo thi giac......................................................................................................................194
Bai 35. Xuo'ng c h u m (tu the Sc h u ll e r) ................................................................................ 197
Bai 36. Xuo'ng da (tu the S te n v e rs )...................................................................................... 201
Bai 37. Tai xuo'ng c h u m (tu the M ay e r).............................................................................. 206
Bai 38. Tai xuo'ng c h u m (tu the Chausse III).....................................................................209


Bai 39. Mom chain (tu the N ad eau ).................................................................................... 212
Bai 40. Xuong chinh m u i ........................................................................................................216
Bai 41. Loi cau xuong h a m du6i va khop thai duong h a m ........................................... 219
Bai 42. Ham dudi chech (ham c h e c h ) ............................................................................... 222
Bai 43. R a n g ..............................................................................................................................227
PHAN II. KY THUAT CHUP X-QUANG CO CHUAN BI
Chu’dng 7. THUOC CAN QUANG, TAI BIEN VA CACH XLT TRI
Bai 44. Thuoc can quang, tai bien va cach xu t r i .............................................................238
Chtfdng 8. KY THUAT CHUP X-QUANG HE TIEU HOA
Bai 45. Thuc q u a n ................................................................................................................... 248
Bai 46. Da day - ta t ra n g .........................................................................................................259
Bai 47. Ruot n o n .......................................................................................................................278
Bai 48. Dai t r a n g .......................................................................................................................287
Bai 49. Duong ma t - tui m a t .................................................................................................305
Chtfdng 9. KY THUAT CHUP X-QUANG HE TIET NIEU
Bai 50. UIV (Urographie Intra Veineuse)............................................................................ 322
Bai 51. He tiet nieu nguoc d o n g .......................................................................................... 344
Bai 52. Dan luu be t h a n .......................................................................................................... 347
Chtftfng 10. KY THUAT CHUP X-QUANG HE SINH DUC
Bai 53. Buong tu cung - voi trUng........................................................................................352
Bai 54. Tuven vu (mamography).......................................................................................... 363
ChUdng 11. KY THUAT CHUP X-QUANG TUY SONG c An QUANG (Myelography)

Bai 55. Tuv song can quang (Myelography)...................................................................... 380
Chtfofng 12. KY THUAT CHUP X-QUANG TUYEN NU6C BOT (SIALOGRAPHY)
Bai 56. Tuven nuo'c bot (Sialography)................................................................................. 392
ChUong 13. KY THUAT CHUP X-QUANG KHOP c An QUANG
Bai 57. Khop can q u a n g ..........................................................................................................402
T H l / M U C THAM KHAO............................................................................................................. 413
CHI MUC (INDEX)........................................................................................................................ 415


x Muc luc


Lfr n 6 i t>Au

Cun g vai sir phat trien nhir vu bao cua khoa hoc cong
nghe, nganh Bien quang d u a c thira hirong cac tien bo do, cac
trang thiet bi tr o n g cac khoa Dien quang t r u a c dav chi co Xquang thi gia dav da co th e m sieu am, cat lop vi tinh, cong
hirong t u va X-quang mach mau. T u kv thuat analogue thi ngav
nav tat ca cac mav m oc tr o n g khoa B ie n quang deu du ng kv
thuat so (digital).
Voi nhieu cac trang thiet bi hien dai da giiip cac bac si
B ien quang co the chan doan chinh xac lion va chuven sau hon
tr o n g nhieu benh lv tuv nhien kv thuat X-quang kinh dien van
dirac sir dung nhieu nhat va la nhu ng th a m kha m ban dau tr o n g
tat ca cac khoa Dien quang tre n the gicri. C ung chinh vi lv do do
ma chung toi bien soan cuon "Kv thu a t chup X-quang" voi m u c
dich lam tai lieu giang dav va tham khao tr o n g dao tao kv thuat
vien B ie n quang tr o n g cac t r u o n g tr u n g cap, t r u o n g cao dang va
dai hoc kv thuat; tai lieu tham khao cho cac bac si chuven nganh
Bie n quang.

