Medical Imaging Technology

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An Advanced Approach to Reconstruct CT Images from limited-angle projections, reducing radiation dose and tube load.
(Al-Quds University, 2023-12-12) Doaa Housni Ali Bani Odeh; دعاء حسني علي بني عودة
Concerns regarding ionizing radiation doses to individuals and patients have arisen as a result of the remarkable advancements in computed tomography (CT) technology and applications over the last ten years, so Computed tomography (CT) scanners and CT exams have increased continuously. Researchers aim to minimize ionizing radiation dose via introducing new CT protocols and providing diagnostic CT images with lower radiation doses to patient. Nevertheless, these investigations have challenges: reducing the radiation dose results in decreased image quality, which might occasionally be non-diagnostic. In This study, the researcher aims to investigate the possibility of forming a CT brain image from a limited number of projections at a projection angle of less than 180 degrees While maintaining image quality based on the ALARA principle and decreasing radiation dose. then determine if the images match the quality criteria of Brain CT. This effort spanned from January 2023 to September 2023. The process of reconstructing CT scan images from limited angle projections is critical and requires strict adherence to the ALARA principle. This principle is designed to minimize radiation exposure while maintaining image quality. Our study utilized filter back-projection (FBP) and algebraic iterative reconstruction (IR) algorithms to reconstruct brain CT images from 500 projection lines with a 100 x 100 and 200 x 200 matrix size. In addition to researching the effect of the reconstruction angle on image quality, two degrees were taken at an angle of 90 and 45 degrees. The images were evaluated for image quality criteria by 10 expert medical imaging technicians and 2 radiologists and specific evaluations were given. Then, a simple descriptive statistical analysis was conducted, including calculating percentages for expert medical imaging technicians and radiologists evaluations and p-values. By combining the results of a MATLAB 2021 functions with the insights of a radiologist, we can produce high-quality images that decrease radiation dose and tube load. Our findings reveal that the algebraic method is superior to the filter back-projection in preserving image quality when utilizing limited-angle projections. In addition to the Statistical t-test (P<.001), which confirms the existence of statistical differences between the two algorithms. With a percentage of 41%, or a moderate scale, the IR algorithm matches quality requirements better. Conversely, the FBP exhibits a proportion of < 25%, signifying a weak scale. Based on the percentages of evaluation, we can confirm that the size of the Matrix 200 x 200 is superior to the size of the Matrix 100 x 100, as it formed a percentage of 36.25%, which is equivalent to a moderate scale. In addition, the reconstruction angle of 90 provides better quality and its percentage was 41.75%, equivalent to a moderate scale. So the IR algorithm at 90 degree with 500 projection only provides images that match the quality criteria for brain CT. while FBP fails to provide any meaningful insights when working with angles of 45 and 90 degrees.
Analysis of Tumor Markers Effect after Radiation Exposure among Palestinian Radiation Workers
(Al-Quds University, 2020-06-12) Areej Najeeb Ali Dahdol; اريج نجيب علي دحدو ل
Objective: The aim of this work was to investigate the effect of low radiation doses on tumor markers tests. And to follow up the policy that carrying out the tests for Radiation Workers. Also, demonstrate the effect of independent variables such the cumulative dose, Hospital location, and type of work on tumor markers. Method: the researcher reviews a retrospectively collected database of tumor marker tests in four governmental hospitals +between 2013- 2019, to following the patterns of tumor marker over the years. The cumulative doses records were taken from energy department in ministry of health. Additionally to distribute a questionnaire to correlate independent variables with tumor markers records and also to demonstrate the policy following of carrying out these tests among RWs. 78 radiation workers participated. Results: after several years of following tumor markers, all tumor markers tend to increase in a normal range, especially the CEA; approximately 57% of radiation workers have an increase in CEA. The smoking workers have a statistically significant change in CEA; also the study not shown any relationship between the radiation doses and tumor markers. While a measure of the knowledge level of policy show 73% of worker answered that no one is responsible for following tests results. Further, 91% of workers admit no action was taken in the event of an abnormal result found. Conclusion: Until now all tumor markers results was in a normal range, even if they tend to a little increase from year to year, but that still prove nothing without repeat this study and comparing this group of worker with another different type of workers, to understand if this increase that have noticed here in this study come from radiation or not. Otherwise highlight the role of policy officer who’s responsible for monitoring the carrying out these tests and follow up what happen on radiation workers tests results.
Assessment of Knowledge and Practices of Intensive Care Unit Staff of Radiation Protection during Portable Radiography in the City of Bethlehem and East Jerusalem, Palestine
(Al-Quds University, 2023-05-13) Elias Issa Elias Juha; الياس عيسى الياس جحا
The application of ionizing radiation in portable radiography is a commonly employed technique within hospital settings, particularly when patients are deemed medically unfit to undergo transportation to the imaging department. Nonetheless, this circumstance might result in personnel being exposed to radiation. This study evaluated the physicians’ and nurses’ awareness level and practices of radiation protection principles and risks of portable radiography in the ICUs, CCUs, and NICUs at nine Bethlehem and East Jerusalem hospitals. For data collection, the researcher designed a prospective multiple-choice questionnaire study consisting of six parts; the first part contains six questions about socio-demographic factors and related work information; the second part deals with radiation protection knowledge and awareness of the intensive care staff; the third part deals with the practices and behavior during portable radiography; the fourth part assesses how often the intensive care staff uses radiation protection equipment; the fifth part studies the staff’s needs for further training and courses regarding radiation protection, and the last part deals with how often the intensive care staff rates their knowledge of radiation protection. The data were analyzed using the SPSS, version 21.0 software, T-test, Tukey test, and ANOVA test. Moreover, the means, standard deviations, and percentages were founded. The results show statistically significant differences between the level of knowledge (P=0.000) and the need for further training and courses regarding radiation protection (P=0.040) according to the years of practice variable. Also, statistically significant differences between the level of knowledge (P=0.000) and the need for further training and courses regarding radiation protection (P=0.045) according to the age variable. Furthermore, statistically significant differences between the level of knowledge (P=0.000) and their behavior and practice (P=0.018) according to the academic education variable, and statistically significant differences between the need for further training and courses (P=0.016) and the use of radiation protection equipment (P=0.029) according to the hospital sector variable. Moreover, the results indicate that there are no differences between the level of knowledge, the need for further training, the use of radiation protection equipment, and practices according to the gender and occupation variables, no differences between the use of radiation protection equipment and practices according to the age and years of practice variables, no differences between the need for further training and courses and the use of radiation protection equipment according to the academic education variable, and no differences between the level of knowledge and practices according to the hospital sector variable. Accordingly, our sample consists of 142 particpents, the overall knowledge and awareness level regarding radiation protection and risks was found to be 56% and rated as fair. Moreover, 56.3% of the participants were found to leave the intensive care department during portable radiography, and 48.6%, 62.7%, 68.3%, and 73.9% stated that they never use lead aprons, thyroid shields, lead gloves, and eyeglasses, respectively. While, 72.5% stated they never attended training or courses regarding radiation protection and 79.6% stated that continuous education officer does not provide them courses or refreshment lectures regarding radiation protection. Thus, their educational level and awareness need to be increased. Implementing courses, presentations, refreshment lectures, and periodic training for these personnel could effectively achieve this goal. Further research using a larger sample is recommended.
