Radiographic Technique II PDF

Radiographic Technique II AMRR 221 Dr. Elbagir Hamza Manssor, Ph.D. Ass. Professor Department of Applied Radiological Sciences College of Applied Medical Sciences Jeddah University. Lec (9) Similarities and differences between males and females .‫ﺔ‬E‫ اﻟﻐﺪد اﻟﺘﻨﺎﺳﻠ‬:‫ﺔ‬E‫ﺔ اﻷوﻟ‬E‫ﺴ‬S‫• اﻷﻋﻀﺎء اﻟﺠ...

Radiographic Technique II AMRR 221 Dr. Elbagir Hamza Manssor, Ph.D. Ass. Professor Department of Applied Radiological Sciences College of Applied Medical Sciences Jeddah University. Lec (9) Similarities and differences between males and females .‫ﺔ‬E‫ اﻟﻐﺪد اﻟﺘﻨﺎﺳﻠ‬:‫ﺔ‬E‫ﺔ اﻷوﻟ‬E‫ﺴ‬S‫• اﻷﻋﻀﺎء اﻟﺠ‬ • Primary sex organs: gonads. The Reproductive System ‫• اﻟﺨﺼ`ﺘﻴﻦ ﻓﻲ اﻟﺬﻛﻮر‬ • Testes in males • Ovaries in females ‫ﺾ ﻓﻲ اﻹﻧﺎث‬g‫ﺎ‬h‫• اﻟﻤ‬ These produce the gametes (sex cells) • Sperm in males. • Ovum (egg) in females. • Endocrine function also: secretion of hormones • Accessory sex organs 1.Internal glands and ducts. 2.External genitalia. (‫ﺔ‬E‫ﺴ‬S‫ﺎ اﻟﺠ‬g‫ﺘﺞ اﻷﻣﺸﺎج )اﻟﺨﻼ‬S‫• ﻫﺬە ﺗ‬ .‫ﺔ ﻋﻨﺪ اﻟﺬﻛﻮر‬rs‫• اﻟﺤﻴﻮاﻧﺎت اﻟﻤﻨ‬ .‫ﺾ( ﻓﻲ اﻹﻧﺎث‬E‫ﺾ )اﻟﺒ‬E‫• اﻟﺒ‬ ‫ إﻓﺮاز اﻟﻬﺮﻣﻮﻧﺎت‬:‫ﻀﺎ‬g‫ﻔﺔ اﻟﻐﺪد اﻟﺼﻤﺎء أ‬E‫• وﻇ‬ ‫ﺔ اﻟﻤﻠﺤﻘﺔ‬E‫ﺴ‬S‫• اﻷﺟﻬﺰة اﻟﺠ‬ .‫ﺔ‬E‫• اﻟﻐﺪد واﻟﻘﻨﻮات اﻟﺪاﺧﻠ‬ .‫ﺔ‬E‫ﺔ اﻟﺨﺎرﺟ‬E‫• اﻷﻋﻀﺎء اﻟﺘﻨﺎﺳﻠ‬ Male reproductive system • Testes : the gonads • In embryo, first develop in posterior abdominal wall, then migrate. • Internal body temp too hot for viable sperm. • Temp cooler in the scrotum because of superficial position. 2 ‫ﺔ‬E‫ اﻟﻐﺪد اﻟﺘﻨﺎﺳﻠ‬:‫• اﻟﺨﺼ`ﺘﻴﻦ‬ .‫ ﺛﻢ ﻳﻬﺎﺟﺮ‬،‫ﻄﻦ اﻟﺨﻠﻔﻲ‬h‫ ﻳﺘﻄﻮر أوﻻ ﻓﻲ ﺟﺪار اﻟ‬،‫• ﻓﻲ اﻟﺠﻨﻴﻦ‬ .‫ﺎة‬E‫ﺔ اﻟﻘﺎ•ﻠﺔ ﻟﻠﺤ‬rs‫ﺔ ﺣﺎرة ﺟﺪا ﻟﻠﺤﻴﻮاﻧﺎت اﻟﻤﻨ‬E‫• درﺟﺔ ﺣﺮارة اﻟﺠﺴﻢ اﻟﺪاﺧﻠ‬ .