This document discusses radiation accidents that can occur in brachytherapy. It notes that over 500,000 brachytherapy procedures are performed annually using high-dose-rate brachytherapy. Any error in loading the radioactive source could result in an overdose. More than 500 high-dose-rate brachytherapy accidents have been documented in previous years. Human error and equipment malfunctions are causes of radiation accidents in brachytherapy.

1. Radiation Accident in Brachytherapy 01/27/2015
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‫ﻗﺮب‬ ‫ﻋﻦ‬ ‫اﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﻓﻲ‬ ‫اﻹﺷﻌﺎﻋﻴﺔ‬ ‫اﻟﺤﻮادث‬
Radiation Accident in BrachytherapyRadiation Accident in Brachytherapy
‫أﻧﺠﻖ‬ ‫أﺳﺎﻣﺔ‬
‫ﺍﻟﺜﺎﻨﻴﺔ‬ ‫ﺍﻟﺴﻨﺔ‬
‫ﻤﺎﺠﺴﺘﻴﺭ‬‫ﻓﻲ‬ ‫ﻭﺍﻟﺘﺨﺼﺹ‬ ‫ﺍﻟﺘﺄﻫﻴل‬‫ﺍﻟﻁﺒﻴﺔ‬ ‫ﺍﻟﻔﻴﺯﻴﺎﺀ‬ ‫ﻴﺭ‬ ‫ﺠ‬‫ﻲ‬ ‫ﺹ‬ ‫ﻭ‬ ‫ﻴل‬‫ﺒﻴ‬ ‫ﺀ‬ ‫ﻴﺯﻴ‬
‫ﺍﻟﻌﻠﻭﻡ‬ ‫ﻜﻠﻴﺔ‬–‫ﺩﻤﺸﻕ‬ ‫ﺠﺎﻤﻌﺔ‬
2015/2014
High-dose-rate brachytherapy
•‫ﺗﻄﻮر‬‫ت‬‫ﺑﺘﻘﻨﻴﺔ‬ ‫اﻹﺷﻌﺎﻋﻴﺔ‬ ‫اﻟﻤﻌﺎﻟﺠﺔ‬High-dose-rate
brachytherapy‫ﻋﺎﻟﻴﺔ‬ ‫ﺒﺴﺭﻋﺔ‬:
–‫اﻟﺘﻘﺮﻳﺮ‬ ‫ﺑﺤﺴﺐ‬ICRP Publication 97ً‫ﺎ‬‫ﺳﻨﻮﻳ‬ ‫ﻳﺠﺮي‬ ‫ﻓﺈﻧﻪ‬
‫أآﺜﺮ‬‫ﻣﻦ‬500,000‫ﺑﺘﻘﻨﻴﺔ‬ ‫ﻣﻌﺎﻟﺠﺔ‬ ‫ﺡﺎﻟﺔ‬HDR.
–‫ﺑﺘﻘﻨﻴﺔ‬ ‫اﻵﻟﻲ‬ ‫اﻟﺘﺤﻤﻴﻞ‬ ‫ﺕﺠﻬﻴﺰات‬ ‫ﺕﺼﻨﻴﻊ‬ ‫إﻳﻘﺎف‬ ‫ﺕﻢ‬LDR‫ﻗﺒﻞ‬ ‫ﻣﻦ‬
‫اﻟﻤﺴﺘﺨﺪﻣﻴﻦ‬ ‫ﻗﺒﻞ‬ ‫ﻣﻦ‬ ‫اﻟﻄﻠﺐ‬ ‫ﻋﺪم‬ ‫ﺑﺴﺒﺐ‬ ‫اﻟﺼﺎﻧﻌﺔ‬ ‫اﻟﺸﺮآﺎت‬ ‫ﻣﻌﻈﻢ‬.
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2. Radiation Accident in Brachytherapy 01/27/2015
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ICRP PublicationICRP Publication
97 Prevention of
High-Dose-Rate
Brachytherapy
Accidents
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High-dose-rate brachytherapy
•‫ﺑﺘﻘﻨﻴﺔ‬High-dose-rate brachytherapy‫ﺍﻟﺠﺭﻋﺔ‬ ‫ﺘﻜﻭﻥ‬
‫ﻋﺎﻟﻴﺔ‬ ‫ﺍﻹﺸﻌﺎﻋﻴﺔ‬.
–‫اﻹﺵﻌﺎﻋﻴﺔ‬ ‫اﻟﺠﺮﻋﺔ‬ ‫ﻣﻌﺪل‬1.6–5.0 Gy/min
–‫إﺵﻌﺎﻋﻲ‬ ‫ﺕﻌﺮﻳﺾ‬ ‫إﻟﻰ‬ ‫ﺳﻴﺆدي‬ ‫اﻟﻤﺸﻊ‬ ‫اﻟﻤﺼﺪر‬ ‫ﺕﺤﻤﻴﻞ‬ ‫ﻓﻲ‬ ‫ﺥﻄﺄ‬ ‫أي‬
ٍ‫ل‬‫ﻋﺎ‬over dosage‫ﻣﺒﺮر‬ ‫وﻏﻴﺮ‬.
–‫ﻣﻦ‬ ‫أآﺜﺮ‬ ‫ﺕﻮﺙﻴﻖ‬ ‫ﺝﺮى‬500‫إﺵﻌﺎﻋﻲ‬ ‫ﺡﺎدث‬)500 HDR
accidents(‫ﺕﻌﺮض‬ ‫ﻋﻠﻰ‬ ‫ﺕﻨﻄﻮي‬ ‫اﻟﺴﺎﺑﻘﺔ‬ ‫اﻟﺴﻨﻮات‬ ‫ﺥﻼل‬ accidents(‫ﺮض‬ ‫ﻰ‬ ‫ﻮي‬ ‫ﺑ‬ ‫ا‬ ‫ﻮا‬ ‫ا‬ ‫ﻼل‬
‫اﻹﺵﻌﺎﻋﻴﺔ‬ ‫اﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺑﺘﻄﺒﻴﻖ‬ ‫اﻟﺨﻄﺄ‬ ‫ﻋﻦ‬ ‫ﻧﺎﺕﺞ‬ ‫ﻣﺒﺮر‬ ‫ﻏﻴﺮ‬ ‫إﺵﻌﺎﻋﻴﺔ‬
‫ﻗﺮب‬ ‫ﻋﻦ‬
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High-dose-rate brachytherapy
•‫ﺑﺘﻘﻨﻴﺔ‬High-dose-rate brachytherapy‫ﺍﻟﺠﺭﻋﺔ‬ ‫ﺘﻜﻭﻥ‬
‫ﻋﺎﻟﻴﺔ‬ ‫ﺍﻹﺸﻌﺎﻋﻴﺔ‬.
–‫ﻣﺸﻊ‬ ‫ﻣﺼﺪر‬ ‫ﺑﺎﺳﺘﺨﺪام‬ ‫اﻟﺘﻘﻨﻴﺔ‬ ‫هﺬﻩ‬ ‫ﺕﻄﺒﻖ‬Ir-192 (T1/2=73.83
days)
•‫أﺵﻬﺮ‬ ‫أرﺑﻊ‬ ‫آﻞ‬ ‫اﻟﻤﺸﻊ‬ ‫اﻟﻤﺼﺪر‬ ‫اﺳﺘﺒﺪال‬ ‫ﻳﺠﺐ‬.
–‫ﻣﻦ‬ ‫أآﺜﺮ‬ ‫ﻧﻘﻞ‬ ‫ﻳﺠﺮي‬ ً‫ﺎ‬‫ﺳﻨﻮﻳ‬10,000 HDR sources
•‫اﻹﺷﻌﺎﻋﻴﺔ‬ ‫اﻟﺤﻮادث‬ ‫ﻟﻮﻗﻮع‬ ‫آﺒﻴﺮ‬ ‫اﺣﺘﻤﺎل‬. ‫ﻴ‬ ‫ﻹ‬ ‫ﻮ‬ ‫ﻮع‬ ‫ﻮ‬ ‫ﺒﻴﺮ‬
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‫اﻹﺵﻌﺎﻋﻴﺔ‬ ‫اﻟﺤﻮادث‬
•‫ﻋﻦ‬ ‫اﻹﺷﻌﺎﻋﻴﺔ‬ ‫اﻟﺤﻮادث‬ ‫ﺗﻨﺘﺞ‬:
–‫ﺑﺸﺮﻳﺔ‬ ‫أﺥﻄﺎء‬Human error:
•‫ﻟﻪ‬ ‫اﻟﻤﻮﺻﻮﻓﺔ‬ ‫اﻟﻤﺮیﺾ‬ ‫ﻏﻴﺮ‬ ‫ﺁﺧﺮ‬ ‫ﻟﻤﺮیﺾ‬ ‫اﻹﺷﻌﺎﻋﻴﺔ‬ ‫اﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺗﻘﺪیﻢ‬.
•‫اﻟﻤﺼﺎب‬ ‫اﻟﻤﻮﺿﻊ‬ ‫ﻏﻴﺮ‬ ‫ﺁﺧﺮ‬ ‫ﻟﻤﻮﺿﻊ‬ ‫اﻹﺷﻌﺎﻋﻴﺔ‬ ‫اﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺗﻘﺪیﻢ‬.
•‫إﺷﻌﺎﻋﻴﺔ‬ ‫ﻡﻌﺎﻟﺠﺔ‬ ‫ﺗﻘﺪیﻢ‬)‫اﻟﻌﻼﺝﻴﺔ‬ ‫اﻟﺠﺮﻋﺔ‬(‫اﻟﺘﻲ‬ ‫اﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﻋﻦ‬ ً‫ﺎ‬‫آﻠﻴ‬ ‫ﺗﺨﺘﻠﻒ‬
‫اﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﻃﺒﻴﺐ‬ ‫وﺻﻔﻬﺎ‬.
–‫واﻟﺘﺠﻬﻴﺰات‬ ‫اﻟﻤﺸﻌﺔ‬ ‫اﻟﻤﺼﺎدر‬ ‫ﻓﻲ‬ ‫ﺥﻠﻞ‬Equipment
malfunction.
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4. Radiation Accident in Brachytherapy 01/27/2015
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IAEA Safety Report
Series 17Series 17
“Lessons learned
from accidental
exposures in
radiotherapy”
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‫اﻟﺤﻮادث‬ ‫ﺕﺼﻨﻴﻒ‬
•‫اﻟﻤﺒﺎﺷﺮ‬ ‫ﻟﺴﺒﺒﻬﺎ‬ ً‫ﺎ‬‫ﺗﺒﻌ‬ ‫اﻹﺷﻌﺎﻋﻴﺔ‬ ‫اﻟﺤﻮادث‬ ‫ﺗﺼﻨﻴﻒ‬ ‫ﺝﺮى‬:
–‫اﻟﺘﺠﻬﻴﺰات‬ ‫ﺕﺼﻤﻴﻢ‬Equipment design ‫ﻢ‬q p g
–‫اﻹﺵﻌﺎﻋﻴﺔ‬ ‫اﻟﺤﺰم‬ ‫ﻣﻌﺎﻳﺮة‬Calibration of beams.
–‫اﻟﺼﻴﺎﻧﺔ‬ ‫ﺑﺈﺝﺮاءات‬ ‫ﺥﻠﻞ‬Maintenance.
–‫اﻟﺠﺮﻋﺔ‬ ‫وﺡﺴﺎب‬ ‫اﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺕﺨﻄﻴﻂ‬ ‫ﻧﻈﻢ‬ ‫ﻓﻲ‬ ‫ﺥﻠﻞ‬Treatment
planning and dose calculation.
‫اﻟﻤﺤﺎآﺎة‬Simulation –‫اﻟﻤﺤﺎآﺎة‬Simulation.
–‫اﻟﻌﻼﺝﻴﺔ‬ ‫اﻟﺠﺮﻋﺔ‬ ‫وإﻋﻄﺎء‬ ‫اﻟﻤﺮﻳﺾ‬ ‫وﺿﻌﻴﺔ‬Treatment set-
up and deliver
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5. Radiation Accident in Brachytherapy 01/27/2015
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Accidents in Brachytherapy
Category No of cases %
Equipment design 5 15
Source order and delivery 3 9
Calibration 5 15
Preparation 6 18
Planning and dose
l l ti
11 34
calculation
Source removal 3 9
Total 33
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‫اﻹﺵﻌﺎﻋﻴﺔ‬ ‫اﻟﺤﻮادث‬ ‫ﻣﻦ‬ ‫اﻟﻮﻗﺎﻳﺔ‬Accident Prevention
•‫یﺠﺐ‬ ‫اﻟﺤﻮادث‬ ‫ﻡﻦ‬ ‫اﻟﻮﻗﺎیﺔ‬ ‫أﺝﻞ‬ ‫ﻡﻦ‬:
–‫اﻟﺨﻄﺄ؟‬ ‫ﻣﺼﺎدر‬ ‫هﻲ‬ ‫ﻣﺎ‬‫ﻲ‬
–‫اﻟﺤﺎدث‬ ‫ﻳﺒﺪأ‬ ‫أن‬ ‫ﻳﻤﻜﻦ‬ ‫آﻴﻒ‬)‫اﻟﺮﺋﻴﺴﻲ‬ ‫اﻟﻤﺼﺪر‬ ‫ﺕﺤﺪﻳﺪ‬(‫؟‬
–‫اﻟﺤﺎدث؟‬ ‫ﻓﻲ‬ ‫اﻟﻤﺴﺎهﻤﺔ‬ ‫اﻟﻌﻮاﻣﻞ‬ ‫هﻲ‬ ‫ﻣﺎ‬
–‫اﻟﻮﻗﻮع‬ ‫ﺕﺠﻨﺐ‬ ‫أﺝﻞ‬ ‫ﻣﻦ‬ ‫ﺑﻬﺎ‬ ‫اﻟﻘﻴﺎم‬ ‫ﻳﻤﻜﻦ‬ ‫اﻟﺘﻲ‬ ‫اﻟﺘﺪاﺑﻴﺮ‬ ‫هﻲ‬ ‫ﻣﺎ‬
‫ﺑﺎﻟﺤﻮادث؟‬
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‫ﻣﺜﺎل‬:
An Accident with Remote Afterloading
•‫اﻹﺷﻌﺎﻋﻴﺔ‬ ‫اﻟﻤﺮاﻗﺒﺔ‬ ‫ﺝﻬﺎز‬ ‫ﻡﻦ‬ ‫إﻥﺬار‬ ‫إﺷﺎرة‬Area monitor
–‫اﻻﻋﺘﺒﺎر‬ ‫ﺑﻌﻴﻦ‬ ‫ﺕﺆﺥﺬ‬ ‫ﻟﻢ‬assumed faulty.
•‫اﻟﻮاﻗﻊ‬ ‫ﻓﻲ‬:‫اﻟﻤﺸﻌﺔ‬ ‫اﻟﻤﺼﺎدر‬ ‫أﺣﺪ‬ ‫آﺴﺮ‬)‫ﻡﺸﻊ‬ ‫ﺱﻠﻚ‬(source
wire was broken‫اﻟﻤﺮیﺾ‬ ‫ﺝﺴﻢ‬ ‫داﺧﻞ‬ ‫وﺑﻘﻲ‬.
•‫ﻡﺼﺪر‬ ‫ﻋﻠﻰ‬ ‫اﻟﻨﻈﺮ‬ ‫دون‬ ‫اﻟﻤﺮﺿﻰ‬ ‫ﻏﺮف‬ ‫إﻟﻰ‬ ‫اﻟﻤﺮیﺾ‬ ‫إﻋﺎدة‬ ‫ﺗﻢ‬
‫اﻹﻥﺬار‬.
•‫ﻡﻘﺪارهﺎ‬ ‫إﺷﻌﺎﻋﻴﺔ‬ ‫ﺝﺮﻋﺔ‬ ‫اﻟﻤﺮیﺾ‬ ‫ﺗﻠﻘﻰ‬16,000 Gy at 1 cm
‫اﻟﻤﻘﺮرة‬ ‫اﻟﺠﺮﻋﺔ‬ ‫ﻡﻦ‬ ً‫ﻻ‬‫ﺑﺪ‬18 Gy.!!!!
•‫اﻟﻨﺘﻴﺠﺔ‬‫اﻟﻤﺮﻳﺾ‬ ‫وﻓﺎة‬Patient died!!!!
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‫ﻗﺮب‬ ‫ﻋﻦ‬ ‫اﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﻓﻲ‬ ‫اﻟﺤﻮادث‬ ‫ﺕﺼﻨﻴﻒ‬
•‫اﻟﺘﺠﻬﻴﺰات‬ ‫ﺗﺼﻤﻴﻢ‬Equipment design
•‫وﺗﻮریﺪهﺎ‬ ‫اﻟﻤﺸﻌﺔ‬ ‫اﻟﻤﺼﺎدر‬ ‫ﻃﻠﺐ‬Source order and ‫ﻮری‬ ‫و‬ ‫ر‬ ‫ﺐ‬Source order and
delivery.
•‫اﻟﻘﺒﻮل‬ ‫واﺧﺘﺒﺎرات‬ ‫اﻟﻤﺸﻌﺔ‬ ‫اﻟﻤﺼﺎدر‬ ‫ﻡﻌﺎیﺮة‬.
•‫اﻟﻤﻌﺎﻟﺠﺔ‬ ‫أﺝﻞ‬ ‫ﻡﻦ‬ ‫اﻟﻤﺸﻌﺔ‬ ‫اﻟﻤﺼﺎدر‬ ‫ﺗﺤﻀﻴﺮ‬Source
calibration and acceptance.
•‫اﻟﺠﺮﻋﺔ‬ ‫وﺡﺴﺎب‬ ‫اﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺕﺨﻄﻴﻂ‬ ‫ﻧﻈﻢ‬ ‫ﻓﻲ‬ ‫ﺥﻠﻞ‬Treatment
planning and dose calculation.
•‫اﻟﻤﺸﻌﺔ‬ ‫اﻟﻤﺼﺎدر‬ ‫ﻥﺰع‬Source removal.
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‫اﻹﺵﻌﺎﻋﻴﺔ‬ ‫اﻟﻤﻌﺎﻟﺠﺔ‬
‫اﻻﺳﺘﻘﺒﺎل‬
‫اﻟ‬‫ﺘﺸﺨﻴﺺ‬
‫ﺔ‬ ‫ﺎ‬ ‫اﻹﺵ‬ ‫ﺔ‬ ‫ﺎﻟ‬ ‫اﻟ‬
‫اﻟﺘﺨﻄﻴﻂ‬
)‫اﻟﻤﺤﺎآﺎة‬(
‫اﻹﺵﻌﺎﻋﻴﺔ‬ ‫اﻟﻤﻌﺎﻟﺠﺔ‬
‫اﻟﺘﺨﻄﻴﻂ‬
)TPS(
‫اﻟﺠﺮع‬ ‫ﻗﻴﺎس‬
‫اﻟﺘﺠﻬﻴﺰات‬ ‫اﺥﺘﻴﺎر‬
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‫اﻟﻤﻤﺎرﺳﺔ‬ ‫ﺗﺒﺮیﺮ‬
Justification of a Practice
.1‫یﺠﺐ‬ ‫اﻟﺴﺎﺑﻘﺔ‬ ‫اﻟﻤﻤﺎرﺱﺔ‬ ‫ﻋﻠﻰ‬ ‫اﻟﻤﺤﺎﻓﻈﺔ‬ ‫أو‬ ‫ﺝﺪیﺪة‬ ‫ﻡﻤﺎرﺱﺔ‬ ‫أیﺔ‬ ‫ﺗﺒﻨﻲ‬ ‫إن‬
‫ان‬‫ﻟﺘﻄﺒﻴﻖ‬ ‫آﻨﺘﻴﺠﺔ‬ ‫اﻹﺷﻌﺎع‬ ‫ﺗﺄﺛﻴﺮ‬ ‫ﻋﻦ‬ ‫اﻟﻨﺎﺗﺞ‬ ‫اﻷذى‬ ‫اﻻﻋﺘﺒﺎر‬ ‫ﺑﻌﻴﻦ‬ ‫یﺄﺧﺬ‬
‫اﻟﻤﻤﺎرﺱﺔ‬ ‫هﺬﻩ‬.
.2‫أن‬ ‫یﺠﺐ‬ ‫آﺎﻡﻦ‬ ‫ﺗﻌﺮض‬ ‫أو‬ ‫ﻟﻺﺷﻌﺎع‬ ‫اﻟﺘﻌﺮض‬ ‫ﺗﺘﻄﻠﺐ‬ ‫اﻟﺘﻲ‬ ‫اﻟﻤﻤﺎرﺱﺔ‬ ‫إن‬
‫اﻟﺼﻌﻴﺪ‬ ‫ﻋﻠﻰ‬ ‫اﻹﺝﺮاء‬ ‫ذﻟﻚ‬ ‫ﻣﻦ‬ ‫ﻣﺆآﺪة‬ ‫ﻓﺎﺋﺪة‬ ‫ﻳﻮﺝﺪ‬ ‫آﺎن‬ ‫إذا‬ ‫ﻓﻘﻂ‬ ‫ﺕﻌﺘﻤﺪ‬
‫ﻟﻠﻤﺠﺘﻤﻊ‬ ‫أو‬ ‫اﻟﺸﺨﺼﻲ‬‫یﻤﻜﻦ‬ ‫اﻟﺬي‬ ‫اﻟﻀﺮر‬ ‫ﻋﻠﻰ‬ ‫آﺒﻴﺮ‬ ‫ﺑﻘﺪر‬ ‫ﺗﺰیﺪ‬‫ان‬
‫اﻟﻤﻤﺎرﺱﺔ‬ ‫ﺗﻠﻚ‬ ‫ﻥﺘﻴﺠﺔ‬ ‫یﺤﺪث‬. ‫ر‬ ‫ﻴﺠ‬ ‫ی‬.