Sach bao gom hai phan:


xii Loi noi dau

Phan I la cac cac kv thuat chup X-quang khong chuan hi.
cac kv thuat du qc phan chia theo giai phau bao gom : cac kv thuat
chup X-quang xuong khop chi duoi, cac kv thuat chup X-quang
xuong khop chi tren, kv thuat chup phoi va long nguc, kv thuat
chup bung - tiet nieu - khung chau; kv thuat chup X-quang cot
song; kv thuat chup X-quang so mat.
Phan II la cac kv thuat chup dac biet va kv thuat chup co
chuan bi bao gom : T h u o c can quang; kv thuat chup X-quang he
tieu hoa; kv thuat chup X-quang he tiet nieu; kv thuat chup Xquang he sinh due; kv thuat chup tuv song can quang; kv thuat
chup tuven nirac hot; kv thuat chup khop can quang.
Sach du qc ke thua cac an pham tr o n g va ngoai nu oc ve kv
thuat chup X-quang cung n h u dua vao kinh nghiem tr o n g thuc
hanh lam sang cua cac bac sT, kv thuat vien khoa Chan doan hinh
anh benh vien Bach Mai va bo m o n Chan doan hinh anh tr u o n g
Cao dang v te Ha Noi. Tu v nhien chac chan chung toi khong
tranh khoi m o t so thieu sot tr o n g qua trinh bien tap ve noi dung
cung n h u hinh thuc, kfnh m o n g cac quv dong nghiep dong gop v
kien de chung toi co dieu kien bo sung va hoan thien, de noi
dung cuon sach cluoc tot hon va cap nhat hon.

PGS.TS P h a m M inh T h o n g
Pho G ia m D o c Benh Vien Bach Mai
T r u o n g Khoa C ha n D o a n H in h A nh Benh Vien Bach Mai
Pho T r u o n g Bo M o n C h i n D o a n H in h Anh Dai H o c Y Ha Noi

Lin G ift THlgU

N a m 1895, W . C Rontgen da tim ra tia X n h a thi nghiem
pho ng dien qua m o t bong chan khong va hinh chup X-quang dau
tien la anh x u on g ban tav cua ba Ron tgen. Ho n m o t the kv da
troi qua, nhieu p h u o n g phap tao anh moi da d uqc phat minh va
ung dung tr o n g v khoa nhun g chieu, chup X-quang van giu
nguven gia tri va van luon luon la kham xet c o ban dau tien cho
hau het cac kham xet be nh lv cua moi chuven khoa lam sang.
Nhieu loai hinh kv thuat vien chan doan hinh anh da du qc
dao tao qua cac t r u o n g tru ng hoc, tr u o n g cao dang va dai hoc
tr o n g nu oc nhung chuven nganh chan doan hinh anh van rat can
m o t cuon sach h u o n g dan thuc hanh chup X-quang, vi chi co the
xac lap du q c chan doan dun g dua tre n m o t phim X-quang chup
dung kv thuat va dat veu cau. Ben canh do, kv thuat \i e n Xquang can n h o phai lam sao de dam bao veu cau an toan buc xa
cho benh nhan va nhung nguoi xung quanh, dac biet la phu n u
mang thai va tre e m la hai doi tu o n g rat nhav cam voi buc xa ion
hoa.


xiv Loi gioi thieu

Cuon kv thuat chup X-quang cua tac gia Pham Minh
T h o n g va Cong su du q c bien soan cong phu, ke thira nhun g an
pha m tro n g nu oc va nu o c ngoai nen co the coi la m ot giao trinh
tu o n g doi hoan chinh hien nav va dap ung du q c veu cau cua cac
dong nghiep cung n h u cua cac co so dao tao kv thuat X-quang
tr o n g ca nude.
Toi tran tr o n g gioi thieu cuon sach nav toi doc gia

chuven nganh Chan doan hinh anh va nhiet liet chuc m u n g cac
thanh \ ien Ban bien soan cuon sach da hoan thanh m ot cong viec
rat co v nghia thuc tien cho chuven nganh.

