The document discusses accidents that can occur in radiotherapy. It provides examples of accidents where patients received much higher radiation doses than intended, resulting in injuries and deaths. Key causes included errors in treatment planning systems when entering shielding block data, equipment malfunctions during brachytherapy treatments, and mistakes made in prescribing and delivering the correct number of treatment sessions. The consequences of overexposure can include reduced tumor control, acute radiation complications appearing within weeks, and chronic effects in slowly-dividing tissues. Reporting incidents and learning from mistakes is important to prevent similar accidents.
Particle beam – proton,neutron & heavy ion therapyAswathi c p
particle therapy is advanced external beam therapy used to treat cancer , which uses beams of protons or other charged particles such as helium, carbon or other ions instead of photons. charged particles have different depth-dose distributions compared to photons. They deposit most of their energy in the last final millimeters of their trajectory (when their speed slows). This results in a sharp and localized peak of dose, known as the Bragg peak.
This ppt explains about Electronic Brachytherapy which is a very special type of Brachytherapy in Radiation therapy. This presentation also demonstrates classifications of brachytherapy, Sources used for Brachytherapy, Advantages and disadvantages of electronic Brachytherapy, Different companies providing Electronic Brachytherapy machines and it portraits working method and components of Electronic Brachytherapy Machine.
Updates on Electron Beam Therapy
I) Introduction
II) Central Axis Depth dose distribution
III) Dosimetric parametrics of electron beam
IV) Clinical Considerations of Electron beam therapy
This is a presentation on total body irradiation. This presentation explains about various techniques. positions used for TBI. Advantages and disadvantages of TBI.
It also gives an idea on Dosage and side effects.
Particle beam – proton,neutron & heavy ion therapyAswathi c p
particle therapy is advanced external beam therapy used to treat cancer , which uses beams of protons or other charged particles such as helium, carbon or other ions instead of photons. charged particles have different depth-dose distributions compared to photons. They deposit most of their energy in the last final millimeters of their trajectory (when their speed slows). This results in a sharp and localized peak of dose, known as the Bragg peak.
This ppt explains about Electronic Brachytherapy which is a very special type of Brachytherapy in Radiation therapy. This presentation also demonstrates classifications of brachytherapy, Sources used for Brachytherapy, Advantages and disadvantages of electronic Brachytherapy, Different companies providing Electronic Brachytherapy machines and it portraits working method and components of Electronic Brachytherapy Machine.
Updates on Electron Beam Therapy
I) Introduction
II) Central Axis Depth dose distribution
III) Dosimetric parametrics of electron beam
IV) Clinical Considerations of Electron beam therapy
This is a presentation on total body irradiation. This presentation explains about various techniques. positions used for TBI. Advantages and disadvantages of TBI.
It also gives an idea on Dosage and side effects.
Radiation Protection by Irum Khan (Medical Imaging Technologist)irumk746
Radiation Protection
Introduction:Since the announcement of the discovery of X Rays by Röntgen in December 1895, X-rays and the radiological techniques associated with their use have become increasingly central tools in medical diagnosis and management.
As a result of the growth in the usefulness of imaging, other, non-radiation-based, imaging techniques have been developed (e.g. ultrasound and magnetic resonance imaging), and image-guided interventional means of treating patients have become common place. The benefits to patients from these methods of investigation and treatment have been immeasurable.
However, it would be unwise to imagine that no harm can come to patients from the use of radiation-based and other imaging techniques, or from interventional radiology procedures.
Radiation protection is a key aspect of maintaining the safety of patients and Radiation worker in diagnostic and interventional radiology.
Human Responses to Ionizing Radiation DETERMINISTIC EFFECTS OF RADIATION ON HUMANS
1. Acute radiation syndrome
a. Hematologic syndrome
b. Gastrointestinal syndrome
c. Central nervous system syndrome
2. Local tissue damage
a. Skin
b. Gonads
c. Extremities
3. Hematologic depression
4. Cytogenetic damage
STOCHASTIC EFFECTS OF RADIATION ON HUMANS
. Leukemia
2. Other malignant disease
a. Bone cancer
b. Lung cancer
c. Thyroid cancer
d. Breast cancer
3. Local tissue damage
a. Skin
b. Gonads
c. Eyes
4. Shortening of life span
5. Genetic damage
EFFECTS OF FETAL IRRADIATION
Prenatal death
2. Neonatal death
3. Congenital malformation
4. Childhood malignancy
5. Diminished growth and development
Purpose Of Radiation Protection
The principle purpose of radiation protection are
To minimize patient exposure in medical diagnostic radiology
To ensure adequate protection of person operating or using x ray equipment.(Radiologist, Medical Imaging Technologist, Radiographer)
To ensure adequate protection of the general public in the vicinity areas where diagnostic procedure are in progress.
The three fundamental principles of radiation protection of patients are
Justification
Optimisation
The application of Dose Limit
The International Commission on Radiological Protection (ICRP) is responsible for the development of these principles.
