1. The document provides guidance from the ICRP on the radiological protection of patients and workers during the use of cone beam computed tomography (CBCT).
2. It notes that CBCT is being used in new medical specialties by practitioners without traditional CT training, so optimized protection principles are needed.
3. The document makes recommendations to justify CBCT use, optimize protocols to reduce dose, and properly record and report patient radiation exposure for management.
43.Merlyn Elizabeth Monsy et al. ROLE OF CBCT IN ORAL AND MAXILLOFACIAL SURGERY – A REVIEW. International Journal of Psychosocial Rehabilitation, Vol. 24, Issue 04, 2020: 10302-10310
USE OF PET – HEALTH CARE POLICY PERSPECTIVESRuby Med Plus
POSITRON EMISSION TOMOGRAPHY (PET) USE BY TERTIARY HEALTH CARE CENT RES AND ITS ACCESSIBILITY TO POPULATION: A POLICY PERSPECTIVE. a BRIEF Cost-Benefit analysis.
Enhancement of clinical outcome using OBI and Cone Beam CT in Radiotherapydrsumandas
Improving the quality of radiation treatment by use of on board image Guidance (OBI) with KV Xray and CBCT. This decreases the variability in daily dose delivery and improves outcome.
enhancement of clinical outcome using On Board Image Guidance Cone Beam CTdrsumandas
Delivery of Radiation therapy has undergone a paradigm shift with the latest technologies. Now with these techniques we can limit daily variation of dose delivery by use of these technology.
43.Merlyn Elizabeth Monsy et al. ROLE OF CBCT IN ORAL AND MAXILLOFACIAL SURGERY – A REVIEW. International Journal of Psychosocial Rehabilitation, Vol. 24, Issue 04, 2020: 10302-10310
USE OF PET – HEALTH CARE POLICY PERSPECTIVESRuby Med Plus
POSITRON EMISSION TOMOGRAPHY (PET) USE BY TERTIARY HEALTH CARE CENT RES AND ITS ACCESSIBILITY TO POPULATION: A POLICY PERSPECTIVE. a BRIEF Cost-Benefit analysis.
Enhancement of clinical outcome using OBI and Cone Beam CT in Radiotherapydrsumandas
Improving the quality of radiation treatment by use of on board image Guidance (OBI) with KV Xray and CBCT. This decreases the variability in daily dose delivery and improves outcome.
enhancement of clinical outcome using On Board Image Guidance Cone Beam CTdrsumandas
Delivery of Radiation therapy has undergone a paradigm shift with the latest technologies. Now with these techniques we can limit daily variation of dose delivery by use of these technology.
the role of brachytherapy in oral cavity carcinoma.
physics of brachytherapy
radiobiology of brachytherapy
clinical application in tongue, buccal mucosa cancer
Radiation Oncology in 21st Century - Changing the ParadigmsApollo Hospitals
Since its inception radiation therapy has been used as one of
the essential treatment options in the management of malignant and some benign tumors. With better understanding of tumor biology many new molecules have been added to the armamentarium of an oncologist. There is continuous improvement in surgical techniques with more emphasis on minimally invasive, organ- and function-preserving techniques. Neoadjuvant chemotherapy with or without addition of radiation therapy has helped surgeon downsizing the tumor and obtaining clearer margins.
the role of brachytherapy in oral cavity carcinoma.