Assessment of radiation doses for cardiac and left anterior descending coronary artery in patients undergoing Left breast radiation therapy in Palestine
(Al-Quds University, 2020-08-15) Bayan Saleh Ali Suleiman; بيان صالح علي سليمان
Purpose: To evaluate radiation doses in cardiac radiotherapy planning in left breast cancer patients using 3D conformal radiotherapy planning technique based on computed tomography (CT) dose planning. Methods: Data was retrospectively collected from archived Computed Tomography (CT) images, whole heart and left anterior descending coronary artery (LAD) radiation doses at Augusta Victoria Hospital (AVH) between 2017-2019. Data composed of 176 breast cancer radiotherapy cases; 70 chest wall irradiated mastectomies patients, and 106 breast irradiated lumpectomies patients. Individual dose volume histograms for the whole heart and for LAD were obtained, in addition to the calculated mean, median and maximum volume percentage (V10%, V25%, V30%) of these structures for the study sample which represents the percentage of heart volume receiving (x) Gy or higher, then compared to the Quantitative Analyses of Normal Tissue Effects in the Clinic (QUANTEC) guidelines and previous studies for dose assessment of heart and LAD. Represents the percentage of an organ’s volume receiving (x) Gy or higher Results: Results showed the whole mean heart dose (MHD) and the mean dose of LAD were 2.2 Gy and 13.94 Gy, respectively. In which, 4.5% of patients received MHD ≥ 4Gy, all subjects received V25% less than 10cm expect one V25% ≥ 10. 11 % of patients received LAD maximum dose ≥ 45 Gy. In spite of the dose variations found in both MHD and LAD in this study, and the dose differences noticed when compared to studies that used other radiotherapeutic techniques such as Deep Inspiration Breath Hold technique (DIPTH), MHD and LAD dose assessments were equivalent to those of the compared previous studies and Quantitative Analyses of Normal Tissue Effects in the Clinic (QUANTEC) guidelines. Conclusions: Dose assessments of adjuvant CT-based radiotherapy of subjects with left breast cancer demonstrated similar MHD but higher LAD doses when compared to previous studies and QUANTEC guidelines used to predict cardiac toxicities in most patients in the study sample. Since there is no worldwide standardized protocol or heart dose constrains in left breast radiotherapy, this study suggests maintaining the lowest received dose and volume of the heart or organ at risk included in the treatment plan, as well as using advanced techniques.as DIPH to reduce the latent effects on radiotherapy patients, especially the heart complications that could occur.
Awareness, Attitude and practice among Palestinian women regarding breast cancer screening (breast self-examination and mammography)
(Al-Quds University, 2024-01-14) Sabreen Ali Mohammed Thawabteh; صابرين علي محمد ثوابته
Breast cancer, being the most prevalent cancer among women worldwide, leads to about 400,000 deaths yearly. All women should have a basic understanding of breast self-examination (BSE). This study aims at determining Palestinian women’s knowledge, behavior and beliefs about BC and BSE. Data were obtained using a structured questionnaire that was distributed 200 female women’s Palestinian. The questionnaire evaluated the students’ knowledge, behavior, and attitudes about BC and BSE. The study revealed that 70% of the participants had an awareness of BC and 30% were unaware of the term BSE. only 30% had had a mammography screening, compared to 70%. The study participants' participation rates in mammography screening and BSE. According to the results, 63% of participants had never practiced BSE, compared to 37% who had. Furthermore, only 30% had had a mammography screening, compared to 70% who had not. These results highlight the necessity of raising public awareness and promoting BSE and mammography screening in order to enhance early identification and preventative measures for BC. Further efforts need to be done to expand women’s knowledge about BC, early detection and treatment.
Criteria for dental implant selection in Palestine
(Al-Quds University, 2024-06-10) Bara'a abd alhakeem jobran rojoub; براءة عبد الحكيم جبران رجوب
Dental implants are alloplastic materials that are placed in order to assist repair or replace damaged orofacial components. The outcome is dependent on how well the implant's substance integrates with the surrounding tissue. However, this integration is influenced by several factors, such as implant material, bone quantity and quality, and implant loading status. Accurately detecting anatomical features in relation to implant size increases the success rate of implant surgery and reduces the risk of surgical damage. This can only be accomplished by a comprehensive and suitable radiological examination. In order to help the dentist, determine the best kind of implant for the patient, the study focuses at the characteristics of the implant and the medical imaging modalities Cone Beam Computed Tomography (CBCT) and panoramic that the dentist performs. A cross-sectional descriptive study about the functions of medical imaging in dental implants and the factors that influence selecting the type of implant among Palestine's dentists who perform dental implant. An online survey including inquiries about preferred dental implants, the status of patient’s economy, and other important factors that influenced their choice of implant type. The statistical analysis conducted using IBM SPSS v27 to investigate the relationships and differences between various variables, Cronbach's alpha, chi-square test, Spearman's rank correlation, Kruskal Wallis and Mann-Whitney U test were used to examine relationship between the study’s variables. Throughout the analysis, we consider statistically significant of a P-value of less than 0.05, indicating that observed effects were unlikely to be due to chance. 94.6% of participants stated that CBCT is their primary medical imaging modality. Additionally, the study's findings indicate that the following factors influenced the dentist's decision regarding the type of implant: (a) the time required for the procedure, which was 69.8% P-Value ˂0.001; (b) the patient's age, which was 60.4% P-Value ˂0.001; (c) the implant's cost, which was 62.8% P-Value ˂0.001; and (d) the patient's required number of implants, which was 59.7% P-Value ˖0.001. Surgical implants were selected primarily in comparison to basal and compressive implants based on characteristics such as implant stability, success and continuity, surrounding bone growth, and the expected medical benefit overall. The majority of Palestinian dentists use CBCT to identify the type of implant. Additionally, the outcomes demonstrated that while basal implants produce equivalent results more quickly, dentists did not initially favor them. When choosing an implant type, dentists considered the patient's age, the duration of the surgery, and the implant's cost into account.