‫• ﻣﺒﺮد درﺟﺔ اﻟﺤﺮارة ﻓﻲ ﻛ•ﺲ اﻟﺼﻔﻦ “ﺴ’ﺐ اﻟﻮﺿﻊ اﻟﺴﻄﺤﻲ‬ The Female Reproductive System • Production of gametes (ova, or eggs) • Preparation for support of developing embryo during pregnancy. • Cyclic changes: menstrual cycle. • Averages 28 days. • Complex interplay between hormones and organs: at level of brain, ovaries and uterus. • Gonads: the ovaries • Paired, almond-shaped, flanking the uterus in lateral wall of true pelvis. • 3 x 1.5 x 1 cm in size. ‫ﺾ‬g‫ﺎ‬h‫ اﻟﻤ‬:‫ﺔ‬E‫• اﻟﻐﺪد اﻟﺘﻨﺎﺳﻠ‬ .‫ﻘﻲ‬E‫ﻂ •ﺎﻟﺮﺣﻢ ﻓﻲ ﺟﺪار ﺟﺎﻧﺒﻲ ﻣﻦ اﻟﺤﻮض اﻟﺤﻘ‬E‫ ﺗﺤ‬،‫ ﻋﻠﻰ ﺷ•ﻞ ﻟﻮز‬،‫• ﻣﻘﺘﺮﻧﺔ‬ .‫ ﺳﻢ‬1 × 1.5 × 3 ‫• ﺣﺠﻢ‬ 3 (‫ﺾ‬M‫ أو اﻟﺒ‬،‫ﻀﺎت‬WX‫• إﻧﺘﺎج اﻷﻣﺸﺎج )اﻟﺒ‬ .‫ﺮ اﻟﺠﻨﻴﻦ أﺛﻨﺎء اﻟﺤﻤﻞ‬WX‫• اﻟﺘﺤﻀﻴﺮ ﻟﺪﻋﻢ ﺗﻄ‬ .‫ﺔ‬Wp‫ اﻟﺪورة اﻟﺸﻬ‬:‫ﺔ‬W‫• اﻟﺘﻐﻴﺮات اﻟﺪور‬ .‫ ﻳﻮﻣﺎ‬28 ‫• ﻣﺘﻮﺳﻂ‬ ‫ ﻋﻠﻰ ﻣﺴﺘﻮى‬:‫• اﻟﺘﻔﺎﻋﻞ اﻟﻤﻌﻘﺪ ﺑﻴﻦ اﻟﻬﺮﻣﻮﻧﺎت واﻷﻋﻀﺎء‬ .‫ﻀﻴﻦ واﻟﺮﺣﻢ‬M‫اﻟﺪﻣﺎغ واﻟﻤﺒ‬ (Hysterosalpingiography) (HSG) Accessory and Optional Equipment ‫اﻟﻣﻠﺣﻘﺎت واﻟﻣﻌدات اﻻﺧﺗﯾﺎرﯾﺔ‬ • Routinely, a sterile, disposable HSG tray is used. .‫ ﻣﻌﻘﻣﺔ ﯾﻣﻛن اﻟﺗﺧﻠص ﻣﻧﮭﺎ‬HSG ‫ ﯾﺗم اﺳﺗﺧدام ﺻﯾﻧﯾﺔ‬،‫ﺑﺷﻛل روﺗﯾﻧﻲ‬ • The general contents of the tray include a vaginal speculum, basin, cotton balls, medicine cup, sterile gauze, sterile drapes, sponge-holding forceps, 10 ml syringes, 16 and 18 gauge needles, extension tubing, and lubricating jelly. • In addition to the HSG tray, sterile gloves, an antiseptic solution, a cannula or balloon catheter, and contrast media are necessary. ‫ﺗﺷﻣل اﻟﻣﺣﺗوﯾﺎت اﻟﻌﺎﻣﺔ ﻟﻠﺻﯾﻧﯾﺔ ﻣﻧظﺎرا ﻣﮭﺑﻠﯾﺎ وﺣوﺿﺎ وﻛرات ﻗطﻧﯾﺔ وﻛﺄس دواء‬ ‫ ﻣل وإﺑر‬10 ‫وﺷﺎﺷﺎ ﻣﻌﻘﻣﺎ وﺳﺗﺎﺋر ﻣﻌﻘﻣﺔ وﻣﻼﻗطﺎ ﺗﺣﻣل اﻹﺳﻔﻧﺞ وﻣﺣﺎﻗن ﺳﻌﺔ‬ .