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X-ray examination is recognised as a valuable aid and
accessory method, but no clinician of experience in this disease
would dream of relying on this method by itself, and it is
important that the information afforded by such X-ray examination
should not be made the excuse for a faulty clinical
examination. It can be stated, however, that viewed in its correct
perspective, with an adequate knowledge of the invaluable help
it can give with correct interpretation and satisfactory technique,
its services are invaluable. In point of fact, no patient has been
completely investigated without such radiological examination, no
more than he has been completely investigated without a complete
clinical examination.
The important factors in the diagnosis of pulmonary tuberculosis
are:—
1. A full history with particular reference to contact exposure,
pleurisy, hæmoptysis, etc.
2. Careful use of the thermometer and pulse record.
3. Careful use of the weighing machine.
4. Repeated examinations of the sputum, collected on special
instructions for the purpose of providing a valid specimen.
5. Complete clinical investigation.
G. Complete X-ray investigation.
It is upon the cumulative results of all these investigations
that diagnosis must rest.
Whilst great significance is placed upon the value of a good
radiological examination it cannot be too strongly emphasised that
a poor radiogram is worse than useless and may prove to be a
veritable danger from the point of view of interpretation. It is
not enough to have an X-ray examination. A radiograph must
be technically satisfactory, i.e., it must be taken with the X-ray
tube at the correct distance from the patient, the tube being correctly
centred and the time exposure sufficiently rapid, i.e., 1/10th
second or less. Serious errors of interpretation may arise from
failure to observe these elementary rules.
The Value of Serial Radiography.
Serial radiograms must be taken under exactly the same conditions
to be of any real value.