Effect of magnetic field strength and sequence type on susceptibility artefacts: a comparative study utilizing low and high field strength magnetic resonance imaging scanners
(Al-Quds University, 2023-12-11) Alaa Mahmoud Ali Qalalweh; علاء محمود علي قلالوة
Many patients need to implant metal screws in several areas in their bodies as treatment procedures, and these metal implants cause an artefact around them in the magnetic resonance image, so the area around the metal implants can't be better evaluated, and this artefact increases whenever the magnetic field increased, for example, using the device with the magnetic field 1.5 T causes a greater susceptibility artefact than using a device with 0.4 T magnetic field. This type of artefact leads to repeat the MR image again using low field MR devices, this will increase the costs of diagnosis, increase the patient's exhaustion to obtain sufficient diagnosis, in addition to consuming more time to complete the diagnosis process. in this study, the measurements of the artefact around the titanium screws in low and high MR field was compared with the measurements of the screws in X-ray images. in addition to other sample was taken from calf spine that purchased from meat store that have been implanted with other 3 titanium screws, then underwent low and high field MR imaging in 3 repeats to get more accurate measurements, this artefact measurement around the screws in the calf spine was compared with the diameter of the same screws measurements on X-ray images. The result of this study was clarify that the use of low field MR device is better than the high field in case of presence of titanium screws in vertebral body, in addition to use titanium rather than other metallic materials that produce high susceptibility artefact in MR image, and this will be shown in the charts in this study. الكثير من المرضى يضطرون الى زرع براغي معدنية في عدة مناطق في اجسامهم كإجراءات علاجية، وهذه الزرعات المعدنية تسبب حولها تشويشا في صورة الرنين المغناطيسي، فتصبح المنطقة التي تحيط بالزرعات المعدنية غير قابلة للتشخيص، ويزيد هذا الخلل كلما ارتفع المجال المغناطيسي المستخدم، فمثلا استخدام الجهاز ذو قوة المجال المغناطيسي 1.5 تسلا يتسبب في خلل أكبر من استخدام جهاز بقوة 0.4 تسلا، هذا الخلل الناتج في الصورة يتسبب أحيانا بإعادة تصوير المريض على الجهاز منخفض المجال، ويزيد من تكاليف التشخيص، بالإضافة الى انه يزيد من معاناة المريض للحصول على تشخيص كاف، بالإضافة الى استهلاك المزيد من الوقت لإكمال عملية التشخيص. في هذه الدراسة يتم قياس الخلل الذي تسببه براغي التيتانيوم حولها عند التصوير باستخدام جهاز الرنين المغناطيسي منخفض المجال والجهاز عالي المجال، هذه القياسات تؤخذ لنفس البراغي بعد تصويرها في كلا المجالين، ثم يتم قياسها بالمليميتر، ومقارنتها مع القياسات لنفس البراغي على صور الاشعة السينية. بالإضافة الى غرس 3 براغي في عمود فقري لعجل تم شرائه من متاجر اللحوم، هذه البراغي جميعا تم تصويرها باستخدام المجالين أيضا، وتم إعادة تصوير هذه البراغي 3 مرات لزيادة دقة النتائج، وتم عمل القياسات لجميع هذه البراغي ومقارنة نتائجها بعضها مع بعض، ومقارنتها مع القياسات التي كتبت على البراغي بواسطة الشركة المصنعة. تبين في هذه الدراسة ان الخلل الناتج في صور الرنين المغناطيسي باستخدام الجهاز ذو المجال المرتفع أكبر بكثير من الخلل الناتج من استخدام الجهاز ذو المجال المنخفض، بالإضافة الى ان استخدام مواد مثل التيتانيوم التي تعتبر اقل تأثيرا في قابلية التمغنط يقلل من التشوه الموجود في صورة الرنين، وتبين المنحنيات في فصل نتائج الدراسة هذه الفروقات بشكل مفصل.
Effective patient Preparation durin Prostate Radiotherapy Evaluations of Bladder and Rectum Doses
(Al-Quds University, 2020-08-22) Qusai Mohammad Mustafa Tamim Tamimi; قصي محمد مصطفى تميم تميمي
Prostate cancer is a form of cancer that affects the prostate gland, it is considered as the second most mortality rate cancer among men. In low and intermediate risk prostate cancer patients,radiotherapy is the choice of treatment. With the advent of the radiation therapy it is now possible to treat the cancerous tissue accurately by localizing the tumor and then providing the exact dosing without harming the surrounding normal tissues. Image-guided radiation therapy or IGRT can evaluate the dose of radiation therapy to the target and Organs at Risks OARs effectively. The dose-volume histograms obtained from IGRT can help in assessing the effective dose of radiation given to the prostate, rectum, and bladder. This study was undertaken to assess the effect of bladder and rectum preparation protocol in dosevolume histograms (DVHs) in prostate cancer patients. The dosimetric changes resulted from the change in bladder and rectum volume with the bladder preparation and rectum clearance protocol were also evaluated in this study. In this retrospective study total 15 patients were included and 396 Cone Beam Computed Tomography CBCT scanning data was evaluated to obtain information. The patients were subjected to a bladder and rectum preparation protocol and insuring that they followed the protocol strictly. After the irradiation process DVH was constructed. The maximum, minimum and average dose to Urinary Bladder and Rectum were checked and compared to the DVH at the original plan which was calculated on the CT simulation images for each patient. Statistical significance was set at a P value < 0.05. Analyses were performed using R software and IBM SPSS version 23 for Windows. The result indicated that there is a significant difference between the planned bladder volume and also the average volume. The bladder filling protocol used by this study was able to reach a mean bladder volume of 314 mL. During the treatment time, this value got reduced and a mean bladder volume of 207 mL was achieved at the time of the radiotherapy. Also a statistically significant differences was observed regarding the bladder and rectum doses between planning and daily treatment sessions. Statistically significant differences in Rectum volume in both planned volume and average volume were reported. These differences are in both real values (P-value=0.024) and proportions to planned values (P-value=0.007). The change in mean dose to the bladder would increase while the volume of the bladder shrinks (P-value=0.00). The present study reported that rectum and bladder volume has a significant effect on the dosimetric parameters. The main contributing factor that can help in achieving the optimal plan is the bladder volume. Bigger bladder volume in the planning phase results in higher differences in volume and doses in the time of the treatment. .