‫ وأﻧﺎﺑﯾب ﺗﻣدﯾد وھﻼم ﺗﺷﺣﯾم‬18‫ و‬16 ‫ﻗﯾﺎس‬ ‫ ﻣن اﻟﺿروري وﺟود ﻗﻔﺎزات ﻣﻌﻘﻣﺔ وﻣﺣﻠول ﻣطﮭر‬،HSG ‫ﺑﺎﻹﺿﺎﻓﺔ إﻟﻰ ﺻﯾﻧﯾﺔ‬ .‫وﻗﻧﯾﺔ أو ﻗﺳطرة ﺑﺎﻟون ووﺳﺎﺋط ﺗﺑﺎﯾن‬ extension tubing basin sterile gauze sterile drapes vaginal speculum sponge-holding forceps 4 Major Equipment lithotomy position The major equipment required for an HSG is a radiographic fluoroscope room. Stirrups attached to the table Newer equipment may provide digital fluoroscopy capabilities. Ideally, the table should have the capability to tilt the patient to a Trendelenburg position if needed. If available, gynecologic stirrups should be attached to the table to assist the patient in the lithotomy position. ‫اﻟﻣﻌدات اﻟرﺋﯾﺳﯾﺔ‬ .‫ ھﻲ ﻏرﻓﺔ اﻟﻔﻠوروﺳﻛوب اﻟﺷﻌﺎﻋﻲ‬HSG ‫اﻟﻣﻌدات اﻟرﺋﯾﺳﯾﺔ اﻟﻣطﻠوﺑﺔ ل‬ .‫ﻗد ﺗوﻓر اﻟﻣﻌدات اﻷﺣدث ﻗدرات اﻟﺗﻧظﯾر اﻟﻔﻠوري اﻟرﻗﻣﻲ‬ .‫ إذا ﻟزم اﻷﻣر‬Trendelenburg ‫ ﯾﺟب أن ﯾﻛون ﻟﻠﺟدول اﻟﻘدرة ﻋﻠﻰ إﻣﺎﻟﺔ اﻟﻣرﯾض إﻟﻰ وﺿﻊ‬،‫ﻣن اﻟﻧﺎﺣﯾﺔ اﻟﻣﺛﺎﻟﯾﺔ‬ .‫ ﯾﺟب إرﻓﺎق اﻟرﻛﺎب اﻟﻧﺳﺎﺋﯾﺔ ﺑﺎﻟطﺎوﻟﺔ ﻟﻣﺳﺎﻋدة اﻟﻣرﯾض ﻓﻲ وﺿﻊ ﺑﺿﻊ اﻟﻘﻠﺔ‬،‫إذا ﻛﺎن ذﻟك ﻣﺗﺎﺣﺎ‬ Preparation 1.Proper bowel preparations to ensure adequate visualization of the reproductive tract unobstructed by bowel gas and/or feces. 2.Preparation may include a mild laxative, suppositories, and/or a cleansing enema before the procedure. 3.In addition, the patient may be instructed to take a mild pain reliever before the examination to alleviate some of the discomfort associated with cramping. ‫إﻋﺪاد‬ .‫أو اﻟﺒﺮاز‬Œ‫ﻣﺴﺘﺤﻀﺮات اﻷﻣﻌﺎء اﻟﻤﻨﺎﺳ•ﺔ ﻟﻀﻤﺎن اﻟﺘﺼﻮر اﻟ“ﺎﻓﻲ ﻟﻠﺠﻬﺎز اﻟﺘﻨﺎﺳﻠﻲ دون ﻋﺎﺋﻖ ﺑﻮاﺳﻄﺔ ﻏﺎز اﻷﻣﻌﺎء و‬ .‫ﺔ‬M‫ﺔ ﻗ•ﻞ اﻟﻌﻤﻠ‬W‫ﺔ ﺗﻄﻬﻴﺮ‬M‫أو ﺣﻘﻨﺔ ﺷﺮﺟ‬Œ‫ﻞ و‬M‫ﻔﺎ وﺗﺤﺎﻣ‬M‫ﺸﻤﻞ اﻟﺘﺤﻀﻴﺮ ﻣﻠﻴﻨﺎ ﺧﻔ‬š ‫ﻗﺪ‬ .