Justification
The justification principle is anecdotally known as the benefit vs risk principle; that is, an individual's exposure to medical radiation should always have a greater benefit to the patient as to outweigh the negative consequences of the proposed examination. For example, the benefit in requesting a CT brain for a patient that has suffered significant head trauma generally outweighs any negative outcomes associated with that radiation exposure.
If the exposure has no justification then it should be avoided regardless of how small the dose might be.
Explain the non safe or harm aspects of CT scan on the patient,, particularly after multiple CT scans done for one patient. mentioned essentially the risk of cancer in later life, which reach 1/2000.
Also, mentioned the organs, age group, and gender which affected more by CT radiation
Finally , stressing on eliminating CT scan as possible
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
2. INTRODUCTION
• Radiotherapy is concerned primarily with tumour cure or palliation.
• Modern radiotherapy has three major concerns: efficacy, quality of life, and
safety .
• It is always necessary to be aware of the potential for an accident, the
relative importance of human factors, and the wider consequences of an
accident.
• A radiation accident is an unintended event (operator error, equipment
failure, or other mishap) that has or may have adverse consequences.
3. Errors in RT: Contributing Factors
• Insufficient education
• Lack of procedures/protocols as part of comprehensive QA program
• Lack of supervision of compliance with QA program
• Lack of training for “unusual” situations
• Lack of a “safety culture”
Sources of Uncertainties
• During Treatment
• Machine performance
• Determination of dose from radiation
• Patient specific data for treatment planning
• Calculation of radiation dose to the patient
• Transfer of data from the treatment plan to the treatment machine
• Day to day variations in the treatment (machine/patient motion/set up)
4. Accidents can be divided into three major groups:
I. members of the general public irradiated as a result of failure of
implementation of radiation protection and safety rules.
II. clinical staff irradiated during preparation of radiation sources or patient
treatment and maintenance staff irradiated during installation, repairs,
source change, or other equipment servicing.
III. patients injured during treatment.
6. Panama Radiation Accident
• The National Oncologic Institute or ION is a specialized hospital for cancer
treatment, located in Panama City, Panama.
• Between August 2000 and March 2001, patients receiving radiation treatment
for prostate cancer and cancer of the cervix received lethal doses of radiation,
resulting in eight fatalities
• As in most radiotherapy departments, the one at ION uses a treatment
planning system (TPS) to calculate the resulting dose distributions and
determine treatment times.
7. • The data for each shielding block should be entered into the TPS separately.
• The TPS allows a maximum of four shielding blocks per field to be taken into
account when calculating treatment times and dose distributions.
• Shielding blocks are used to protect healthy tissue of patients undergoing
radiotherapy at the Institute, as is the normal practice.
• In order to satisfy the request of a radiation oncologist to include five blocks in
the field, in August 2000 the method of digitizing shielding blocks was changed.
• It was found that it was possible to enter data into the TPS for multiple
shielding blocks together as if they were a single block, thereby apparently
overcoming the limitation of four blocks per field
8. • As was found later, although the TPS accepted entry of the data for multiple
shielding blocks as if they were a single block, at least one of the ways in
which the data were entered the computer output indicated a treatment time
substantially longer than it should have been.
• The result was that patients received a proportionately higher dose than that
prescribed. The modified treatment protocol was used for 28 patients, who
were treated between August 2000 and March 2001 for prostate cancer and
cancer of the cervix. There were eight deaths and 20 injuries.
• The modified protocol was used without a verification test, i.e. a manual
calculation of the treatment time for comparison with the computer
calculated treatment time, or a simulation of treatment by irradiating a water
phantomand measuring the dose delivered.
9. • In spite of the treatment times being about twice those required for correct
treatment, the error went unnoticed.
• Some early symptoms of excessive exposure were noted in some of the
irradiated patients.
• The seriousness, however, was not realized, with the consequence that the
accidental exposure went unnoticed for a number of months.
• The continued emergence of these symptoms, however, eventually led to
the accidental exposure being detected in March 2001.
10. • In May 2001, the Government of Panama requested assistance under the
terms of the Convention on Assistance in the Case of a Nuclear Accident or
Radiological Emergency.
• In its response, the International Atomic Energy Agency (IAEA) sent a team of
five medical doctors and two physicists to Panama to perform a dosimetric
and medical assessment of the accidental exposure and a medical evaluation
of the affected patients’ prognosis and treatment.
• The team was complemented by a physicist from the Pan American Health
Organization (PAHO), also at the request of the Government of Panama.
11. • The accidental exposures at the ION in Panama were very serious. Many
patients have suffered severe radiation effects due to excessive dose. Both
morbidity and mortality have increased significantly.
• The IAEA report was consistent with the report made by local investigators.
• It was found that the radiotherapy equipment was properly calibrated and
worked properly.
• The error was on the data entry, using a protocol not validated to enter more
shielding blocks, that resulted in increased dose in the treatment.