‫א‬
‫א‬
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‫ﺍﻟﻁﺒﻲ‬ ‫ﺍﻟﺘﻌﺭﺽ‬ ‫ﺘﺒﺭﻴﺭ‬
Justification of Medical Exposures
•‫اﻟﻔﻮاﺋﺪ‬ ‫ﺑﻴﻦ‬ ‫اﻟﻤﻮازﻥﺔ‬ ‫ﺧﻼل‬ ‫ﻡﻦ‬ ‫اﻟﻄﺒﻲ‬ ‫اﻟﺘﻌﺮض‬ ‫ﺗﺒﺮیﺮ‬ ‫یﺠﺐ‬
‫اﻷذى‬ ‫ﻡﻘﺎﺑﻞ‬ ‫اﻟﺘﻄﺒﻴﻖ‬ ‫هﺬا‬ ‫ﻡﻦ‬ ‫ﻋﻠﻴﻬﺎ‬ ‫ﺱﻨﺤﺼﻞ‬ ‫اﻟﺘﻲ‬ ‫اﻟﻌﻼﺝﻴﺔ‬‫ى‬ ‫ﺑ‬ ‫ﺒﻴﻖ‬ ‫ﻦ‬ ‫ﻴﻬ‬ ‫ﻲ‬ ‫ﺝﻴ‬
‫ﺁﺧﺬیﻦ‬ ‫اﻟﺘﻄﺒﻴﻖ‬ ‫هﺬا‬ ‫ﻡﻘﺎﺑﻞ‬ ‫یﺤﺼﻞ‬ ‫أن‬ ‫یﻤﻜﻦ‬ ‫اﻟﺬي‬ ‫اﻹﺷﻌﺎﻋﻲ‬
‫ﺗﺴﺘﺨﺪم‬ ‫ﻻ‬ ‫اﻟﺘﻲ‬ ‫اﻟﻤﺘﺎﺣﺔ‬ ‫اﻷﺧﺮى‬ ‫اﻟﺒﺪاﺋﻞ‬ ‫آﺎﻓﺔ‬ ‫اﻻﻋﺘﺒﺎر‬ ‫ﺑﻌﻴﻦ‬
‫اﻟﻄﺒﻲ‬ ‫اﻟﺘﻌﺮض‬
‫א‬
‫א‬
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‫اﻹﺵﻌﺎﻋﻴﺔ‬ ‫اﻟﻤﻌﺎﻟﺠﺔ‬
•‫اﻷﻡﺎن‬ ‫ﻥﻈﺮ‬ ‫وﺝﻬﺔ‬ ‫ﻡﻦ‬ ‫ﻥﻮﻋﻬﺎ‬ ‫ﻡﻦ‬ ‫ﻓﺮیﺪة‬ ‫اﻹﺷﻌﺎﻋﻴﺔ‬ ‫اﻟﻤﻌﺎﻟﺠﺔ‬
‫ﺑﺴﺒﺐ‬ ‫اﻹﺷﻌﺎﻋﻲ‬: ‫ﻲ‬
–‫ﻋﺎﻟﻴﺔ‬ ‫ﺝﺮع‬ ‫ﺕﻌﻄﻲ‬ ‫اﻟﺘﻲ‬ ‫اﻟﻤﺸﻌﺔ‬ ‫ﻟﻠﻤﺼﺎدر‬ ‫اﻟﻮﺡﻴﺪ‬ ‫اﻻﺳﺘﺨﺪام‬ ‫ﺕﻤﺜﻞ‬
‫اﻟﺒﺸﺮي‬ ‫ﻟﻠﺠﺴﻢ‬ ‫ﻣﻘﺼﻮد‬ ‫ﺑﺸﻜﻞ‬.
–‫أﻳﻀﺎ‬ ‫وﻟﻜﻦ‬ ‫إﺵﻌﺎﻋﻴﺔ‬ ‫ﺝﺮع‬ ‫ﻳﺘﻠﻘﻰ‬ ‫اﻟﺬي‬ ‫اﻟﻮﺡﻴﺪ‬ ‫هﻮ‬ ‫اﻟﻮرم‬ ‫ﻟﻴﺲ‬
‫اﻟﻮرم‬ ‫ﺝﺮﻋﺔ‬ ‫ﻣﻊ‬ ‫ﻣﻘﺎرﻧﺘﻬﺎ‬ ‫ﻳﻤﻜﻦ‬ ‫ﺝﺮﻋﺔ‬ ‫ﺕﺘﻠﻘﻰ‬ ‫اﻟﺴﻠﻤﻴﺔ‬ ‫اﻟﻨﺴﺞ‬.
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‫؟؟؟‬ ‫اﻹﺵﻌﺎﻋﻴﺔ‬ ‫اﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﻓﻲ‬ ‫ﻣﺆﺳﻔﺔ‬ ‫ﺡﻮادث‬ ‫وﻗﻮع‬ ‫اﻟﻤﻜﻦ‬ ‫ﻣﻦ‬ ‫هﻞ‬
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‫ﻟﻬﺎ‬ ‫ﻳﺘﻌﺮض‬ ‫اﻟﺘﻲ‬ ‫اﻟﺤﻮادث‬ ‫ﻋﻦ‬ ‫اﻟﻨﺎﺕﺠﺔ‬ ‫اﻟﺘﻌﺮﺿﺎت‬ ‫هﻲ‬ ‫ﻣﺎ‬
‫ﺑﺎﻹﺵﻌﺎع؟‬ ‫اﻟﻤﻌﺎﻟﺠﻮن‬ ‫اﻟﻤﺮﺿﻰ‬
•‫اﻹﺷﻌﺎﻋﻴﺔ‬ ‫اﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﻓﻲ‬:
–‫إﺵﻌﺎﻋﻴﺔ‬ ‫ﻣﻌﺎﻟﺠﺔ‬ ‫إﺝﺮاء‬ ‫هﻮ‬ ‫اﻹﺵﻌﺎﻋﻲ‬ ‫ﻟﻠﺘﻌﺮض‬ ‫اﻟﻄﺒﻴﻌﻴﺔ‬ ‫اﻟﺤﺎﻟﺔ‬‫ﻲ‬ ‫ﻹ‬
‫اﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﻣﻠﻒ‬ ‫ﻓﻲ‬ ‫ﻣﻮﺹﻮﻓﺔ‬ ‫ﻟﺨﻄﺔ‬ ً‫ﺎ‬‫وﻓﻘ‬.
–‫ﺡﺎدث‬ ‫ﻋﻦ‬ ‫اﻟﻨﺎﺕﺞ‬ ‫اﻟﺘﻌﺮض‬An accidental exposure‫هﻮ‬
‫ﻳﻘﻊ‬ ‫واﻟﺬي‬ ‫اﻟﻄﺒﻴﺔ‬ ‫اﻟﻮﺹﻔﺔ‬ ‫ﻓﻲ‬ ‫اﻟﻮارد‬ ‫ﻏﻴﺮ‬ ‫ﻟﻺﺵﻌﺎع‬ ‫اﻟﺘﻌﺮض‬ ‫ذﻟﻚ‬
‫اﻹﺵﻌﺎﻋﻴﺔ‬ ‫اﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺕﻄﺒﻴﻖ‬ ‫ﻣﺮاﺡﻞ‬ ‫ﻣﻦ‬ ‫ﻣﺎ‬ ‫ﻣﺮﺡﻠﺔ‬ ‫ﻓﻲ‬.
•‫یﺤﺪث‬ ‫أن‬ ‫یﻤﻜﻦ‬ ‫اﻟﻤﻮﺻﻮﻓﺔ‬ ‫اﻟﺠﺮع‬ ‫ﻗﻴﻤﺔ‬ ‫ﻡﻦ‬ ‫اﻷﻗﻞ‬ ‫اﻟﺠﺮﻋﺎت‬‫ی‬ ‫ن‬ ‫ﻦ‬ ‫ی‬ ‫ﻮ‬ ‫ﻮ‬ ‫ﺠﺮع‬ ‫ﻴ‬ ‫ﻦ‬ ‫ﻞ‬ ‫ﻷ‬ ‫ﺠﺮ‬
‫ﺿﻤﻦ‬ ‫ﻡﻦ‬ ‫ﺗﻌﺪ‬ ‫أن‬ ‫ویﻤﻜﻦ‬ ‫ﻟﻠﻤﺮیﺾ‬ ‫ﺑﺎﻟﻨﺴﺒﺔ‬ ‫هﺎﻡﺔ‬ ‫ﻥﺘﺎﺋﺞ‬ ‫ﻋﻨﻬﺎ‬
‫اﻹﺷﻌﺎﻋﻴﺔ‬ ‫اﻟﺤﻮادث‬.
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10. Radiation Accident in Brachytherapy 01/27/2015
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‫ﺤﺎﺩﺙ‬ ‫ﻭﻗﻭﻉ‬ ‫ﺤﺎل‬ ‫ﻓﻲ‬ ‫ﻴﺘﺄﺜﺭﻭﻥ‬ ‫ﺍﻟﺘﻲ‬ ‫ﺍﻷﺸﺨﺎﺹ‬ ‫ﻫﻡ‬ ‫ﻤﻥ‬
‫ﺍﻹﺸﻌﺎﻋﻴﺔ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﻤﺠﺎل‬ ‫ﻓﻲ‬ ‫ﺇﺸﻌﺎﻋﻲ‬
.1‫ﺍﻟﻨﺎﺱ‬ ‫ﻋﻤﻭﻡ‬Members of the general public
–‫ﺍﻹﺸﻌﺎﻋﻴﺔ‬ ‫ﻭﺍﻟﻭﻗﺎﻴﺔ‬ ‫ﺍﻷﻤﺎﻥ‬ ‫ﻨﻅﻡ‬ ‫ﺘﺄﺴﻴﺱ‬ ‫ﻓﻲ‬ ‫ﻟﺨﻠل‬ ‫ﻜﻨﺘﻴﺠﺔ‬ ‫ﻟﻺﺸﻌﺎﻉ‬ ‫ﺘﻌﺭﺽ‬‫ﻴ‬ ‫ﺍﻹ‬ ‫ﻴ‬ ‫ﻭ‬ ‫ﻭﺍ‬ ‫ﻥ‬ ‫ﺍﻷ‬ ‫ﻡ‬ ‫ﻴﺱ‬ ‫ﻲ‬ ‫ل‬ ‫ﻴﺠ‬ ‫ﻉ‬ ‫ﻺ‬ ‫ﺭﺽ‬
)‫ﺍﻟﻤﺜﺎل‬ ‫ﺴﺒﻴل‬ ‫ﻋﻠﻰ‬ ‫ﺍﻟﺒﻨﺎﺀ‬ ‫ﺘﺩﺭﻴﻊ‬ ‫ﻓﻲ‬ ‫ﻀﻌﻑ‬(
.2‫ﺍﻟﻌﺎﻤﻠﻭﻥ‬Clinical staff
–‫ﺃﻭ‬ ،‫ﺍﻟﻤﺭﻀﻰ‬ ‫ﻤﻌﺎﻟﺠﺔ‬ ‫ﺃﻭ‬ ‫ﺍﻟﻤﺸﻌﺔ‬ ‫ﺍﻟﻤﻨﺎﺒﻊ‬ ‫ﺘﺤﻀﻴﺭ‬ ‫ﺨﻼل‬ ‫ﻟﻺﺸﻌﺎﻉ‬ ‫ﺘﻌﺭﺽ‬
‫ﺃﺨﺭﻯ‬ ‫ﺨﺩﻤﺎﺕ‬ ‫ﺃﻴﺔ‬ ‫ﺃﻭ‬ ‫ﺍﻟﻤﻨﺒﻊ‬ ‫ﺘﺒﺩﻴل‬ ‫ﺃﻭ‬ ‫ﺍﻟﺼﻴﺎﻨﺔ‬ ‫ﺃﻭ‬ ‫ﺍﻟﺘﺭﻜﻴﺏ‬ ‫ﺨﻼل‬
‫ﻟﻠﺘﺠﻬﻴﺯﺍﺕ‬.
.3‫ﺍﻟﻤﺭﻀﻰ‬:‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺨﻼل‬ ‫ﺘﺄﺫﻱ‬Patient injured during treatment
01/27/2015 19Osama Anjak
‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺨﻼل‬ ‫ﺤﺎﺩﺙ‬ ‫ﻋﻥ‬ ‫ﻨﺎﺘﺞ‬ ‫ﺍﻟﻤﺭﻴﺽ‬ ‫ﺘﺄﺫﻱ‬
Necrosis in area of prior
surgical scar
June 4, 01
Dec 1, 01
Dose 50 Gy Co60 +
Boost 1x2.5 Gy 8 MeV +
Accident (on Feb. 2001)
Oct, 01
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‫ﺍﻹﺸﻌﺎﻋﻴﺔ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﻓﻲ‬ ‫ﺍﻟﺤﻭﺍﺩﺙ‬ ‫ﻭﻗﻭﻉ‬ ‫ﺇﻤﻜﺎﻨﻴﺔ‬
Potential for an accident in Radiotherapy
•‫ﻤﻌﻘﺩﺓ‬ ‫ﻋﻤﻠﻴﺔ‬ ‫ﺍﻹﺸﻌﺎﻋﻴﺔ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺇﻥ‬‫ﻤﺎ‬ ‫ﹰ‬‫ﺎ‬‫ﻨﻭﻋ‬‫ﻤﺭﺍﺤﻠﻬﺎ‬ ‫ﺒﻜﺎﻓﺔ‬.
‫ﻜﺔ‬ ‫ﺸﺎ‬ ‫ﺍﻟ‬ ‫ﺘﺘﻁﻠ‬ •‫ﺒﻴﻥ‬ ‫ﺍﻟﻤﺸﺎﺭﻜﺔ‬ ‫ﺘﺘﻁﻠﺏ‬:
–‫ﺍﻻﺨﺘﺼﺎﺼﺎﺕ‬ ‫ﻤﻥ‬ ‫ﻋﺩﺩ‬
–‫ﺍﻟﺨﻁﻭﺍﺕ‬ ‫ﻤﻥ‬ ‫ﺒﻌﺩﺩ‬ ‫ﺘﻤﺭ‬‫ﻭ‬‫ﺍﻟ‬‫ﻤﺭﺍﺤل‬‫ﺇﻟﻰ‬ ‫ﻟﻠﻭﺼﻭل‬‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬
–‫ﺍﻟﻤﺘﻐﻴﺭﺓ‬ ‫ﺍﻟﻤﻌﺎﻤﻼﺕ‬ ‫ﻤﻥ‬ ‫ﺍﻟﻌﺩﻴﺩ‬ ‫ﻤﻊ‬)،‫ﺍﻟﻤﺭﻴﺽ‬ ‫ﺴﻤﺎﻜﺔ‬ ،‫ﺍﻟﻭﺭﻡ‬ ‫ﺃﺒﻌﺎﺩ‬
‫ﺍﻟﻤﺭﻴﺽ‬ ‫ﻭﻀﻌﻴﺔ‬.(....
‫ﹰ‬ •‫ﺤﻭﺍﻟﻲ‬ ‫ﻋﻠﻰ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺘﻁﺒﻴﻕ‬ ‫ﻋﻠﻰ‬ ‫ﺍﻹﺸﻌﺎﻋﻴﺔ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﻓﻨﻲ‬ ‫ﻴﻌﻤل‬ ‫ﹰ‬‫ﺎ‬‫ﺃﻴﻀ‬
50‫ﺒﺎﻟﻴﻭﻡ‬ ‫ﻤﺭﻴﺽ‬.‫ﻤﺭﻴﺽ‬ ‫ﻤﻥ‬ ‫ﻤﺨﺘﻠﻑ‬ ‫ﺍﻵﺨﺭ‬ ‫ﻭﺒﻌﻀﻬﺎ‬ ‫ﻤﺘﺸﺎﺒﻪ‬ ‫ﺒﻌﻀﻬﺎ‬
‫ﺒﺎﻟﻤﺭﻴﺽ‬ ‫ﺍﻟﺨﺎﺼﺔ‬ ‫ﺍﻷﺩﻭﺍﺕ‬ ‫ﻟﺒﻌﺽ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺘﺤﺘﺎﺝ‬ ‫ﻭﻏﺎﻟﺒﺎ‬ ‫ﻷﺨﺭ‬
)،‫ﺘﺜﺒﻴﺕ‬ ‫ﺃﺩﻭﺍﺕ‬ ،‫ﺤﻤﺎﻴﺔ‬(....
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‫ﺍﻹﺸﻌﺎﻋﻴﺔ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﻓﻲ‬ ‫ﺍﻟﺤﻭﺍﺩﺙ‬ ‫ﻭﻗﻭﻉ‬ ‫ﺇﻤﻜﺎﻨﻴﺔ‬
Potential for an accident in Radiotherapy
‫اﻟ‬‫ﺘﺸﺨﻴﺺ‬
‫اﻹﺵﻌﺎﻋﻴﺔ‬ ‫اﻟﻤﻌﺎﻟﺠﺔ‬
‫اﻻﺳﺘﻘﺒﺎل‬
‫اﻟﺘﺨﻄﻴﻂ‬
)‫اﻟﻤﺤﺎآﺎة‬(
‫اﻟﺘﺨﻄﻴﻂ‬
)TPS(
‫اﻟﺠﺮع‬ ‫ﻗﻴﺎس‬
‫اﻟﺘﺠﻬﻴﺰات‬ ‫اﺥﺘﻴﺎر‬
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‫ﺍﻹﺸﻌﺎﻋﻴﺔ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﻓﻲ‬ ‫ﺍﻟﺤﻭﺍﺩﺙ‬ ‫ﻭﻗﻭﻉ‬ ‫ﺇﻤﻜﺎﻨﻴﺔ‬
Potential for an accident in Radiotherapy
•‫ﺍﻹﺠﺭﺍﺀﺍﺕ‬ ،‫ﺍﻟﺘﻘﻨﻴﺎﺕ‬ ،‫ﺍﻟﺘﺠﻬﻴﺯﺍﺕ‬ ‫ﻓﻲ‬ ‫ﺍﻟﺘﻌﻘﻴﺩ‬ ‫ﺒﺴﺒﺏ‬
‫ﻏ‬ ‫ﺃ‬ ‫ﺎ‬ ‫ﺍ‬ ‫ﻔ‬ ‫ﺍﻟ‬ ‫ﺃ‬ ‫ﻁﺎ‬ ‫ﺍﻷ‬ ‫ﺎ‬ ‫ﺍ‬ ‫ﺫ‬ ‫ﺄ‬ ‫ﺃ‬ –‫ﻏﻴﺭ‬ ‫ﻤﻥ‬ ‫ﺃﻨﻪ‬ ‫ﻜﻤﺎ‬ ‫ﺍﻟﻬﻔﻭﺍﺕ‬ ‫ﺃﻭ‬ ‫ﺍﻷﺨﻁﺎﺀ‬ ‫ﺍﻻﻋﺘﺒﺎﺭ‬ ‫ﺒﻌﻴﻥ‬ ‫ﻨﺄﺨﺫ‬ ‫ﺃﻥ‬ ‫ﻴﺠﺏ‬
‫ﻨﻘﺼﺎﻥ‬ ‫ﺃﻭ‬ ‫ﺯﻴﺎﺩﺓ‬ ‫ﺇﻟﻰ‬ ‫ﻴﺅﺩﻱ‬ ‫ﺨﻁﺄ‬ ‫ﺃﻱ‬ ‫ﺒﺤﺩﻭﺙ‬ ‫ﺍﻟﺴﻤﺎﺡ‬ ‫ﺍﻟﻤﺤﺘﻤل‬
‫ﺍﻟﺠﺭﻋﺔ‬.
•‫ﻟﻸﺨﻁﺎﺀ‬ ‫ﻭﺤﺴﺎﺴﻴﺘﻬﺎ‬ ‫ﺍﻹﺸﻌﺎﻋﻴﺔ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﻓﻲ‬ ‫ﺍﻟﺘﻌﻘﻴﺩ‬ ‫ﺒﺴﺒﺏ‬
‫ﻟﻠﺤﻅ‬ ‫ﺸﻲﺀ‬ ‫ﺃﻱ‬ ‫ﻨﺩﻉ‬ ‫ﻻ‬ ‫ﺃﻥ‬ ‫ﻓﻴﺠﺏ‬ ‫ﻭﺍﻟﻬﻔﻭﺍﺕ‬
–‫ﻤﻁﻠﻭﺏ‬ ‫ﻫﻭ‬ ‫ﻟﻤﺎ‬ ًً‫ﹰ‬‫ﺎ‬‫ﻭﻓﻘ‬ ‫ﻴﺘﻡ‬ ‫ﺃﻥ‬ ‫ﻴﺠﺏ‬ ‫ﻭﺍﻟﺘﺭﺘﻴﺒﺎﺕ‬ ‫ﺍﻟﺒﻨﻴﺔ‬ ‫ﻜﺎﻤل‬.
•‫ﺒﺎﻟﻌﻤﻕ‬ ‫ﺍﻟﺩﻓﺎﻉ‬ ‫ﻤﺒﺩﺃ‬ ‫ﺘﻁﺒﻴﻕ‬ ‫ﻴﺠﺏ‬Defence in Depth
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‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﻓﻲ‬ ‫ﺍﻹﺸﻌﺎﻋﻴﺔ‬ ‫ﺍﻟﺤﻭﺍﺩﺙ‬
‫ﺍﻹﺸﻌﺎﻋﻴﺔ‬
‫ﺍﻟﻤﺭﺘﺒﻁﺔ‬ ‫ﺍﻟﺤﻭﺍﺩﺙ‬
‫ﺒﺎﻟﺘﺠﻬﻴﺯﺍﺕ‬
‫ﺍﻟﻤﺭﺘﺒﻁﺔ‬ ‫ﺍﻟﺤﻭﺍﺩﺙ‬
‫ﺒﺎﻟﻤﺭﻴﺽ‬
‫اﻟﻤﺮیﺾ‬ ‫ﻋﻠﻰ‬ ‫ﻓﻘﻂ‬ ‫اﻟﺘﺄﺛﻴﺮ‬‫ﻋﻠﻰ‬ ‫اﻟﺘﺄﺛﻴﺮ‬‫ﻡﻦ‬ ‫آﺒﻴﺮ‬ ‫ﻋﺪد‬
‫اﻟﻤﺮﺿﻰ‬
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‫ﺒﻌﺽ‬‫ﺍﻟﺭﺌﻴﺴﻴﺔ‬ ‫ﺍﻟﺤﻭﺍﺩﺙ‬
patients
b blCountry approx. dates
patients
affected
probable cause
USA 1974-76 450 Mistake in drawing decay curves for 60Co
Germany 1986-87 86
Error in dose tables 60Co for treatment
planning
(varying overdoses)
United
Kingdom
1988 207
Mistake in calibration 60Co beam (25%
overdoses)
Spain 1990 27
Wrong repair (maintenance LINAC)
l f
Spain 1990 27
Failure of communication
United
Kingdom
1982-91 1045
Error in the use of a treatment planning
system (TPS)
(5-30% underdoses)
01/27/2015 25Osama Anjak
‫ﺒﻌﺽ‬‫ﺍﻟﺭﺌﻴﺴﻴﺔ‬ ‫ﺍﻟﺤﻭﺍﺩﺙ‬
Recent accidents in radiotherapy in France.