physics of brachytherapy
radiobiology of brachytherapy
clinical application in tongue, buccal mucosa cancer
Radiation Oncology in 21st Century - Changing the ParadigmsApollo Hospitals
Since its inception radiation therapy has been used as one of
the essential treatment options in the management of malignant and some benign tumors. With better understanding of tumor biology many new molecules have been added to the armamentarium of an oncologist. There is continuous improvement in surgical techniques with more emphasis on minimally invasive, organ- and function-preserving techniques. Neoadjuvant chemotherapy with or without addition of radiation therapy has helped surgeon downsizing the tumor and obtaining clearer margins.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
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
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the 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 lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
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. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
4. This slide set copies information from ICRP
Publication 129 in Main Points and in
Recommendations
Readers of this slide set are advised to go through
the full publication for detailed information as this
material is only a glimpse, rather than being a
comprehensive presentation of contents
4
5. 1. Introduction
2. CBCT Technology
3. The Biological Effects of Radiation
4. Principles of Radiological Protection for Patients and
Workers
5. Assessing Patient Doses in CBCT
6. Optimisation of Protection of Patients and Workers in
CBCT
7. Radiation Dose Management in Specific Applications of
CBCT
8. Training Considerations for CBCT
9. Quality Assurance Programmes
10. Recommendations
5
6. CBCT extends the use of CT to areas that were not
typically associated with CT imaging in the past, e.g.
surgery, dental and otolaryngology (ear-nose-throat,
ENT) imaging, angiography suites, radiotherapy
treatment vaults, and orthopaedic imaging.
The associated radiological protection issues are
substantially different from those of conventional CT.
The perception that CBCT involves lower doses was
only true in initial applications. CBCT is now used
widely by specialists who have little or no training in
radiological protection.
6
ICRP P129 p.13 and p 9
7. The manufacturers of CBCT scanners have
invested considerable effort into meeting the
electrical and mechanical safety requirements of
the users. Similar diligence is needed for issues
related to radiation dose and radiological
protection.
This document provides a basis to develop
informed decisions and to direct the usage of
CBCT for optimising the trade-off between
clinical benefit and radiation risk.
7
8. The ICRP emphasises that protection should be
optimised not only for whole-body exposures, but
also for exposures to specific tissues, especially
those of the lens of the eye, thyroid, breast, heart,
and cerebrovascular system.
Equipment used for both fluoroscopy and CBCT
should provide aggregate dose indices for individual
patients during the entire procedure through
electronic display on the operator console and a
radiation dose structured report (RDSR file).
8
9. Optimisation of both patient and worker doses,
particularly when the worker has to be near the modality,
is important wherein monitoring of doses become an
essential tool. Recording, reporting and tracking of
radiation dose for an individual patient should be made
possible in a consistent manner across vendors.
Low dose protocols may be sufficient for diagnostic
procedures focused on high-contrast structures, such as
lung, bones, dental and maxillofacial scans, ENT scans
(paranasal sinuses, skull, temporal bone), interventional
material, and contrast-enhanced vessels (angiographic
interventions).
9
10. Protocols with higher dose should only be
selected if visualisation of low-contrast
structures such as intracranial haemorrhage,
soft-tissue tumours, or abscesses are the
primary focus.
Most interventional and intra-procedural C-arm
CBCT systems can scan an angular range
spanning 180o to 240o + the cone angle of the x-
ray beam. Localised critical organs, such as the
thyroid, eyes, female breasts and gonads, should
be on the “detector side” of the arc, whenever
possible. 10
11. Clinical need permitting, every effort should be made
by users to ensure the volume of interest is fully
incorporated in the field of view (FOV) provided by
the CBCT scanners while radiosensitive organs are
placed outside the FOV.
The aim of CBCT should be to answer a specific
diagnostic or intra-operative question vis-à-vis other
imaging modalities and not to obtain image quality
that rivals MDCT. The decision by the referring
practitioner to utilise CBCT should be made in
consultation with the imaging professional.
11
12. There is a need to provide checks and balances,
for example, dose check alerts implemented in
CT in recent years, to avoid unintended high
patient exposure as compared to locally defined
reference values.
Methods which provide reliable estimates of
patient eye dose under practical situations
should be established and utilised.
The user of CBCT in interventions can influence
the radiation dose imparted to the patient
significantly by judiciously using a “low-image-
quality or low dose” vs. a “high-image-quality or
high dose” scan protocol.
