Accidental in radiotherapy mrp008

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Published on March 9, 2014

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Ossama Anjak

‫א‬ ‫א‬ ‫א‬ ‫א‬ ‫א‬ ‫מא‬ –‫מ‬ ‫א‬ ‫א‬ ‫א‬ ‫א‬ ‫א‬ ‫א‬ ‫א‬ ‫א‬ ‫א‬ − 2010- 2011 2010‫هﻴﺌﺔ اﻟﻄﺎﻗﺔ اﻟﺬرﻳﺔ اﻟﺴﻮرﻳﺔ‬ 6091 ‫دﻣﺸﻖ ص.ب‬ oanjak@yahoo.com 1 Ossama Anjak, AECS Damascus SYRIA /email: oanjak@gmail.com

‫א‬ ‫א א‬ ‫א‬ ‫• اﻟﺤﻮادث اﻹﺵﻌﺎﻋﻴﺔ ﻓﻲ ﻣﺠﺎل اﻟﻤﻌﺎﻟﺠﺔ اﻹﺵﻌﺎﻋﻴﺔ‬ .‫• دراﺱﺔ ﺑﻌﺾ ﺡﺎﻻت اﻟﺤﻮادث اﻹﺵﻌﺎﻋﻴﺔ‬ 7 Narch 2011 2 Ossama Anjak Slide 4 Ossama Anjak, AECS Damascus SYRIA /email: oanjak@gmail.com

‫א‬ ‫א‬ ‫א‬ ‫• ﻤﻌﺎﻟﺠﺔ ﺸﺎﻓﻴﺔ‬ ‫– ﺠﺭﻋﺔ ﻋﺎﻟﻴﺔ ﻟﻠﻭﺭﻡ‬ ‫– ﻀﺒﻁ ﺍﻟﻭﺭﻡ ﺒﺸﻜل ﺠﻴﺩ ﻭﺍﻟﺤﺩ ﻤﻥ ﺍﻨﺘﺸﺎﺭﻩ.‬ ‫– ﺠﺭﻋﺔ ﻤﻨﺨﻔﻀﺔ ﻟﻠﻨﺴﺞ ﺍﻟﺴﻠﻴﻤﺔ ﻤﺎ ﺃﻤﻜﻥ.‬ ‫– ﺘﺨﻔﻴﻑ ﺍﻟﻤﻀﺎﻋﻔﺎﺕ.‬ ‫• ﻤﻌﺎﻟﺠﺔ ﺘﻠﻁﻴﻔﻴﺔ )ﺘﺨﻔﻴﻑ ﺍﻷﻟﻡ( ‪Palliative‬‬ ‫– ﺘﻘﺩﻴﻡ ﺠﺭﻋﺔ ﻤﻨﺎﺴﺒﺔ ﻟﻠﻤﻨﻁﻘﺔ ﺍﻟﻤﻌﺎﻟﺠﺔ )ﺍﻟﻬﺩﻑ(.‬ ‫– ﺘﺤﻘﻴﻕ ﺃﻓﻀل ﺤﺎﻟﺔ ﻤﻥ ﺍﻟﺭﺍﺤﺔ ﻋﻨﺩ ﺍﻟﻤﺭﻴﺽ.‬ ‫– ﺘﺨﻔﻴﻑ ﺍﻟﻤﻀﺎﻋﻔﺎﺕ.‬ ‫‪Curative‬‬ ‫اﻟﻤﻌﺎﻟﺠﺔ اﻹﺵﻌﺎﻋﻴﺔ‬ ‫اﻟﺘﺸﺨﻴﺺ‬ ‫اﻻﺳﺘﻘﺒﺎل‬ ‫اﻟﺘﺨﻄﻴﻂ‬ ‫)اﻟﻤﺤﺎآﺎة(‬ ‫اﻟﺘﺨﻄﻴﻂ‬ ‫)‪(TPS‬‬ ‫اﻟﻤﻌﺎﻟﺠﺔ اﻹﺷﻌﺎﻋﻴﺔ‬ ‫اﺥﺘﻴﺎر اﻟﺘﺠﻬﻴﺰات‬ ‫ﺃﺤﺩ ﺍﻟﻌﻭﺍﻤل ﺍﻟﻬﺎﻤﺔ ﻓﻲ ﺍﺴﺘﻤﺜﺎل ﺍﻟﻭﻗﺎﻴﺔ ﻓﻲ‬ ‫ﺃﺤﺩ ﺍﻟﻌﻭﺍﻤل ﺍﻟﻬﺎﻤﺔ ﻓﻲ ﺍﺴﺘﻤﺜﺎل ﺍﻟﻭﻗﺎﻴﺔ ﻓﻲ‬ ‫ﻤﺠﺎل ﺍﻟﺘﻌﺭﺽ ﺍﻟﻁﺒﻲ‬ ‫ﻤﺠﺎل ﺍﻟﺘﻌﺭﺽ ﺍﻟﻁﺒﻲ‬ ‫) )ﺭﺍﺠﻊ ﺍﻟﻔﻘﺭﺘﻴﻥ 01ﻭﻭ 51 ﻤﻥ ‪(BSS‬‬ ‫ﺭﺍﺠﻊ ﺍﻟﻔﻘﺭﺘﻴﻥ 01 51 ﻤﻥ ‪(BSS‬‬ ‫6‬ ‫‪Ossama Anjak, AECS Damascus SYRIA /e‬‬‫‪mail: oanjak@gmail.com‬‬ ‫‪Osama Anjak‬‬ ‫ﻗﻴﺎس اﻟﺠﺮع‬ ‫1102 ,71 ‪January‬‬ ‫3‬