Where Year/period
Patients
involved
Case 1 2003 1
Case 2 2004 1
Case 3 2004 1
Case 4 1 May 2004 May 2005 24Case 4.1 May 2004–May 2005 24
Case 4.2 2001–2006 397
Case 4.3 1987–2000 312
Case 5 April 2006–April 2007 145
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‫ﺍﻹﺸﻌﺎﻋﻴﺔ‬ ‫ﺍﻟﺤﻭﺍﺩﺙ‬ ‫ﻤﻥ‬ ‫ﺍﻟﻤﺴﺘﻔﺎﺩﺓ‬ ‫ﺍﻟﺩﺭﻭﺱ‬
•‫ﺍﻟﻤﺤﺎﻭﺭ‬ ‫ﻋﻠﻰ‬ ‫ﺍﻟﺤﻭﺍﺩﺙ‬ ‫ﻤﻥ‬ ‫ﺍﻟﻤﺴﺘﻔﺎﺩﺓ‬ ‫ﺍﻟﺩﺭﻭﺱ‬ ‫ﺘﺘﻭﺯﻉ‬‫ﻭﺭ‬ ‫ﻰ‬ ‫ﻭ‬ ‫ﻥ‬ ‫ﺭﻭﺱ‬ ‫ﻭﺯﻉ‬
‫ﺍﻟﺘﺎﻟﻴﺔ‬:
.1‫ﻭﺍﻟﺘﺠﻬﻴﺯﺍﺕ‬ ‫ﺍﻟﻌﺎﻤﻠﻭﻥ‬Workers and Equipment.
‫ﺔ‬ .2‫ﺍﻟﺒﺸﺭﻴﺔ‬ ‫ﺍﻟﻌﻭﺍﻤل‬Human Factors.
.3‫ﺍﻟﺘﺩﺭﻴﺏ‬Training.
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1.‫ﻭﺍﻟﺘﺠﻬﻴﺯﺍﺕ‬ ‫ﺍﻟﻌﺎﻤﻠﻭﻥ‬Workers&Equipment
•ً‫ا‬‫ﺝﻴﺪ‬ ‫وﻡﺆهﻞ‬ ‫ﻡﺪرب‬ ‫ﻃﺎﻗﻢ‬ ‫ﻋﻠﻰ‬ ‫اﻹﺷﻌﺎﻋﻴﺔ‬ ‫اﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﻗﺴﻢ‬ ‫یﺤﺘﺎج‬
‫یﺘﻮاﻓﻖ‬ ‫أن‬ ‫ویﺠﺐ‬‫واﻷﺝﻬﺰة‬ ‫اﻟﻌﺎﻣﻠﻴﻦ‬ ‫ﻋﺪد‬‫ﻡﻊ‬‫اﻟﻤﺮﺿﻰ‬ ‫ﻋﺪد‬
‫ﺔ‬ ‫ﺎﻟ‬ ‫اﻟ‬ ‫ﺔ‬ ‫ﻃ‬‫اﻟﻤﻌﺎﻟﺠﺔ‬ ‫وﻃﺒﻴﻌﺔ‬.
•‫ﺗﻘﻠﻴﻞ‬ ‫إن‬‫واﻷﺝﻬﺰة‬ ‫اﻟﻌﺎﻡﻠﻴﻦ‬ ‫ﻋﺪد‬‫اﺣﺘﻤﺎل‬ ‫ﻡﻦ‬ ‫یﺰیﺪ‬ ‫أن‬ ‫یﻤﻜﻦ‬
‫ﺑﺴﺐ‬ ‫وذﻟﻚ‬ ‫اﻷﺧﻄﺎء‬ ‫وارﺗﻜﺎب‬ ‫اﻹﺷﻌﺎﻋﻴﺔ‬ ‫اﻟﺤﻮادث‬ ‫وﻗﻮع‬
‫اﻟﻌﻤﻞ‬ ‫ﺿﻐﻂ‬.
•‫ﻋﻨﺪ‬ ‫وﺧﺎﺻﺔ‬ ‫وﺗﺪریﺒﻬﻢ‬ ‫اﻟﻌﺎﻡﻠﻴﻦ‬ ‫ﺗﻘﻴﻢ‬ ‫إﻋﺎدة‬ ‫اﻟﻀﺮوري‬ ‫ﻡﻦ‬‫ﻢ‬ ‫ﻢ‬ ‫ي‬
‫اﻟﺒﺪء‬ ‫أو‬ ‫ﺝﺪیﺪة‬ ‫ﺗﺠﻬﻴﺰات‬ ‫ﺗﺮآﻴﺐ‬ ‫أو‬ ‫اﻟﻤﺮﺿﻰ‬ ‫ﻋﺪد‬ ‫زیﺎدة‬
‫ﺑﻌﺾ‬ ‫ﻓﻲ‬ ‫ﺗﻌﺪیﻞ‬ ‫إﺝﺮاء‬ ‫أو‬ ‫اﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﻓﻲ‬ ‫ﺝﺪیﺪة‬ ‫ﺗﻘﻨﻴﺎت‬ ‫ﺑﺘﻄﺒﻴﻖ‬
‫اﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺣﺎﻻت‬.
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2.‫ﺍﻟﺒﺸﺭﻴﺔ‬ ‫ﺍﻟﻌﻭﺍﻤل‬Human Factors
•‫اﻟﻌﺎﻡﻠﻴﻦ‬ ‫أداء‬ ‫ﻋﻠﻰ‬ ً‫ا‬‫آﺜﻴﺮ‬ ‫اﻹﺷﻌﺎﻋﻴﺔ‬ ‫اﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺗﻌﺘﻤﺪ‬.
•‫واﻟﻤﺮاﺣﻞ‬ ‫اﻟﺨﻄﻮات‬ ‫ﻡﻦ‬ ً‫ا‬‫آﺜﻴﺮ‬ ‫اﻹﺷﻌﺎﻋﻴﺔ‬ ‫اﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺗﺘﻀﻤﻦ‬‫ﻞ‬ ‫ﺮ‬ ‫و‬ ‫ﻮ‬ ‫ﻦ‬ ‫ﻴﺮ‬ ‫ﻴ‬ ‫ﻹ‬ ‫ﺠ‬ ‫ﻦ‬
‫اﻟﻮاﺣﺪ‬ ‫اﻟﻴﻮم‬ ‫ﻓﻲ‬ ‫اﻟﻤﺮات‬ ‫ﻡﻦ‬ ‫ﻋﺪد‬ ‫أو‬ ً‫ﺎ‬‫یﻮﻡﻴ‬ ‫إﻥﺠﺎزهﺎ‬ ‫یﺠﺐ‬ ‫اﻟﺘﻲ‬
ً‫ﺎ‬‫ﻃﻔﻴﻔ‬ ‫اﻻﺧﺘﻼف‬ ‫یﻜﻮن‬ ً‫ﺎ‬‫وأﺣﻴﺎﻥ‬ ‫ﻵﺧﺮ‬ ‫ﻡﺮیﺾ‬ ‫ﻡﻦ‬ ‫ﺗﺨﺘﻠﻒ‬ ‫وهﻲ‬
‫اﻟﺤﺎﻻت‬ ‫ﺑﻌﺾ‬ ‫ﻓﻲ‬.
•‫ﻹﻥﺠﺎز‬ ‫اﻟﻌﺎﻡﻠﻴﻦ‬ ‫ﻡﻦ‬ ‫ﻃﺎﻗﻢ‬ ‫ﺗﻮﻓﺮ‬ ‫یﺠﺐ‬ ‫اﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﻡﺮاﺣﻞ‬ ‫آﺎﻓﺔ‬ ‫ﻓﻲ‬
‫ﺎ‬ ‫ﺈ‬ ‫ﺎ‬ ‫آﻞ‬ ‫ﻞ‬ ‫اﻟ‬‫ﻪ‬ ‫ﺎ‬ ‫ﻻﺥﺘ‬ ً‫ﺎ‬‫ﻓﻘ‬ ‫ﻨﻪ‬ ‫ﺰ‬ ‫ﺑﺈﻥﺠﺎز‬ ‫یﺴﺎهﻢ‬ ‫ﻡﻨﻬﻢ‬ ‫آﻞ‬ ‫اﻟﻌﻤﻞ‬‫ﻻﺥﺘﺼﺎﺹﻪ‬ ‫وﻓﻘﺎ‬ ‫ﻣﻨﻪ‬ ‫ﺝﺰء‬
‫ﻋﺎﻟﻴﺔ‬ ‫ﺑﺪﻗﺔ‬ ‫أﻋﻤﺎﻟﻬﻢ‬ ‫إﻥﺠﺎز‬ ‫ﻋﻠﻴﻬﻢ‬ ‫ویﺠﺐ‬ ‫ﺑﻪ‬ ‫اﻟﻤﻜﻠﻒ‬ ‫واﻟﻌﻤﻞ‬.
01/27/2015 29Osama Anjak
2.‫ﺍﻟﺒﺸﺭﻴﺔ‬ ‫ﺍﻟﻌﻭﺍﻤل‬Human Factors
•‫ﻓﻲ‬‫ﻓﻲ‬ ‫ﺍﻵﺨﺭﻴﻥ‬ ‫ﻋﻠﻰ‬ ‫ﺍﻻﻋﺘﻤﺎﺩ‬ ‫ﺤﺎل‬
‫ﺍﻷﻋﻤﺎل‬ ‫ﺇﻨﺠﺎﺯ‬‫ﻭ‬‫ﻋﻨﺼﺭ‬ ‫ﺒﺭﻭﺯ‬‫ﺍﻹﺘﻜﺎﻟﻴﺔ‬ ‫ل‬ ‫ﺯ‬ ‫ﺠ‬ ‫ﺇ‬‫ﻭ‬‫ﺭ‬ ‫ﺒﺭﻭﺯ‬‫ﻴ‬ ‫ﻹ‬
‫ﺍﻟﻌﺎﻤﻠﻴﻥ‬ ‫ﻤﺠﻤﻭﻋﺔ‬ ‫ﺒﻴﻥ‬
•‫ﻋﻠﻴﺔ‬ ‫ﺒﺩﻗﺔ‬ ‫ﺍﻷﻋﻤﺎل‬ ‫ﺇﻨﺠﺎﺯ‬ ‫ﻋﺩﻡ‬.
•‫ﹰ‬‫ﺍ‬‫ﻜﺒﻴﺭ‬ ‫ﻋﻠﻴﻬﻡ‬ ‫ﺍﻟﻌﻤل‬ ‫ﻀﻐﻁ‬
•‫ﺍﻟﺘﻜﻠﻴﻑ‬‫ﻋﻥ‬ ‫ﺒﻌﻴﺩﺓ‬ ‫ﺇﻀﺎﻓﻴﺔ‬ ‫ﺒﺄﻋﻤﺎل‬
‫ﺍﻷﺴﺎﺴﻲ‬ ‫ﺍﺨﺘﺼﺎﺼﻬﻡ‬
ً
‫ﻛﺒﲑﺍ‬ ‫ﺍﳊﻮﺍﺩﺙ‬ ‫ﻭﻗﻮﻉ‬ ‫ﺍﺣﺘﻤﺎﻝ‬ ‫ﻳﺼﺒﺢ‬
‫یﺮﺗﻜﺒﻮا‬ ‫أن‬ ‫یﻤﻜﻦ‬ ً‫ا‬‫ﺝﻴﺪ‬ ‫واﻟﻤﺆهﻠﻴﻦ‬ ‫اﻟﻤﺪرﺏﻴﻦ‬ ‫اﻷﺷﺨﺎص‬ ‫أن‬ ‫یﻼﺡﻆ‬ ‫ﻡﺎ‬ ً‫ﺎ‬‫وﻏﺎﻟﺒ‬
‫وﺥﺎﺻﺔ‬ ‫اﻷﺥﻄﺎء‬‫ﻋﻨﺪ‬‫اﻷﻋﻤﺎل‬ ‫ﻓﻲ‬ ً‫ا‬‫ﺝﻴﺪ‬ ‫اﻟﺘﺪﻗﻴﻖ‬ ‫وﻋﺪم‬ ‫اﻟﺬات‬ ‫ﻋﻠﻰ‬ ‫اﻻﻋﺘﻤﺎد‬
‫ﺏﻬﺎ‬ ‫یﻘﻮﻡﻮن‬ ‫اﻟﺘﻲ‬
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‫ﺍﻹﺸﻌﺎﻋﻴﺔ‬ ‫ﺍﻟﺤﻭﺍﺩﺙ‬ ‫ﻭﻗﻭﻉ‬ ‫ﻤﻥ‬ ‫ﻭﺍﻟﺘﻘﻠﻴل‬ ‫ﺍﻷﺨﻁﺎﺀ‬ ‫ﺘﻼﻓﻲ‬
.1‫واﻟﺘﺄآﺪ‬ ‫اﻟﻘﺒﻮل‬ ‫اﺧﺘﺒﺎرات‬ ‫وإﺝﺮاء‬ ‫ﺝﻴﺪ‬ ‫ﺑﺸﻜﻞ‬ ‫اﻟﺘﺠﻬﻴﺰات‬ ‫اﺱﺘﻼم‬
‫ﻟﻠﻌﻤﻞ‬ ‫وﺝﺎهﺰیﺘﻬﺎ‬ ‫أداهﺎ‬ ‫دﻗﺔ‬ ‫ﻡﻦ‬.
.2‫اﻹﺷﻌﺎﻋﻴﺔ‬ ‫واﻟﺤﺰم‬ ‫اﻟﻤﺸﻌﺔ‬ ‫ﻟﻠﻤﺼﺎدر‬ ‫اﻟﺪوریﺔ‬ ‫اﻟﻤﻌﺎیﺮات‬ ‫إﺝﺮاء‬
.3‫اﻟﺤﺰﻡﺔ‬ ‫وﻃﺎﻗﺔ‬ ‫اﻟﺠﺮﻋﺔ‬ ‫ﻡﻦ‬ ‫اﻟﺘﺄآﺪ‬ ‫ﺑﻌﺪ‬ ‫إﻻ‬ ‫اﻟﻤﻌﺎﻟﺠﺔ‬ ‫إﺝﺮاء‬ ‫ﻋﺪم‬
‫اﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﻓﻲ‬ ‫اﻟﻤﺴﺘﺨﺪﻡﺔ‬ ‫اﻹﺷﻌﺎﻋﻴﺔ‬.
.4‫ﻋﻠﻰ‬ ‫ﺗﺤﺘﻮي‬ ‫اﻟﺘﻲ‬ ‫اﻟﺘﺠﻬﻴﺰات‬ ‫أو‬ ‫اﻟﻤﺸﻌﺔ‬ ‫اﻟﻤﺼﺎدر‬ ‫ﻡﻦ‬ ‫اﻟﺘﺨﻠﺺ‬
‫ﻡﺸﻌﺔ‬ ‫ﻡﺼﺎدر‬‫ﻡﺸﻌﺔ‬ ‫ﻡﺼﺎدر‬.
.5‫ﺧﻄﺔ‬ ‫اﻋﺘﻤﺎد‬)‫ﺑﺮﺗﻮآﻮل‬(‫اﻟﻤﻌﺎﻟﺠﺔ‬.
.6‫اﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺑﺘﻄﺒﻴﻖ‬ ‫اﻟﺒﺪء‬ ‫ﻗﺒﻞ‬ ‫اﻟﻤﻌﺎﻟﺞ‬ ‫اﻟﻤﺮیﺾ‬ ‫هﻮیﺔ‬ ‫ﻡﻦ‬ ‫اﻟﺘﺤﻘﻖ‬.
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‫ﺍﻹﺸﻌﺎﻋﻴﺔ‬ ‫ﺍﻟﺤﻭﺍﺩﺙ‬ ‫ﻭﻗﻭﻉ‬ ‫ﻤﻥ‬ ‫ﻭﺍﻟﺘﻘﻠﻴل‬ ‫ﺍﻷﺨﻁﺎﺀ‬ ‫ﺘﻼﻓﻲ‬
.7‫اﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﻡﻜﺎن‬ ‫ﻡﻦ‬ ‫اﻟﺘﺤﻘﻖ‬)‫اﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺱﺎﺣﺔ‬.(
.8‫اﻟﻤﺤﺎآﻲ‬ ‫ﺑﺎﺱﺘﻌﻤﺎل‬ ‫اﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺱﺎﺣﺔ‬ ‫ﺗﺨﻄﻴﻂ‬Simulator ‫ﻲ‬
‫ﺱﺎﺣﺔ‬ ‫ﻋﻠﻰ‬ ‫ﺗﺪل‬ ‫اﻟﻤﺮیﺾ‬ ‫ﺝﺴﻢ‬ ‫ﻋﻠﻰ‬ ‫ﻓﺎرﻗﺔ‬ ‫ﻋﻼﻡﺎت‬ ‫ووﺿﻊ‬
‫اﻟﻤﻌﺎﻟﺠﺔ‬.
.9‫اﻥﺘﻬﺎء‬ ‫وﻋﻘﺐ‬ ‫اﻟﻤﺮیﺾ‬ ‫یﺘﻠﻘﺎهﺎ‬ ‫اﻟﺘﻲ‬ ‫اﻟﻴﻮﻡﻴﺔ‬ ‫اﻟﺠﺮﻋﺎت‬ ‫ﺗﺪویﻦ‬
ً‫ة‬‫ﻡﺒﺎﺷﺮ‬ ‫اﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺝﻠﺴﺔ‬
‫أ‬ ‫اﻟ‬ ‫ﻗ‬ ‫اﻟ‬ ‫اﻟ‬ ‫ﺔ‬ ‫اﻟ‬ ‫ﺎ‬ ‫اﻟ‬ .10‫أي‬ ‫اﻟﻤﺤﺪد‬ ‫اﻟﻮﻗﺖ‬ ‫ﻓﻲ‬ ‫اﻟﻤﺮیﺾ‬ ‫ﻡﻦ‬ ‫اﻟﻤﺸﻌﺔ‬ ‫اﻟﻤﺼﺎدر‬ ‫ﻥﺰع‬
‫ﻗﺮب‬ ‫ﻋﻦ‬ ‫اﻟﻤﻌﺎﻟﺠﺔ‬ ‫زﻡﻦ‬ ‫اﻥﺘﻬﺎء‬ ‫ﻋﻨﺪ‬.‫إﻟﻰ‬ ‫إﻋﺎدﺗﻬﺎ‬ ‫ویﺠﺐ‬
‫ﻡﺒﺎﺷﺮة‬ ‫ﻟﺬﻟﻚ‬ ‫اﻟﻤﺨﺼﺼﺔ‬ ‫اﻟﺤﺎویﺔ‬.
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‫ﺍﻹﺸﻌﺎﻋﻴﺔ‬ ‫ﺍﻟﺤﻭﺍﺩﺙ‬ ‫ﻭﻗﻭﻉ‬ ‫ﻤﻥ‬ ‫ﻭﺍﻟﺘﻘﻠﻴل‬ ‫ﺍﻷﺨﻁﺎﺀ‬ ‫ﺘﻼﻓﻲ‬
.11‫ذات‬ ‫اﻟﻤﻨﺎﺑﻊ‬ ‫وﺧﺎﺻﺔ‬ ‫اﻟﻤﺸﻌﺔ‬ ‫اﻟﻤﺼﺎدر‬ ‫ﺗﺨﺰیﻦ‬ ‫ﻡﻦ‬ ‫اﻟﺘﺄآﺪ‬
‫اﻟﻄﻮیﻞ‬ ‫اﻟﻌﻤﺮ‬ ‫ﻥﺼﻒ‬)Cs-137ً‫ﻼ‬‫ﻡﺜ‬.(
.12‫ﻟﻠﻤﻨﺎﺑﻊ‬ ‫اﻹﺷﻌﺎﻋﻲ‬ ‫اﻟﻨﺸﺎط‬ ‫أو‬ ‫اﻹﺷﻌﺎﻋﻴﺔ‬ ‫اﻟﺠﺮﻋﺔ‬ ‫ﻡﻌﺪل‬ ‫ﻗﻴﺎس‬
‫اﺱﺘﻌﻤﺎﻟﻬﺎ‬ ‫ﻗﺒﻞ‬ ‫اﻟﻘﺼﻴﺮ‬ ‫اﻟﻌﻤﺮ‬ ‫ﻥﺼﻒ‬ ‫ذات‬.
.13‫أو‬ ‫اﻟﺨﺎﺻﺔ‬ ‫اﻟﺤﺎﻻت‬ ‫ﺑﻌﺾ‬ ‫ﻓﻲ‬ ‫واﻻهﺘﻤﺎم‬ ‫اﻟﻌﻨﺎیﺔ‬ ‫یﺠﺐ‬
‫اﻟﻘﺴﻢ‬ ‫ﻓﻲ‬ ‫اﻟﻤﺄﻟﻮﻓﺔ‬ ‫ﻏﻴﺮ‬ ‫أو‬ ‫اﻟﻤﻌﻘﺪة‬ ‫اﻟﻤﻌﺎﻟﺠﺎت‬.
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‫ﺍﻟﺘﺩﺭﻴﺏ‬Training:
•‫ﻓﻲ‬ ‫اﻟﺒﺪء‬ ‫ﻗﺒﻞ‬ ‫اﻟﻌﺎﻡﻞ‬ ‫ﺗﻠﻘﺎﻩ‬ ‫اﻟﺬي‬ ‫ﺑﺎﻟﺘﺪریﺐ‬ ‫ﻥﻜﺘﻔﻲ‬ ‫ﻻ‬ ‫أن‬ ‫یﺠﺐ‬
،‫اﻟﺪراﺱﺔ‬ ‫ﻡﺮاﺣﻞ‬ ‫ﻓﻲ‬ ‫أو‬ ‫اﻟﻌﻤﻞ‬
•‫اﻷﻃﺒﺎء‬ ،‫اﻟﻌﺎﻡﻠﻴﻦ‬ ‫ﻟﻜﺎﻓﺔ‬ ‫ﺗﺪریﺐ‬ ‫إﺝﺮاء‬ ‫اﻟﻀﺮوري‬ ‫ﻡﻦ‬
‫ﻹﻥﺠﺎز‬ ‫وذﻟﻚ‬ ‫واﻟﺘﻤﺮیﺾ‬ ‫اﻹﺷﻌﺎﻋﻴﻴﻦ‬ ‫واﻟﻔﻨﻴﻴﻦ‬ ‫واﻟﻔﻴﺰیﺎﺋﻴﻴﻦ‬
‫ﻡﺠﺎل‬ ‫ﻓﻲ‬ ‫ﺣﺪیﺚ‬ ‫هﻮ‬ ‫ﻡﺎ‬ ‫ﻋﻠﻰ‬ ‫واﻹﻃﻼع‬ ‫ﺑﻬﺎ‬ ‫اﻟﻤﻜﻠﻔﻴﻦ‬ ‫اﻷﻋﻤﺎل‬
‫اﺧﺘﺼﺎﺻﻬﻢ‬.