‫ﺸﻨﺞ‬œ‫ﻒ •ﻌﺾ اﻻﻧﺰﻋﺎج اﻟﻤﺮﺗ•ﻂ •ﺎﻟ‬M‫ﻒ ﻟﻸﻟﻢ ﻗ•ﻞ اﻟﻔﺤﺺ ﻟﺘﺨﻔ‬M‫ﺾ إﻟﻰ ﺗﻨﺎول ﻣﺴﻜﻦ ﺧﻔ‬Wp‫ﻪ اﻟﻤ‬M‫ ﻗﺪ ﻳﺘﻢ ﺗﻮﺟ‬،‫•ﺎﻹﺿﺎﻓﺔ إﻟﻰ ذﻟﻚ‬ 4. To prevent displacement of the uterus and uterine tubes, the patient should be instructed to empty her bladder immediately before the examination. 5. The procedure and possible complications should be explained to the patient. 6- informed consent obtained. 5 .‫ـ ــﻎ ﻣﺜﺎﻧﺘﻬﺎ ﻣ•ﺎﺷﺮة ﻗ•ﻞ اﻟﻔﺤﺺ‬Wp‫ﻀﺔ ﻟﺘﻔ‬Wp‫ﻪ اﻟﻤ‬M‫ ¯ﺠﺐ ﺗﻮﺟ‬،‫ﺐ اﻟﺮﺣﻢ‬°‫ ﻟﻤﻨﻊ إزاﺣﺔ اﻟﺮﺣﻢ وأﻧﺎﺑ‬.4 .‫ﺾ‬Wp‫ ¯ﺠﺐ ﺷﺮح اﻹﺟﺮاء واﻟﻤﻀﺎﻋﻔﺎت اﻟﻤﺤﺘﻤﻠﺔ ﻟﻠﻤ‬.5 .‫ﻨﻴﺮة‬œ‫ اﻟﺤﺼﻮل ﻋﻠﻰ ﻣﻮاﻓﻘﺔ ﻣﺴ‬-6 Contrast media • Contrast media, such as Omnipaque 300, Water-soluble iodinated contrast is preferred. • It is absorbed easily by the patient, does not leave a residue within the reproductive tract, and provides adequate visualization. • This contrast medium causes pain when injected within the uterine cavity, and the pain may persist for several hours after the procedure. ‫وﺳﺎﺋﻞ اﻹﻋﻼم اﻟﻤﺘ•ﺎﻳﻨﺔ‬ .‫ اﻟﺘ•ﺎﻳﻦ اﻟﻴﻮد اﻟﻘﺎ•ﻞ ﻟﻠﺬو·ﺎن ﻓﻲ اﻟﻤﺎء‬،Omnipaque 300 ‫ ﻣﺜﻞ‬،‫¯ﻔﻀﻞ وﺳﺎﺋﻂ اﻟﺘ•ﺎﻳﻦ‬ .‫ﺎ‬M‫ﺎﻓ‬º ‫ﻮﻓﺮ ﺗﺼﻮرا‬W‫ و‬،‫ وﻻ ﻳﺘﺮك •ﻘﺎ¯ﺎ داﺧﻞ اﻟﺠﻬﺎز اﻟﺘﻨﺎﺳﻠﻲ‬،‫ﺾ‬Wp‫ﻳﺘﻢ اﻣﺘﺼﺎﺻﻪ ¼ﺴﻬﻮﻟﺔ ﻣﻦ ﻗ•ﻞ اﻟﻤ‬ .‫ﺔ‬M‫ﺴﺘﻤﺮ اﻷﻟﻢ ﻟﻌﺪة ﺳﺎﻋﺎت •ﻌﺪ اﻟﻌﻤﻠ‬š ‫ وﻗﺪ‬،‫ﻒ اﻟﺮﺣﻢ‬WX‫ﺴ¿ﺐ وﺳﻂ اﻟﺘ•ﺎﻳﻦ ﻫﺬا اﻷﻟﻢ ﻋﻨﺪ ﺣﻘﻨﻪ داﺧﻞ ﺗﺠ‬š Cannula/Catheter Placement and Injection Process: • The patient lies supine on the table in the lithotomy position. • The patient is draped with sterile towels, and with sterile technique, a vaginal speculum is inserted into the vagina. .‫ﺎ ﻋﻠﻰ اﻟﻄﺎوﻟﺔ ﻓﻲ وﺿﻊ •ﻀﻊ اﻟﻘﻠﺔ‬E‫ﺾ ﻣﺴﺘﻠﻘ‬r¯‫ﺴﺘﻠﻘﻲ اﻟﻤ‬° • .