GS. TS. H o a n g D i r e K i £ t
Chii tich Hoi Dien qua ng va Y ho c hat nhan Viet N a m


Lfr nh A xu At ban

Noi dung "Ky thua t chup X-quang, Ky thua t vien chan
doan hinh anh" gom hai phan, kv thuat chup X-quang khong
chuan hi (th uong quv) va kv thuat chup X-quang co chuan hi,
du q c trinh bav lan luqt qua 1 3 chu ong tro ng 57 bai.
Phan " T u luo n g gia" du qc soan cho tun g bai. T r o n g no
luc nang cao chat luqng sach, chung toi cho in sach bon mau
tren giav tot. N h a m lam giam gia thanh cho cuon sach, toan bo
phan "Tur luqn g gia" duqc tach roi khong in cung tr o n g sach.
Phan nav se duqc cung cap cho nguoi hoc bang m o t file PDF.
D oc gia can dung phan " T u lu qn g gia" cua cuon "Kv thu a t chup
X-quang, Ky thu a t vien chan doan hinh anh" xin vui long gdi
email veu cau ve dia chi: c a o tr a n _ in c @ v a h o o .c o m se du o c nhan
tile nav (mien phi).
Nha xuat ban Y Hoc m o n g quv doc gia \ u i long don
nhan.

N H A X U A T BAN Y H O C
xv

xvi Loi nha xuat ban


K? THUAT CHyP X-QUAWG

khong chuan 1
(thircmg qr



Chirong

K? THUAT CHIjJP x -quang

xirong khop chi duoi


Xirong dui

171uc tidu hoc t$p
• N£u (JiiOc cac chi dinh chup xuong dui.
•Trlnh bdy tfuoc ky thuat chup xutfng dui thing, nghieng.

I. g i A i p h a u x u q n g d u i
/

^

v

V

V

La xtfdng dai nhat cua bo xtfdng, gom co mot than va hai dau. Than xtfdng gom 3 mat
(sau ngoai, sau trong va sau trtfdc) va 3 bd (ngoai, trong va sau).
Dau tren xtfdng dui gom co co va chom xtfdng. Chom xtfdng tiep khdp vdi o cdi
*

"f

S

xtfdng chau tao thanh khdp hang. Hai mau chuyen ldn va be, gitfa hai mau chuven la
dtfdng lien mau.
Dau dtfdi xtfdng dui hdi cong va ra sau. Loi cau trong va ngoai tiep khdp vdi mam
chay ttfdng tfng. Dien khdp rong roc d trtfdc tiep khdp vdi xtfdng banh che.
II. CHI DINH CHUP

A. Chan thirong
1. Gay than xtfdng dui
V .

w

' .

v

Xtfdng dui nam trong khoi cd ldn dtfdc nhieu mach mau nudi dtfdng nen lien

nhanh nhtfng trai lai gay xtfdng dui thtfdng chay nhieu mau co the gay sdc mat
mau.
Cac cd mdng khoe bam vao mau chuyen ldn lam dau tren dang, cd that ltfng
/

I

V

y

V

__

chau bam vao mau chuyen be lam dau tren gap ra trtfdc. Dieu nay giai thich ga\
xtfdng dui rat hay di lech. Khi chup X-quang phai het stfc nhe nhang. tranh iho
bao. Ttf the chup xtfdng dui thang la can thiet. khong dat van de chup nghieng
neu nhtf thay tinh trang lam sang khong cho phep.

4


Ddi i . Auuny uui j

2. Gay tren loi cau xtfdng dui
'W

V

V

^

1

Gay tren loi cau xtfdng dui thtfdng do tai nan o to, do nga cao, day la ton thtfdng
s

,

v

'

o

\

v

it gap. Khi th am k h a m can phat hien dau hieu thUOng ton than kinh h on g k h e o va

ton thtfOng m a c h mau.