•‫یﻌﺪ‬‫اﻟﻤﺴﺘﻤﺮ‬ ‫اﻟﺘﺪرﻳﺐ‬‫أﺣﺪ‬ ‫وهﻮ‬ ً‫ا‬‫ﺝﺪ‬ ‫اﻟﻀﺮوریﺔ‬ ‫اﻷﻋﻤﺎل‬ ‫ﻡﻦ‬
‫اﻹﺷﻌﺎﻋﻴﺔ‬ ‫اﻟﻮﻗﺎیﺔ‬ ‫ﺑﺮﻥﺎﻡﺞ‬ ‫ﻓﻲ‬ ‫اﻷﺱﺎﺱﻴﺔ‬ ‫اﻟﻌﻨﺎﺻﺮ‬.
•‫ﺑﺤﻀﻮر‬ ‫ﻟﻠﻌﺎﻡﻠﻴﻦ‬ ‫اﻟﺴﻤﺎح‬ ‫یﺠﺐ‬ ً‫ﺎ‬‫أیﻀ‬‫اﻟﻌﻠﻤﻴﺔ‬ ‫اﻟﻤﺆﺕﻤﺮات‬
‫اﻟﺘﺪریﺒﻴﺔ‬ ‫واﻟﺪورات‬ ‫اﻟﻤﻬﻨﻴﺔ‬ ‫واﻻﺝﺘﻤﺎﻋﺎت‬
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‫ﺘﺅﺜﺭ‬ ‫ﺃﻥ‬ ‫ﻴﻤﻜﻥ‬ ‫ﻭﺍﻟﺘﻲ‬ ‫ﺒﺎﻟﺘﺠﻬﻴﺯﺍﺕ‬ ‫ﺘﺤﺩﺙ‬ ‫ﺍﻟﺘﻲ‬ ‫ﺍﻷﻋﻁﺎل‬ ‫ﻤﻥ‬ ‫ﺃﻱ‬
‫ﺍﻟﻤﻌﺎﻟﺠﺔ؟‬ ‫ﻋﻠﻰ‬
•‫اﻹﺷﻌﺎﻋﻴﺔ‬ ‫اﻟﺠﺮع‬ ‫ﻗﻴﺎس‬ ‫ﺗﺠﻬﻴﺰات‬
–‫اﻟﻤﻌﺎﻟﺠﺔ‬ ‫أﺝﻬﺰة‬ ‫ﻣﻌﺎﻳﺮة‬)‫اﻟﻤﺼﺪر‬ ‫ﺵﺪة‬ ‫أو‬ ‫اﻟﺠﺮﻋﺔ‬ ‫ﻣﻌﺪل‬ ‫)ﻗﻴﺎس‬
‫اﻟﻤﺸﻊ‬.(
•‫اﻟﻤﺤﺎآﺎة‬ ‫ﺝﻬﺎز‬Treatment simulator
•‫اﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺗﺨﻄﻴﻂ‬ ‫ﻥﻈﺎم‬Treatment planning system
–‫اﻟﺒﺮﻣﺠﻴﺎت‬ ‫ﻓﻬﻢ‬ ‫ﻓﻲ‬ ‫ﻧﻘﺺ‬ ،‫ﺥﺎﻃﺊ‬ ‫ﺑﺸﻜﻞ‬ ‫اﻟﻤﻌﻠﻮﻣﺎت‬ ‫إدﺥﺎل‬...
•‫اﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺝﻬﺎز‬Treatment machine
–‫اﻟﺘﺮاﺑﻂ‬ ‫أﻧﻈﻤﺔ‬ ‫ﻓﻲ‬ ‫ﺥﻠﻞ‬Malfunction of interlocks
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‫ﺨﺎﻁﺌﺔ؟‬ ‫ﻨﺘﺎﺌﺞ‬ ‫ﻴﻌﻁﻲ‬ ‫ﺃﻥ‬ ‫ﺍﻟﺠﺭﻋﺔ‬ ‫ﻟﻤﻘﻴﺎﺱ‬ ‫ﻴﻤﻜﻥ‬ ‫ﻜﻴﻑ‬
•‫اﻟﻘﻴﺎس‬ ‫ﺑﻨﻈﺎم‬ ‫اﻟﻤﺮﺗﺒﻄﺔ‬ ‫اﻟﺤﻮادث‬:
.1‫اﻟﻤﺮﺝﻌﻲ‬ ‫اﻟﺠﺮﻋﺔ‬ ‫ﻟﻤﻘﻴﺎس‬ ‫اﻟﻤﻌﺎﻳﺮة‬ ‫ﻟﻤﻌﺎﻣﻞ‬ ‫ﺹﺤﻴﺢ‬ ‫ﻏﻴﺮ‬ ‫اﺳﺘﻌﻤﺎل‬‫ﻲ‬ ‫ﺢ‬
Reference dosimeter.
.2‫ﺥﺎﻃﺊ‬ ‫ﺑﺸﻜﻞ‬ ‫ﺙﺎﻧﻮي‬ ‫ﻣﻌﻴﺎر‬ ‫ﻣﻊ‬ ‫داﺥﻠﻴﺔ‬ ‫ﻣﻘﺎرﻧﺔ‬.
.3‫ﺥﺎﻃﺊ‬ ‫ﺑﺸﻜﻞ‬ ‫اﻟﺠﺮﻋﺔ‬ ‫ﻣﻘﻴﺎس‬ ‫اﺳﺘﻌﻤﺎل‬.
.4‫اﻟﻤﻌﺎﻳﺮة‬ ‫إﺝﺮاء‬ ‫ﻓﻲ‬ ‫اﻟﻌﻤﻠﻴﺔ‬ ‫اﻟﺨﺒﺮة‬ ‫ﻗﻠﺔ‬
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‫؟‬ ‫ﺨﺎﻁﺌﺔ‬ ‫ﻨﺘﺎﺌﺞ‬ ‫ﻴﻌﻁﻲ‬ ‫ﺃﻥ‬ ‫ﺍﻟﺠﺭﻋﺔ‬ ‫ﺘﺨﻁﻴﻁ‬ ‫ﻟﻨﻅﺎﻡ‬ ‫ﻴﻤﻜﻥ‬ ‫ﻫل‬
•‫ﺧﺎﻃﺊ‬ ‫ﺑﺸﻜﻞ‬ ‫اﻟﻤﻌﻠﻮﻡﺎت‬ ‫إدﺧﺎل‬.
•‫اﻟﺨﻮارزﻡﻴﺔ‬ ‫ﻓﻬﻢ‬ ‫ﻋﺪم‬)‫اﻟﺒﺮﻡﺠﻴﺎت‬.( ‫ﻴ‬ ‫رز‬ ‫ﻮ‬ ‫ﻬﻢ‬ ‫م‬)‫ﺠﻴ‬ ‫ﺒﺮ‬.(
•ٍ‫ف‬‫آﺎ‬ ‫ﻏﻴﺮ‬ ‫ﺗﺪریﺐ‬.
•‫ﻡﺆهﻞ‬ ‫ﻏﻴﺮ‬ ‫ﺷﺨﺺ‬ ‫ﻗﺒﻞ‬ ‫ﻡﻦ‬ ‫اﻟﻨﻈﺎم‬ ‫اﺱﺘﺨﺪام‬.
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‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺒﺠﻬﺎﺯ‬ ‫ﺒﺎﻷﺨﻁﺎﺀ‬ ‫ﻨﻘﻊ‬ ‫ﺃﻥ‬ ‫ﻴﻤﻜﻥ‬ ‫ﺃﻴﻥ‬‫؟‬
•‫اﻟﻘﺒﻮل‬ ‫اﺧﺘﺒﺎرات‬ ‫أو‬ ‫اﻻﺱﺘﻼم‬ ‫اﺧﺘﺒﺎرات‬.
•‫اﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺝﻬﺎز‬ ‫ﻡﻌﺎیﺮة‬. ‫ﺠ‬ ‫ز‬ ‫ﺝﻬ‬ ‫یﺮ‬.
•‫اﻟﺨﺮج‬ ‫ﺛﺒﺎﺗﻴﺔ‬ ‫اﺧﺘﺒﺎر‬)‫اﻷﺱﺒﻮﻋﻲ‬ ،‫اﻟﻴﻮﻡﻲ‬.(
•‫اﻟﺠﻬﺎز‬ ‫ﻓﻲ‬ ‫ﻃﺎرئ‬ ‫ﺧﻠﻞ‬ ‫ﺣﺪوث‬.
•‫ﺧﺎﻃﺊ‬ ‫ﺑﺸﻜﻞ‬ ‫اﻟﺠﻬﺎز‬ ‫اﺱﺘﻌﻤﺎل‬.
•‫اﻟﻘﻴﺎس‬ ‫أﺝﻬﺰة‬ ‫ﻓﻲ‬ ‫ﺧﻠﻞ‬‫اﻟﻘﻴﺎس‬ ‫أﺝﻬﺰة‬ ‫ﻓﻲ‬ ‫ﺧﻠﻞ‬.
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‫ﻗﺭﺏ‬ ‫ﻋﻥ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﻤﺠﺎل‬ ‫ﻓﻲ‬ ‫ﺍﻟﺤﻭﺍﺩﺙ‬
% No of cases Category
15 5 •‫اﻟﺘﺠﻬﻴﺰات‬ ‫ﺗﺼﻤﻴﻢ‬Equipment design
9 3 •‫اﻟﻤﺸﻌﺔ‬ ‫اﻟﻤﺼﺎدر‬Source order and delivery
15 5 •‫اﻟﻤﻌﺎیﺮة‬Calibration
18 6 •‫اﻟﻤﺼﺎدر‬ ‫ﺗﺤﻀﻴﺮ‬Preparation
34 11 •‫اﻟﺠﺮﻋﺔ‬ ‫ﺗﻮزع‬ ‫ﺗﺨﻄﻴﻂ‬Planning and dose
calculation
9 3 •‫اﻟﻤﺼﺎدر‬ ‫ﻥﺰع‬Source removal9 3 ‫اﻟﻤﺼﺎدر‬ ‫ﻥﺰع‬Source removal
33 Total
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‫ﻗﺭﺏ‬ ‫ﻋﻥ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﻤﺠﺎل‬ ‫ﻓﻲ‬ ‫ﺍﻟﺤﻭﺍﺩﺙ‬
•‫ﻡﻊ‬ ‫ﻗﺮب‬ ‫ﻋﻦ‬ ‫ﻡﻌﺎﻟﺠﺘﻬﻢ‬ ‫یﺠﺮي‬ ‫اﻟﺬیﻦ‬ ‫اﻟﻤﺮﺿﻰ‬ ‫ﻋﺪد‬ ‫ﺑﻤﻘﺎرﻥﺔ‬
‫ﻗﺮب‬ ‫ﻋﻦ‬ ‫اﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﻓﻲ‬ ‫اﻟﺤﻮادث‬ ‫ﻋﺪد‬ ‫أن‬ ‫یﻼﺣﻆ‬ ‫اﻟﺤﻮادث‬ ‫ﻋﺪد‬‫ﻲ‬
‫أآﺒﺮ‬‫ﺑـ‬10‫اﻟﺨﺎرﺝﻴﺔ‬ ‫اﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﻡﻦ‬EBRT.
•‫اﻟﻤﺸﻌﺔ‬ ‫اﻟﻤﺼﺎدر‬ ‫وﻡﻌﺎیﺮة‬ ‫اﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺗﺨﻄﻴﻂ‬
•Treatment planning and source calibration are
the most important factors in both
I l t d t th di ti •Issues related to the radioactive source are
important in brachytherapy
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‫ﺍﻟﺤﻭﺍﺩﺙ‬ ‫ﻤﻥ‬ ‫ﺍﻟﻭﻗﺎﻴﺔ‬
•‫ﺍﻟﺘﺩﺭﻴﺏ‬
•‫ﺒﺎﻟﻌﻤﻕ‬ ‫ﺍﻟﺩﻓﺎﻉ‬Defence in depth. ‫ﻕ‬ ‫ﺒ‬ ‫ﻉ‬p
•‫ﻭﺍﻟﻤﻠﻔﺎﺕ‬ ‫ﺍﻟﺘﻭﺜﻴﻕ‬Documentation.
•‫ﺍﻟﻁﻭﺍﺭﺉ‬ ‫ﺃﺩﻭﺍﺕ‬Emergency equipment.
•‫ﺍﻟﺠﻭﺩﺓ‬ ‫ﻀﻤﺎﻥ‬ ‫ﻨﻅﺎﻡ‬ ‫ﺇﺘﺒﺎﻉ‬Quality Assurance system‫ﺩﻗﻴﻕ‬
‫ﻭﺼﺎﺭﻡ‬. ‫ﺭﻡ‬
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‫ﺍﻟﺤﻭﺍﺩﺙ‬ ‫ﻤﻥ‬ ‫ﺍﻟﻭﻗﺎﻴﺔ‬–‫ﺍﻟﺘﺩﺭﻴﺏ‬
•‫اﻟﻌﺎﻡﻠﻴﻦ‬ ‫آﺎﻓﺔ‬ ‫اﻟﺘﺪریﺐ‬ ‫یﺸﻤﻞ‬ ‫أن‬ ‫یﺠﺐ‬)،‫اﻟﻄﺒﻴﺐ‬ ، ‫اﻟﻔﻴﺰیﺎﺋﻲ‬
،‫اﻟﺼﻴﺎﻥﺔ‬ ‫ﻡﻬﻨﺪس‬ ،‫اﻷﺷﻌﺔ‬ ‫ﻓﻨﻲ‬ ،‫اﻟﺘﻤﺮیﺾ‬.(..... ‫ﻲ‬(
•‫إﻟﻰ‬ ‫ﺑﺎﻹﺿﺎﻓﺔ‬ ‫ویﺸﻤﻞ‬ ‫ﺗﺨﺼﺼﻲ‬ ‫اﻟﺘﺪریﺐ‬ ‫یﻜﻮن‬ ‫أن‬ ‫یﺠﺐ‬
‫اﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺗﺨﻄﻴﻂ‬ ‫ﻥﻈﻢ‬ ‫ﻋﻠﻰ‬ ‫اﻟﺘﺠﻬﻴﺰات‬treatment
planning system.
•‫اﻟﻄﻮارئ‬ ‫ﺣﺎﻻت‬ ‫اﻟﺘﺪریﺐ‬ ‫یﺘﻀﻤﻦ‬ ‫أن‬ ‫یﺠﺐ‬–‫ﻏﻴﺮ‬ ‫اﻟﺤﺎﻻت‬
‫ﺬ‬ ‫اﻟ‬ ‫ا‬ ‫ا‬ ‫اﻹ‬ ‫ﺔ‬ ‫ﺎ‬ ‫اﻻ‬‫اﻟﻤﺘﺨﺬة‬ ‫واﻹﺝﺮاءات‬ ‫اﻻﻋﺘﻴﺎدیﺔ‬.
•‫زیﺎدة‬ ‫ﻡﻊ‬ ‫ﺱﻴﻤﺎ‬ ‫وﻻ‬ ‫اﻟﺘﺪریﺐ‬ ‫وإﺝﺮاءات‬ ‫ﻟﻠﻌﺎﻡﻠﻴﻦ‬ ‫دوري‬ ‫ﺗﻘﻴﻴﻢ‬
‫اﻟﻤﺮﺿﻰ‬ ‫ﻋﺪد‬‫و‬‫ﺝﺪیﺪة‬ ‫ﺗﺠﻬﻴﺰات‬ ‫ﻋﻠﻰ‬ ‫اﻟﺤﺼﻮل‬.
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‫ﺍﻟﺤﻭﺍﺩﺙ‬ ‫ﻤﻥ‬ ‫ﺍﻟﻭﻗﺎﻴﺔ‬–‫ﺍﻟﺘﺩﺭﻴﺏ‬
•‫ﻗﺒل‬ ‫ﻤﻥ‬ ‫ﺍﻟﺘﺩﺭﻴﺏ‬ ‫ﻤﺠﺎل‬ ‫ﻓﻲ‬ ‫ﺍﻟﻤﻌﺘﻤﺩﺓ‬ ‫ﺍﻟﺘﻭﺼﻴﺎﺕ‬ ‫ﺇﺘﺒﺎﻉ‬ ‫ﻴﺠﺏ‬
‫ﺍﻟﺼﻠﺔ‬ ‫ﺫﺍﺕ‬ ‫ﺍﻟﻬﻴﺌﺎﺕ‬.
•‫ﺍﻟﺤﻭﺍﺩﺙ‬ ‫ﺒﻌﺽ‬ ‫ﺩﺭﺍﺴﺔ‬ ‫ﻋﻠﻰ‬ ‫ﺍﻟﺘﺩﺭﻴﺏ‬ ‫ﻴﺸﺘﻤل‬ ‫ﺃﻥ‬ ‫ﻴﺠﺏ‬
‫ﻤﻨﻬﺎ‬ ‫ﻟﻠﻭﻗﺎﻴﺔ‬ ‫ﺍﻟﻼﺯﻤﺔ‬ ‫ﻭﺍﻟﺘﻭﺼﻴﺎﺕ‬ ‫ﺍﻹﺸﻌﺎﻋﻴﺔ‬.
•‫ﺇﻟﻰ‬ ‫ﺍﻹﺸﻌﺎﻋﻴﺔ‬ ‫ﺍﻟﺤﻭﺍﺩﺙ‬ ‫ﺘﺎﺭﻴﺦ‬ ‫ﺤﻭل‬ ‫ﺍﻟﻤﻌﻠﻭﻤﺎﺕ‬ ‫ﻨﻘل‬ ‫ﻴﺠﺏ‬
‫ﺍﻟﻤﺴﺘﺸﻔﻰ‬ ‫ﻓﻲ‬ ‫ﺍﻹﺩﺍﺭﻴﻴﻥ‬hospital managers.
01/27/2015 43Osama Anjak
‫ﺍﻟﺤﻭﺍﺩﺙ‬ ‫ﻤﻥ‬ ‫ﺍﻟﻭﻗﺎﻴﺔ‬–‫ﺒﺎﻟﻌﻤﻕ‬ ‫ﺍﻟﺩﻓﺎﻉ‬
•‫ﺣﻮادث‬ ‫وﻗﻮع‬ ‫دون‬ ‫واﻟﺤﻴﻠﻮﻟﺔ‬ ‫ﻟﻸﻡﺎن‬ ‫ﻥﻈﺎم‬ ‫ﻡﻦ‬ ‫أآﺜﺮ‬ ‫ﺗﻮﻓﺮ‬ ‫یﺠﺐ‬
‫إﺷﻌﺎﻋﻴﺔ‬.
–‫اﻟﻤﺜﺎل‬ ‫ﺳﺒﻴﻞ‬ ‫ﻋﻠﻰ‬:
•‫ﻤﺴﺘﻘل‬ ‫ﻭﺒﺸﻜل‬ ‫ﻓﻴﺯﻴﺎﺌﻴﻴﻥ‬ ‫ﻗﺒل‬ ‫ﻤﻥ‬ ‫ﺍﻟﻤﻌﺎﻴﺭﺍﺕ‬ ‫ﺇﺠﺭﺍﺀ‬
independent calibration،
•‫ﺍﻟﺨﺎﺭﺠﻲ‬ ‫ﺍﻟﺘﻔﺘﻴﺵ‬external audits،
•‫ﺍﻟﺩﺍﺨﻠﻴﺔ‬ ‫ﺍﻟﺠﺭﻋﺎﺕ‬ ‫ﻗﻴﺎﺱ‬ ‫ﻨﻅﺎﻡ‬ ‫ﺘﻁﺒﻴﻕ‬in vivo dosimetry، ‫ﺍﻟﺩﺍﺨﻠﻴﺔ‬ ‫ﺍﻟﺠﺭﻋﺎﺕ‬ ‫ﻗﻴﺎﺱ‬ ‫ﻨﻅﺎﻡ‬ ‫ﺘﻁﺒﻴﻕ‬in vivo dosimetry
•‫ﺍﻟﻤﻕ‬ ‫ﺍﺨﺘﺒﺎﺭﺍﺕ‬ ‫ﻓﻲ‬ ‫ﺍﻟﻤﺸﺎﺭﻜﺔ‬‫ارﻥﺔ‬TLD postal services.
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‫ﺍﻟﺤﻭﺍﺩﺙ‬ ‫ﻤﻥ‬ ‫ﺍﻟﻭﻗﺎﻴﺔ‬–‫ﺍﻟﻁﻭﺍﺭﺉ‬ ‫ﺘﺠﻬﻴﺯﺍﺕ‬
•‫اﻟﺘﺸﻐﻴﻞ‬ ‫آﺘﻴﺐ‬ ‫ﺗﻮﻓﺮ‬ ‫یﺠﺐ‬Manual‫اﻟﻌﻤﻞ‬ ‫وإﺝﺮاءات‬
procedures‫اﻟﻮﺛﺎﺋﻖ‬ ‫وآﺎﻓﺔ‬documentation‫ذات‬
‫اﻟﺼﻠﺔ‬.