‫א א‬ ‫7‬ ‫א‬ ‫א‬ ‫ﺍﻟﺸﺭﻴﺤﺔ 7 ﻤﻥ 84‬ ‫א‬ ‫‪Ossama Anjak‬‬ ‫א‬ ‫א‬ ‫1102 ‪7 Narch‬‬ ‫ﺗﺒﺮﻳﺮ اﻟﻤﻤﺎرﺳﺔ‬ ‫‪Justification of a Practice‬‬ ‫1. إن ﺗﺒﻨﻲ أﻳﺔ ﻣﻤﺎرﺳﺔ ﺟﺪﻳﺪة أو اﻟﻤﺤﺎﻓﻈﺔ ﻋﻠﻰ اﻟﻤﻤﺎرﺳﺔ اﻟﺴﺎﺑﻘﺔ ﻳﺠﺐ ان ﻳﺄﺧﺬ ﺑﻌﻴﻦ‬ ‫اﻻﻋﺘﺒﺎر اﻷذى اﻟﻨﺎﺗﺞ ﻋﻦ ﺗﺄﺛﻴﺮ اﻹﺷﻌﺎع آﻨﺘﻴﺠﺔ ﻟﺘﻄﺒﻴﻖ هﺬﻩ اﻟﻤﻤﺎرﺳﺔ.‬ ‫2. إن اﻟﻤﻤﺎرﺳﺔ اﻟﺘﻲ ﺗﺘﻄﻠﺐ اﻟﺘﻌﺮض ﻟﻺﺷﻌﺎع أو ﺗﻌﺮض آﺎﻣﻦ ﻳﺠﺐ أن ﺗﻌﺘﻤﺪ ﻓﻘﻂ إذا‬ ‫آﺎن ﻳﻮﺟﺪ ﻓﺎﺋﺪة ﻣﺆآﺪة ﻣﻦ ذﻟﻚ اﻹﺟﺮاء ﻋﻠﻰ اﻟﺼﻌﻴﺪ اﻟﺸﺨﺼﻲ أو ﻟﻠﻤﺠﺘﻤﻊ ﺗﺰﻳﺪ ﺑﻘﺪر‬ ‫آﺒﻴﺮ ﻋﻠﻰ اﻟﻀﺮر اﻟﺬي ﻳﻤﻜﻦ ان ﻳﺤﺪث ﻥﺘﻴﺠﺔ ﺗﻠﻚ اﻟﻤﻤﺎرﺳﺔ.‬ ‫א‬ ‫8‬ ‫‪Ossama Anjak, AECS Damascus SYRIA /e‬‬‫‪mail: oanjak@gmail.com‬‬ ‫א‬ ‫‪Ossama Anjak‬‬ ‫1102 ‪7 Narch‬‬ ‫4‬

‫א‬ ‫א‬ ‫‪Justification of Medical Exposures‬‬ ‫• ﻴﺠﺏ ﺘﺒﺭﻴﺭ ﺍﻟﺘﻌﺭﺽ ﺍﻟﻁﺒﻲ ﻤﻥ ﺨﻼل ﺍﻟﻤﻭﺍﺯﻨﺔ ﺒﻴﻥ ﺍﻟﻔﻭﺍﺌﺩ ﺍﻟﻌﻼﺠﻴﺔ ﺍﻟﺘﻲ‬ ‫ﺴﻨﺤﺼل ﻋﻠﻴﻬﺎ ﻤﻥ ﻫﺫﺍ ﺍﻟﺘﻁﺒﻴﻕ ﻤﻘﺎﺒل ﺍﻷﺫﻯ ﺍﻹﺸﻌﺎﻋﻲ ﺍﻟﺫﻱ ﻴﻤﻜﻥ ﺃﻥ‬ ‫ﻴﺤﺼل ﻤﻘﺎﺒل ﻫﺫﺍ ﺍﻟﺘﻁﺒﻴﻕ ﺁﺨﺫﻴﻥ ﺒﻌﻴﻥ ﺍﻻﻋﺘﺒﺎﺭ ﻜﺎﻓﺔ ﺍﻟﺒﺩﺍﺌل ﺍﻷﺨﺭﻯ‬ ‫ﺍﻟﻤﺘﺎﺤﺔ ﺍﻟﺘﻲ ﻻ ﺘﺴﺘﺨﺩﻡ ﺍﻟﺘﻌﺭﺽ ﺍﻟﻁﺒﻲ‬ ‫4-‪BSS –Appendix II , II‬‬ ‫-‪II‬‬ ‫‪Ossama Anjak‬‬ ‫9 ‪Slide‬‬ ‫א‬ ‫א‬ ‫א‬ ‫א‬ ‫1102 ‪7 Narch‬‬ ‫א‬ ‫؟‬ ‫• اﻟﺤﺎدث اﻹﺵﻌﺎﻋﻲ هﻮ واﻗﻌﺔ ﻏﻴﺮ ﻣﺮﻏﻮب ﺑﻬﺎ أو رﺑﻤﺎ ﺗﻜﻮن ذات‬ ‫ﻧﺘﻴﺠﺔ ﻏﻴﺮ ﻣﻨﺎﺱﺒﺔ.‬ ‫• ﺗﻠﻚ اﻟﺤﻮادث ﻳﻤﻜﻦ أن ﺗﻘﻊ ﻧﺘﻴﺠﺔ ﻟـ:‬ ‫– ﺧﻄﺄ اﻟﻤﺸﻐﻞ- ﺧﻄﺄ ﺑﺸﺮي.‬ ‫– ﻋﻄﻞ ﻃﺎرئ أو ﺧﻠﻞ ﻓﻲ اﻟﺘﺠﻬﻴﺰات.‬ ‫– أو أي ﺡﺎدث ﻣﺆﺱﻒ، زﻟﺰال، ﺡﺮﻳﻖ ....‬ ‫01 ‪Slide‬‬ ‫‪Ossama Anjak, AECS Damascus SYRIA /e‬‬‫‪mail: oanjak@gmail.com‬‬ ‫‪Ossama Anjak‬‬ ‫1102 ‪7 Narch‬‬ ‫5‬