Tham kham X-quang cung chup hai tu the thang va nghieng de xac dinh o gay
va mtfc do hj lech.

B. Chup xuong dui phuc vu cho dieu trj
Gay xUOng dui co chi dinh dieu trj dong dinh noi tuy: Vai tro cua X-quang luc nay

la xac dinh vung tuy rong hay hep de chon dinh noi tuy phu hop.
Danh gia tinh trang lien xtfefng sau dieu tri:
- Phtfdng phap dieu trj dong dinh noi tuy ngtfdc dong cho ket qua tot. Sau
mot thcJi gian (2-3 tuan), chup X-quang xUOng dui danh gia tinh trang lien
1

V

xtfdng de co htfdng dieu tri thich hdp.
- Neu nhu gay xtfdng dui khong co chi dinh phau thuat, chi ho hot sau khi da
du thdi gian (khoang 6 tuan). Trtfdc khi thao hot tien hanh chup lai xtfdng
.

'

V

dui, nhan djnh sd bo ve stf lien xtfdng, can xtfdng o gay.

C. Cac ton thuong khac
Chan doan viem xtfdng, u xtfdng, loang xtfdng...
9

/

V

/

Mac du da dtfdc thay the chan doan bang chup cat ldp vi tinh nhtfng X-quang

thtfdng quy van con nguyen gia tri vi re tien, de thuc hien, vtfa giup chan doan va
theo ddi trong qua trinh dieu tri. Trong nhtfng trtfdng hdp nay, tham kham X-quang
r

•■>

s

'

*

bat but)c phai chup 2 ttf the: thang va nghieng.
III. KY THUAT C H U P XUONG DUI

A. Ky thuat chup xirong dui thang (Hinh 1- 1)
- Benh nhan nam ngtfa tren ban X-quang. Chan ben can chup dudi thang, ban
chan xoay nhe vao trong (neu gay khong hoan toan).
- Phim 30x40 cm, dat doc dtfdi dui, chinh diem giufa xtfdng dui vao gitfa
phim. khu tru chum tia hoac che la chan chi theo chieu doc.
- Tia trung tarn: chieu vuong goc ttf tren xuong qua diem gitfa dui vao trung
tarn phim.
- T hong so chup: 60-65 kV, 40 mAs. khoang cach 100 cm.
Lifu y:
- Neu benh nhan to beo hoac bd hot thi phai dung ltfdi chdng md va tang


6 C h i. Ky thuat chup X-quang xuong khop chi diroi

hang so chup (kV, mAs).

- Trong trtfdng hdp gay xtfdng dui dtfdc dieu tri bang dong dinh noi tuy. can
danh gia kich thtfdc that cua ong tuy, thi phai dat phim sat vao dui. bong Xquang de khoang cach xa tir 1,5 den 2 m.
9

^

V

/

/

^

- Phai lay dtfdc mot doan gay hoac mot khdp gan nhat neu chup khu tru.

Hinh 1-1.

Ky thuat chup xuong dui thang, tia trung tarn vuong goc 6 diem giifia dui vao giufa phim.

B. Ky thuat chup xirong dui nghieng
1. Ky thuat chup nghieng ngoai (Hinh 1-2)
- Benh nhan nam nghieng hoan toan tren ban X-quang, ve phia ben can chup.
Chan ben khong chup co len dtfa ra trtfdc hoac dtfa ra sau toi da. Co chan ke
■>

goi dem muc dich de xtfdng dui sat phim. Chan ben chup gap lai dang ra
mat ngoai dui sat phim.
- Cung co the benh nhan nam nghieng khong hoan toan. xtfdng dui can chup
gap nhe va xoay ra ngoai sao cho mat ngoai ap vao phim. Chan ben doi

dien gap goi dat ban chan thang goc xuong ban lam diem ti cd djnh cho ttf
the.