• Most of the exposed patients have died, some radiation related, others by
means of their advanced cancer.
• The Government of Panama agreed to share urgently the conclusions of the
report to help prevent similar accidents. The physicists of ION involved were
taken to trial by the patients' families
12. Malfunction Of Brachytherapy High Dose Rate Equipment (USA, 1992)
• A patient was to be treated using a high dose rate (HDR) brachytherapy unit
equipped with a 4.3 Ci 192-Ir source.
• The prescribed dose was 18 Gy in three fractions. Five catheters were placed in
the tumor and the source was to be stepped through the pre-programmed
positions in each catheter.
• During the first fraction the radiation oncologist experienced difficulties in
positioning the source into the fifth catheter and decided to retract the source.
• The source became detached from the driving mechanism while still inside the
patient.
13. • The staff disregarded an alarm from an external area radiation monitor
because the console of the brachytherapy unit indicated ‘safe’.
• All three technologists and one physician who were attending the patient
were aware of the alarm condition but none of them conducted a survey with
the available portable radiation survey instrument.
• The patient, with the source still in the catheter, was transported back to the
nursing home.
• The source remained inside the patient for almost four days, until the catheter
containing the source fell out.
• The patient received a dose of 16,000 Gy at 1 cm distance from the source,
instead of the prescribed 18 Gy.
14. • The nursing home staff disposed of the catheter in an area used to store non-
radioactive medical waste and was removed later by an incinerator company. (
A type of company which used a kind of an apparatus for burning waste material, especially
industrial waste, at high temperatures until it is reduced to ash.)
• The source was discovered when it tripped a radiation monitor located at the
incinerator.
• The patient died shortly after the source was dislodged. The overexposure
was the major contributing cause of death.
• The lost source also caused radiation exposure to 94 other individuals,
including persons at the cancer clinic, nursing home, ambulance staff, and
workers at the waste-disposal company.
15. • A similar accident in another hospital was subsequently avoided because
the medical physicist was aware of the first case and immediately
recognized the problem.
• This is the importance of incident reporting and dissemination of the
lessons learned.
16. October 2011 –
• At a hospital in Rio de Janeiro, a 7-year-old girl was treated for acute lymphoblastic
leukemia with whole brain radiation.
• The prescriptions were done manually in a form with no formal evaluation of work
is done.
• Because of an error in the registration of the number of sessions, she received the
full dose in each session of radiotherapy.
• Even with early toxicity, the doctor refused to assess the patient, because some of
the complaints were usual.
• The full treatment was finished in about 8 sessions and the girl was admitted with
radiation burns.
• She developed frontal lobe necrosis. and died in June 2012. After an investigation,
the physicist, technician, and physician were charged with murder.
17. Consequences of accidental exposures in radiotherapy
• The consequences of accidental exposures can be categorised into three
types:-
1. impact on local tumour control rate.
2. early (or acute) complications.
3. late (or chronic) complications.
18. Impact on local tumour control rate.
• In the case of an accidental over dosage, the tumour control probability
may increase.
• But it’s overdose to normal tissues, leading to death or to a severely
reduced quality of life.
• The tumour control probability (TCP) is a formalism derived to compare
various treatment regimens of radiation therapy, defined as the
probability that given a prescribed dose of radiation, a tumour has been
eradicated or controlled.
19. Early (or acute) complications
• Acute complications are early deterministic effects (effects due to cell killing).
• They are dose related and have a threshold (i.e., below a certain dose they are
not seen).
• These effects are usually observed in tissues or organs with rapid cell turnover
rates (e.g., skin, mucosa, and bone marrow).
• These complications are observed within days or weeks after irradiation.
• They are often transient ( short-time) .
20. Late (chronic) complications
• These late effects are mainly observed in tissues or organs with slowly
proliferating cells.
• They can also be seen in organs with rapidly proliferating cells, a consequence
of very severe acute reactions.
• These late complications usually occur more than six months after the end of
irradiation, but can be observed much later (several years).
• They are usually considered as irreversible, and are often slowly progressive.
21. CAUSES OF AND FACTORS CONTRIBUTING TO ACCIDENTAL EXPOSURES IN
RADIOTHERAPY
Equipment problems
Maintenance
Beam calibration
Treatment planning systems
Treatment simulation
Treatment set-up and delivery
In Brachytherapy
Source preparation
Source removal
22.
23.
24. CONCLUSION
• Safety is not to be considered in isolation or as a separate chapter of the
radiotherapy syllabus for education of professionals.
• Rather, safety should be incorporated in all steps of management of
radiotherapy, so that an integrated quality management system involves both
quality and safety.
• In fact, most of the control measures to monitor quality serve to detect any
deviation concerning safety as well, since the parameters to be controlled are
often the same.
• The quality control programmes and frequency of the constancy checked can
be designed to combine both objectives (quality and safety).
• Test tools exist nowadays to make more frequent relative measurements as
constancy checks, which monitor quality and safety at the same time.