‫מא‬ ‫1. ﻋﻤﻮم اﻟﻨﺎس‬ ‫א‬ ‫א‬ ‫א‬ ‫‪Members of the general public‬‬ ‫– ﺗﻌﺮض ﻟﻺﺵﻌﺎع آﻨﺘﻴﺠﺔ ﻟﺨﻠﻞ ﻓﻲ ﺗﺄﺱﻴﺲ ﻧﻈﻢ اﻷﻣﺎن واﻟﻮﻗﺎﻳﺔ اﻹﺵﻌﺎﻋﻴﺔ‬ ‫2. اﻟﻌﺎﻣﻠﻮن ‪Clinical staff‬‬ ‫– ﺗﻌﺮض ﻟﻺﺵﻌﺎع ﺧﻼل ﺗﺤﻀﻴﺮ اﻟﻤﻨﺎﺑﻊ اﻟﻤﺸﻌﺔ أو ﻣﻌﺎﻟﺠﺔ اﻟﻤﺮﺿﻰ، أو ﺧﻼل اﻟﺘﺮآﻴﺐ أو‬ ‫اﻟﺼﻴﺎﻧﺔ أو ﺗﺒﺪﻳﻞ اﻟﻤﻨﺒﻊ أو أﻳﺔ ﺧﺪﻣﺎت أﺧﺮى ﻟﻠﺘﺠﻬﻴﺰات.‬ ‫3.‬ ‫א‬ ‫א‬ ‫‪Patient injured during treatment‬‬ ‫א‬ ‫א‬ ‫א‬ ‫א‬ ‫.‬ ‫א‬ ‫א‬ ‫‪Ossama Anjak‬‬ ‫11 ‪Slide‬‬ ‫א‬ ‫א‬ ‫א‬ ‫א‬ ‫א‬ ‫א‬ ‫א‬ ‫1102 ‪7 Narch‬‬ ‫א‬ ‫א‬ ‫؟‬ ‫68 ‪ICRP Publication‬‬ ‫• ﻓﻲ ﺍﻟﻤﻌﺎﻟﺠﺔ ﺍﻹﺸﻌﺎﻋﻴﺔ:‬ ‫– ﺍﻟﺤﺎﻟﺔ ﺍﻟﻁﺒﻴﻌﻴﺔ ﻟﻠﺘﻌﺭﺽ ﺍﻹﺸﻌﺎﻋﻲ ﻫﻭ ﺇﺠﺭﺍﺀ ﻤﻌﺎﻟﺠﺔ ﺇﺸﻌﺎﻋﻴﺔ‬ ‫ﻭﻓﻘﺎ ﻟﺨﻁﺔ ﻤﻭﺼﻭﻓﺔ ﻓﻲ ﻤﻠﻑ ﺍﻟﻤﻌﺎﻟﺠﺔ.‬ ‫ﹰ‬ ‫– ﺍﻟﺘﻌﺭﺽ ﺍﻟﻨﺎﺘﺞ ﻋﻥ ﺤﺎﺩﺙ ‪ An accidental exposure‬ﻫﻭ ﺫﻟﻙ‬ ‫ﺍﻟﺘﻌﺭﺽ ﻟﻺﺸﻌﺎﻉ ﻏﻴﺭ ﺍﻟﻭﺍﺭﺩ ﻓﻲ ﺍﻟﻭﺼﻔﺔ ﺍﻟﻁﺒﻴﺔ ﻭﺍﻟﺫﻱ ﻴﻘﻊ ﻓﻲ‬ ‫ﻤﺭﺤﻠﺔ ﻤﺎ ﻤﻥ ﻤﺭﺍﺤل ﺘﻁﺒﻴﻕ ﺍﻟﻤﻌﺎﻟﺠﺔ.‬ ‫• ﺍﻟﺠﺭﻋﺎﺕ ﺍﻷﻗل ﻤﻥ ﻗﻴﻤﺔ ﺍﻟﺠﺭﻉ ﺍﻟﻤﻭﺼﻭﻓﺔ ﻴﻤﻜﻥ ﺃﻥ ﻴﺤﺩﺙ ﻋﻨﻬﺎ‬ ‫ﻨﺘﺎﺌﺞ ﻫﺎﻤﺔ ﺒﺎﻟﻨﺴﺒﺔ ﻟﻠﻤﺭﻴﺽ ﻭﻴﻤﻜﻥ ﺃﻥ ﺘﻌﺩ ﻤﻥ ﻀﻤﻥ ﺍﻟﺤﻭﺍﺩﺙ‬ ‫ﺍﻹﺸﻌﺎﻋﻴﺔ.‬ ‫21 ‪Slide‬‬ ‫‪Ossama Anjak, AECS Damascus SYRIA /e‬‬‫‪mail: oanjak@gmail.com‬‬ ‫‪Ossama Anjak‬‬ ‫1102 ‪7 Narch‬‬ ‫6‬