•‫ﺍﻹﺸﻌﺎﻋﻴﺔ‬ ‫ﺍﻟﻤﺭﺍﻗﺒﺔ‬ ‫ﻭﺠﻬﺎﺯ‬ ‫ﺍﻹﺸﻌﺎﻋﻲ‬ ‫ﺍﻟﻤﺴﺢ‬ ‫ﻤﻘﻴﺎﺱ‬
Radiation monitor
•‫ﻤﺜل‬ ‫ﺃﺨﺭﻯ‬ ‫ﺃﺩﻭﺍﺕ‬:
–‫ﺘﻨﻅﻴﻑ‬ ‫ﺃﺩﻭﺍﺕ‬spill kit
–‫ﺭﺼﺎﺼﻴﺔ‬ ‫ﺤﺎﻭﻴﺔ‬
–‫ﺍﻟﺩﻡ‬ ‫ﺠﻤﻊ‬ ‫ﺃﺩﻭﺍﺕ‬)‫ﺍﻟﺒﻴﻭﻟﻭﺠﻴﺔ‬ ‫ﺍﻟﻤﺭﺍﻗﺒﺔ‬ ‫ﺃﺠل‬ ‫ﻤﻥ‬.(
01/27/2015 45Osama Anjak
‫ﻜﺎﻟﺔ‬ ‫ﺍﻟ‬ ‫ﻟ‬ ‫ﻠﺔ‬ ‫ﺍﻟ‬ ‫ﺙ‬ ‫ﺍ‬ ‫ﺍﻟ‬ ‫ﺽ‬‫ﺍﻟﻭﻜﺎﻟﺔ‬ ‫ﻟﺩﻯ‬ ‫ﺍﻟﻤﺴﺠﻠﺔ‬ ‫ﺍﻟﺤﻭﺍﺩﺙ‬ ‫ﺒﻌﺽ‬
‫ﺍﻟﺫﺭﻴﺔ‬ ‫ﻟﻠﻁﺎﻗﺔ‬ ‫ﺍﻟﺩﻭﻟﻴﺔ‬‫ﻓﻲ‬‫ﺘ‬‫ﺍﻷﻤﺎﻥ‬ ‫ﻘﺭﻴﺭ‬
‫ﺭﻗﻡ‬17

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‫ﺍﻟﺤﺎﺩﺙ‬1:‫ﺍﻟﻤﻌﺎﻴﺭﺓ‬ ‫ﻟﺘﻘﺭﻴﺭ‬ ‫ﺨﺎﻁﺊ‬ ‫ﺍﺴﺘﻌﻤﺎل‬
•‫ﻤﻌﺎﻴﺭﺓ‬ ‫ﺠﺭﺕ‬‫ﻤﻘﻴﺎﺱ‬‫ﺍﻹﺸﻌﺎﻋﻴﺔ‬ ‫ﺍﻟﺠﺭﻉ‬)‫ﺍﻟﺘﺄﻴﻥ‬ ‫ﺤﺠﻴﺭﺓ‬+
‫ﻘﻴﺎﺱ‬ ‫ﺍﻟ‬(‫ﻴﺔ‬ ‫ﺍﻟﺜﺎﻨ‬ ‫ﻌﺎﻴﺭﺓ‬ ‫ﺍﻟ‬ ‫ﺨﺎﺒﺭ‬ ‫ﺇﺤﺩﻯ‬ ‫ﻓ‬SSDL‫ﺭﺩ‬ ‫ﻗﺩ‬ ‫ﺍﻟﻤﻘﻴﺎﺱ‬(‫ﺍﻟﺜﺎﻨﻭﻴﺔ‬ ‫ﺍﻟﻤﻌﺎﻴﺭﺓ‬ ‫ﻤﺨﺎﺒﺭ‬ ‫ﺇﺤﺩﻯ‬ ‫ﻓﻲ‬SSDL‫ﻭﺭﺩ‬ ‫ﻭﻗﺩ‬
‫ﺍﻟﻤﻌﺎﻴﺭﺓ‬ ‫ﺸﻬﺎﺩﺓ‬ ‫ﻓﻲ‬‫ﺍﻟﻤﺎﺀ‬ ‫ﻓﻲ‬ ‫ﺠﺭﺕ‬ ‫ﺍﻟﻤﻌﺎﻴﺭﺓ‬ ‫ﺃﻥ‬‫ﺒﺤﺯﻤﺔ‬
‫ﻜﻭﺒﺎﻟﺕ‬ ‫ﻤﻨﺒﻊ‬ ‫ﻋﻥ‬ ‫ﺼﺎﺩﺭﺓ‬ ‫ﺇﺸﻌﺎﻋﻴﺔ‬-60
•‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺘﺠﻬﻴﺯﺍﺕ‬ ‫ﺒﻤﻌﺎﻴﺭﺓ‬ ‫ﺍﻟﻔﻴﺯﻴﺎﺌﻲ‬ ‫ﻗﺎﻡ‬)‫ﻤﻌﺩل‬ ‫ﻗﻴﺎﺱ‬
‫ﺍﻟﺠﺭﻋﺔ‬(‫ﺍﻟﺴﺎﺒﻕ‬ ‫ﺍﻟﻤﻘﻴﺎﺱ‬ ‫ﺒﺎﺴﺘﻌﻤﺎل‬‫ﺍﻟﻤﻌﺎﻤل‬ ‫ﺍﺴﺘﻌﻤل‬ ‫ﻭﻟﻜﻥ‬
01/27/2015 Osama Anjak Slide47
‫ﺍﻟﺠﺭﻋﺔ‬(‫ﺍﻟﺴﺎﺒﻕ‬ ‫ﺍﻟﻤﻘﻴﺎﺱ‬ ‫ﺒﺎﺴﺘﻌﻤﺎل‬‫ﺍﻟﻤﻌﺎﻤل‬ ‫ﺍﺴﺘﻌﻤل‬ ‫ﻭﻟﻜﻥ‬
‫ﺃﻥ‬ ‫ﺃﺴﺎﺱ‬ ‫ﻋﻠﻰ‬‫ﺒﺎﻟﻬﻭﺍﺀ‬ ‫ﺠﺭﺕ‬ ‫ﺍﻟﻤﻌﺎﻴﺭﺓ‬‫ﺯﻴﺎﺩﺓ‬ ‫ﻴﻭﺠﺩ‬ ‫ﻭﺒﺎﻟﺘﺎﻟﻲ‬
‫ﺒﻤﻘﺩﺍﺭ‬ ‫ﺍﻹﺸﻌﺎﻋﻴﺔ‬ ‫ﺍﻟﺠﺭﻋﺔ‬ ‫ﻓﻲ‬11%‫ﻟﻤﺩﺓ‬‫ﻜﺎﻤﻠﺔ‬ ‫ﺴﻨﺔ‬.
‫ﺍﻟﺤﺩﺙ‬ ‫ﺘﺤﻠﻴل‬
•‫ﺍﻷﻭﻟﻲ‬ ‫ﺍﻟﺤﺩﺙ‬:
‫ﺓ‬ ‫ﺎ‬ ‫ﺍﻟ‬ ‫ﺎﺩﺓ‬ ‫ﻟﺸ‬ ‫ﺨﺎﻁ‬ ‫ﺎل‬ ‫ﺘ‬ ‫ﺍ‬ ‫ﺓ‬ ‫ﺎ‬ ‫ﺍﻟ‬ ‫ﻓ‬ ‫ﺨﻁﺄ‬ –‫ﺍﻟﻤﻌﺎﻴﺭﺓ‬ ‫ﻟﺸﻬﺎﺩﺓ‬ ‫ﺨﺎﻁﺊ‬ ‫ﺍﺴﺘﻌﻤﺎل‬ ‫ﺒﺴﺒﺏ‬ ‫ﺍﻟﻤﻌﺎﻴﺭﺓ‬ ‫ﻓﻲ‬ ‫ﺨﻁﺄ‬.
•‫ﺍﻟﺤﺎﺩﺙ‬ ‫ﻟﻭﻗﻭﻉ‬ ‫ﺃﺩﺕ‬ ‫ﺍﻟﺘﻲ‬ ‫ﺍﻷﺴﺒﺎﺏ‬:
–،‫ﺍﻟﺘﺩﺭﻴﺏ‬ ‫ﻓﻲ‬ ‫ﻭﺘﻘﺼﻴﺭ‬ ‫ﻭﺍﻟﻌﻤﻠﻴﺔ‬ ‫ﺍﻟﻌﻠﻤﻴﺔ‬ ‫ﺍﻟﺨﺒﺭﺍﺕ‬ ‫ﻀﻌﻑ‬
‫ﺍﻟﻤﻌﺎﻴﺭﺓ‬ ‫ﺸﻬﺎﺩﺓ‬ ‫ﻤﻀﻤﻭﻥ‬ ‫ﺍﺴﺘﻴﻌﺎﺏ‬ ‫ﻋﻠﻰ‬ ‫ﻗﺎﺩﺭ‬ ‫ﻏﻴﺭ‬ ‫ﻭﺍﻟﻔﻴﺯﻴﺎﺌﻲ‬
‫ﺍﻟﻤﻌﺎﻴﺭﺓ‬ ‫ﻤﻌﺎﻤﻼﺕ‬ ‫ﺒﻴﻥ‬ ‫ﺍﻟﺘﻤﻴﺯ‬ ‫ﻴﺴﺘﻁﻴﻊ‬ ‫ﻻ‬ ‫ﻭﻜﺫﻟﻙ‬.‫ﻴﺭﺓ‬ ‫ﺍ‬ ‫ﻼ‬ ‫ﺒﻴﻥ‬ ‫ﻴﺯ‬ ‫ﺍ‬ ‫ﻴﻊ‬ ‫ﻴ‬ ‫ﻻ‬ ‫ﻭ‬
–‫ﻭﻤﻘﺎﺭﻨﺔ‬ ‫ﺤﺩﻩ‬ ‫ﻋﻠﻰ‬ ‫ﻜل‬ ‫ﺸﺨﺼﻴﻥ‬ ‫ﻗﺒل‬ ‫ﻤﻥ‬ ‫ﻤﻌﺎﻴﺭﺓ‬ ‫ﺇﺠﺭﺍﺀ‬ ‫ﻋﺩﻡ‬
‫ﺒﻌﺩ‬ ‫ﻓﻴﻤﺎ‬ ‫ﺍﻟﻨﺘﺎﺌﺞ‬
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‫ﺍﻟﺤﺎﺩﺙ‬2:‫ﺨﺎﻁﺊ‬ ‫ﺍﺴﺘﻌﻤﺎل‬‫ﻟﺤﺠﻴﺭﺓ‬‫ﺍﻟﺸﻜل‬ ‫ﻤﺴﺘﻭﻴﺔ‬ ‫ﺘﺄﻴﻥ‬
•‫ﺤﺠﻴﺭﺓ‬ ‫ﺍﻟﻌﻤل‬ ‫ﻓﻲ‬ ‫ﺍﻟﻌﻬﺩ‬ ‫ﺤﺩﻴﺙ‬ ‫ﻓﻴﺯﻴﺎﺌﻲ‬ ‫ﺍﺴﺘﻌﻤل‬
‫ﺍﻹﻟﻜﺘﺭﻭﻨﺎﺕ‬ ‫ﺤﺯﻡ‬ ‫ﻟﻤﻌﺎﻴﺭﺓ‬ ‫ﺍﻟﻭﺠﻬﻴﻥ‬ ‫ﻤﺴﺘﻭﻴﺔ‬ ‫ﺘﺄﻴﻥ‬‫ﺭﻭ‬ ‫ﻹ‬ ‫ﺯﻡ‬ ‫ﻴﺭ‬ ‫ﻬﻴﻥ‬ ‫ﻭ‬ ‫ﻭﻴ‬ ‫ﻴﻥ‬
،‫ﺍﻟﺨﻁﻲ‬ ‫ﺍﻟﻤﺴﺭﻉ‬ ‫ﺠﻬﺎﺯ‬ ‫ﻋﻥ‬ ‫ﺍﻟﺼﺎﺩﺭﺓ‬
•‫ﻭﻀﻌﺕ‬ ‫ﺇﺸﺎﺭﺓ‬ ‫ﺍﻟﺘﺄﻴﻥ‬ ‫ﺤﺠﻴﺭﺓ‬ ‫ﻋﻠﻰ‬ ‫ﻴﻭﺠﺩ‬ ‫ﻜﺎﻥ‬
‫ﺤﺠﻴﺭﺓ‬ ‫ﺠﻬﺔ‬ ‫ﻋﻠﻰ‬ ‫ﺘﺩل‬ ‫ﺍﻟﺴﺎﺒﻕ‬ ‫ﺍﻟﻔﻴﺯﻴﺎﺌﻲ‬ ‫ﻗﺒل‬ ‫ﻤﻥ‬
‫ﹺ‬‫ﻉ‬‫ﺍﻹﺸﻌﺎ‬ ‫ﺒﺎﺘﺠﺎﻩ‬ ‫ﺍﻟـﺘﺄﻴﻥ‬‫ﺘﻠﻙ‬ ‫ﺃﻥ‬ ‫ﺒﻌﺩ‬ ‫ﻓﻴﻤﺎ‬ ‫ﻭﺘﺒﻴﻥ‬
‫ﺼﺤﻴﺢ‬ ‫ﻏﻴﺭ‬ ‫ﺒﺸﻜل‬ ‫ﻭﻀﻌﺕ‬ ‫ﺍﻹﺸﺎﺭﺓ‬.
01/27/2015 Slide49Osama Anjak
‫ﺍﻟﺨﻁﺄ‬ ‫ﻨﺴﺒﺔ‬
‫اﻹﺷﻌﺎﻋﻴﺔ‬ ‫اﻟﺠﺮﻋﺔ‬ ‫ﻓﻲ‬ ‫اﻟﻔﺮق‬‫اﻟﺤﺰﻣﺔ‬ ‫ﻃﺎﻗﺔ‬
‫زیﺎدة‬‫ﻓﻲ‬‫اﻟﺠﺮﻋﺔ‬‫اﻹﺷﻌﺎﻋﻴﺔ‬‫ﺑﻤﻘﺪار‬20%6 MeV
‫زیﺎدة‬‫ﻓﻲ‬‫اﻟﺠﺮﻋﺔ‬‫اﻹﺷﻌﺎﻋﻴﺔ‬‫ﺑﻤﻘﺪار‬10%9 MeV ‫زی‬‫ﻲ‬‫ﺠﺮ‬‫ﻴ‬ ‫ﻹ‬‫ر‬ ‫ﺑ‬10%9 MeV
‫زیﺎدة‬‫ﻓﻲ‬‫اﻟﺠﺮﻋﺔ‬‫اﻹﺷﻌﺎﻋﻴﺔ‬‫ﺑﻤﻘﺪار‬8%MeV 12
‫اﻟﺠﺮﻋﺔ‬‫اﻹﺷﻌﺎﻋﻴﺔ‬‫ﺻﺤﻴﺤﺔ‬MeV 16
‫ﻧﻘﺼﺎن‬‫ﻓﻲ‬‫اﻟﺠﺮﻋﺔ‬‫اﻹﺷﻌﺎﻋﻴﺔ‬‫ﺑﻤﻘﺪار‬% 1MeV20
‫ﺍﻟﺠﺭﻋﺔ‬ ‫ﻤﻘﺎﻴﻴﺱ‬ ‫ﺒﺎﺴﺘﻌﻤﺎل‬ ‫ﺃﺠﺭﻴﺕ‬ ‫ﻤﺴﺘﻘﻠﺔ‬ ‫ﻗﻴﺎﺴﺎﺕ‬ ‫ﺨﻼل‬ ‫ﻤﻥ‬ ‫ﺍﻟﻤﻌﺎﻴﺭﺓ‬ ‫ﻓﻲ‬ ‫ﺍﻟﺨﻁﺄ‬ ‫ﺍﻜﺘﺸﺎﻑ‬ ‫ﺠﺭﻯ‬
01/27/2015 Osama Anjak Slide50
‫ﺠﺭ‬ ‫ﻴﻴﺱ‬ ‫ل‬ ‫ﺒ‬ ‫ﺠﺭﻴ‬ ‫ﻴ‬ ‫ل‬ ‫ﻥ‬ ‫ﻴﺭ‬ ‫ﻲ‬ ‫ﺠﺭﻯ‬
‫ﺍﻟﻀﻭﺌﻲ‬ ‫ﺒﺎﻟﻭﻤﻴﺽ‬TLD‫ﻟﺠﻬﺎﺯ‬ ‫ﺍﻟﺩﻭﺭﻴﺔ‬ ‫ﻀﺒﻁ‬ ‫ﺒﺈﺠﺭﺍﺀ‬ ‫ﺒﺎﻟﻘﻴﺎﻡ‬ ‫ﹰ‬‫ﺎ‬‫ﻤﻜﻠﻔ‬ ‫ﻜﺎﻥ‬ ‫ﻤﺴﺘﻘل‬ ‫ﻓﻴﺯﻴﺎﺌﻲ‬ ‫ﻗﺒل‬ ‫ﻤﻥ‬
‫ﺍﻟﻤﺴﺭﻉ‬.
‫ﺒﺸﻜل‬ ‫ﺍﻟﻤﺭﻀﻰ‬ ‫ﻤﻥ‬ ‫ﻗﻠﻴل‬ ‫ﻋﺩﺩ‬ ‫ﻤﻌﺎﻟﺠﺔ‬ ‫ﺠﺭﻯ‬ ‫ﻭﺍﻟﺜﺎﻨﻴﺔ‬ ‫ﺍﻷﻭﻟﻰ‬ ‫ﺍﻟﻤﻌﺎﻴﺭﺓ‬ ‫ﺒﻴﻥ‬ ‫ﺍﻟﻔﺎﺼﻠﺔ‬ ‫ﺍﻟﺯﻤﻨﻴﺔ‬ ‫ﺍﻟﻔﺘﺭﺓ‬ ‫ﺨﻼل‬
‫ﺨﺎﻁﺊ‬.

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‫ﺍﻟﺤﺩﺙ‬ ‫ﺘﺤﻠﻴل‬
•‫ﺍﻷﻭﻟﻲ‬ ‫ﺍﻟﺤﺩﺙ‬:
–‫ﺨﺎﻁﺊ‬ ‫ﺍﺴﺘﻌﻤﺎل‬ ‫ﺒﺴﺒﺏ‬ ‫ﺍﻟﻤﻌﺎﻴﺭﺓ‬ ‫ﻓﻲ‬ ‫ﺨﻁﺄ‬‫ﻟﺤﺠﻴﺭﺓ‬‫ﺍﻟﻭﺠﻬﻴﻥ‬ ‫ﻤﺴﺘﻭﻴﺔ‬ ‫ﺘﺄﻴﻥ‬
‫ﺍﻹﻟﻜﺘﺭﻭﻨﺎﺕ‬ ‫ﺤﺯﻡ‬ ‫ﻤﻌﺎﻴﺭﺓ‬ ‫ﻓﻲ‬. ‫ﻡ‬ ‫ﻲ‬
•‫ﺍﻟﺤﺎﺩﺙ‬ ‫ﻟﻭﻗﻭﻉ‬ ‫ﺃﺩﺕ‬ ‫ﺍﻟﺘﻲ‬ ‫ﺍﻷﺴﺒﺎﺏ‬:
–‫ﻭﺍﻟﻔﻴﺯﻴﺎﺌﻲ‬ ،‫ﺍﻟﺘﺩﺭﻴﺏ‬ ‫ﻓﻲ‬ ‫ﻭﺘﻘﺼﻴﺭ‬ ‫ﻭﺍﻟﻌﻤﻠﻴﺔ‬ ‫ﺍﻟﻌﻠﻤﻴﺔ‬ ‫ﺍﻟﺨﺒﺭﺍﺕ‬ ‫ﻀﻌﻑ‬
‫ﻜﻴﻔﻴﺔ‬ ‫ﻤﻥ‬ ‫ﻴﺘﺤﻘﻕ‬ ‫ﺃﻥ‬ ‫ﺩﻭﻥ‬ ‫ﻟﻪ‬ ‫ﺒﺎﻟﻨﺴﺒﺔ‬ ‫ﻤﺄﻟﻭﻓﺔ‬ ‫ﻏﻴﺭ‬ ‫ﺘﺄﻴﻥ‬ ‫ﺤﺠﻴﺭﺓ‬ ‫ﺍﺴﺘﻌﻤل‬
‫ﺍﺴﺘﻌﻤﺎﻟﻬﺎ‬.
–‫ﺨﺎﻁﺊ‬ ‫ﺒﺸﻜل‬ ‫ﺍﻟﺘﺄﻴﻥ‬ ‫ﺤﺠﻴﺭﺓ‬ ‫ﻋﻠﻰ‬ ‫ﺇﺸﺎﺭﺓ‬ ‫ﻭﻀﻊ‬ ‫ﺍﻟﺴﺎﺒﻕ‬ ‫ﺍﻟﻔﻴﺯﻴﺎﺌﻲ‬.
–‫ﺍﻟﻌﻤﻠﻴﺔ‬ ‫ﺍﻟﺨﺒﺭﺓ‬ ‫ﻟﻨﻘل‬ ‫ﺍﻟﻔﻴﺯﻴﺎﺌﻴﻴﻥ‬ ‫ﺒﻴﻥ‬ ‫ﺍﻟﻌﻠﻤﻲ‬ ‫ﺍﻟﺘﻭﺍﺼل‬ ‫ﻋﺩﻡ‬.
•‫ﺘﻁﺒﻴﻘﻪ‬ ‫ﺠﺭﻯ‬ ‫ﺍﻟﺫﻱ‬ ‫ﺍﻹﺠﺭﺍﺀ‬:‫ﺘﻁﺒﻴﻘﻪ‬ ‫ﺠﺭﻯ‬ ‫ﺍﻟﺫﻱ‬ ‫ﺍﻹﺠﺭﺍﺀ‬:
–‫ﺍﻟﻤﻭﻀﻭﻋﺔ‬ ‫ﺍﻹﺸﺎﺭﺓ‬ ‫ﺘﺼﺤﻴﺢ‬ ‫ﻭﺠﺭﻯ‬ ‫ﺁﺨﺭ‬ ‫ﻤﻘﻴﺎﺱ‬ ‫ﺒﻭﺍﺴﻁﺔ‬ ‫ﺍﻟﻤﻌﺎﻴﺭﺓ‬ ‫ﺇﻋﺎﺩﺓ‬
‫ﺍﻟﺘﺄﻴﻥ‬ ‫ﺤﺠﻴﺭﺓ‬ ‫ﻋﻠﻰ‬.