The Efficiency of FLAIR-Weighted BLADE in image Quality Parameter Correction for Moved Patient
(Al-Quds University, 2023-03-11) maram mohammad motee ghazawna; مرام محمد مطيع غزاونة
Magnetic resonance imaging (MRI) is a medical tool that can provide detailed information about the inner structure of a person's body. The use of the fluid-attenuated inversion recovery (FLAIR) sequence in imaging the brain is very useful, as it can help identify subtle changes in the brain's structure and function. Due to the sensitivity of MRI to artifacts, it is not always possible to achieve high-quality imaging. The presence of motion artifacts can affect the overall diagnostic value. In this study dipole filling for k-space (BLADE) was implemented for 46 different images with different motion types including right rotation, left rotation, right bending, left bending, flexion, extension, and combination. In this work, we aimed to measure signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and percentage of signal ghosting (PSG). RADIANT DICOM viewer was used to calculate signal intensity (SI) and its standard deviation (SD), the SD is used as the noise index. ImageQC was used to calculate PSG while these measurements are plotted in Microsoft Excel. In this research, we used a control group of 46 patients who have standard images which use the cartesian filling for k-space for comparing the measurements with standard FLAIR sequence. Results showed using BLADE lead to a significant improvement in SNR, CNR, and ghosting in almost all types of motion while failing to correct ghosting from severe patient motion. The mean value of SNR was 1.08 for the dipole filling (BLADE) sequence and significantly reduced to 0.92 for the routine sequence (p<0.05). While the mean CNR was 0.75 for dipole filling and significantly reduced to 0.49 for routine sequence (p<0.05). Finally, the mean PSG for dipole filling was 0.75 and significantly reduced to 0.18 for routine sequence (p<0.05). In conclusion, the dipole filling sequence enhances SNR, and CNR due to flow and eye motion. Although BLADE reduced ghosting artifacts in most types of motion, BLADE was unable to eliminate ghosting appearance from the severe patient motion. التصوير بالرنين المغناطيسي (MRI) يوفر معلومات مفصلة حول التشريح الداخلي لجسم المريض, ويعد استخدام بروتوكول تثبيط اشارة السوائل (FLAIR) ذو أهمية في تصوير الدماغ حيث يساعد على التمييز بين السوائل وامراض الدماغ, ومع الأسف ليس من الممكن الحصول على صورة تشخيصية في جميع الحالات نظرا لحساسية التصوير بالرنين المغناطيسي لحركة المريض هذه الحركة تؤثر على القيمة التشخيصية للصورة, في هذه الدراسة نسعى لدراسة أثر الملء القطبي للبيانات ل 46 صورة تم تصويرها ب حركات مختلفة بحيث تشمل هذه الحركات دوران لليمين, دوران لليسار, انحناء لليمين, انحناء لليسار, انحناء للأمام, وانحناء للخلف. قمنا في هذه الدراسة بحساب نسبة التباين, نسبة الإشارة الى التشويش, ونسبة الإشارة الوهمية. حيث تم استخدام برنامج RADIANT DICOM لقياس كثافة الإشارة والانحراف المعياري للإشارة, ويستخدم الانحراف المعياري كمؤشر على كمية التشويش. استخدمنا أيضا في هذه الدراسة برنامج imageQC لحساب نسبة الإشارة الوهمية. تم تسجيل النتائج على برنامج مايكروسوفت اكسل وتمت مقارنتها ب 46 صورة تم اجرائها بالبروتوكول المعياري الذي يستخدم الملء الخطي للبيانات, أظهرت النتائج تحسنا في نسبة الإشارة الى التشويش ونسبة التباين, بالإضافة الى حل مشكلة الإشارة الوهمية الناتجة عن تدفق السائل النخاعي وحركة رموش العين بينما لم يتم تصحيح الإشارة الوهمية الناتجة عن الحركات المتكررة للمريض, كان متوسط نسبة الإشارة الى التشويش في الصور التي تم اجرائها باستخدام الملء القطبي 1.08 بينما صور الملء الخطي 0.92 حيث يعتبر فرق ذو دلالة إحصائية عند قيمة احتمالية اقل من 5%, وبالنسبة لنسبة التباين لصور الملء القطبي 0.75 وانخفض الى 0.49 في صور الملء الخطي ويعتبر هذا فرق ذو دلالة إحصائية عند قيمة احتمالية اقل من 5%. ختاما نسبة الإشارة الوهمية 0.75 في صور الملء القطبي وانخفض الى 0.18 في صور الملء الخطي حيث يعتبر هذا فرق ذو دلالة إحصائية عند قيمة احتمالية اقل من 5%. ونستنتج ان الملء القطبي يعزز نسبة التباين ونسبة الإشارة الى التشويش ويحل مشكلة الإشارة الوهمية الناتجة عن تدفق السائل النخاعي وحركة العين بينما يفشل في حل مشكلة الحركات المتكرة.
Evaluating the Accuracy of 128-Section Multi-Detector Computed Tomography (MDCT) in Detecting Coronary Artery Stenosis
(Al-Quds University, 2022-05-22) Mutasem Mohammad Rafiq Kmail; معتصم محمد رفيق كميل
تعتبر أمراض الشرايين التاجية من الأمراض الرئيسية المسببة للوفاة في جميع أنحاء العالم. يتم استخدام العديد من التقنيات لتشخيصهم واكتشافهم بما في ذلك التقنيات التداخلية وغير التداخلية (الجراحية وغير الجراحية). الطريقة التداخلية (القسطرة): هي عملية جراحية تعتمد على شق جراحي من الجلد يتم عن طريقه الوصول الى الشرايين التاجية. تعد هذه الطريقة المعيار الذهبي في تشخيص أمراض الشرايين التاجية. على الجهة المقابلة، تتسبب القسطرة في آثار جانبية متعددة للمرضى والتي يجب محاولة تجنبها خصيصاً عند من يعانون من اضطرابات في التخثر واضطرابات في الأوعية الدموية. بناءً على ذلك، هناك ضرورة ملحة لإيجاد طرق ذات أضرار جانبية أقل في الوقت الذي يمكن الاعتماد عليها في تقييم أمراض الشرايين التاجية . يعد التصويرالمقطعي المحوسب متعدد الكاشفات المكون من 128 قسمًا (128-slice MultiDetector CT scan) أحد أهم الطرق غير الجراحية وأكثرها شيوعًا, حيث يساعد في تقييم حالة الشرايين التاجية. هناك حاجة ملحّة لتقييم مدى دقة التصوير المقطعي في اكتشاف أية تغيرات مرضية في الشرايين التاجية من أجل إحلال التصوير المقطعي كبديل عن تصوير الأوعية التاجية بالطريقة التداخلية لتجنب المخاطر المحتملة. لذلك، تهدف هذه الدراسة إلى تقييم دقة التصوير المقطعي في اكتشاف أمراض الشرايين التاجية، ولتحقيق ذلك، تم جمع تقارير التصوير المقطعي و تقارير عمليات القسطرة الشريانية لـ 65 مريض من أجل دراستهم ومقارنة نتائجهم. قمنا باستخدام مقاييس إحصائية مختلفة لحساب دقة جهاز التصوير المقطعي مثل: حساسية المعيار والنوعية للمعيار والقيمة الإيجابية المتوقعة والقيمة السلبية المتوقعة للمعيار. أظهرت النتائج التي تم الحصول عليها أن التصوير المقطعي يتمتع بدقة عالية مع قيم عالية لكل من الحساسية والنوعية وقيمة التنبؤية الايجابي وقيمة التنبؤية السلبية. بعض النتائج اظهرت ان نتيجة القسطرة مغايرة لنتيجة التصوير المقطعي المحوسب متعدد الكاشفات المكون من 128 قسمًا لعدة اسباب منها: ضعف التعتيم (الماده الملونه) أو ضبابية الحركة(حركة النبض). نستنتج أن التصوير المقطعي المحوسب متعدد الكاشفات المكون من 128 قسمًا يمكن أن يحل محل القسطرة خاصة للمرضى الذين لا يستطيعون إجراء العمليات الجراحية التداخلية أو الذين يعانون من اضطرابات في التخثر أو الأوعية الموسعة المشوهة.