‫א‬ ‫א‬ ‫א‬ ‫؟‬ ‫א‬ ‫• ﻴﺘﻠﻘﻰ ﺍﻟﻤﺭﻴﺽ ﺨﻼل ﺍﻟﻤﻌﺎﻟﺠﺔ ﺍﻹﺸﻌﺎﻋﻴﺔ ﺠﺭﻋﺔ ﻜﺒﻴﺭﺓ‬ ‫]‪ to 80Gy‬ﺁﺨﺫﻴﻥ ﺒﻌﻴﻥ ﺍﻻﻋﺘﺒﺎﺭ ﺍﻟﺤﺩ ﺍﻟﻤﺴﻤﻭﺡ ﺒﻪ ﺒﺎﻟﻨﺴﺒﺔ‬ ‫ﻟﻠﻨﺴﺞ ﺍﻟﻁﺒﻴﻌﻴﺔ. ﻭﺒﺎﻟﺘﺎﻟﻲ ﻓﺈﻥ ﺃﻱ ﺤﺎﺩﺙ ﻴﺅﺩﻱ ﺇﻟﻰ ﺯﻴﺎﺩﺓ ﻓﻲ‬ ‫ﺍﻟﺘﻌﺭﺽ ﻴﻤﻜﻥ ﺃﻥ ﻨﺘﺎﺌﺞ ﻏﻴﺭ ﻤﺭﻏﻭﺏ ﺒﻬﺎ.‬ ‫• ﺘﻭﺠﻪ ﺍﻟﺤﺯﻤﺔ ﺍﻹﺸﻌﺎﻋﻴﺔ ﻨﺤﻭ ﺍﻟﻤﺭﻴﺽ ﺃﻭ ﻴﺘﻡ ﺯﺭﻉ ﺍﻟﻤﻨﺒﻊ‬ ‫ﺍﻟﻤﺸﻊ ﻓﻲ ﺠﺴﻡ ﺍﻟﻤﺭﻴﺽ ﻭﺇﻥ ﺃﻱ ﺨﻁﺄ ﻓﻲ ﺘﻠﻙ ﺍﻹﺠﺭﺍﺀﺍﺕ‬ ‫ﻴﻤﻜﻥ ﺃﻥ ﻴﻜﻭﻥ ﻟﻪ ﺘﺄﺜﻴﺭ ﺴﻠﺒﻲ ﻋﻠﻰ ﺍﻟﻤﻌﺎﻟﺠﺔ. ﻭﻓﻲ ﺒﻌﺽ‬ ‫ﺍﻟﺤﺎﻻﺕ ﻴﻤﻜﻥ ﺃﻥ ﻴﺅﺩﻱ ﺇﻟﻰ ﻭﻓﺎﺓ ﺍﻟﻤﺭﻴﺽ.‬ ‫‪[20Gy‬‬ ‫‪Ossama Anjak‬‬ ‫31 ‪Slide‬‬ ‫1102 ‪7 Narch‬‬ ‫א‬ ‫א‬ ‫א א‬ ‫א‬ ‫‪Potential for an accident in Radiotherapy‬‬ ‫• ﺇﻥ ﺍﻟﻤﻌﺎﻟﺠﺔ ﺍﻹﺸﻌﺎﻋﻴﺔ ﻋﻤﻠﻴﺔ ﻤﻌﻘﺩﺓ ﺠﺩﺍ ﺒﻜﺎﻓﺔ ﻤﺭﺍﺤﻠﻬﺎ )ﻤﻥ ﺍﻟﻭﺼﻑ‬ ‫ﹰ‬ ‫ﺇﻟﻰ ﺍﻟﺘﻁﺒﻴﻕ(.‬ ‫• ﺘﺘﻁﻠﺏ ﺍﻟﻤﺸﺎﺭﻜﺔ ﺒﻴﻥ ﻋﺩﺩ ﻤﻥ ﺍﻻﺨﺘﺼﺎﺼﺎﺕ ﻭﺘﻤﺭ ﺒﻌﺩﺩ ﻤﻥ‬ ‫ﺍﻟﺨﻁﻭﺍﺕ ﻭﺍﻟﻌﺩﻴﺩ ﻤﻥ ﻤﺭﺍﺤل ﺍﻟﻤﻌﺎﻟﺠﺔ ﻤﻊ ﺍﻟﻌﺩﻴﺩ ﻤﻥ ﺍﻟﻤﻌﺎﻤﻼﺕ‬ ‫ﺍﻟﻤﺘﻐﻴﺭﺓ )ﺃﺒﻌﺎﺩ ﺍﻟﻭﺭﻡ، ﺴﻤﺎﻜﺔ ﺍﻟﻤﺭﻴﺽ، ﻭﻀﻌﻴﺔ ﺍﻟﻤﺭﻴﺽ ....(.‬ ‫• ﺃﻴﻀﺎ ﻴﻌﻤل ﻓﻨﻲ ﺍﻟﻤﻌﺎﻟﺠﺔ ﺍﻹﺸﻌﺎﻋﻴﺔ ﻋﻠﻰ ﺘﻁﺒﻴﻕ ﺍﻟﻤﻌﺎﻟﺠﺔ ﻋﻠﻰ ﺤﻭﺍﻟﻲ‬ ‫ﹰ‬ ‫05 ﻤﺭﻴﺽ ﺒﺎﻟﻴﻭﻡ. ﺒﻌﻀﻬﺎ ﻤﺘﺸﺎﺒﻪ ﺒﺎﻟﺒﺭﺍﻤﺘﺭﺍﺕ ﻭﺒﻌﻀﻬﺎ ﺍﻵﺨﺭ‬ ‫ﻤﺨﺘﻠﻑ ﻤﻥ ﻤﺭﻴﺽ ﻷﺨﺭ ﻭﻏﺎﻟﺒﺎ ﺘﺤﺘﺎﺝ ﺍﻟﻤﻌﺎﻟﺠﺔ ﻟﺒﻌﺽ ﺍﻷﺩﻭﺍﺕ‬ ‫ﺍﻟﺨﺎﺼﺔ ﺒﺎﻟﻤﺭﻴﺽ )ﺤﻤﺎﻴﺔ، ﺃﺩﻭﺍﺕ ﺘﺜﺒﻴﺕ، ....(. ً‬ ‫41 ‪Slide‬‬ ‫‪Ossama Anjak, AECS Damascus SYRIA /e‬‬‫‪mail: oanjak@gmail.com‬‬ ‫‪Ossama Anjak‬‬ ‫1102 ‪7 Narch‬‬ ‫7‬