01/27/2015 51Osama Anjak
‫ﺍﻟﺤﺎﺩﺙ‬3:‫ﺍﻟﻤﻌﺎﻴﺭﺓ‬ ‫ﻹﺠﺭﺍﺀﺍﺕ‬ ‫ﺨﺎﻁﺊ‬ ‫ﺘﻁﺒﻴﻕ‬
•‫ﻗﺒل‬ ‫ﻤﻥ‬ ‫ﻓﻲ‬ ‫ﺍﻟﻤﻌﺘﻤﺩ‬ ‫ﺍﻟﻤﻌﺎﻴﺭﺓ‬ ‫ﻟﺒﺭﻭﺘﻭﻜﻭل‬ ‫ﺨﺎﻁﺊ‬ ‫ﺒﺘﻁﺒﻴﻕ‬ ‫ﺠﺩﻴﺩ‬ ‫ﻓﻴﺯﻴﺎﺌﻲ‬ ‫ﻗﺎﻡ‬
‫ﺒﺎﺴﺘﻌﻤﺎل‬ ‫ﺍﻟﺨﻁﻲ‬ ‫ﺍﻟﻤﺴﺭﻉ‬ ‫ﻟﺠﻬﺎﺯ‬ ‫ﻤﻌﺎﻴﺭﺓ‬ ‫ﻴﺠﺭﻱ‬ ‫ﻜﺎﻥ‬ ‫ﺍﻟﺫﻱ‬ ‫ﺍﻟﺴﺎﺒﻕ‬ ‫ﺍﻟﻔﻴﺯﻴﺎﺌﻲ‬‫ﺒﺎﺴﺘﻌﻤﺎل‬ ‫ﺍﻟﺨﻁﻲ‬ ‫ﺍﻟﻤﺴﺭﻉ‬ ‫ﻟﺠﻬﺎﺯ‬ ‫ﻤﻌﺎﻴﺭﺓ‬ ‫ﻴﺠﺭﻱ‬ ‫ﻜﺎﻥ‬ ‫ﺍﻟﺫﻱ‬ ‫ﺍﻟﺴﺎﺒﻕ‬ ‫ﺍﻟﻔﻴﺯﻴﺎﺌﻲ‬
‫ﺠﺭﻋﺔ‬ ‫ﻤﻌﺩل‬200MU/min‫ﺒﺎﺴﺘﺜﻨﺎﺀ‬ ‫ﺍﻹﺸﻌﺎﻋﻴﺔ‬ ‫ﺍﻟﺤﺯﻡ‬ ‫ﻟﻜﺎﻓﺔ‬‫ﻭﺍﺤﺩﺓ‬‫ﻴﺘﻡ‬
‫ﺃﺴﺎﺱ‬ ‫ﻋﻠﻰ‬ ‫ﻤﻌﺎﻴﺭﺘﻬﺎ‬300MU/min‫ﻤﻥ‬ ‫ﺘﺤﻭﻴل‬ ‫ﻤﻌﺎﻤل‬ ‫ﻴﻁﺒﻕ‬ ‫ﺜﻡ‬
300MU/min‫ﺇﻟﻰ‬200MU/min
•‫ﺃﺠﺭ‬ ‫ﺍﻟﺠﺩﻴﺩ‬ ‫ﺍﻟﻔﻴﺯﻴﺎﺌﻲ‬ ‫ﻟﻜﻥ‬‫ﻯ‬‫ﺃﺴﺎﺱ‬ ‫ﻋﻠﻰ‬ ‫ﺍﻹﺸﻌﺎﻋﻴﺔ‬ ‫ﺍﻟﺤﺯﻡ‬ ‫ﻟﻜﺎﻓﺔ‬ ‫ﺍﻟﻤﻌﺎﻴﺭﺓ‬200
/‫ﻁ‬ ‫ﺎ‬‫ل‬ ‫ﺍﻟ‬ ‫ل‬ ‫ﺎ‬‫ﺔ‬ ‫ﺍﻟ‬ ‫ﺎ‬ ‫ﺇﻟ‬ ‫ﺃ‬ ‫ﺎ‬
01/27/2015 Osama Anjak Slide52
MU/min‫ﺒﺘﻁﺒﻴﻕ‬ ‫ﻗﺎﻡ‬ ‫ﺜﻡ‬‫ﺍﻟﺘﺤﻭﻴل‬ ‫ﻤﻌﺎﻤل‬‫ﺍﻟﺠﺭﻋﺔ‬ ‫ﻓﻲ‬ ‫ﺯﻴﺎﺩﺓ‬ ‫ﺇﻟﻰ‬ ‫ﺃﺩﻯ‬ ‫ﻤﻤﺎ‬
‫ﺒﻤﻘﺩﺍﺭ‬ ‫ﺍﻹﺸﻌﺎﻋﻴﺔ‬50%

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‫ﺍﻟﺤﺩﺙ‬ ‫ﺘﺤﻠﻴل‬
•‫ﺍﻷﻭﻟﻲ‬ ‫ﺍﻟﺤﺩﺙ‬:
–‫ﺨﺎﻁﺌﺔ‬ ‫ﺒﻁﺭﻴﻘﺔ‬ ‫ﺍﻟﺘﺤﻭﻴل‬ ‫ﻤﻌﺎﻤل‬ ‫ﺘﻁﺒﻴﻕ‬ ‫ﺒﺴﺒﺏ‬ ‫ﺍﻟﻤﻌﺎﻴﺭﺓ‬ ‫ﻓﻲ‬ ‫ﺨﻁﺄ‬‫ﻕ‬ ‫ﻲ‬
•‫ﺍﻟﺤﺎﺩﺙ‬ ‫ﻟﻭﻗﻭﻉ‬ ‫ﺃﺩﺕ‬ ‫ﺍﻟﺘﻲ‬ ‫ﺍﻷﺴﺒﺎﺏ‬:
–‫ﺍﻟﻔﻴﺯﻴﺎﺌﻲ‬ ‫ﻗﺒل‬ ‫ﻤﻥ‬ ‫ﺍﻟﻤﻭﻀﻭﻋﺔ‬ ‫ﺍﻹﺠﺭﺍﺀﺍﺕ‬ ‫ﺒﺘﻁﺒﻴﻕ‬ ‫ﺍﻟﻔﻴﺯﻴﺎﺌﻲ‬ ‫ﻗﺎﻡ‬
‫ﺍﻹﺠﺭﺍﺀ‬ ‫ﻟﻤﻀﻤﻭﻥ‬ ‫ﻜﺎﻑ‬ ‫ﻓﻬﻡ‬ ‫ﺩﻭﻥ‬ ‫ﺍﻟﺴﺎﺒﻕ‬.
–‫ﻨﻘل‬ ‫ﻭﺠﺭﻯ‬ ‫ﻭﺍﻟﺤﺩﻴﺙ‬ ‫ﺍﻟﻘﺩﻴﻡ‬ ‫ﺍﻟﻔﻴﺯﻴﺎﺌﻲ‬ ‫ﺒﻴﻥ‬ ‫ﺘﻭﺍﺼل‬ ‫ﺃﻱ‬ ‫ﻭﺠﻭﺩ‬ ‫ﻋﺩﻡ‬
‫ﻀﻌﻴﻑ‬ ‫ﺒﺸﻜل‬ ‫ﺍﻟﻤﻌﺎﻴﺭﺓ‬ ‫ﺇﺠﺭﺍﺀﺍﺕ‬.
01/27/2015 Osama Anjak Slide53
–‫ﻓﺒل‬ ‫ﻤﻥ‬ ‫ﻤﺴﺘﻘﻠﺔ‬ ‫ﻤﻌﺎﻴﺭﺓ‬ ‫ﻴﻭﺠﺩ‬ ‫ﻻ‬ ،‫ﺍﻷﻤﺎﻥ‬ ‫ﻋﻭﺍﻤل‬ ‫ﻓﻲ‬ ‫ﻨﻘﺹ‬
‫ﺃﺨﺭ‬ ‫ﺸﺨﺹ‬.
‫ﺨﺎﻁﺊ‬ ‫ﺒﺸﻜل‬ ‫ﺍﻟﺠﺭﻋﺔ‬ ‫ﻟﻤﻌﺎﻴﺭﺓ‬ ‫ﻨﺘﻴﺠﺔ‬ ‫ﺍﻹﺸﻌﺎﻋﻴﺔ‬ ‫ﺍﻟﺤﻭﺍﺩﺙ‬
–‫ﺤﺎﻟﺔ‬4-
•‫ﺍﻟﺤﺎﺩﺜﺔ‬:‫ﺍﻟﺠﻬﺎﺯ‬ ‫ﻤﻌﺎﻴﺭﺓ‬ ‫ﺠﺭﻯ‬‫ﺍﻟﻌﻴﺎﺭﻱ‬‫ﻋﻠﻰ‬ ‫ﺍﻟﻤﺤﻠﻲ‬
‫ﺍﻟﻤﺎﺀ‬ ‫ﻓﻲ‬ ‫ﺠﺭﻋﺔ‬ ‫ﺃﺴﺎﺱ‬dose to water.‫ﻭﻟﻜﻥ‬ ‫ﻲ‬ ‫ﺠﺭ‬ ‫ﺱ‬‫ﻥ‬ ‫ﻭ‬
‫ﺒﺎﻟﻬﻭﺍﺀ‬ ‫ﺠﺭﻋﺔ‬ ‫ﺃﻨﻬﺎ‬ ‫ﻋﻠﻰ‬ ‫ﻓﺴﺭﺕ‬ ‫ﺨﺎﻁﺊ‬ ‫ﺒﺸﻜل‬dose
in air.
–‫ﺒﻤﻘﺩﺍﺭ‬ ‫ﺍﻟﺠﺭﻋﺔ‬ ‫ﻓﻲ‬ ‫ﺯﻴﺎﺩﺓ‬ ‫ﺃﺤﺩﺙ‬ ‫ﺍﻟﺨﻁﺄ‬ ‫ﻫﺫﺍ‬11%
•‫ﺍﻟﺴﺒﺏ‬:، ‫ﻭﺍﻟﺘﻌﻠﻴﻡ‬ ‫ﺍﻟﺘﺩﺭﻴﺏ‬ ‫ﺤﻴﺙ‬ ‫ﻤﻥ‬ ‫ﻭﺘﻘﺼﻴﺭ‬ ‫ﻀﻌﻴﻑ‬
‫ﺍﻟﻤﺭﻓﻘﺔ‬ ‫ﺍﻟﻤﻌﺎﻴﺭﺓ‬ ‫ﻟﺸﻬﺎﺩﺓ‬ ‫ﺨﺎﻁﺊ‬ ‫ﺍﺴﺘﻌﻤﺎل‬ ‫ﺇﻟﻰ‬ ‫ﺒﺎﻹﻀﺎﻓﺔ‬
‫ﺍﻟﺠﻬﺎﺯ‬ ‫ﻤﻊ‬‫ﺍﻟﻌﻴﺎﺭﻱ‬‫ﺍﻟﻤﺤﻠﻲ‬local standard
dosimeter.
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28. Radiation Accident in Brachytherapy 01/27/2015
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‫ﺨﺎﻁﺊ‬ ‫ﺒﺸﻜل‬ ‫ﺍﻟﺠﺭﻋﺔ‬ ‫ﻟﻤﻌﺎﻴﺭﺓ‬ ‫ﻨﺘﻴﺠﺔ‬ ‫ﺍﻹﺸﻌﺎﻋﻴﺔ‬ ‫ﺍﻟﺤﻭﺍﺩﺙ‬
–‫ﺤﺎﻟﺔ‬5-
•‫اﻟﺤﺎدث‬:‫ﻣﻌﺎیﺮة‬ ‫إﺝﺮاء‬ ‫ﺧﻼل‬ ‫اﻟﺠﻮي‬ ‫اﻟﻀﻐﻂ‬ ‫ﻟﻤﻘﻴﺎس‬ ‫ﺧﺎﻃﺊ‬ ‫اﺳﺘﻌﻤﺎل‬
‫آﻮﺑﺎﻟﺖ‬ ‫ﻟﺠﻬﺎز‬ ‫اﻹﺷﻌﺎﻋﻲ‬ ‫اﻟﺨﺮج‬-60‫یﺮﺕﻔﻊ‬ ‫ﻣﻌﺎﻟﺠﺔ‬ ‫ﻣﺮآﺰ‬ ‫ﻓﻲ‬1000‫م‬ ‫آﻮﺑﺎﻟﺖ‬ ‫ﻟﺠﻬﺎز‬ ‫اﻹﺷﻌﺎﻋﻲ‬ ‫اﻟﺨﺮج‬-60‫یﺮﺕﻔﻊ‬ ‫ﻣﻌﺎﻟﺠﺔ‬ ‫ﻣﺮآﺰ‬ ‫ﻓﻲ‬1000‫م‬
‫اﻟﺒﺤﺮ‬ ‫ﺳﻄﺢ‬ ‫ﻋﻦ‬.
•‫اﻟﻨﺘﻴﺠﺔ‬:
–‫ﺏﻤﻘﺪار‬ ‫ﻟﻬﻢ‬ ‫اﻟﻤﻘﺮرة‬ ‫اﻟﺠﺮﻋﺔ‬ ‫ﻡﻦ‬ ‫أﻋﻠﻰ‬ ‫ﻟﺠﺮﻋﺔ‬ ‫اﻟﻤﺮﺿﻰ‬ ‫ﺗﻌﺮض‬
21%
•‫اﻟﺴﺒﺐ‬:
–‫ﻡﻜﺎن‬ ‫ﻓﻲ‬ ‫اﻟﺠﻮي‬ ‫اﻟﻀﻐﻂ‬ ‫ﻟﻘﻴﺎس‬ ‫ﺝﻮي‬ ‫ﺿﻐﻂ‬ ‫ﻡﻘﻴﺎس‬ ‫یﻮﺝﺪ‬ ‫ﻻ‬
‫اﻟﻘﻴﺎس‬
–‫اﻷرﺻﺎد‬ ‫ﻡﺮآﺰ‬ ‫ﻡﻦ‬ ‫اﻟﺠﻮي‬ ‫اﻟﻀﻐﻂ‬ ‫ﻗﻴﻤﺔ‬ ‫ﻋﻠﻰ‬ ‫اﻟﻔﻴﺰیﺎﺋﻲ‬ ‫ﺡﺼﻞ‬
‫ﺳﻄﺢ‬ ‫ﻟﻤﺴﺘﻮى‬ ‫ﺏﺎﻟﻨﺴﺒﺔ‬ ‫ﻡﺼﺤﺤﺔ‬ ‫اﻟﻘﻴﻤﺔ‬ ‫وآﺎﻥﺖ‬ ‫اﻟﻤﻄﺎر‬ ‫ﻓﻲ‬ ‫اﻟﺠﻮیﺔ‬
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‫ﺍﻟﺠﺭﻋﺔ؟‬ ‫ﻗﻴﻤﺔ‬ ‫ﻋﻠﻰ‬ ‫ﺨﺎﻁﺊ‬ ‫ﺒﺸﻜل‬ ‫ﺍﻟﻀﻐﻁ‬ ‫ﻗﺭﺍﺀﺓ‬ ‫ﺘﺅﺜﺭ‬ ‫ﻜﻡ‬
‫ﺡﻴﺚ‬T&P‫اﻟﻘﻴﺎ‬ ‫اء‬ ‫إﺝ‬ ‫ﻜﺎن‬ ‫ﻓ‬ ‫اﻟﺠﻮ‬ ‫واﻟﻀﻐﻂ‬ ‫ة‬ ‫ا‬ ‫اﻟﺤ‬ ‫ﺝﺔ‬ ‫د‬ ‫ﺎ‬ ‫ه‬
o
o
o
TP
T273.2
C)T(273.2
P
p
K
+
+
×=
‫ﺡﻴﺚ‬T&P‫اﻟﻘﻴﺎس‬ ‫إﺝﺮاء‬ ‫ﻡﻜﺎن‬ ‫ﻓﻲ‬ ‫اﻟﺠﻮي‬ ‫واﻟﻀﻐﻂ‬ ‫اﻟﺤﺮارة‬ ‫درﺝﺔ‬ ‫هﻤﺎ‬.
‫و‬ToPo &‫اﻟﻨﻈﺎﻡﻴﻴﻦ‬ ‫اﻟﺠﻮي‬ ‫واﻟﻀﻐﻂ‬ ‫اﻟﺠﺮارة‬ ‫درﺝﺔ‬ ‫هﻤﺎ‬[usually 760mmHg and 20oC]
‫اﻟﻀﻐﻂ‬ ‫أن‬ ‫ﺑﻔﺮض‬P‫یﺴﺎوي‬630mmHg]1000m‫اﻟﺒﺤﺮ‬ ‫ﻣﺴﺘﻮى‬ ‫ﻓﻮق‬[‫و‬‫اﻟﺤﺮارة‬20oC‫ﻓﻨﺠﺪ‬
‫أن‬:
206.1=630)*20+2.273/ (760)*20+2.273(=TPK
‫اﻟﻀﻐﻂ‬ ‫أن‬ ‫ﻓﺮﺽﻨﺎ‬ ‫إذا‬P‫یﺴﺎوي‬760mmHg]‫اﻟﺒﺤﺮ‬ ‫ﻣﺴﺘﻮى‬[‫واﻟﺤﺮارة‬20oC‫أن‬ ‫ﻧﺠﺪ‬ ‫ﻋﻨﺪﺋﺬ‬:
KTP = (273.2+20)* 760/ ((273.2+20)* 760) = 1
‫ﻴﻌﺎﺩل‬ ‫ﹰ‬‫ﺎ‬‫ﺘﻘﺭﻴﺒ‬ ‫ﺍﻟﺨﻁﺄ‬ ‫ﻫﺫﺍ‬20%‫ﺒﻤﻘﺩﺍﺭ‬ ‫ﺍﻟﻤﺭﻴﺽ‬ ‫ﺠﺭﻋﺔ‬ ‫ﻓﻲ‬ ‫ﺯﻴﺎﺩﺓ‬ ‫ﺇﻟﻰ‬ ‫ﺴﻴﺅﺩﻱ‬ ‫ﻭﺒﺎﻟﺘﺎﻟﻲ‬ ‫ﺃﻗل‬20%
(~10Gy if the dose 50Gy)
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‫ﺍﻟﺠﺭﻋﺎﺕ‬ ‫ﺘﺨﻁﻴﻁ‬ ‫ﻨﻅﺎﻡ‬ ‫ﻋﻥ‬ ‫ﺍﻟﻨﺎﺘﺠﺔ‬ ‫ﺍﻹﺸﻌﺎﻋﻴﺔ‬ ‫ﺍﻟﺤﻭﺍﺩﺙ‬
–‫ﺤﺎﻟﺔ‬6-
•‫ﺍﻟﺤﺎﺩﺙ‬:‫ﺍﻹﺴﻔﻴﻥ‬ ‫ﺘﻭﻫﻴﻥ‬ ‫ﻤﻌﺎﻤل‬ ‫ﺘﻁﺒﻴﻕ‬Wedge factor‫ﻤﺭﺘﻴﻥ‬.
•‫ﺍﻟﺘﺴﻠﺴل‬Sequence:
–‫ﺍﻹﺸﻌﺎﻋﻴﺔ‬ ‫ﺍﻟﺠﺭﻋﺔ‬ ‫ﺘﻭﺯﻉ‬ ‫ﺘﺨﻁﻴﻁ‬ ‫ﻨﻅﺎﻡ‬ ‫ﻴﺘﻀﻤﻥ‬Treatment planning system
‫ﺍﻹﺴﻔﻴﻨﻲ‬ ‫ﺍﻟﻤﺭﺸﺢ‬ ‫ﺍﺴﺘﻌﻤﺎل‬ ‫ﻋﻨﺩ‬ ‫ﺍﻹﺸﻌﺎﻋﻴﺔ‬ ‫ﺍﻟﺠﺭﻋﺔ‬ ‫ﺘﻭﺯﻉ‬ ‫ﺘﺼﺤﻴﺢ‬
–‫ﹰ‬‫ﺎ‬‫ﻴﺩﻭﻴ‬ ‫ﺍﻟﺤﺴﺎﺒﺎﺕ‬ ‫ﺇﺠﺭﺍﺀ‬ ‫ﻋﻨﺩ‬ ‫ﺜﺎﻨﻴﺔ‬ ‫ﻤﺭﺓ‬ ‫ﺍﻟﺘﺼﺤﻴﺢ‬ ‫ﻤﻌﺎﻤل‬ ‫ﺘﻁﺒﻴﻕ‬ ‫ﺠﺭﻯ‬
‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺯﻤﻥ‬ ‫ﻟﺤﺴﺎﺏ‬.
•‫ﺍﻟﻨﺘﻴﺠﺔ‬:‫ﺒﻤﻘﺩﺍﺭ‬ ‫ﺍﻟﺠﺭﻋﺔ‬ ‫ﻓ‬ ‫ﺯﻴﺎﺩﺓ‬14% •‫ﺍﻟﻨﺘﻴﺠﺔ‬:‫ﺒﻤﻘﺩﺍﺭ‬ ‫ﺍﻟﺠﺭﻋﺔ‬ ‫ﻓﻲ‬ ‫ﺯﻴﺎﺩﺓ‬14.%
•‫ﺍﻟﺴﺒﺏ‬:
–‫ﺠﻴﺩ‬ ‫ﺒﺸﻜل‬ ‫ﺍﻹﺸﻌﺎﻋﻴﺔ‬ ‫ﺍﻟﺠﺭﻋﺔ‬ ‫ﺘﻭﺯﻉ‬ ‫ﺘﺨﻁﻴﻁ‬ ‫ﻨﻅﺎﻡ‬ ‫ﺨﻭﺍﺭﺯﻤﻴﺔ‬ ‫ﻓﻬﻡ‬ ‫ﻋﺩﻡ‬.
Do not pay me
twice
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‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺤﺴﺎﺏ‬ ‫ﻓﻲ‬ ‫ﺨﻁﺄ‬
–‫ﺤﺎﻟﺔ‬7-
•‫ﺍﻟﺤﺎﺩﺙ‬:
–‫ﻤﺭﻴﺽ‬‫ﻋﻤﺭﻩ‬30‫ﺸﻬﺭ‬.‫ﺘﻘﺭﺭ‬‫ﺇﻋﻁﺎﺀﻩ‬‫ﺠﻠﺴﺘﻲ‬‫ﻤﻌﺎﻟﺠﺔ‬‫ﻋﻠﻰ‬‫ﺠﻬﺎﺯ‬
‫ﺒﺎﻟﺕ‬ ‫ﻜ‬60‫ﻜل‬‫ﺔ‬ ‫ﺠﻠ‬150‫ﺍﺩ‬)1 5‫ﻏ‬(‫ﻋﺔ‬ ‫ﺍﻟﺠ‬‫ﺍﻟﻜﻠﻴﺔ‬ ‫ﻜﻭﺒﺎﻟﺕ‬-60‫ﻜل‬‫ﺠﻠﺴﺔ‬150‫ﺭﺍﺩ‬)1.5‫ﻏﺭﻱ‬(‫ﻭﺍﻟﺠﺭﻋﺔ‬‫ﺍﻟﻜﻠﻴﺔ‬
300‫ﺭﺍﺩ‬)3‫ﻏﺭﻱ‬(‫ﻭﺫﻟﻙ‬‫ﻟﺘﺨﻔﻴﻑ‬‫ﺤﺠﻡ‬‫ﺍﻨﺘﻔﺎﺥ‬‫ﻴﻘﻊ‬‫ﺨﻠﻑ‬‫ﺍﻟﻌﻴﻥ‬
–‫ﺍﻟﻤﺴﺅﻭل‬‫ﻋﻥ‬‫ﻗﻴﺎﺱ‬‫ﺍﻟﺠﺭﻋﺔ‬‫ﺍﺭﺘﻜﺏ‬‫ﺨﻁﺄ‬‫ﻓﻲ‬‫ﺤﺴﺎﺏ‬‫ﺍﻟﺠﺭﻋﺔ‬‫ﻭﺃﺠﺭﻯ‬
‫ﺍﻟﺤﺴﺎﺏ‬‫ﻋﻠﻰ‬‫ﺃﺴﺎﺱ‬‫ﺍﻟﺠﺭﻋﺔ‬‫ﺒﺎﻟﺠﻠﺴﺔ‬300‫ﺭﺍﺩ‬‫ﻭﺠﺭﻯ‬‫ﻤﻌﺎﻟﺠﺔ‬
‫ﺽ‬ ‫ﺍﻟ‬‫ﺩﺓ‬ ‫ﻟ‬‫ﻥ‬‫ﺎﻟﺘﺎﻟ‬‫ﻋﺔ‬ ‫ﺍﻟ‬‫ﺔ‬ ‫ﺍﻟﻜﻠ‬600‫ﺍﺩ‬ ‫ﺍﻟﻤﺭﻴﺽ‬‫ﻟﻤﺩﺓ‬‫ﻴﻭﻤﻴﻥ‬‫ﻭﺒﺎﻟﺘﺎﻟﻲ‬‫ﺍﻟﺠﺭﻋﺔ‬‫ﺍﻟﻜﻠﻴﺔ‬600‫ﺭﺍﺩ‬.