Evaluation of the Application of Orthopedic Metal Artifact Reduction and Iterative Reconstruction Algorithms in CT Imaging of Hip Prostheses
(Al-Quds University, 2021-05-28) Omarah Naser Saed AbdAlqader; عماره ناصر سعيد عبد القادر
The CT imaging of metal hip prosthesis causes metal-related artifacts reducing the overall image quality and clinical value of CT. This study aims to an evaluation of using orthopedic metal artifact reduction (O-MAR) technique and iterative model-based reconstruction (IMR) in CT imaging of bilateral total hip prostheses in a pelvis phantom. The fabricated pelvis phantom has four major components, pelvis bones, muscle, fat, and vascular structures, and was made using different concentrations of respectively calcium sulfate, bee wax, agarose powder, and Iohexol. Two types of hip prosthesis were used total hip and Austen Moore prosthesis. Different types of algorithms, filtered back projection (FBP), iDose4, and IMR with different Kilo-Voltage peak (kVps) settings at 80, 100, 120, and 140, combined with O-MAR were applied on this phantom. The image quality criteria were CT number, noise, and signal to noise ratio (SNR) and were analyzed by five regions of interest (ROIs), while regions R1 and R5 were the primary focusing. The five RIOs representing the following anatomy (right common iliac artery, left common iliac artery, right gluteus medius muscle, fat, and urinary bladder) respectively from R1 – R5. Without the prosthesis, results showed that IMR resulted in lower CT number, noise values, and increased SNRs relative to FBP and iDose4 for regions R1-R5. With the prosthesis, O-MAR improved CT-number precision for region R1 by 49% and 83% for FBP and IMR (p<0.05), relative to iDose4 by 57% without any significant changes at (p<0.05). For region R5, O-MAR improved CT-number precision by 81%, 89%, and 92% towards baseline values for respectively FBP, iDose4, and IMR (p<0.05). Also, O-MAR was most efficient in minimizing noise when integrated with IMR with corrections in the noise in R5 with 79 %, 90 %, and 92 % for respectively FBP, iDose4, and IMR (p<0.05). . Additionally, O-MAR was most effective in correcting SNR deviations when integrated with IMR with absolute SNR corrections in region R5 with 29 ± 1 and 43 ± 4 for FBP and IMR (p<0.05), compared to iDose4 by 37 ± 7 without any significant changes (p>0.05). For region R1, O-MAR improves SNR corrections by 5 ± 1, 23 ± 5, and 42 ± 9 for respectively FBP, iDose4, and IMR (p<0.05). O-MAR paired with IMR revealed an HU correction for region R5 of 90%, 90%, 93%, and 93% for respectively 80, 100, 120, and 140-kVp results. Noise was corrected for with 92%, 91%, 92% and 92% for respectively 80, 100, 120 and 140-kVp results. SNR corrections were 37%, iv 38%, 46% and 52% for respectively 80, 100, 120 and 140-kVp results. For region R1, O-MAR combined with IMR showed an average HU correction of 90%, 68%, 81%, and 93% for respectively 80, 100, 120, and 140-kVp results. Noise was corrected with 89%, 88%, 90% and 89% for respectively 80, 100, 120 and 140-kVp results. SNR corrections were 55%, 42%, 38% and 34% for respectively 80, 100, 120 and 140-kVp results. In conclusion, O-MAR decreases the appearance of metal artifacts using iDose4 and is most efficient in severe artifacts when used in combination with 140-kVp and IMR. CT imaging of a bilateral total hip prosthesis phantom, using IMR together with O-MAR increases image quality by significantly minimizing metal artifacts, reducing noise, and enhancing CT number and SNR.
The Impact of COVID-19 Pandemic on Medical Imaging Workers: Infection Sources, Awareness and Commitment to relevant Safety Guidelines
(Al-Quds University, 2021-08-02) Abdulkarim Khalil Atallah Dahdolan; عبد الكريم خليل عطاالله دحدولان
مقدمة: يُعتبر مرض كورونا (كوفيد-19) هو مرضا معدياً، يُسببه أحد الفايروسات التاجية والذي يُدعى بـِ (SARS-Cov-2)، ظهر لأول مرة في شهر كانون الأول من العام 2019، يعاني معظم الأشخاص اللذين يصابون بمرض كوفيد – 19 أعراضا خفيفة أو متوسطة ويتعافون من دون علاج خاص، ولكن في بعض الحالات تتفاقم الأعراض وحينها يتطلب رعاية طبية. لعب قسم التصوير الطبي دورا مهماً في تشخيص حالات الاصابة بفايروس كورونا بشكلٍ مبكر، لذا كان من الضروري الإلمام بأساليب الوقاية والحماية الشخصية من الأمراض المعدية لدى العاملين في أقسام التصوير الطبي، من أجل تجنب الإصابة بالعدوى وكذلك تجنب المساهمة في نقلها للآخرين. أهداف الدراسة: هدفت هذه الدراسة الى تقيّيم تأثير جائحة كورونا على العاملين في أقسام التصوير الطبي من حيث مصادر العدوى ومدى الوعي والإلتزام بإرشادات السلامة والوقاية. طريقة البحث: تم إجراء دراسة وصفية مقطعية في الفترة من 15 تموز ولغاية 15 أيلول من العام 2020، في أقسام التصوير الطبي في المستشفيات الفلسطينية، عن طريق استبيان تم توزيعه بشكل مباشر على الزملاء العاملين في تلك الأقسام، وكان معيار التضمين او المشاركة في الدراسة هو كافة العاملين في المجال الطبي ( طبيب الأشعة، مقيم الأشعة، تقني التصوير الطبي، وممرضة قسم التصوير الطبي)، اللذين كانوا على رأس عملهم خلال الجائحة. النتائج: تم جمع 205 استبيان، من بينها 54.5% من القطاع الحكومي، 27.2% من القطاع الخاص، 18.3% من القطاع الأهلي، كانت نسبة الإناث 26.8%، و 81.9% يحملون شهادة البكالوريوس، وحوالي 41.2% لديهم خبرة في العمل اقل من خمس سنوات. 36.1% أصيبوا بفايروس كورونا من بينهم 61.6% كان سبب اصابتهم عدوى داخل مكان العمل. كان هناك فقط 63.2% يثقون بجهوزية مستشفاهم لمواجهة جائحة كورونا و 65.1% يعتقدون بجهوزية قسم التصوير الطبي لديهم للتعامل مع الحالات المشتبه او المؤكد اصابتها بفايروس كورونا. 43.3% فقط افادوا بتلقيهم تدريبا للتعامل مع مرضى كورونا، 58.7% أفادوا بأن القراءة الذاتية هي مصدر معلوماتهم حول فايروس كورونا وما يتعلق به، كما أنه لوحظ عدم كفاية التدريب او المعرفة حول نظافة (تعقيم) اليدين والإستخدام الصحيح لوسائل الحماية الشخصية للوقاية من العدوى. الخلاصة: نتيجة لذلك، تؤكد النتائج التي توصلنا اليها على الحاجة الحيوية لتوسيع نطاق التدريب للعاملين في أقسام التصوير الطبي على مكافحة جائحة كورونا فصلا عن تدابير الحماية والوقاية ذات الصلة، وفي سياق متصل نوصي الكليات التي تقوم بتخريج طلاب التصوير الطبي بإستحداث مساق حول الأمراض المعدية وسبل الوقاية واعتماده كمساق اجباري للطلاب.
Influence of Iterative Reconstruction Algorithm on Image Quality of Ultra Low-Dose CT Protocol of the Lumber Spine
(Al-quds University, 2022-12-11) Israa Jamal Mostafa Odeh; اسراء جمال مصطفى عودة
Quantitative computed tomography (QCT) or QCT Densitometry is a new examination in computed tomography (CT) used to diagnose bone mineral density. QCT scan is a low-dose protocol with an effective dose value of 1 millisievert (mSv)The dose reduction technique leads to a significant reduction in effective dose at the expense of image quality as it uses the traditional filtered back projection (FBP) method. This study aims to evaluate the impact of the iterative reconstruction (IR) algorithm on image quality and measure the effective dose from low-dose QCT protocol of the lumbar spine CT. This study consisted of 33 patients ( all patients files in the selected period) from both genders aged who were clinically suspected of lower back pain and Osteoporosis during the period from 7th July 2021 to the date of ethical approval. Different types of algorithms, FBP, Sinogram Affirmed Iterative Reconstruction (SAFIRE), and iterative beam hardening correction (iBHC) were applied. The image quality criteria including CT number, noise, and signal were analyzed by three regions of interest (ROIs). The three RIOs represent the following anatomy (intervertebral disc, right psoas muscle, and dural sac) respectively, from region 1 – region 3. In addition, for qualitative analysis, the images reconstructed by SAFIRE level 5 (s5) were compared with the grading system by European standards for CT for the evaluation of disc herniation and lumber spine. The noticed results for the signal-to-noise ratio (SNR) and contrast-to-nose ratio (CNR), showed optimization for images when reconstructed by SAFIRE level 5, with mean SNR of 2.9 which is significantly higher than other reconstruction algorithms (p<0.05). Also, the mean CNR was 2.9 which is significantly higher than other reconstruction techniques (p<0.05). The mean effective dose for the whole population was 1.9 mSv. The SAFIRE algorithm was able to reduce the noise levels at all RIO. The quality of the images according to the grading system by European standards for CT for the evaluation of disc herniation and lumber spine.was similar among the radiologists with good agreement. There is no relationship between body mass index (BMI) and SNR, CNR, and effective dose. In conclusion the use of QCT and using SAFIRE level 5 resulted in higher SNR, CNR, and fewer noise values compared to classic FBP and other levels of SAFIRE. Also, QCT using SAFIRE level 5 revealed equivalent image quality compared to standard protocols of the lumbar spine CT.
