Surgery, with Special Reference to PodiatryStern, Maximilian
Science
Surgery, with Special Reference to Podiatry
Stern, Maximilian
Foot -- Surgery; Surgery
A further objection to the use of the screen is that the constant
exposure of the hands and other parts of the body of the observer may
result in an intractable, dangerous and chronic dermatitis.
By using a photographic plate the danger of dermatitis can be avoided,
since it is not necessary to expose the hands at all; and at the same
time greater accuracy is ensured and a permanent record is obtained.
Although examination by radiography is a somewhat tedious procedure in
comparison with direct observation by the fluorescent screen, yet it
is less difficult if the photographic side of this method is
approached in a proper and businesslike manner.
+Interpretation of Radiograms.+ A successful result in X-ray examination
involves a clear understanding of the meaning of the radiogram
produced. Even with the most accurate knowledge of anatomy, it is
difficult to interpret X-ray shadows; for a radiogram is only a
shadow, and the outline of the part thus demonstrated is liable to
great variation. For example, in the case of injury to bone, it is
always possible to secure strong and accurate X-ray shadows of the
part, and no error ought to be made in diagnosis, yet errors of this
kind are not uncommon.
To avoid such mistakes, it is imperative that the quality of the
radiogram secured should be the best possible. For instance, in the
examination of the ankle-joint and the bones of the foot, a radiogram
which is flat, indistinct, and altogether wanting in detail, is of no
value, while a radiogram of good quality of the same ankle-joint and
foot, is of value. The interpretation of the latter is easy, while
that of the former would be almost impossible, and certainly
inaccurate.
The usual practice in securing radiograms is to place the subject in a
position considered likely to give the best results, and then roughly,
almost at random, to place the tube in some unknown relation to the
part of the body under examination. The resulting shadow is often of
no value because it is wanting in detail and depth. One method of
avoiding this fault is to produce stereoscopic views of the part
examined.
Two views having been secured in stereoscopic register, and placed in
a stereoscope, the part can be viewed in relief. Theoretically, then,
by this means one is able to view the parts of the body opaque to the
X-rays as they would appear to the naked eye. In practice, however,
this method, though it may prove of value in exceptional
circumstances, is laborious. Moreover, though the parts may be made to
appear in relief, they are not really as one would see them with the
naked eye, but are still X-ray shadows.
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