‫א‬ ‫א‬ ‫א‬ ‫א‬ ‫א‬ ‫‪Potential for an accident in Radiotherapy‬‬ ‫• ﺒﺴﺒﺏ ﺍﻟﺘﻌﻘﻴﺩ ﻓﻲ ﺍﻟﺘﺠﻬﻴﺯﺍﺕ، ﺍﻟﺘﻘﻨﻴﺎﺕ، ﺍﻹﺠﺭﺍﺀﺍﺕ، ﻓﺈﻨﻪ ﻴﺠﺏ ﺃﻥ‬ ‫ﻨﺄﺨﺫ ﺒﻌﻴﻥ ﺍﻻﻋﺘﺒﺎﺭ ﺍﻷﺨﻁﺎﺀ ﺃﻭ ﺍﻟﻬﻔﻭﺍﺕ ﻜﻤﺎ ﺃﻨﻪ ﻤﻥ ﻏﻴﺭ ﺍﻟﻤﺤﺘﻤل‬ ‫ﺍﻟﺴﻤﺎﺡ ﺒﺤﺩﻭﺙ ﺃﻱ ﺨﻁﺄ ﻴﺅﺩﻱ ﺇﻟﻰ ﺯﻴﺎﺩﺓ ﺃﻭ ﻨﻘﺼﺎﻥ ﺍﻟﺠﺭﻋﺔ.‬ ‫• ﺒﺴﺒﺏ ﺍﻟﺘﻌﻘﻴﺩ ﻓﻲ ﺍﻟﻤﻌﺎﻟﺠﺔ ﺍﻹﺸﻌﺎﻋﻴﺔ ﻭﺤﺴﺎﺴﻴﺘﻬﺎ ﻟﻸﺨﻁﺎﺀ‬ ‫ﻭﺍﻟﻬﻔﻭﺍﺕ ﻓﻴﺠﺏ ﺃﻥ ﻻ ﻨﺩﻉ ﺃﻱ ﺸﻲﺀ ﻟﻠﺤﻅ ﺃﻭ ﺒﺎﻷﺤﺭﻯ ﻜﺎﻤل ﺍﻟﺒﻨﻴﺔ‬ ‫ﺍﻟﺘﺭﺘﻴﺒﺎﺕ ﻴﺠﺏ ﺃﻥ ﻭﻓﻘﺎ ﻟﻤﺎ ﻫﻭ ﻤﻁﻠﻭﺏ.‬ ‫ﹰ‬ ‫ً‬ ‫• ﻴﺠﺏ ﺘﻁﺒﻴﻕ ﻤﺒﺩﺃ ﺍﻟﺩﻓﺎﻉ ﺒﺎﻟﻌﻤﻕ ‪Defense in Depth‬‬ ‫‪Ossama Anjak‬‬ ‫51 ‪Slide‬‬ ‫א‬ ‫1.‬ ‫2.‬ ‫3.‬ ‫4.‬ ‫5.‬ ‫א‬ ‫א‬ ‫א‬ ‫א‬ ‫1102 ‪7 Narch‬‬ ‫מא‬ ‫:‬ ‫ﻓﻘﺪان اﻟﻤﺼﺎدر اﻟﻤﺸﻌﺔ.‬ ‫ﻓﻘﺪان أو ﺗﺨﺮﻳﺐ اﻟﺪرع اﻟﻮاﻗﻲ ﻟﻠﻤﺼﺪر اﻟﻤﺸﻊ.‬ ‫ﻧﻘﺺ ﻓﻲ ﺿﻮاﺏﻂ ﻋﺪم اﻧﺘﺸﺎر اﻟﻤﻮاد اﻟﻤﺸﻌﺔ اﻟﺘﻲ ﺗﺴﺒﺐ ﻓﻲ‬ ‫اﻧﺘﺸﺎر أو ﺗﺤﺮر اﻟﻤﻮاد اﻟﻤﺸﻌﺔ.‬ ‫ﺗﻌﺮض ﻏﻴﺮ ﻡﻘﺼﻮد ﻟﺠﺰء أو آﺎﻡﻞ اﻟﺠﺴﻢ ﻟﻺﺵﻌﺎع.‬ ‫ﺗﻠﻮث ﻏﻴﺮ ﻡﻘﺼﻮد ﺏﺎﻟﻤﻮاد اﻟﻤﺸﻌﺔ ﻟﺠﺰء أو آﺎﻡﻞ اﻟﺠﺴﻢ.‬ ‫61 ‪Slide‬‬ ‫‪Ossama Anjak, AECS Damascus SYRIA /e‬‬‫‪mail: oanjak@gmail.com‬‬ ‫‪Ossama Anjak‬‬ ‫1102 ‪7 Narch‬‬ ‫8‬

‫ﺘﺼﻨﻴﻑ ﺍﻟﺤﻭﺍﺩﺙ ﺍﻹﺸﻌﺎﻋﻴﺔ‬ ‫‪Classification of Radiation Accidents‬‬ ‫ﺍﻟﺤﻭﺍﺩﺙ ﺍﻹﺸﻌﺎﻋﻴﺔ ﻓﻲ ﺍﻟﻤﻌﺎﻟﺠﺔ ﺍﻹﺸﻌﺎﻋﻴﺔ‬ ‫ﺍﻟﺤﻭﺍﺩﺙ ﺍﻟﻤﺭﺘﺒﻁﺔ ﺒﺎﻟﻤﺭﻴﺽ‬ ‫ﺍﻟﺤﻭﺍﺩﺙ ﺍﻟﻤﺭﺘﺒﻁﺔ ﺒﺎﻟﺘﺠﻬﻴﺯﺍﺕ‬ ‫اﻟﺘﺄﺛﻴﺮ ﻓﻘﻂ ﻋﻠﻰ اﻟﻤﺮﻳﺾ‬ ‫اﻟﺘﺄﺛﻴﺮ ﻓﻘﻂ ﻋﻠﻰ اﻟﻤﺮﻳﺾ‬ ‫اﻟﺘﺄﺛﻴﺮ ﻋﻠﻰ ﻋﺪد ﻣﻦ اﻟﻤﺮﺽﻰ‬ ‫اﻟﺘﺄﺛﻴﺮ ﻋﻠﻰ ﻋﺪد ﻣﻦ اﻟﻤﺮﺽﻰ‬ ‫‪Ossama Anjak‬‬ ‫71 ‪Slide‬‬ ‫א‬ ‫א‬ ‫א‬ ‫1102 ‪7 Narch‬‬ ‫؟؟‬ ‫• ﺍﻟﺤﻭﺍﺩﺙ ﺍﻹﺸﻌﺎﻋﻴﺔ ﻓﻲ ﻤﺠﺎل ﺍﻟﺘﻌﺭﺽ ﺍﻟﻁﺒﻲ )511 ‪:(BSS‬‬ ‫– ﺃﻴﺔ ﻤﻌﺎﻟﺠﺔ ﺇﺸﻌﺎﻋﻴﺔ ﺠﺭﺕ:‬ ‫• ﻟﻤﺭﻴﺽ ﺁﺨﺭ ﻏﻴﺭ ﺍﻟﻤﺭﻴﺽ ﺍﻟﺫﻱ ﻭﺼﻔﺕ ﻟﻪ ﺍﻟﻤﻌﺎﻟﺠﺔ.‬ ‫• ﺃﻭ ﻟﻌﻀﻭ ﻏﻴﺭ ﺍﻟﻌﻀﻭ ﺍﻟﻤﻁﻠﻭﺏ ﻤﻌﺎﻟﺠﺘﻪ‬ ‫• ﺃﻭ ﺍﺴﺘﺨﺩﺍﻡ ﺍﻟﺼﻴﺩﻻﻨﻴﺎﺕ ﺍﻹﺸﻌﺎﻋﻴﺔ ﺒﺼﻭﺭﺓ ﺨﺎﻁﺌﺔ‬ ‫• ﺃﻭ ﺃﻱ ﺨﻁﺄ ﺒﺎﻟﺠﺭﻋﺔ ﺍﻟﻜﻠﻴﺔ ﺃﻭ ﺍﻟﺠﺭﻋﺔ ﺒﺎﻟﺠﻠﺴﺔ.‬ ‫– ﺃﻱ ﺨﻠل ﻓﻲ ﺍﻷﺠﻬﺯﺓ ﺃﻭ ﺤﺎﺩﺙ ﺃﻭ ﺨﻁﺄ ﺃﺩﻯ ﺇﻟﻰ ﺘﻌﺭﺽ‬ ‫ﺍﻟﻤﺭﻴﺽ ﺇﻟﻰ ﺠﺭﻋﺔ ﺇﺸﻌﺎﻋﻴﺔ ﻏﻴﺭ ﺍﻟﺠﺭﻋﺔ ﺍﻟﻤﺘﻭﻗﻌﺔ.‬ ‫81 ‪Slide‬‬ ‫‪Ossama Anjak, AECS Damascus SYRIA /e‬‬‫‪mail: oanjak@gmail.com‬‬ ‫‪Ossama Anjak‬‬ ‫1102 ‪7 Narch‬‬ ‫9‬