Job Satisfaction of Palestinian Radiographers
(جامعة القدس Alquds University, 2022-07-18) IHAB RAED AHMAD SALAMEH; إيهاب رائد أحمد سلامة
Radiographer’s overall condition is paramount to the promotion of excellent patient wellbeing in every country. Thus, radiographs are highly integral and highly indispensable to healthcare institutions and patient care all over the world. This study aims to assess job satisfaction for radiographers in Palestine. A cross sectional study was conducted, using electronic questionnaire distributed among radiographers in Palestine. There were 173 respondents. Participants were mostly males (70.5%), married (61.3%) in the age group of 30 years or less (60.1%), with a bachelor degree (81.5%), working in the private sector (63.6%), with average monthly income above 3500 New Israeli Shekel (50.3%). Most of participants (78.0%) agreed that level of Job satisfaction affect their daily performance and attendance to work. Of the radiographers, (27.2%) were satisfied in their job. The highest level of satisfaction was reported for their relationship with co-workers followed by the amount of responsibility, giving mean scores of 4.53 ±1.445, 4.1 ±1.384, respectively, and they were least satisfied with additional remuneration for work giving mean score 2.24 ±1.465. Spearman’s ratio demonstrated that the strongest correlation factors were support from supervisors (0.820), other factors were participation in decision making (0.805) and utilization of skills (0.790), respectively. Statistically significant differences among overall job satisfaction and sector were radiographers work (p-value: 0.002) were found, which showed that radiographers are more satisfied in other sector (private and NGOs) than in public sector. Radiographers overall job satisfaction was low, (27.2 %) were satisfied, except their relationship with co-workers followed by the amount of responsibility, participants were generally dissatisfied with other job factors. From findings, the main factors correlated with radiographers overall job satisfaction were support from supervisors, other factors that influenced their satisfaction were participation in decision making, and utilization of skills. Statistically significant differences among overall job satisfaction and sector were radiographers work were found. Healthcare policy-makers and hospital managers need to develop and institutionalize evidence based satisfaction strategies considering the factors that influence radiographer’s job satisfaction. تعتبر الحالة العامة لفني الأشعة أمرًا بالغ الأهمية لتعزيز الرفاهية الممتازة للمرضى في كل بلد. وبالتالي ، فان الصور الشعاعية هي جزءً لا يتجزأ ولا غنى عنه في مؤسسات الرعاية الصحية ورعاية المرضى في جميع أنحاء العالم. تهدف هذه الدراسة إلى تقييم الرضا الوظيفي لفنيي الأشعة في فلسطين. دراسة مقطعية أجريت باستخدام الاستبيان الإلكتروني ووزع على فنيي الاشعة في فلسطين. كان هناك 173 مستجيبا. كان معظم المشاركين من الذكور (70.5٪) ، متزوجين (61.3٪) في الفئة العمرية 30 سنة فأقل (60.1٪) ، حاصلون على بكالوريوس (81.5٪) ، يعملون في القطاع الخاص (63.6٪) ، بمتوسط شهري. الدخل فوق 3500 شيقل (50.3٪). وافق معظم المشاركين (78.0٪) على أن مستوى الرضا الوظيفي يؤثر على أدائهم اليومي وحضورهم إلى العمل. من بين فنيي الاشعة ، (27.2٪) كانوا راضين عن عملهم. تم الإبلاغ عن أعلى مستوى من الرضا عن علاقتهم بزملاء العمل متبوعًا بمقدار المسؤولية ، مع إعطاء متوسط درجات 4.53 ± 1.445 ، 4.1 ± 1.384 ، على التوالي ، وكانوا أقل رضا عن الأجر الإضافي للعمل الذي أعطى متوسط درجة 2.24 ± 1.465. أظهرت نسبة سبيرمان أن أقوى عوامل الارتباط كانت الدعم من المشرفين (0.820) ، والعوامل الأخرى كانت المشاركة في صنع القرار (0.805) واستخدام المهارات (0.790) ، على التوالي. تم العثور على فروق ذات دلالة إحصائية ( p: 0.002) في الرضا الوظيفي بين فنيي الاشعة العاملين في القطاع العام والقطاع الخاص (مستشفيات و مراكز خاصة و مؤسسات اهلية) ، مما أظهر أن فنيي الاشعة كانوا أكثر رضا في القطاع الخاص عن القطاع العام. كان الرضا الوظيفي العام لفنيي الأشعة منخفضًا ، باستثناء علاقتهم بزملاء العمل متبوعًا بحجم المسؤولية ، كان المشاركون غير راضين عمومًا عن عوامل الوظيفة الأخرى. من النتائج ، كانت العوامل الرئيسية المرتبطة بالرضا الوظيفي العام لفنيي الأشعة هي الدعم من المشرفين ، والعوامل الأخرى التي أثرت على رضاهم كانت المشاركة في صنع القرار ، والاستفادة من المهارات. تم العثور على فروق ذات دلالة إحصائية في الرضا الوظيفي بين العاملين في القطاع العام والقطاع الخاص , حيث أظهر أن فنيي الاشعة كانوا أكثر رضا في القطاع الخاص عن القطاع العام. يحتاج صانعو سياسات الرعاية الصحية ومديرو المستشفيات إلى تطوير وإضفاء الطابع المؤسسي على استراتيجيات الرضا القائمة على الأدلة مع مراعاة العوامل التي تؤثر على الرضا الوظيفي لفنيي الأشعة.