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‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺤﺴﺎﺏ‬ ‫ﻓﻲ‬ ‫ﺨﻁﺄ‬
–‫ﺤﺎﻟﺔ‬7–
•‫ﺍﻟﺴﺒﺏ‬:
‫ﻭﻗﻊ‬‫ﻫﺫﺍ‬‫ﺍﻟﺨﻁﺄ‬‫ﻨﺘﻴﺠﺔ‬‫ﻟﺨﻁﺄ‬‫ﺤﺴﺎﺒ‬‫ﺍﺭﺘﻜﺒﻪ‬‫ﺍﻟﻤﺴﺅﻭل‬‫ﻋﻥ‬‫ﻗﻴﺎﺱ‬ –‫ﻭﻗﻊ‬‫ﻫﺫﺍ‬‫ﺍﻟﺨﻁﺄ‬‫ﻨﺘﻴﺠﺔ‬‫ﻟﺨﻁﺄ‬‫ﺤﺴﺎﺒﻲ‬‫ﺍﺭﺘﻜﺒﻪ‬‫ﺍﻟﻤﺴﺅﻭل‬‫ﻋﻥ‬‫ﻗﻴﺎﺱ‬
‫ﺍﻟﺠﺭﻋﺎﺕ‬.
–‫ﺃﺠﺭﻴﺕ‬‫ﻨﻅﺭﺓ‬‫ﻏﻴﺭ‬‫ﻜﺎﻓﻴﺔ‬‫ﻟﻠﺤﺴﺎﺏ‬‫ﻤﻥ‬‫ﻗﺒل‬‫ﺍﻟﻁﺒﻴﺏ‬‫ﺍﻟﻤﻌﺎﻟﺞ‬‫ﻗﺒل‬
‫ﺃﻥ‬‫ﺘﺒﺩﺃ‬‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬.
–‫ﺃﻴﻀﺎ‬‫ﻜﺎﻥ‬‫ﻫﻨﺎﻙ‬‫ﻤﺸﻜﻠﺔ‬‫ﻓﻲ‬‫ﻭﻀﻭﺡ‬‫ﻭﺸﻜل‬)‫ﻨﻤﻭﺫﺝ‬(‫ﺨﻁﺔ‬
‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬)‫ﻁﺭﻴﻘﺔ‬‫ﺘﺩﻭﻴﻥ‬‫ﺍﻟﺒﻴﺎﻨﺎﺕ‬‫ﻏﻴﺭ‬‫ﻭﺍﻀﺤﺔ‬( ‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬)‫ﻁﺭﻴﻘﺔ‬‫ﺘﺩﻭﻴﻥ‬‫ﺍﻟﺒﻴﺎﻨﺎﺕ‬‫ﻏﻴﺭ‬‫ﻭﺍﻀﺤﺔ‬(.
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‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺤﺴﺎﺏ‬ ‫ﻓﻲ‬ ‫ﺨﻁﺄ‬
–‫ﺤﺎﻟﺔ‬7–
•‫ﺍﻟﻌﻤل‬‫ﺍﻟﻤﺘﺨﺫ‬Action taken:
–‫ﺘﻡ‬‫ﺍﻜﺘﺸﺎﻑ‬‫ﺍﻟﺨﻁﺄ‬‫ﻤﻥ‬‫ﻗﺒل‬‫ﻁﺎﻟﺏ‬)‫ﻴﺩﺭﺱ‬‫ﻓﻨﻲ‬‫ﺃﺸﻌﺔ‬(‫ﺨﻼل‬ ‫ﻡ‬)‫ﻲ‬(
‫ﺍﻟﻤﺭﺍﺠﻌﺔ‬‫ﺍﻟﺸﻬﺭﻴﺔ‬‫ﻟﺒﻁﺎﻗﺎﺕ‬‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬.
–‫ﻤﻥ‬‫ﺃﺠل‬‫ﻋﺩﻡ‬‫ﺘﻜﺭﺍﺭ‬‫ﻤﺜل‬‫ﻫﺫﺍ‬‫ﺍﻟﺨﻁﺄ‬‫ﻗﺎﻡ‬‫ﺍﻟﺠﻬﺔ‬‫ﺍﻟﻤﺭﺨﺹ‬‫ﻟﻬﺎ‬
‫ﺒﺈﻋﺎﺩﺓ‬‫ﺘﺩﺭﻴﺏ‬‫ﺍﻟﻌﺎﻤﻠﻴﻥ‬‫ﺍﻟﻤﺴﺅﻭﻟﻴﻥ‬‫ﻋﻥ‬‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬‫ﻟﺘﺠﻨﺏ‬‫ﺍﻟﻭﻗﻭﻉ‬
‫ﻓﻲ‬‫ﻤﺜل‬‫ﻫﺫﻩ‬‫ﺍﻟﺤﺎﻻﺕ‬‫ﻭﺍﻟﺘﻲ‬‫ﻴﻤﻜﻥ‬‫ﺘﻌﺯﻯ‬‫ﺇﻟﻰ‬‫ﻀﻌﻑ‬‫ﺍﻹﺩﺍﺭﺓ‬.
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‫ﺍﻟﺘﺠﻬﻴﺯﺍﺕ‬ ‫ﻓﻲ‬ ‫ﻋﻁل‬ ‫ﺃﻭ‬ ‫ﺨﻠل‬ ‫ﺒﺴﺒﺏ‬ ‫ﺍﻟﺤﻭﺍﺩﺙ‬
–‫ﺤﺎﻟﺔ‬8-
•‫اﻟﺤﺎدث‬Incident:
‫ﻨ‬ ‫ﻔ‬ ‫اﻹ‬ ‫ﺷ‬ ‫اﻟ‬ ‫اة‬ ‫أ‬ ‫ا‬ ‫ﻓﻘ‬‫ﻠ‬ ‫ﺔ‬ ‫ﻏ‬ ‫ﺔ‬ ‫اﻟ‬ –‫اﻹﺳﻔﻴﻨﻲ‬ ‫اﻟﻤﺮﺷﺢ‬ ‫ﺗﺮآﻴﺐ‬ ‫أداة‬ ‫ﻓﻘﺪان‬‫و‬‫ﻋﻠﻰ‬ ‫ﺻﺤﻴﺤﺔ‬ ‫ﻏﻴﺮ‬ ‫اﻟﺠﺮﻋﺔ‬
‫اﻟﻤﺮآﺰي‬ ‫اﻟﻤﺤﻮر‬.
•‫اﻟﺴﺒﺐ‬Cause:
–‫اﻟﻤﺮﺷﺤﺎت‬ ‫ﻡﻌﺎﻡﻞ‬ ‫وﺏﺎﻟﺘﺎﻟﻲ‬ ‫اﻹﺳﻔﻴﻨﻲ‬ ‫اﻟﻤﺮﺷﺢ‬ ‫ﺗﺮآﻴﺐ‬ ‫أداة‬ ‫ﻓﻘﺪان‬
‫ﺗﻮزع‬ ‫وﺏﺎﻟﺘﺎﻟﻲ‬ ‫ﺻﺤﻴﺢ‬ ‫ﻏﻴﺮ‬ ‫اﻟﻤﺮآﺰي‬ ‫اﻟﻤﺤﻮر‬ ‫ﻋﻠﻰ‬ ‫اﻟﺠﺎﻥﺒﻲ‬
‫ﻏ‬ ‫ﻟ‬‫ﺻﺤﻴﺢ‬ ‫ﻏﻴﺮ‬ ‫اﻟﺠﺮﻋﺎت‬.
–‫ﻟﻠﺤﺰم‬ ‫اﻟﻤﺮﺷﺢ‬ ‫ﻡﻌﺎﻡﻞ‬ ‫وآﺬﻟﻚ‬ ‫اﻟﻤﺮﺷﺢ‬ ‫ﺗﺜﺒﻴﺖ‬ ‫أداة‬ ‫ﻓﺤﺺ‬ ‫یﺘﻢ‬ ‫ﻟﻢ‬
‫اﻟﺠﺎﻥﺒﻴﺔ‬.
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‫ﺍﻟﺤﺯﻤﺔ‬ ‫ﻤﺤﻭﺭ‬ ‫ﻋﻥ‬ ‫ﺍﻟﻤﺭﺸﺢ‬ ‫ﺍﻨﺯﻴﺎﺡ‬ ‫ﺘﺄﺜﻴﺭ‬
Lack of{
Excess
attenuation
•‫ﺍﻟﻤﺭﺸﺢ‬ ‫ﺴﻤﺎﻜﺔ‬ ‫ﻋﻠﻰ‬ ‫ﺍﻟﻤﺭﺸﺢ‬ ‫ﻤﻌﺎﻤل‬ ‫ﻗﻴﻤﺔ‬ ‫ﺘﺘﻭﻗﻑ‬‘t’‫ﻋﻨﺩ‬
‫ﻟﻠﺤﺯﻤﺔ‬ ‫ﺍﻟﻤﺭﻜﺯﻱ‬ ‫ﺍﻟﻤﺤﻭﺭ‬.
t t
}{ {
Lack of
thickness
{
•‫ﺍﻟﻨﺘﻴﺠﺔ‬:‫ﺠﺎﻨﺒﻲ‬ ‫ﺇﺤﺩﻯ‬ ‫ﻓﻲ‬ ‫ﻋﺎﻟﻴﺔ‬ ‫ﻟﺠﺭﻋﺎﺕ‬ ‫ﺍﻟﻤﺭﻀﻰ‬ ‫ﺘﻌﺭﺽ‬
‫ﻟﻤﺤﻭﺭ‬ ‫ﺒﺎﻟﻨﺴﺒﺔ‬ ‫ﺍﻵﺨﺭ‬ ‫ﺍﻟﺠﺎﻨﺏ‬ ‫ﻓﻲ‬ ‫ﻤﻨﺨﻔﻀﺔ‬ ‫ﻭﺠﺭﻋﺔ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬
‫ﺍﻟﺤﺯﻤﺔ‬.
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‫ﺒﺎﻟﺼﻴﺎﻨﺔ‬ ‫ﺍﻟﺨﺎﺼﺔ‬ ‫ﺍﻟﺘﺸﻐﻴل‬ ‫ﺤﺎﻟﺔ‬ ‫ﻓﻲ‬ ‫ﺍﻟﺨﻁﻲ‬ ‫ﺍﻟﻤﺴﺭﻉ‬ ‫ﺍﺴﺘﻌﻤﺎل‬PHSYCAL mode
-‫ﺤﺎﻟﺔ‬9-
•‫ﺍﻟﺤﺎﺩﺙ‬:
–‫ﺃﺸﻌﺔ‬ ‫ﺤﺯﻤﺔ‬ ‫ﺍﺨﺘﻴﺎﺭ‬ ‫ﻓﻲ‬ ‫ﻤﺸﻜﻠﺔ‬-X‫ﺒﻨﻤﻁ‬ ‫ﺍﻟﻤﺴﺭﻉ‬ ‫ﺘﺸﻐﻴل‬ ‫ﻋﻨﺩ‬ ‫ﺍﻹﻟﻜﺘﺭﻭﻨﺎﺕ‬ ‫ﻭﺤﺯﻡ‬
‫ﺔ‬‫ﺔ‬‫ﺒﺎﻟﻤﻌﺎﻟﺠ‬ ‫ﺍﻟﺨﺎﺹ‬ ‫ﺍﻟﺘﺸﻐﻴل‬Clinical mode
–‫ﺒﺎﻟﺼﻴﺎﻨﺔ‬ ‫ﺍﻟﺨﺎﺼﺔ‬ ‫ﺒﺎﻟﺤﺎﻟﺔ‬ ‫ﺍﻟﺘﺸﻐﻴل‬ ‫ﻤﺴﺘﺨﺩﻤﻴﻥ‬ ‫ﺍﻟﺨﻁﻲ‬ ‫ﺍﻟﻤﺴﺭﻉ‬ ‫ﺍﺴﺘﻌﻤل‬
PHSYCAL mode
–‫ﺒﺤﺎﻟﺔ‬ ‫ﺍﻟﺘﺸﻐﻴل‬PHYSICAL mode‫ﺃﻭ‬ ‫ﺍﻟﺼﻴﺎﻨﺔ‬ ‫ﺇﺠﺭﺍﺀ‬ ‫ﺒﺤﺎﻻﺕ‬ ‫ﻓﻘﻁ‬ ‫ﺨﺎﺼﺔ‬
‫ﻤﻔﻘﻭﺩﺓ‬ ‫ﺘﻜﻭﻥ‬ ‫ﺍﻟﺤﺎﻟﺔ‬ ‫ﻫﺫﻩ‬ ‫ﻓﻲ‬ ‫ﺍﻟﺘﺸﺎﺒﻙ‬ ‫ﺇﺠﺭﺍﺀﺍﺕ‬ ‫ﻭﻤﻌﻅﻡ‬ ‫ﺃﺒﺤﺎﺙ‬ ‫ﺇﺠﺭﺍﺀ‬)‫ﺘﻌﻤل‬ ‫ﻻ‬.(
–‫ﺇﻴﻘﺎﻑ‬ ‫ﻟﻠﻤﺴﺭﻉ‬ ‫ﻴﻤﻜﻥ‬ ‫ﻻ‬ ‫ﺭﺒﻤﺎ‬‫ﺍﻟﺘﺸﻌﻴﻊ‬‫ﺍﻹﺸﻌﺎﻋﻲ‬ ‫ﺍﻟﺨﺭﺝ‬ ‫ﻓﻲ‬ ‫ﺨﻠل‬ ‫ﻭﺠﻭﺩ‬ ‫ﺤﺎل‬ ‫ﻓﻲ‬
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‫ﺇﻴ‬ ‫ﺭﻉ‬ ‫ﻥ‬ ‫ﻴ‬ ‫ﺭﺒ‬‫ﻴﻊ‬‫ﻲ‬ ‫ﻹ‬ ‫ﺭﺝ‬ ‫ﻲ‬ ‫ل‬ ‫ﻭﺠﻭ‬ ‫ل‬ ‫ﻲ‬
‫ﻟﻠﻬﺩﻑ‬ ‫ﺍﻟﻤﻴﻜﺎﻨﻴﻜﻴﺔ‬ ‫ﺍﻟﺤﺭﻜﺔ‬ ‫ﻜﺎﻨﺕ‬ ‫ﺇﺫﺍ‬ ‫ﺃﻭ‬target‫ﺃﻭ‬‫ﺍﻟﻭﺸﺎﺌﻊ‬foils‫ﺍﻟﻤﺭﺸﺤﺎﺕ‬ ‫ﺃﻭ‬
filters‫ﻤﻌﻁﻠﺔ‬ ‫ﻜﺎﻨﺕ‬
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‫ﺒﺎﻟﺼﻴﺎﻨﺔ‬ ‫ﺍﻟﺨﺎﺼﺔ‬ ‫ﺍﻟﺘﺸﻐﻴل‬ ‫ﺤﺎﻟﺔ‬ ‫ﻓﻲ‬ ‫ﺍﻟﺨﻁﻲ‬ ‫ﺍﻟﻤﺴﺭﻉ‬ ‫ﺍﺴﺘﻌﻤﺎل‬PHSYCAL mode
-‫ﺤﺎﻟﺔ‬9-
•‫ﺍﻷﺤﺩﺍﺙ‬ ‫ﺘﺴﻠﺴل‬Sequence
–‫ﺒﺎﻟﺤﺎﻟﺔ‬ ‫ﺍﻟﻤﺴﺭﻉ‬ ‫ﺘﺸﻐﻴل‬ ‫ﺠﺭﻯ‬PHYSICAL (Service) mode‫ﻗﺒل‬ ‫ﻤﻥ‬ ‫ﻉ‬
‫ﺍﻹﻟﻜﺘﺭﻭﻨﻴﺎﺕ‬ ‫ﻤﻬﻨﺩﺱ‬‫ﺍﻹﺸﻌﺎﻋﻴﺔ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﻁﺒﻴﺏ‬ ‫ﻤﻥ‬ ‫ﺒﺄﻤﺭ‬.
–‫ﺒﻤﺴﺎﻋﺩﺓ‬ ‫ﺍﻹﺸﻌﺎﻋﻲ‬ ‫ﺍﻟﺨﺭﺝ‬ ‫ﻤﻌﺩل‬ ‫ﻗﻴﺎﺱ‬ ‫ﺠﺭﻯ‬‫ﺍﻷﺸﻌﺔ‬ ‫ﻓﻨﻲ‬
‫ﺒﺎﻟﺤﺎﻟﺔ‬ ‫ﻴﻌﻤل‬ ‫ﺍﻟﻤﺴﺭﻉ‬PHYSICAL mode
–‫ﻟﻬﺫﻩ‬ ‫ﻭﻓﻕ‬ ‫ﺍﻟﺘﺸﻐﻴل‬ ‫ﻁﺭﻴﻘﺔ‬ ‫ﻋﻠﻰ‬ ‫ﺍﻟﻔﻨﻲ‬ ‫ﺒﺘﺩﺭﻴﺏ‬ ‫ﺍﻟﻤﻬﻨﺩﺱ‬ ‫ﻗﺎﻡ‬
‫ﺍﻟﺤﺎﻟﺔ‬PHYSICAL mode‫ﻤﻌﺎﻟﺠﺔ‬ ‫ﺤﺎﻟﺘﻲ‬ ‫ﻭﺭﺍﻗﺏ‬.
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‫ﺠ‬ ‫ﻲ‬ ‫ﺏ‬ ‫ﻭﺭ‬
‫ﺒﺎﻟﺼﻴﺎﻨﺔ‬ ‫ﺍﻟﺨﺎﺼﺔ‬ ‫ﺍﻟﺘﺸﻐﻴل‬ ‫ﺤﺎﻟﺔ‬ ‫ﻓﻲ‬ ‫ﺍﻟﺨﻁﻲ‬ ‫ﺍﻟﻤﺴﺭﻉ‬ ‫ﺍﺴﺘﻌﻤﺎل‬PHSYCAL mode
-‫ﺤﺎﻟﺔ‬9-
•‫ﻤﻌﺎﻟﺠﺔ‬ ‫ﺠﺭﻯ‬30‫ﻴﻌﺎﻟﺞ‬ ‫ﺍﻷﺨﻴﺭ‬ ‫ﺍﻟﻤﺭﻴﺽ‬ ‫ﻭﻜﺎﻥ‬ ‫ﻤﺸﻜﻠﺔ‬ ‫ﺃﻴﺔ‬ ‫ﺩﻭﻥ‬ ‫ﻤﺭﻴﺽ‬
‫ﺒﻁﺎﻗﺔ‬ ‫ﺇﻟﻜﺘﺭﻭﻨﺎﺕ‬ ‫ﺒﺤﺯﻤﺔ‬10 MeV. ‫ﺒﻁﺎﻗﺔ‬ ‫ﺇﻟﻜﺘﺭﻭﻨﺎﺕ‬ ‫ﺒﺤﺯﻤﺔ‬10 MeV.
•‫ﻓﻭﺘﻭﻨﺎﺕ‬ ‫ﺒﺤﺯﻤﺔ‬ ‫ﻟﻠﻤﻌﺎﻟﺠﺔ‬ ‫ﻴﻠﻴﻪ‬ ‫ﺍﻟﺫﻱ‬ ‫ﺍﻟﻤﺭﻴﺽ‬ ‫ﺘﺤﻀﻴﺭ‬ ‫ﺠﺭﻯ‬20MV x
rays‫ﺠﺭﻋﺔ‬ ‫ﻭﻤﻌﺩل‬300MU/min‫ﺒﻌﺩ‬ ‫ﺃﻭﻗﻔﺕ‬ ‫ﻭﻟﻜﻥ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺒﺩﺃﺕ‬ ،
21s‫ﻗﻠﻴﻠﺔ‬ ‫ﺠﺭﻋﺔ‬ ‫ﺇﻟﻰ‬ ‫ﺍﻟﻤﺭﻴﺽ‬ ‫ﻭﺘﻌﺭﺽ‬)few monitor units.(
•‫ﻭﺠﻭﺩ‬ ‫ﺍﻷﺸﻌﺔ‬ ‫ﻓﻨﻲ‬ ‫ﻻﺤﻅ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﻏﺭﻓﺔ‬ ‫ﻤﻥ‬ ‫ﺍﻟﻤﺭﻴﺽ‬ ‫ﺇﺨﺭﺍﺝ‬ ‫ﻋﻨﺩ‬
‫ﻟﺠﺭﻋﺔ‬ ‫ﺘﻌﺭﺽ‬ ‫ﻗﺩ‬ ‫ﺍﻟﻤﺭﻴﺽ‬ ‫ﺃﻥ‬ ‫ﻋﻠﻰ‬ ‫ﺘﺩل‬ ‫ﺍﻟﻤﺭﻴﺽ‬ ‫ﺠﻠﺩ‬ ‫ﻋﻠﻰ‬ ‫ﻋﻼﻤﺔ‬
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‫ﻟﺠﺭﻋﺔ‬ ‫ﺘﻌﺭﺽ‬ ‫ﻗﺩ‬ ‫ﺍﻟﻤﺭﻴﺽ‬ ‫ﺃﻥ‬ ‫ﻋﻠﻰ‬ ‫ﺘﺩل‬ ‫ﺍﻟﻤﺭﻴﺽ‬ ‫ﺠﻠﺩ‬ ‫ﻋﻠﻰ‬ ‫ﻋﻼﻤﺔ‬
‫ﻋﺎﻟﻴﺔ‬ ‫ﺇﺸﻌﺎﻋﻴﺔ‬.