‫א‬ ‫)‬ ‫511 ‪:(BSS‬‬ ‫• ﻴﺠﺏ ﺘﺩﻭﻥ ﺍﻟﺤﻭﺍﺩﺙ ﻓﻲ ﺴﺠل ﺨﺎﺹ ﺒﺎﻟﺤﻭﺍﺩﺙ ﺍﻹﺸﻌﺎﻋﻴﺔ .‬ ‫• ﻴﺠﺏ ﺃﻥ ﻴﺘﻀﻤﻥ ﺍﻟﺘﻘﺭﻴﺭ ﺍﻟﺨﺎﺹ ﺒﺎﻟﺤﺎﺩﺙ ﻤﺎ ﻴﻠﻲ:‬ ‫• ﺍﺴﻡ ﺍﻟﻤﺭﻴﺽ‬ ‫• ﻤﻭﺍﺼﻔﺎﺕ ﺍﻟﺤﺎﺩﺙ ﻭﺘﺎﺭﻴﺦ ﻭﻗﻭﻋﻪ‬ ‫• ﺍﻷﺴﺒﺎﺏ ﺍﻟﺘﻲ ﺃﺩﺕ ﺇﻟﻰ ﻭﻗﻭﻉ ﺍﻟﺤﺎﺩﺙ ﻭﻜﻴﻑ ﻴﻤﻜﻥ ﺘﺩﺍﺭﻙ‬ ‫ﺫﻟﻙ‬ ‫• ﺍﻟﺘﻭﻗﻌﺎﺕ ﺍﻟﻁﺒﻴﺔ ﺍﻟﺘﻲ ﻴﻤﻜﻥ ﺃﻥ ﺘﺤﺩﺙ ﻟﻠﻤﺭﻴﺽ.‬ ‫• ﺍﺴﻡ ﺍﻷﻓﺭﺍﺩ ﺍﻟﻤﺴﻭﺅﻟﻴﻴﻥ ﻋﻥ ﺍﻟﺤﺎﺩﺙ ﻭﺍﻟﻁﺒﻴﺏ ﺍﻟﻤﻌﺎﻟﺞ‬ ‫91 ‪Slide‬‬ ‫02‬ ‫‪Ossama Anjak, AECS Damascus SYRIA /e‬‬‫‪mail: oanjak@gmail.com‬‬ ‫‪Ossama Anjak‬‬ ‫‪Ossama Anjak‬‬ ‫1102 ‪7 Narch‬‬ ‫1102 ‪7 Narch‬‬ ‫01‬

IAEA Training Course (‫ﺥﻠﻞ ﻓﻲ أﻧﻈﻤﺔ اﻷﻡﺎن ﻓﻲ اﻟﻤﺴﺮع اﻟﺨﻄﻲ )ﺏﻮﻟﻨﺪا‬ Accelerator interlock failure (Poland) IAEA International Atomic Energy Agency Where are we going this time? Białystok Poland IAEA 11 Ossama Anjak 7 Narch 2011 22 Ossama Anjak, AECS Damascus SYRIA /email: oanjak@gmail.com

Poland - Białystok IAEA Ossama Anjak The Neptun 10P Linac 7 Narch 2011 23 ‫اﻟﻤﺴﺮع اﻟﺨﻄﻲ ﻧﻤﻮذج‬ Built on license from CGR, France by The Institute of Nuclear Studies, Experimental Establishment for Nuclear Equipment, Swerk, Poland 70’s type design The circuits involved in this accidental exposure are essentially unchanged from the original version Standing wave type 3 GHz 2 MW pulse magnetron IAEA 12 The Białystok Machine Ossama Anjak 7 Narch 2011 24 Ossama Anjak, AECS Damascus SYRIA /email: oanjak@gmail.com