Justification of Urgent Brain Computed Tomography Scan Examinations In The Palestinian Government Hospitals
(Al-Quds University, 2022-01-16) Anas Yahya issa Hamad Nazzal; أنس يحيى عيسى حمد نزال
Emergency departments may need valuable imaging tools such as CT scans, especially in cases of minor head injury. However, they can cause unnecessary radiation risk to patients and can have a high-cost burden if used improperly. The purpose of this study is to assess the use of CT scans in Palestinian public hospitals. A multi-center descriptive cross-sectional analytical design was carefully chosen for achieving the study objectives. A questionnaire survey was also administered to physicians in government hospitals in order to know that to which extent physicians at the emergency departments have the basic knowledge for ordering CT scans. Data was collected by emergency physicians or residents in the hospitals. The study took place in Darwish Nazzal Hospital, Al Hussein Hospital, and Palestine Medical Complex that were in different areas of Palestine. SPSS v25 was used to list frequencies and analyze the collected data by the use of tests. 40% of doctors in the hospitals ordered CT scans with no guideline to depend on. Patients' complaints were compared with international guidelines, the unjustified value was about 41.8% of patients who came to the emergency department. As a result of that, many of the physicians need to be educated on international guidelines about CT scan requirements and the radiation dose from CT scans
Medical Wastes Management and Recycling: The Case of Bethlehem Governorate
(Al-Quds University, 2024-07-21) Rayyan Marwan Mohammed AbuZayyad; ريّان مروان محمد أبوزيّاد
Background: Medical waste management is a crucial issue in healthcare due to its potential health risks. Rapid population growth increases the demand for disposable medical equipment and supplies, leading to more medical waste. Purpose: The main purpose of the study is to investigate the current medical wastes management process in Bethlehem governorate. Then addressing the required steps needed in order to implement recycling program, and highlight its impact on health and economy. It assesses current medical waste management practices, the feasibility of recycling, and the effects of medical waste on health and the environment. Methods and Data Collection: The study was conducted in Bethlehem governorate, targeting healthcare facilities. Data was collected through structured interviews with healthcare management and site visits, along with secondary data from annual reports by the Joint Services Council (JSC). The study focused on facilities, which generates significant medical wastes, such as Beit Jala governmental hospital that consists of several specialized departments, that indicates the large volume of service provided, which in turn provided us with supplies and used items list that was helpful to identify and classify wastes materials to be recycled. Results: The study found a direct correlation between medical waste volume and healthcare services provided. The Arab Society for Rehabilitation and Beit Jala Governmental Hospital produced the most waste in 2021 and 2022, with plastic waste making up 66% of the total. This presents both environmental challenges and opportunities for economic benefits through recycling. However, the Palestinian plastic recycling market is constrained by insufficient investment. Medical sharp wastes, representing 14% of waste, pose safety risks but can be recycled with proper treatment. Other materials which represent 20% of medical wastes, that mainly consist of bed sheets, surgical gowns and fabrics, offer economic value when recycled (140-199 $ per ton). The annual high cost of medical waste management (242,000 – 292,000 $) highlights the potential economic benefits of recycling, which can reduce costs, extend landfill lifespan, conserve energy, and protect public health. The study showed that establishing a medical waste recycling facility in Bethlehem is not only feasible but also beneficial. It promises to reduce the environmental impact of medical waste, provide economic gains through revenue generation, and support the principles of a circular economy. This initiative can serve as a model for other regions, demonstrating the transformative potential of effective medical waste recycling practices. Conclusion: Medical waste recycling positively impacts health, the environment, and the economy. Investing in recycling infrastructure and technology is essential to realize these benefits and reduce the costs associated with inadequate waste management practices.
Public Exposure from Radiofrequency Electromagnetic Smog in the West Bank – Palestine
(Al-Quds University, 2020-06-14) Mahmoud N. AlKhatib; محمود الخطيب
Since the increase of sources and technologies that usingRadiofrequency (RF) Electromagnetic radiation worldwide and locally, and increase in public fear about the adverse health effect of RF, especially after it has been classified as possibly carcinogenic to humans (Group 2B) by the International Agency for Research on Cancer (IARC) as a part of World Health Organization (WHO), this study was performed to show the RF levels in the West Bank, and compare them with the International Commission on Non-Ionizing Radiation Protection (ICNIRP). Experimental measurements conducted in 149 locations over the area of the West Bank, using exposure meter EME Spy 140, measured the Electric field strength (Vm-1). These measurement results show that the highest exposure level at any point was 7.428 Vm-1, at Ramallah city center which is a highly-populated area. The main contributor was the FM frequency with 50% of total exposure, the next main contributors were the mobile phone base stations downlinks with 34%. The exposure in dense urban areas was significantly the highest compared to other types of areas. The total exposure quotient (TEQ) is calculated for each location, the maximum TEQ was 0.13. All of these results ensure that the level of RF in the West Bank is below the ICNIRP level.
A Quantitative Prospective Study for Whole Body- Diffusion MRI and PET-CT in Detection of Primary and Metastatic Malignant Lesions
(Al-Quds University, 2022-05-22) Ahmed Mohammed Ahmed Abu Ali; أحمد محمد أحمد أبوعلي
فكرة وجود وحدة طب نووي متكاملة تتكون من جهاز ماسح مع مصدر للنظائر المشعة مثل المسارع النووي الدائري للعمل بكفاءة في فلسطين يكاد يكون مستحيلًا بسبب العديد من القضايا التي تبدأ من القضايا السياسية وتنتهي بالقضايا المالية بسبب الإحتلال الإسرائيلي. الهدف من هذه الدراسة هو إيجاد طريقة آمنة وصالحة ومتاحة على نطاق واسع كبديل للتصوير البوزيتروني الطبقي لمساعدة أطباء الأورام وكذلك المرضى ، اقترحنا بروتوكول نموذجي معدل للرنين المغناطيسي لتصوير الجسم بالكامل (WB-DWI MRI) لاستسغلال خاصية الإنتشار من جزيئات الماء داخل انسجة الجسم. شارك 33 مريضًا من مرضى الأورام بهذه الدراسة ، 60٪ ذكور (20) و 40٪ إناث (13) ، تتراوح أعمارهم بين 18-74 عامًا بمتوسط عمري 48 عامًا ومتوسط وزن جسم 83 كجم . تم تشخيص إصابة المشاركين بالفعل بأورام أولية بما في ذلك سرطان الغدد الليمفاوية اللاهودجكين،و سرطان الغدد الليمفاوية هودجكين ، سرطان الرحم ، والبروستات ، والبنكرياس ، والمعدة ، والغدة الدرقية ، والكسور المرضية ، والكُتل الجلدية. أظهرت نتائجنا أن التصوير المقطعي بالإصدار البوزيتروني أظهر 181 كتلة ذات نشاط حيوي عالي في المناطق الأربع (الرأس والعنق، الصدر، البطن والحوض، والجهاز العضلي الهيكلي) لجميع المرضى ، تم اكتشاف نفس الكتل بواسطة WB-DWI MRI الذي يُظهر معظم الكتل نفسها مقيدة في الانتشار بالإضافة لكتل لمفاوية ذات حجم أقل من 1سم بعدد إجمالي 251 كتلة مع مقارنة بين حجم الامتصاص القياسي (SUV) ومعامل الانتشار الظاهر ADC حيث تبين أن الكتل ذات حجم الإمتصاص القياسي (SUV> 2.5) كان معامل الإنتشار الظاهر لها ADC أقل من 1.1 × 10-3 مم 2 / ث. يُظهر التحليل الكمي الإحصائي ارتباطًا إيجابيًا معنويًا بين عدد الكتل المكتشفة باستخدم الرنين المغناطيسي والتصوير البوزيتروني في نفس المنطقة لكل مريض بدلالات إحصائية موزعة كالتالي: 0.178 و 0.434 و 0.606 و 0.840 للرأس والعنق والصدر والبطن والحوض والجهاز العضلي الهيكلي على التوالي ، ويظهر الارتباط المقارن بين ADC و SUV وجود ارتباط سلبي بقيمة p <0.05 وقيمة R = -0.3073. يمكن أن يحل التصوير بالرنين المغناطيسي WB-DWI محل التصوير المقطعي بالإصدار البوزيتروني في حالات سرطان الغدد الليمفاوية ومتابعة الأورام لمراقبة الاستجابة للعلاج بعد العلاج الكيميائي أو العلاج الإشعاعي وكذلك الأمر بعد عمليات الإستئصال الجراحي.