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‫ﺒﺎﻟﺼﻴﺎﻨﺔ‬ ‫ﺍﻟﺨﺎﺼﺔ‬ ‫ﺍﻟﺘﺸﻐﻴل‬ ‫ﺤﺎﻟﺔ‬ ‫ﻓﻲ‬ ‫ﺍﻟﺨﻁﻲ‬ ‫ﺍﻟﻤﺴﺭﻉ‬ ‫ﺍﺴﺘﻌﻤﺎل‬
PHSYCAL mode
-‫ﺤﺎﻟﺔ‬9–
‫ﺔ‬ ‫ﻟ‬ ‫ﺘ‬ ‫ﻗ‬ ‫ﺍﻟ‬ ‫ﺃ‬ ‫ﺘ‬ ‫ﺜﺔ‬ ‫ﺎ‬ ‫ﺍﻟ‬ ‫ﻓ‬ ‫ﻕ‬ ‫ﻘ‬ ‫ﺍﻟﺘ‬ ‫ﻟ‬
‫اﻟﻤﺴﺎهﻤﺔ‬ ‫اﻟﻌﻮاﻣﻞ‬contributing factors
•‫ﻟﺠﺭﻋﺔ‬ ‫ﺘﻌﺭﺽ‬ ‫ﻗﺩ‬ ‫ﺍﻟﻤﺭﻴﺽ‬ ‫ﺃﻥ‬ ‫ﺘﺒﻴﻥ‬ ‫ﺍﻟﺤﺎﺩﺜﺔ‬ ‫ﻓﻲ‬ ‫ﺍﻟﺘﺤﻘﻴﻕ‬ ‫ﻟﺩﻯ‬
‫ﻫﺩﻑ‬ ‫ﺤﺭﻜﺔ‬ ‫ﻓﻲ‬ ‫ﻓﺸل‬ ‫ﻋﻥ‬ ‫ﻨﺎﺘﺠﺔ‬ ‫ﺍﻟﺴﺎﺤﺔ‬ ‫ﻤﺭﻜﺯ‬ ‫ﻓﻲ‬ ‫ﻋﺎﻟﻴﺔ‬ ‫ﺇﺸﻌﺎﻋﻴﺔ‬
‫ﺃﺸﻌﺔ‬-XX-ray target‫ﺍﻟﺘﺴﻁﺢ‬ ‫ﻭﻤﺭﺸﺢ‬flattening filter‫ﻭﺤﺠﻴﺭﺓ‬
‫ﺍﻟﺘﺄﻴﻥ‬monitor chamber.
•‫ﺍﻟﺴﺒﺏ‬:
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‫ﺒﺏ‬
–‫ﺒﺎﻟﺼﻴﺎﻨﺔ‬ ‫ﺍﻟﺨﺎﺼﺔ‬ ‫ﺍﻟﺤﺎﻟﺔ‬ ‫ﻓﻲ‬ ‫ﺍﻟﺨﻁﻲ‬ ‫ﺍﻟﻤﺴﺭﻉ‬ ‫ﺘﺸﻐﻴل‬ ‫ﻋﻨﺩ‬PHYSICAL
mode‫ﺍﻟﺨﻁﺭﺓ‬ ‫ﺍﻟﻤﺸﺎﻜل‬ ‫ﻫﺫﻩ‬ ‫ﻜﺸﻑ‬ ‫ﻋﻠﻰ‬ ‫ﻗﺎﺩﺭ‬ ‫ﻏﻴﺭ‬ ‫ﺍﻟﻤﺴﺭﻉ‬ ‫ﻴﺼﺒﺢ‬.
‫ﺍﻟﻌﻤل‬ ‫ﻋﻥ‬ ‫ﺍﻟﻤﻌﻁﻠﺔ‬ ‫ﺍﻷﺠﻬﺯﺓ‬ ‫ﻤﻊ‬ ‫ﺍﻟﺘﻌﺎﻤل‬ ‫ﺇﺴﺎﺀﺓ‬
–‫ﺤﺎﻟﺔ‬10-
•‫ﺍﻟﺤﺎﺩﺜﺔ‬:‫ﺒﻁﺎﻗﺔ‬ ‫ﺇﻟﻜﺘﺭﻭﻨﺎﺕ‬ ‫ﺤﺯﻤﺔ‬ ‫ﺍﻟﻤﺴﺭﻉ‬ ‫ﺤﺭﺭ‬36MeV
‫ﺍﻟﺘﺸﻐﻴل‬ ‫ﻭﺤﺩﺓ‬ ‫ﻤﻥ‬ ‫ﺍﻟﻤﺨﺘﺎﺭﺓ‬ ‫ﺍﻟﺤﺯﻤﺔ‬ ‫ﻁﺎﻗﺔ‬ ‫ﻋﻥ‬ ‫ﺍﻟﻨﻅﺭ‬ ‫ﺒﻐﺽ‬.
•‫ﺍﻷﺤﺩﺍﺙ‬ ‫ﺘﺴﻠﺴل‬:
–‫ﺇﻟﻜﺘﺭﻭﻨﺎﺕ‬ ‫ﺤﺯﻡ‬ ‫ﺒﺘﻭﻟﻴﺩ‬ ‫ﺍﻟﺨﻁﻲ‬ ‫ﺍﻟﻤﺴﺭﻉ‬ ‫ﺃﺨﻔﻕ‬.
–‫ﺍﻟﺼﻴﺎﻨﺔ‬ ‫ﻓﻨﻲ‬ ‫ﻗﺒل‬ ‫ﻤﻥ‬ ‫ﻤﻌﺎﻟﺠﺘﻪ‬ ‫ﺠﺭﺕ‬ ‫ﺍﻟﺨﻠل‬ ‫ﻫﺫﺍ‬.
–‫ﺍﻟﻘﻴﻤﺔ‬ ‫ﺍﻟﺘﻤﺜﻴﻠﻴﺔ‬ ‫ﺍﻟﻤﺅﺸﺭﺍﺕ‬ ‫ﺃﻅﻬﺭﺕ‬ ‫ﺼﻴﺎﻨﺔ‬ ‫ﻋﻘﺏ‬36MeV‫ﺒﺩﻻ‬
‫ﺓ‬ ‫ﺨﺘﺎ‬ ‫ﺍﻟ‬ ‫ﺔ‬ ‫ﺍﻟﻘ‬ ‫ﻋﻥ‬
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‫ﺍﻟﻤﺨﺘﺎﺭﺓ‬ ‫ﺍﻟﻘﻴﻤﺔ‬ ‫ﻋﻥ‬

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‫ﺍﻟﻌﻤل‬ ‫ﻋﻥ‬ ‫ﺍﻟﻤﻌﻁﻠﺔ‬ ‫ﺍﻷﺠﻬﺯﺓ‬ ‫ﻤﻊ‬ ‫ﺍﻟﺘﻌﺎﻤل‬ ‫ﺇﺴﺎﺀﺓ‬
–‫ﺤﺎﻟﺔ‬10-
‫ﻤﻌﺎﻟﺠﺔ‬ ‫ﺠﺭﻯ‬27‫ﻤﺭﻴﺽ‬‫ﺨﻼل‬‫ﻓﺘﺭﺓ‬10‫ﺃﻴﺎﻡ‬‫ﻁﺒﻴﺏ‬ ‫ﺒﺩﺃ‬ ‫ﺃﻥ‬ ‫ﺇﻟ‬ ‫ﻤﻌﺎﻟﺠﺔ‬ ‫ﺠﺭﻯ‬27‫ﻤﺭﻴﺽ‬‫ﺨﻼل‬‫ﻓﺘﺭﺓ‬10‫ﺃﻴﺎﻡ‬‫ﻁﺒﻴﺏ‬ ‫ﺒﺩﺃ‬ ‫ﺃﻥ‬ ‫ﺇﻟﻰ‬
‫ﺍﻟﻤﺴﻤﻭﺡ‬ ‫ﺍﻟﺼﻐﻴﺭﺓ‬ ‫ﺍﻟﺤﺩﻭﺩ‬ ‫ﺒﻴﻥ‬ ‫ﺍﻟﺘﺭﺍﺒﻁ‬ ‫ﺒﻌﺽ‬ ‫ﺒﺈﺠﺭﺍﺀ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬
‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺍﻟﺤﺎﻻﺕ‬ ‫ﺒﻌﺽ‬ ‫ﻓﻲ‬ ‫ﺍﻟﻤﻼﺤﻅﺔ‬ ‫ﺍﻟﺸﺩﻴﺩ‬ ‫ﻭﺍﻟﺘﺄﺜﻴﺭﺍﺕ‬ ‫ﺒﻬﺎ‬
‫ﺍﻟﺠﻬﺎﺯ‬ ‫ﻋﻠﻰ‬ ‫ﻁﺭﺃ‬ ‫ﺍﻟﺫﻱ‬ ‫ﺍﻟﻌﻁل‬ ‫ﻤﻊ‬.
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‫ﺍﻟﺤﺎﻟﺔ‬10‫ﺍﻟﺤﺎﺩﺙ‬ ‫ﻓﻲ‬ ‫ﺍﻟﻤﺴﺎﻫﻤﺔ‬ ‫ﺍﻟﻌﻭﺍﻤل‬.
contributing factor
•‫ﻓﻲ‬ ‫ﻋﻁل‬ ‫ﺒﺴﺒﺏ‬ ‫ﻜﺎﻥ‬ ‫ﺍﻹﻟﻜﺘﺭﻭﻨﺎﺕ‬ ‫ﺤﺯﻤﺔ‬ ‫ﺍﺨﺘﻴﺎﺭ‬ ‫ﻓﻲ‬ ‫ﺍﻟﺨﻠل‬ ‫ﺇﻥ‬‫ﻓﻲ‬ ‫ﻋﻁل‬ ‫ﺒﺴﺒﺏ‬ ‫ﻜﺎﻥ‬ ‫ﺍﻹﻟﻜﺘﺭﻭﻨﺎﺕ‬ ‫ﺤﺯﻤﺔ‬ ‫ﺍﺨﺘﻴﺎﺭ‬ ‫ﻓﻲ‬ ‫ﺍﻟﺨﻠل‬ ‫ﺇﻥ‬
‫ﺍﻹﻟﻜﺘﺭﻭﻥ‬ ‫ﺤﺯﻤﺔ‬ ‫ﺍﺨﺘﻴﺎﺭ‬ ‫ﻋﻥ‬ ‫ﺍﻟﻤﺴﺅﻭﻟﺔ‬ ‫ﺍﻟﻨﻅﺎﻡ‬ ‫ﺩﺍﺭﺍﺕ‬ ‫ﺇﺤﺩﻯ‬
electron beam.
•‫ﺍﻟﻤﺸﻜﻠﺔ‬ ‫ﻫﺫﻩ‬ ‫ﺤﻭل‬ ‫ﻜﺎﻑ‬ ‫ﺒﺸﻜل‬ ‫ﺍﻟﺘﺸﺎﻭﺭ‬ ‫ﻟﻡ‬‫ـ‬‫ﺇﻋﻼﻡ‬ ‫ﻴﺘﻡ‬ ‫ﻟﻡ‬
‫ﻤﺒﺎﺸﺭﺓ‬ ‫ﺒﺼﻭﺭﺓ‬ ‫ﺍﻟﻤﺸﻜﻠﺔ‬ ‫ﻫﺫﻩ‬ ‫ﻋﻥ‬ ‫ﺍﻟﻔﻴﺯﻴﺎﺌﻲ‬.
•‫ﺨﺎﻁﺊ‬ ‫ﺸﻜل‬ ‫ﻠ‬ ‫ﺜ‬ ‫ﺍﻟﺘ‬ ‫ﺅﺸ‬ ‫ﺍﻟ‬ ‫ﻪ‬ ‫ﻋﻠ‬ ‫ﺩل‬ ‫ﺍﻟﺘ‬ ‫ﺎﻟﺔ‬ ‫ﺍﻟ‬ ‫ﺘﻔ‬
01/27/2015 Osama Anjak Slide70
•‫ﺨﺎﻁﺊ‬ ‫ﺒﺸﻜل‬ ‫ﺍﻟﺘﻤﺜﻴﻠﻲ‬ ‫ﺍﻟﻤﺅﺸﺭ‬ ‫ﻋﻠﻴﻪ‬ ‫ﺩل‬ ‫ﺍﻟﺘﻲ‬ ‫ﺍﻟﺭﺴﺎﻟﺔ‬ ‫ﺘﻔﺴﻴﺭ‬ ‫ﺠﺭﻯ‬
‫ﺍﻟﻘﻴﻤﺔ‬ ‫ﻋﻠﻰ‬ ‫ﺍﻟﺩﺍﻟﺔ‬ ‫ﺍﻹﺸﺎﺭﺓ‬ ‫ﺘﺠﺎﻫل‬ ‫ﺠﺭﻯ‬ ‫ﺤﻴﺙ‬36MeV‫ﺍﻟﺘﻲ‬
‫ﺍﻟﻤﺅﺸﺭ‬ ‫ﻋﻠﻰ‬ ‫ﺜﺎﺒﺕ‬ ‫ﺒﺸﻜل‬ ‫ﻅﻬﺭﺕ‬.

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‫ﺍﻟﺨﻼﺼﺔ‬:‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﻓﻲ‬ ‫ﺍﻟﻤﺤﺘﻤﻠﺔ‬ ‫ﺍﻟﺤﻭﺍﺩﺙ‬
‫ﺍﻟﺨﺎﺭﺠﻴﺔ‬ ‫ﺍﻹﺸﻌﺎﻋﻴﺔ‬.
‫ﺍﻟﺨﻼﺼﺔ‬:‫ﺍﻹﺸﻌﺎﻋﻴﺔ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﻓﻲ‬ ‫ﺍﻟﻤﺤﺘﻤﻠﺔ‬ ‫ﺍﻟﺤﻭﺍﺩﺙ‬
‫ﺍﻟﺨﺎﺭﺠﻴﺔ‬.
•‫ﺍﻟﻤﻌﺎﻴﺭﺓ‬ ‫ﻓﻲ‬ ‫ﺍﻟﻤﺘﻭﻗﻌﺔ‬ ‫ﺍﻷﺨﻁﺎﺀ‬:
–‫ﺨﺎﻁﺊ‬ ‫ﺒﺸﻜل‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺠﻬﺎﺯ‬ ‫ﻤﻌﺎﻴﺭﺓ‬
–‫ﻟﺠﻬﺎﺯ‬ ‫ﺍﻟﺨﺭﺝ‬ ‫ﻤﻌﺩل‬ ‫ﺒﺘﻌﻴﻥ‬ ‫ﺍﻟﺨﺎﺹ‬ ‫ﺍﻟﺘﻔﻜﻙ‬ ‫ﻟﺠﺩﻭل‬ ‫ﺨﺎﻁﺊ‬ ‫ﺍﺴﺘﻌﻤﺎل‬
‫ﺍﻟﻜﻭﺒﺎﻟﺕ‬-60
–‫ﺍﻟﻤﺸﻊ‬ ‫ﺍﻟﻤﻨﺒﻊ‬ ‫ﺘﺒﺩﻴل‬ ‫ﺒﻌﺩ‬ ‫ﺍﻹﺸﻌﺎﻋﻲ‬ ‫ﺍﻟﺨﺭﺝ‬ ‫ﺠﺩﻭل‬ ‫ﺘﺠﺩﻴﺩ‬ ‫ﻋﺩﻡ‬
–‫ﺃﺠﺭﻱ‬ ‫ﺍﻟﺫﻱ‬ ‫ﻭﺍﻟﻌﻤﻕ‬ ‫ﻭﺤﺩﺍﺕ‬ ‫ﺤﻭل‬ ‫ﺍﻟﻤﻌﻠﻭﻤﺎﺕ‬ ‫ﺘﺒﺎﺩل‬ ‫ﻓﻲ‬ ‫ﻀﻌﻑ‬
‫ﺍﻟﺠﺭﻋﺔ‬ ‫ﺘﺤﺩﻴﺩ‬ ‫ﻋﻠﻴﺔ‬. (e.g. D or 5cm)
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‫ﺍﻟﺠﺭﻋﺔ‬ ‫ﺘﺤﺩﻴﺩ‬ ‫ﻋﻠﻴﺔ‬. (e.g. Dmax or 5cm)

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‫ﺍﻟﺨﻼﺼﺔ‬:‫ﺍﻹﺸﻌﺎﻋﻴﺔ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﻓﻲ‬ ‫ﺍﻟﻤﺤﺘﻤﻠﺔ‬ ‫ﺍﻟﺤﻭﺍﺩﺙ‬
‫ﺍﻟﺨﺎﺭﺠﻴﺔ‬.
•‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺘﺨﻁﻴﻁ‬ ‫ﻓﻲ‬ ‫ﺍﻟﻤﺤﺘﻤﻠﺔ‬ ‫ﺍﻷﺨﻁﺎﺀ‬Treatment
PlanningPlanning
–‫ﺨﺎﻁﺊ‬ ‫ﺒﺸﻜل‬ ‫ﺍﻟﺒﻴﺎﻨﺎﺕ‬ ‫ﺇﺩﺨﺎل‬PDD or TMR،
–‫ﺍﻟﻤﺭﺸﺢ‬ ‫ﺍﺴﺘﻌﻤﺎل‬ ‫ﻋﻨﺩ‬ ‫ﺍﻟﺘﺼﺤﻴﺢ‬ ‫ﻋﻤﻠﻴﺔ‬ ‫ﺘﻜﺭﺍﺭ‬‫ﺍﻻﺴﻔﻴﻨﻲ‬.
–‫ﺍﻟﻤﺴﺎﻓﺔ‬ ‫ﺘﺼﺤﻴﺢ‬ ‫ﺘﻁﺒﻴﻕ‬ ‫ﻋﺩﻡ‬.
–‫ﺍﻟﺘﺩﺭﻴﺏ‬ ‫ﻓﻲ‬ ‫ﻭﻀﻌﻑ‬ ‫ﺨﺎﻁﺌﺔ‬ ‫ﺒﺼﻭﺭﺓ‬ ‫ﹰ‬‫ﺎ‬‫ﻴﺩﻭﻴ‬ ‫ﺍﻟﺤﺴﺎﺒﺎﺕ‬ ‫ﺇﺠﺭﺍﺀ‬
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‫ﺍﻟﺠﻭﺩﺓ‬ ‫ﻀﻤﺎﻥ‬ ‫ﻭﺇﺠﺭﺍﺀﺍﺕ‬
‫ﺍﻟﺨﻼﺼﺔ‬:‫ﺍﻹﺸﻌﺎﻋﻴﺔ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﻓﻲ‬ ‫ﺍﻟﻤﺤﺘﻤﻠﺔ‬ ‫ﺍﻟﺤﻭﺍﺩﺙ‬
‫ﺍﻟﺨﺎﺭﺠﻴﺔ‬.
•‫اﻟﺘﺠﻬﻴﺰات‬ ‫ﺗﻌﻄﻞ‬ ‫أو‬ ‫ﺥﻠﻞ‬ ‫ﺏﺴﺒﺐ‬ ‫اﻟﻤﺤﺘﻤﻠﺔ‬ ‫اﻟﺤﻮادث‬:
–‫ﺥﺎﻃﺊ‬ ‫ﺏﺸﻜﻞ‬ ‫اﻟﻤﺘﻤﻤﺔ‬ ‫اﻷدوات‬ ‫ﺗﺮآﻴﺐ‬)‫اﻹﺳﻔﻴﻨﻲ‬ ‫اﻟﻤﺮﺷﺢ‬.(
–‫ﺏﺎﻟﺼﻴﺎﻥﺔ‬ ‫اﻟﺨﺎص‬ ‫اﻟﺘﺸﻐﻴﻞ‬ ‫ﺏﻨﻈﺎم‬ ‫اﻟﺨﻄﻲ‬ ‫اﻟﻤﺴﺮع‬ ‫اﺳﺘﻌﻤﺎل‬
Physical mode
–‫اﻟﺠﻬﺎز‬ ‫أﻋﻄﺎل‬ ‫ﻡﻊ‬ ‫ﺝﻴﺪ‬ ‫ﺏﺸﻜﻞ‬ ‫اﻟﺘﻌﺎﻡﻞ‬ ‫ﻋﺪم‬)‫اﻟﺼﻴﺎﻥﺔ‬ ‫ﻓﻲ‬ ‫ﺿﻌﻒ‬.(
–‫اﻟﻌﺎﻡﻠﻴﻦ‬ ‫ﺗﺪریﺐ‬ ‫ﻓﻲ‬ ‫ﺿﻌﻒ‬‫اﻟﻤﺴﺆوﻟﻴﻦ‬‫اﻟﺼﻴﺎﻥﺔ‬ ‫ﻋﻦ‬
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‫اﻟﻌﺎﻡﻠﻴﻦ‬ ‫ﺗﺪریﺐ‬ ‫ﻓﻲ‬ ‫ﺿﻌﻒ‬‫اﻟﻤﺴﺆوﻟﻴﻦ‬‫اﻟﺼﻴﺎﻥﺔ‬ ‫ﻋﻦ‬.
–‫اﻟﺘﺠﻬﻴﺰات‬ ‫ﺏﺼﻴﺎﻥﺔ‬ ‫اﻟﺨﺎﺻﺔ‬ ‫اﻹﺝﺮاءات‬ ‫ﺗﻮﺙﻴﻖ‬ ‫ﻋﺪم‬.
–‫اﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﻷﺝﻬﺰة‬ ‫اﻟﺠﻮدة‬ ‫ﺿﻤﺎن‬ ‫إﺝﺮاءات‬ ‫ﻓﻲ‬ ‫وﺥﻠﻞ‬ ‫ﺿﻌﻒ‬.

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References
ROSIS: Radiation Oncology Safety Information System
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References
• ‘Lessons Learned from accidental exposures in Radiation
Therapy’
– IAEA publication Safety Report Series No 17
• ‘Prevention of Accidental Exposures to Patients undergoing
Radiation Therapy’
– Annals of the ICRP Publication No 86
• Basic Safety Standards
– Safety series No 115 IAEA publication
• Investigation of an accidental exposure of Radiotherapy patients
i
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in Panama
– Report of a team of experts (IAEA publication 26 May-1June
2001)

39. Radiation Accident in Brachytherapy 01/27/2015
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‫ﺍﻹﺸﻌﺎﻋﻴﺔ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺒﺩﺍﻴﺎﺕ‬
01/27/2015 Osama Anjak Slide77
‫اﻟﻤﺮاﺝﻊ‬
•ICRP, 2005. Prevention of High-dose-rate Brachytherapy Accidents.
ICRP Publication 97. Ann. ICRP 35
•‘Lessons Learned from accidental exposures in Radiation Therapy’
A A bli i S f S i 1 •IAEA publication Safety Report Series No 17
•‘Prevention of Accidental Exposures to Patients undergoing
Radiation Therapy’
•Annals of the ICRP Publication No 86
•Basic Safety Standards
•Safety series No 115 IAEA publication
•Investigation of an accidental exposure of Radiotherapy patients in
PanamaPanama
•Report of a team of experts (IAEA publication 26 May-1June 2001)
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