‫آﻴﻒ وﻗﻌﺖ اﻟﺤﺎدﺛﺔ؟ ﻡﺎ هﻮ اﻟﺴﺒﺐ اﻟﺮﺋﻴﺴﻲ؟‬ ‫• 72 ﺸﺒﺎﻁ 1002.‬ ‫• ﺍﻨﻘﻁﺎﻉ ﺍﻟﺘﻴﺎﺭ ﺍﻟﻜﻬﺭﺒﺎﺌﻲ.‬ ‫• 5 ﻤﺭﻀﻰ ﺒﺎﻨﺘﻅﺎﺭ ﺘﻠﻘﻲ ﺍﻟﻤﻌﺎﻟﺠﺔ ﺒﺫﻟﻙ ﺍﻟﻴﻭﻡ.‬ ‫• ﺘﻡ ﺇﻋﺎﺩﺓ ﺇﻗﻼﻉ ﺍﻟﺠﻬﺎﺯ )ﺍﻟﻤﺴﺭﻉ( ﻋﻘﺏ ﻭﺼل ﺍﻟﺘﻐﺫﻴﺔ‬ ‫ﺍﻟﻜﻬﺭﺒﺎﺌﻴﺔ.‬ ‫• ﺠﺭﺕ ﻜﺎﻓﺔ ﺍﻻﺨﺘﺒﺎﺭﺍﺕ ﺍﻟﺫﺍﺘﻴﺔ ‪) Self test‬ﻓﻲ‬ ‫ﺠﻬﺎﺯ ﺍﻟﻤﺴﺭﻉ ﺍﻟﺨﻁﻲ( ﺩﻭﻥ ﺍﻹﺸﺎﺭﺓ ﺇﻟﻰ ﺃﻱ ﺨﻠل ﻓﻲ‬ ‫ﺍﻟﺠﻬﺎﺯ.‬ ‫52‬ ‫1102 ‪7 Narch‬‬ ‫‪IAEA‬‬ ‫‪Ossama Anjak‬‬ ‫ﻡﺎذا ﺡﺪث‬ ‫‪x‬‬ ‫?‪What happened‬‬ ‫• ﺩل ﺍﻟﻤﺅﺸﺭ ﺍﻟﺘﻤﺜﻴﻠﻲ ﻟﻤﻌﺩل ﺍﻟﺠﺭﻋﺔ ‪Analog‬‬ ‫‪ dose rate indicator‬ﻋﻠﻰ ﻤﻌﺩل ﺠﺭﻋﺔ‬ ‫‪ 150 MU/min‬ﺒﺩﻻ ﻋﻥ ﺍﻟﻤﻌﺩل ﺍﻟﻤﻁﻠﻭﺏ 003‬ ‫‪MU/min‬‬ ‫• ﻗﺎﻡ ﺍﻟﻔﻴﺯﻴﺎﺌﻲ ﺒﺘﻌﺩﻴل ﺍﻟﻤﺅﻗﺕ ﺍﻟﺯﻤﻨﻲ‬ ‫ﺇﻟﻰ ﺯﻤﻥ ﺃﻋﻠﻰ ﺒﺴﺒﺏ ﺍﻻﻨﺨﻔﺎﺽ‬ ‫ﺍﻟﻤﻼﺤﻅ ﻓﻲ ﻤﻌﺩل ﺍﻟﺠﺭﻋﺔ.‬ ‫• ﻻﺤﻅ ﺍﻟﻔﻴﺯﻴﺎﺌﻲ ﺨﻠل ﺒﺴﻴﻁ ﻓﻲ ﺘﻨﺎﻅﺭ ﺍﻟﺤﺯﻤﺔ‬ ‫‪ beam asymmetry‬ﻓﺄﺠﺭﻯ ﺍﻟﺘﺼﺤﻴﺢ ﺍﻟﻼﺯﻡ‬ ‫62‬ ‫1102 ‪7 Narch‬‬ ‫‪Ossama Anjak‬‬ ‫‪Ossama Anjak, AECS Damascus SYRIA /e‬‬‫‪mail: oanjak@gmail.com‬‬ ‫وﺡﺪة اﻟﺘﺤﻜﻢ ﺑﺘﺸﻐﻴﻞ اﻟﻤﺴﺮع ‪the‬‬ ‫‪Neptun 10 P in Bialystok‬‬ ‫‪IAEA‬‬ ‫31‬

‫ﻡﺎذا ﺡﺪث‬ ‫?‪What happened‬‬ ‫• ﺠﺭﻯ ﻤﻌﺎﻟﺠﺔ ﺍﻟﻤﺭﻀﻰ ﺍﻟﺨﻤﺴﺔ.‬ ‫• ﺘﻠﻘﻭﺍ ﺠﺭﻋﺔ ﺇﺸﻌﺎﻋﻴﺔ ﻤﻥ ﺤﺯﻤﺔ ﺇﻟﻜﺘﺭﻭﻨﺎﺕ ﺒﻁﺎﻗﺔ ‪.8 MeV‬‬ ‫• ﻻ ﺤﻅ ﺍﻟﻤﺭﻀﻰ )3(، )4(، )5( ﺘﺄﺜﻴﺭﺍﺕ ﻏﻴﺭ ﻁﺒﻴﻌﻲ )ﻟﻴﺴﺕ ﻤﺄﻟﻭﻓﺔ( ﻋﻠﻰ ﺍﻟﺠﻠﺩ‬ ‫ﻋﻘﺏ ﺠﻠﺴﺔ ﻤﺒﺎﺸﺭﺓ.‬ ‫• ﻋﺎﺩ ﺍﻟﻤﺭﻴﺽ )5( ﺇﻟﻰ ﻗﺴﻡ ﺍﻟﻤﻌﺎﻟﺠﺔ ﺍﻹﺸﻌﺎﻋﻴﺔ ﻤﻊ ﺸﻜﻭﻯ ﺒﺤﻜﺔ ﺸﺩﻴﺩﺓ ﻭﺇﺤﺴﺎﺱ‬ ‫ﺤﺭﻕ ﻓﻲ ﻤﻭﻀﻊ ﺍﻟﻤﻌﺎﻟﺠﺔ.‬ ‫• ﻻﺤﻅ ﻁﺒﻴﺏ ﺍﻟﻤﻌﺎﻟﺠﺔ ﺃﻴﻀﺎ ﺍﺤﻤﺭﺍﺭ ﻏﻴﺭ ﻁﺒﻴﻌﻲ ﻟﻠﺠﻠﺩ.‬ ‫ﹰ‬ ‫• ﻋﻘﺏ ﻤﻌﺎﻟﺠﺔ ﺍﻟﻤﺭﻴﺽ ﺍﻷﺨﻴﺭ ﻭﻀﻊ ﺍﻟﺠﻬﺎﺯ ﺨﺎﺭﺝ ﺍﻟﺨﺩﻤﺔ )ﻟﻡ ﻴﺴﺘﺨﺩﻡ ﻓﻲ ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺒﻌﺩ ﺫﻟﻙ(.‬ ‫72‬ ‫1102 ‪7 Narch‬‬ ‫‪IAEA‬‬ ‫‪Ossama Anjak‬‬ ‫اﻟﻌﻤﻞ اﻟﺬي ﻗﺎم ﺏﻪ اﻟﻔﻴﺰﻳﺎﺋﻲ‬ ‫‪Action of the physicist‬‬ ‫• ﻗﺎﻡ ﺍﻟﻔﻴﺯﻴﺎﺌﻲ ﺒﺈﺠﺭﺍﺀ ﺒﻌﺽ ﺍﻟﻘﻴﺎﺴﺎﺕ.‬ ‫• ﻗﺭﺍﺀﺓ ﺍﻟﻤﻘﻴﺎﺱ ﻜﺎﻨﺕ ﺨﺎﺭﺝ ﺍﻟﻤﺄﻟﻭﻑ.‬ ‫• ﻤﻌﺩل ﺍﻟﺠﺭﻋﺔ )ﺩﻭﻥ ﺇﺠﺭﺍﺀ ﺍﻟﺘﺼﺤﻴﺢ(‬ ‫ﻜﺎﻨﺕ:‬ ‫• ﺃﻜﺒﺭ 73 ﻀﻌﻑ ﻤﻥ ﺍﻟﻤﺄﻟﻭﻑ ) ﻤﻥ ﺃﺠل ﺤﺯﻤﺔ‬ ‫ﺍﻹﻟﻜﺘﺭﻭﻨﺎﺕ ‪.(8 MeV‬‬ ‫• ﺃﻜﺒﺭ 71 ﻀﻌﻑ ﻤﻥ ﺍﻟﻤﺄﻟﻭﻑ ) ﻤﻥ ﺃﺠل ﺤﺯﻤﺔ‬ ‫ﺍﻹﻟﻜﺘﺭﻭﻨﺎﺕ ‪.(10 MeV‬‬ ‫• ﺃﻜﺒﺭ 5.3 ﻀﻌﻑ ﻤﻥ ﺍﻟﻤﺄﻟﻭﻑ ) ﻤﻥ ﺃﺠل ﺤﺯﻤﺔ‬ ‫ﺍﻹﻟﻜﺘﺭﻭﻨﺎﺕ ‪.(9 MV‬‬ ‫82‬ ‫1102 ‪7 Narch‬‬ ‫‪Ossama Anjak‬‬ ‫‪Ossama Anjak, AECS Damascus SYRIA /e‬‬‫‪mail: oanjak@gmail.com‬‬ ‫‪The Neptun 10 P in Bialystok‬‬ ‫‪IAEA‬‬ ‫41‬