Radiation Doses and Cancer Risk Assessment for Patients Undergoing Computed Tomography Angiography Procedures in Palestine
(Al-Quds University, 2022-07-25) Reema Abduallah Ahmad Za'roor; ريما عبدالله أحمد زعرور
CT procedures may cause radiogenic risk because of the high radiation dose used in image acquisition, comparing to other diagnostic imaging modalities. In global studies, there was a large variation in the Effective Dose (ED) values duringcomputed tomography angiogram (CTA)procedures(2.2-24.4) mSv.The increasing use of CT scans in Palestine has spurredresearchers to do dose assessments and cancer risk studies. However, there is no previous study conducted in Palestine about estimation of radiation dose of CTA scans. Therefore, a dose assessment for CTA patients is highly recommended in Palestine. The main objective of this study is to estimate the radiation effective dose and cancer risk to adult patients (>18years old) CTA procedures, including: lower limp angiogram (LLA), pulmonary embolism angiogram (PEA), head and neck angiogram (HNA) in the selected governmental hospitals in the Palestine. A quantitative cohort retrospective design was used to conduct this study. All adult patients (>18 years old)underwent the selected CTA examinations in the chosen three governmental hospitals. Data collection was through PACS system during two months. The average effective dose was estimated by CT-EXPO softwarefor LLA, PEA and HNA was 7.2±2.9, 5.2±2 and 4.18±2 mSv, respectively, for the total study populationof the three scans ranged between 3 mSv - 11.3 mSv, which was lower than the international studies. Based on hospitals in LLA protocol, the largest value of ED was in Beit Jala Hospital (B.J.H) with 11.3±1mSv in arterial phase and 10.6 in venous phase, Palestine medical complex Hospital (P.M.C) had done only arterial phase with 7±2 mSv then Rafedia surgical Hospital (R.S.H) with 4.79 ± 1 mSv in arterial phase and 4.68±1.1 in venous phase. In PEA protocol, the highest value of ED was also in Beit Jala Hospital (B.J.H) with 7.9±0.9 mSv, Rafedia surgical Hospital (R.S.H) with 4.54±1 mSv then Palestine medical complex Hospital (P.M.C) with 4±1.9 mSv. While in HNA protocol, the largest value of ED in arterial phase was R.S.H with 5.5±1.5 mSv, B.J.H with 4.5±3 mSv then P.M.C with 3.3 ± 0.3 mSv.The overall cancer risk per 100000 procedures for all CTA scans included in the study was 39.7±15.9 for LLA, 28±11.5 for PEA and 23±11.6 for HNA.These values are considered as a low-dose risk estimates due to results derived from Hiroshima atomic bomb data that stated, effective doses ranging between 5 to 50 mSv are associated with higher chances to increase risk of cancer mortality.
Radiation effective dose measurement for medical staff during orthopedic surgery at Hebron Governmental Hospital
(Al-Quds University, 2020-02-08) Ahmad AbdElkreem Ismail Farjallah; أحمد عبد الكريم إسماعيل فرج الله
The study aims at identifying and estimating the radiation does exposes by orthopedic specialist, nurse and anesthetist technician during performing surgeries to pelvic fractures with the assistance of the x-ray machine (C-arm). The study’s hypothesis stated that the orthopedist and medical staff are exposed to high levels of radiation, even though they are not considered as Radiation Workers (RWs). The radiation was monitored by using the Thermoluminescent Dosimeter "TLDs" that store the amount of radiation exposure and then measure it. TLD was placed on the chest area under the lead apron at the level of the center of the body to record the amount of radiation exposure of the whole body. The study was conducted on three workers in the Orthopedic Operation Theatre, and they are: the orthopedic specialist , nurse and anesthesia technician. The total number of surgeries conducted was 21 pelvic fractures fixations . The amount of x-rays exposure during the period of two months was as follows: 0.36 mSv for the orthopedic specialist, 0.34 mSv for the nurse, while the anesthetist technician was the least exposed to radiation with 0.21 mSv. As for the study findings, it becomes clear that the annual dose of exposure for orthopedic staff can reach more than 1.28 mSv only during one type of operation. In general, the orthopedic specialist who performs pelvic surgeries is exposed to a high dose of radiation, which affects the endocrine and body cells. since the amount of radiation exposure exceeds 10% of the maximum permissible radiation dose for medical imaging staff (20 mSv per year), orthopedic specialist and his team should be classified as radiation workers and they must be monitored radiologically on a regular basis because I do not know the harmful effects of this small dose on the human body تم عمل الدراسة بهدف معرفة و تقدير كمية الأشعة التي يتعرض لها أخصائي العظام و والممرض وفني التخدير أثناء إجراء العمليات الجراحية لكسور الحوض بمساعدة جهاز الأشعة ( C-arm) ، كانت الفرضية في هذه الدراسة بأن أخصائي جراحة العظام والطاقم الطبي يتعرضون لكميات أشعة عالية رغم أنهم لا يعتبرون من فئة العاملين في الأشعة . تم مراقبة الأشعة باستخدام مجسات شعاعيه "TLDs" تقوم بحفظ كمية الأشعة المتعرضة لها ومن ثم يتم قراءتها. تم وضع المجسات في منطقة الصدر تحت الواقي الرصاصي على مستوى وسط الجسم لتسجيل كمية الأشعة المتعرض لها كل الجسم . أجريت الدراسة على 3 عاملين في غرفة عمليات العظام وهم : أخصائي العظام و الممرض وفني التخدير. إجمالي العمليات الجراحية كان 12 عملية لكسور الحوض. وكانت كمية الأشعة التي تعرض لها أخصائي العظام خلال شهرين 6.30 ميليسيفرت . بينما كانت كمية الأشعة التي تعرض لها الممرض 6.30 ميليسيفرت إما فني التخدير فكان الأقل تعرض للأشعة بواقع 6.12 ميليسيفرت . من نتائج البحث اتضح انه يمكن أن تصل الجرعة السنوية للعاملين في قسم عمليات العظام إلى أكثر من 2.11 ميلسيفرت في العام خلال نوع واحد من العمليات فقط . بشكل عام فإن أخصائي العظام , الذي يجري عمليات جراحية للحوض يتعرض إلي جرعة عالية من الأشعة تؤثر علي الغدد الصماء و خلايا الجسم و بما أن كمية الأشعة التي يتعرض لها تتجاوز إل 10 % من جرعة الأشعة القصوى المسموح فيها للعاملين في مجال الأشعة 20) ملييسيفرت في السنة .( لذلك يجب أن يصنف جراحي العظام , علي أنهم من فئة العاملين في الأشعة و يجب مراقبتهم إشعاعيا بصفة دورية، و ذلك لعدم معرفتنا بضرر هذه الجرعة الصغيرة علي جسم الإنسان .

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