12
13. In radiotherapy, justified use of CBCT has
potential uses at different stages of therapy such
as: pre-treatment verification of patient position
and target volume localisation, evaluation of
non-rigid misalignments, such as flexion of the
spine or anatomic changes in soft tissue, and
during or after treatment to verify that the patient
position has remained stable throughout the
procedure. Low-dose CBCT protocols should be
used for pre-treatment alignment of bony
structures.
13
14. Many machines were initially only capable of
fluoroscopy, but can now additionally perform CBCT.
Because of the improved clinical information in
CBCT and its ability to remove overlying structures,
the user may be tempted to over-utilise the CBCT
mode. Users should judiciously use CBCT mode.
In orthopaedics, justified use of CBCT can help in
assessing the 2 dimensional position of fractures
and implants with respect to the bony anatomy,
especially in situations where fluoroscopy alone is
insufficient, and thus can help in patient dose
management.
14
15. In urology, low-dose CBCT protocols should be
used when imaging high-contrast structures,
such as calcified kidney stones or device
placements.
Dental and maxillofacial CBCT scans should be
justified, considering alternative imaging
modalities. Once justified, it should be optimised
to obtain images with minimal radiation dose
without compromising the diagnostic
information.
15
16. The level of training in radiological protection
should be commensurate with the level of
expected radiation exposure (ICRP, 2009).
All personnel intending to use CBCT for
diagnostic purposes should be trained in the
same manner as for diagnostic CT and those
intending to perform interventional CBCT should
be in trained in same manner as for
interventional CT.
16
17. 1. Expanded availability and newer applications have
put CBCT technology in the hands of medical
professionals who do not traditionally use CT.
ICRP’s radiological protection principles and
recommendations provided in earlier publications,
particularly Publications 87 and 102 apply to these
newer applications and should be adhered to.
17
18. 2. As many applications of CBCT involve patient
doses similar to MDCT, the room layout and
shielding requirements in such cases need to be
similar to protect workers adequately.
3. Medical practitioners bear the responsibility for
making sure that each CBCT examination is
justified and appropriate.
18
19. 4. When referring a patient for a diagnostic CBCT
examination, the referring practitioner should be aware
of the strengths and weaknesses for CBCT vis-à-vis
MDCT, magnetic resonance imaging, and other
competing imaging modalities. The decision to utilise
CBCT should be made in consultation with an imaging
professional.
5. Manufacturers are challenged to practice standardised
methods for dosimetry and dose display in CBCT in
conformance with international recommendations such
as ICRU. Unfortunately, at present, there is wide
variation in dose quantities and units being displayed in
CBCT machines. The users are often unable to
compare doses among different scanners or protocols.
19
20. 6. Use of CBCT systems for both fluoroscopy and
tomography pose new challenges in quantitating
radiation dose. There is a need to develop
methods that aggregate exposures to individual
patients during the entire procedure that may utilise
a combination of fluoroscopy and CBCT during a
given examination.
7. Recording, reporting and tracking of radiation dose
for an individual patient should be made possible in
a consistent manner across vendors.
20
21. 8. There is a need to provide checks and balances
(e.g. dose check alerts implemented in CT in
recent years), to avoid unintended high patient
exposure as compared with locally defined
reference values.
9. Positioning radiosensitive organs such as the
thyroid, the lens of the eye, breasts and gonads on
the detector side during the partial rotation scan is
a useful feature in CBCT that needs to be utilised
for radiological protection of these organs.
21
22. 10. Many machines were initially only capable of
fluoroscopy, but can now additionally perform
CBCT. Because of the improved clinical information
on CBCT, and its ability to remove overlying
structures, a user may be tempted to over utilise
the CBCT mode. Users must understand that the
CBCT function of their system is not a low-dose
“fluoroscopy run” and use this mode judiciously.
22
23. ICRP, 2015. Radiological Protection in Cone Beam
Computed Tomography (CBCT). ICRP Publication 129.
Ann. ICRP .
23