‫ﻞ‬h‫ﻠﻲ ﻓﻲ اﻟﻤﻬ‬h‫ ﻳﺘﻢ إدﺧﺎل ﻣﻨﻈﺎر ﻣﻬ‬،‫ﺔ ﻣﻌﻘﻤﺔ‬E‫ و´ﺘﻘﻨ‬،‫ﺾ •ﺎﻟﻤﻨﺎﺷﻒ اﻟﻤﻌﻘﻤﺔ‬r¯‫• ﻳﺘﻢ ﻟﻒ اﻟﻤ‬ 6 Lithotomy position. • The vaginal walls and cervix are cleansed with an antiseptic solution. • A cannula or balloon catheter then is inserted into the cervical canal. • Dilation with a balloon catheter helps to occlude the cervix, preventing contrast medium from flowing out of the uterine cavity during the injection phase. • Once cervical placement of the cannula or catheter has been obtained, the physician may remove the speculum and place the patient in a slight Trendelenburg position. .‫ﻞ وﻋﻨﻖ اﻟﺮﺣﻢ •ﻤﺤﻠﻮل ﻣﻄﻬﺮ‬h‫ﻒ ﺟﺪران اﻟﻤﻬ‬E‫ﻳﺘﻢ ﺗﻨﻈ‬ .‫ﺔ أو ﻗﺴﻄﺮة •ﺎﻟﻮن ﻓﻲ ﻗﻨﺎة ﻋﻨﻖ اﻟﺮﺣﻢ‬E‫ﺛﻢ ﻳﺘﻢ إدﺧﺎل ﻗﻨ‬ .‫ﻒ اﻟﺮﺣﻢ ﺧﻼل ﻣﺮﺣﻠﺔ اﻟﺤﻘﻦ‬rs‫ﺎﻳﻦ ﻣﻦ اﻟﺘﺪﻓﻖ ﻣﻦ ﺗﺠ‬h‫ﻤﻨﻊ وﺳﻂ اﻟﺘ‬g ‫ ﻣﻤﺎ‬،‫ﺎﻟﻮن ﻋﻠﻰ ا»ﺴﺪاد ﻋﻨﻖ اﻟﺮﺣﻢ‬h‫ﺴﺎﻋﺪ اﻟﺘﻤﺪد •ﺎﺳﺘﺨﺪام ﻗﺴﻄﺮة اﻟ‬° .‫ﻒ‬E‫ﺒﻮرغ ﻃﻔ‬S‫ﻨﺪﻟﻴ‬r¯‫ﺾ ﻓﻲ وﺿﻊ ﺗ‬r¯‫ﺐ إزاﻟﺔ اﻟﻤﻨﻈﺎر ووﺿﻊ اﻟﻤ‬E‫ﺠﻮز ﻟﻠﻄﺒ‬g ،‫ﺔ أو اﻟﻘﺴﻄﺮة‬E‫•ﻤﺠﺮد اﻟﺤﺼﻮل ﻋﻠﻰ وﺿﻊ ﻋﻨﻖ اﻟﺮﺣﻢ ﻟﻠﻘﻨ‬ • Trendelenburg position facilitates the flow of contrast media into the uterine cavity. • A syringe filled with contrast is attached to the cannula or balloon catheter. • • • • .‫ﻒ اﻟﺮﺣﻢ‬rs‫ﺎﻳﻦ إﻟﻰ ﺗﺠ‬h‫ ﺗﺪﻓﻖ وﺳﺎﺋﻂ اﻟﺘ‬Trendelenburg ‫ﺴﻬﻞ وﺿﻊ‬° • .‫ﺎﻟﻮن‬h‫ﺔ أو ﻗﺴﻄﺮة اﻟ‬E‫ﺎﻳﻦ •ﺎﻟﻘﻨ‬h‫• ﻳﺘﻢ إرﻓﺎق ﺣﻘﻨﺔ ﻣﻠﻴﺌﺔ •ﺎﻟﺘ‬ . • Using fluoroscopy, the physician slowly injects contrast medium into the uterine cavity. ‫ﻒ اﻟﺮﺣﻢ‬rs‫ﻂء ﻓﻲ ﺗﺠ‬h‫ﺎﻳﻦ ﺑ‬h‫ﺐ •ﺤﻘﻦ وﺳﻂ اﻟﺘ‬E‫ﻘﻮم اﻟﻄﺒ‬g ،‫• •ﺎﺳﺘﺨﺪام اﻟﺘﻨﻈﻴﺮ اﻟﻔﻠﻮري‬ • If the uterine tubes are patent (open), contrast media will flow from the distal ends of the tubes into the peritoneal cavity. ‫ﺘﺪﻓﻖ وﺳﺎﺋﻂ‬Å‫ ﻓﺴ‬،(‫ﺎﻧﺖ أﻧﺎﺑ•ﺐ اﻟﺮﺣﻢ ﺑﺮاءة اﺧﺘﺮاع )ﻣﻔﺘﻮﺣﺔ‬È ‫• إذا‬ .‫ﺘﻮﻧﻲ‬r‫ﻒ اﻟﺒﺮ‬rs‫ﺪة ﻟﻸﻧﺎﺑ•ﺐ إﻟﻰ اﻟﺘﺠ‬E‫ﻌ‬h‫ﺎﻳﻦ ﻣﻦ اﻷﻃﺮاف اﻟ‬h‫اﻟﺘ‬ 7