X-RAY EXAMINATIONS (RTG)

Lungs

Imaging examinations comprise X-ray examinations. It is the main method of diagnosis of primary and secondary lung tumours, tumours of mediastinum and lymphomas. This is an initial examination only. In case, when suspected change is found, more precise examinations are performed, i.e. computed tomography.

Radiogram of chest is performed with administration of contrast medium to esophagus. In such examination the neoplastic changes may be seen as visible round shadows on the lungs surface, disturbances of lung ventilation (emphysema or atelectasis), changes in pulmonary hilus or mediastinum or visible patches in pulmonary parenchyma as well.

However, no therapeutic decisions should be made on the basis of X-ray examination, because very frequently it gives incomplete infor­mation about the advancement and type of changes. Complementation of the examination in computed tomography or endoscopy examination (bronchoscopy, mediastinoscopy, videothoracoscopy, esophagoscopy) is necessary.

Bones

When symptoms in patient show neoplastic changes in bones, the radiogra­m performance is necessary. However, it should be remembered in this case that, clinical symptoms very frequently significantly precede the fact of appearance of recognisable radiological changes.

Primary neoplastic changes in bones are relatively rare, more frequently metastases are observed. They may have osteolytic (bone mass loss), osteoblastic (osteophytes) or mixed character. Recognition of these changes is frequently hampered by the osteoporosis effect.

Bone changes in case of multiple myeloma, prostatic cancer and in some primary bone tumours are well recognised with this method.

In some cases the X-ray examination of bones should be complemented with more sensitive scintigraphic examination.

Gastrointestinal track

Radiological examinations are still the main element of diagnostics of tumours of gastrointestinal track. To examine esophagus, stomach and large intestine, method of double contrast (barite and air) is used. However, the method does not find less advanced changes. In consequence, full results are obtained using combination of radiogram and endoscopy examinations (esophagoscopy, gastroscopy, rectoscopy, colonoscopy). Not only they find small changes, but also during such examination material to histological examination can be also precisely taken.

Breasts

Mammography is a basic method of diagnostics of changes in mammary gland and is the main screening examination. Its sensitiveness is over 90%. It is important to perform this procedure in specialistic examination room equipped in operational equipment and qualified cooperating personnel - pathologist and surgeon-oncologist. Mammographic apparatus must comply with all safety norms with regard to patients’ exposure of on radiation.

This examination carried out every 12 months in women above 50th year of life enables to decrease the risk of death from breast cancer for about 30%.

Mammography is also indispensable when suspected changes in breasts are found. It can be also performed during examination of patients in the course of chemotherapy or hormonotherapy. 

Computed tomography (CT)

The biggest role in diagnostics of tumours is played by computed tomography (CT). Thanks to its sensitiveness and specificity it enables the recognition of changes localised in any region of the body. In some cases only (for instance in tumours of lymphatic system of mediastinum), its specificity is smaller and the diagnosis should be confirmed with endoscopic methods.

Computed tomography helps to demarcate precisely the border between healthy tissue, vessels, bone tissue and neoplastic change. It gives a possibility of precise operation planning or radiotherapy. This examination is frequently indispensable in monitoring of the organism’s response on radiotherapy or chemotherapy (especially in cases of tumours of liver, chest, retroperitoneal space, head and neck).

Computed tomography depends on emission of X-ray radiation, produced by lamp that circulates around the patient. Picture is built as a result of difference between densities of particular tissues and organs of human body.

This examination should be performed in fasting state. During procedure patient must not move, because it could significantly hamper the evaluation of final result. Computed tomography should not be used in pregnant women and children under 10.

Innovation in computed tomography is use of multirow spiral volumetric imaging technique. Thanks to this, data is collected significantly faster than using conventional CT; possibility to modulate the intensiveness of beam also exists, thanks to this the radiation of healthy tissues can be limited. Changes are significantly more precise imaging, then creation of tri-dimensional picture, very helpful in planning the surgical treatment or radiotherapy, is possible.

Currently it is a recommended method in the routine examination on presence of changes in lungs and liver, as well as in preoperative evaluation of the grade of advancement of kidneys and pancreatic tumours. 

Magnetic resonance (MRI)

It is a main method of diagnostics of primary and secondary tumours of central nervous system, head and neck tumours, as well as finding and determination of the grade of advancement of malignant tumours in small pelvis. To examination usually contrast medium - gadolinium is used. It helps to demonstrate disturbance of continuity of brain-blood barrier, characteristic for neoplastic infiltration. Technique of magnetic resonance enables a detailed determination of oedema zone around the neoplastic change, as well as the tumour alone, thanks to what level of pressure on spinal cord can be evaluated. Obtainment of pictures of bigger resolution than in computed tomography enables the precise evaluation of the tumours boundaries, especially during planning the operation.

Method is very useful in evaluation of lymph nodes, differential diagnostics of brachial plexus infiltration, chest wall and pericardium. It enables also on very precise differentiation of postradiation changes from the tumour’s recurrence, what has an fundamental importance during obser­vation after past chest radiation.

Unfortunately, cost of MR is few times bigger than TK. What is more, not always has a significant advantage on this examination. 

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