Ddi 1. AUUliy UUI /
•>

°

V •

V

. —

- Phim 30x40 cm, dat doc dtfcfi dui, chinh diem gitfa xtfdng dui vao gitfa
phim, khu tru chum tia hoac che la chan chi theo chieu doc.

Hinh 1-2.

Ky thuat chup xuting dui, ttf the nghieng ngoai hoan toan (A) va khong hoan toan
(B), tia trung tarn chieu vuong goc qua di§m giu'a dui va vao trung tarn phim.

- Tia trung tarn: chieu vuong goc ttf tren xuong qua diem gitfa dui vao trung
tam phim.


8 C h i. Ky thuat chup X-quang xirong khop chi diroi

- Thong so chup: 60 kV. 40 mAs, khoang cach 1(K) cm. co the dung lUiM

chong mO.
2. Ky thuat chup nghieng trong (Hinh 1-3)
- D u u c ap d u n g irong n h u n g triTOng h o p chan thifefng nang.
V

»

1

- Benh nhan nam ngUa. hai chan duoi thang (hoac chan ben khong dau dua ra
trifOc co het sUc len bong). Dui ben can chup dtfOc ke cao bang mot goi
dem.
- Phim 30x40 cm, dat thang dung doc dUOc co dinh boi kep giOfa hai dui
(hoac dUOc co dinh bang bao cat neu chan ben khong chup co). Bong X,

->

q u a n g chie u ng an g , ch in h d i em giura xUOng dui v a o giua p hi m , khu tru
c h u m lia hoa c ch e la c h a n chi theo c h ie u doc.

t it

a n ^ o o o

T IA X 01 N G A N G
Hinh 1-3.

Ky thuat chup xu'efng dui, tu' the nghieng trong, tia trung tarn di ngang giua dui (chi
lay dtfdc 2/3dut(i dui).
- Tia trung tain: di n g a n g va v u o n g goc q u a d i e m giua xUdng dui v a o trung

tarn phim.

- T hong so chup: 60 kV. 40 mAs. khoang cach 100 cm. co the dung luoi
chong m i l
Lifti y: Tu the chup nay chi thay Jiroc 2/3 duoi xuong dui.


Xirong ding chan

ITIuc tieu hoc tip
• Trinh bay dtfdc ky thuat chup xudng ding chan thing, nghieng.

I. GlAl PHAU XUON G CANG CHAN (Hinh 1-4)
II. CAC CHI D!NH CH UP XUONG CANG CHAN
- Ph at hien nhtfng ton thiTcfng ga y xUdng c a n g chan.

- Theo doi danh gia lien xudng sau bo bot hoac phau thuat.
o

- T i m n h u n g ton thUdng be n h ly: vi em , u xUdng.

III. KY THUAT C H U P XUONG CANG CHAN

A. Ky thuat chup tiling (Hinh 1-5)
-

B e n h n h a n n a m ngUa tren ban X - q u a n g , c h a n can c h u p duoi than g, ban
c h a n x o a y nhe v a o trong (de tach dUOc toi da hai xUdng c h a y m ac).

- Phim 30x40 cm, dat doc duoi cang chan, chinh cang chan vao trung tarn

phim, khu tru chum tia hoac che la chan chi theo chieu doc.
/

i

/

- Tia trung tam: c hi e u th an g tu tren x u o n g v u o n g goc v6i p h i m . k h u tru v a o
d i e m gitfa xUOng c a n g c ha n, 0 phia ngoa i c a ch b d trUOc x u o n g c h a y k h o a n g
2 c m va v a o trung ta m phim.

- T hong so chup: 50 kV, 20 mAs, 100 cm. khong dung luoi chong md.

B. Ky thuat chup nghieng (Hinh 1-6)
- Benh nhan nam nghieng ve phia chan can chup, chan nay duoi thang, mat
ngoai cang chan sat phim sao cho go trUOc cua xtfdng chav song sone vdi
mat phim. Chan ben ddi dien co len va dua ra phia trUdc.
9