Presentation: Radiation Protection Week CAH BUKIT RIMAU

Dr. Wong Soon LiMBBS (INDIA), M.Med Radiology(UKM)A.M. (Malaysia)

Discovery of X-rays was accidental. Wilhelm Conrad Roentgen on the 8th of November

1895. Introduced in the Malay Peninsula on February

1897, with the installation of the first x-ray machine in South East Asia. This occurred in Taiping, Perak.

Mammographic services were started in KLGH in 1972.

Ultrasound came on the scene in 1974 when the Faculty of Medicine, University Kebangsaan Malaysia bought the first machine.

1977 saw the introduction of Computer Tomography when a scanner was installed in Institute of Radiotherapy and Oncology, KLGH.

The History…

1. General X-ray 2. Hysterosalphingraphy (HSG) 3. Ultrasound 4. Computed Tomography (CT) 5. Magnetic Resonance Imaging (MRI) 6. Procedures:

A. Fine needle aspiration. B. Biopsy

C. Drainage

Modalities

ULTRASOUND

Safe and relatively painless. do not use ionizing radiation. for a study of the gallbladder, you may be asked to eat a fat-free meal on

the evening before the test and then to avoid eating for eight to 12 hours before the test.

for ultrasound of the kidneys, you may be asked to drink liquid about an hour before the test to fill your bladder.

LIMITATIONS: Not an ideal imaging technique for air-filled bowel or organs obscured by the bowel since ultrasound waves are disrupted by air or gas.

Basic informations about ultrasound examinations

GB polyp

MAMMOGRAPHY

Recent advances in mammography equipment and techniques have resulted in women now only receiving a small radiation dose (0.7mSv), which is about the same as that received every year from normal background radiation.

The benefits of being screened for breast cancer far outweigh any potential risks of radiation from a mammogram examination.

Mammography is the most effective, non invasive and the best way to detect early breast cancer especially when it is too small to be felt by the patient or the doctor.

Breast screening is now available to all women aged 40 and above.

The present guidelines for screening of asymptomatic women (women who do not have any symptoms related to the breast) are:  

At age 35-40: baseline mammogram At age 40-49: mammograms at one or two year intervals At age 50 and above: annual mammograms

Mammography…

Background radiation – June 2006

The women are advised not to use deodorant, talcum powder or perfume which may cause artifacts on the X-ray film.

The mammogram may miss up to 5-15% of cancers in the breast. The management of patient should be based on clinical grounds.

Mammography…

Incidence: 1 in 10 females Approx. 3000 new cases are diagnosed each

year 1 in 10 cancer cases will be breast cancer

Mammogram Reduce the risk of death from breast cancer for population aged 50 – 65 by approx. 29%

Accuracy 90 %

BREAST CANCER

FINDINGS◦MASSES◦CALCIFICATIONS◦ARCHITECTURAL DISTORTION◦DENSITY◦SKIN / AXILLARY NODES

WHAT DO WE LOOK FOR?

MEDIOLATERAL OBLIQUE

BREAST CANCER

MALIGNANT CALCIFICATIONS

US: BREAST CANCER

CT SCAN

CT

the chest gives a radiation dose equivalent to 400 chest radiographs (chest tomography 8 mSv; chest radiography=0.02 mSv).

the thoracic spine, mediastinum, abdomen, liver, pancreas, kidney, lumbar spine, and pelvis is associated with effective doses of >5 mSv (equivalent to over 250 chest radiographs) and in some cases as high as 30 mSv (equivalent to 1500 chest radiographs).

Furthermore, the dose to the breast in many thoracic examinations ranges from 18 to 33 mSv.

The dose to the lens of the eye is around 30 mSv in computed tomography of the head, about 70 mSv in scanning of sinuses, and about 10-130 mSv in scanning for orbital trauma.

Typically, CT of …

The annual average dose for the world population is approximately 2.8 mSv (3.0 mSv in the United States)

MRI

It is safe for women who are more than four months pregnant to undergo this examination.

The total duration of the examination varies from 30-90 minutes depending on the part of the body being examined.

MRI…

It is important to understand that the effect of the powerful magnet is typically only exhibited on iron-containing objects.

Most other metals (titanium, aluminum, copper, etc.) will not experience the ferromagnetic forces.

Titanium was developed over the past 15 years as a viable surgical metal. At present, almost all neurosurgical clips are made of titanium.

MRI…

MRI can cause serious injury and even death in those with metal embedded in their bodies. Patients with the following objects inside the body generally cannot undergo an MRI examination:

Battery-operated devices (eg. cardiac pacemakers, bladder pacemakers, nerve-stimulating devices of various types for inner ear and spinal diseases).

Metallic foreign bodies Metallic implants At the time of examination, female patients should not use

any facial make-up as this may interfere with the image.

MRI…

THANK YOU…