‫اﻟﻌﻤﻞ اﻟﺬي ﻗﺎم ﺏﻪ اﻟﻔﻴﺰﻳﺎﺋﻲ‬ ‫‪Action of the physicist‬‬ ‫• ﻻﺤﻅ ﺍﻟﻔﻴﺯﻴﺎﺌﻲ ﺯﻴﺎﺩﺓ ﻓﻲ ﺘﻴﺎﺭ ﺍﻟﻔﺘﻴل ﻟﻤﺩﻓﻊ ﺍﻹﻟﻜﺘﺭﻭﻨﺎﺕ )ﻤﻥ‬ ‫02.1 ﺇﻟﻰ 64.1 ﻷﺠل ﺍﻟﺤﺯﻤﺔ ‪.(8 MeV‬‬ ‫• ﺍﻟﻤﺴﺭﻉ ﻴﺩل ﻋﻠﻰ ﺍﻨﺨﻔﺎﺽ ﻓﻲ ﻤﻌﺩل ﺍﻟﺠﺭﻋﺔ.‬ ‫‪Electronic cabinet‬‬ ‫92‬ ‫1102 ‪7 Narch‬‬ ‫03‬ ‫1102 ‪7 Narch‬‬ ‫‪IAEA‬‬ ‫‪Ossama Anjak‬‬ ‫ﺝﺎء اﻟﺒﺎﺋﻊ ﻓﻲ اﻟﻴﻮم اﻟﺘﺎﻟﻲ:‬ ‫ُ‬ ‫َ‬ ‫• ﺍﻨﻘﻁﺎﻉ ﻓﻴﻭﺯ‬ ‫• ﻻ ﻴﻭﺠﺩ ﺘﻐﺫﻴﺔ ﻟﻨﻅﺎﻡ ﻗﻴﺎﺱ ﺍﻟﺠﺭﻋﺔ‬ ‫‪Broken fuse‬‬ ‫‪.dosimetry system‬‬ ‫• ﺜﺎﻨﺌﻲ ‪ Diode‬ﻋﺎﻁل ﻓﻲ ﺴﻠﺴﻠﺔ‬ ‫ﺍﻷﻗﻔﺎل ﺍﻟﻤﺘﺭﺍﺒﻁﺔ ‪.interlock chain‬‬ ‫• ﺩﻻﻟﺔ ﻋﻠﻰ ﺨﻠل ﻓﻲ ﻨﻅﺎﻡ ﻗﻴﺎﺱ‬ ‫ﺍﻟﺠﺭﻋﺔ.‬ ‫• ﺇﺸﺎﺭﺓ ﻀﻌﻴﻔﺔ ﻤﻥ ﺤﺠﻴﺭﺓ ﺍﻟﺘﺄﻴﻥ.‬ ‫• ﺯﻴﺎﺩﺓ ﻓﻲ ﺘﻴﺎﺭ ﻤﺩﻓﻊ ﺍﻹﻟﻜﺘﺭﻭﻨﺎﺕ‬ ‫ﻟﻠﺘﻌﻭﻴﺽ ﻋﻥ ﺍﻨﺨﻔﺎﺽ ﻤﻌﺩل‬ ‫ﺍﻟﺠﺭﻋﺔ.‬ ‫‪Ossama Anjak‬‬ ‫‪Ossama Anjak, AECS Damascus SYRIA /e‬‬‫‪mail: oanjak@gmail.com‬‬ ‫‪IAEA‬‬ ‫51‬

Dose rate vs gun current 120 Accident condition Dose rate, Gy/min 100 80 60 40 20 Normal condition 0 0.8 1.0 1.2 1.4 1.6 E le ctron gun filame nt curre nt, A IAEA Ossama Anjak 7 Narch 2011 31 ‫ﻗﻴﺎﺳﺎت اﻟﺠﺮﻋﺔ اﻹﺵﻌﺎﻋﻴﺔ ﻓﻲ ﻇﺮوف ﻡﻤﺎﺛﻠﺔ ﻟﻠﺤﺎدث‬ Made in December 2001 ‫اﻟﻄﺮﻳﻘﺔ اﻟﻤﺴﺘﺨﺪﻡﺔ‬ ‫ﺡﺠﻴﺮة ﺗﺄﻳﻦ‬ ‫( اﻟﺠﺮﻋﺔ‬Gy) per 150 MU 127 ± 4 Plane parallel ionization chamber (Roos) Alanine 122 ± 4 GAFchromic film 115 ± 3 IAEA 16 Ossama Anjak 7 Narch 2011 32 Ossama Anjak, AECS Damascus SYRIA /email: oanjak@gmail.com

‫اﻟﺠﺮﻋﺔ اﻟﺘﻲ ﺗﻌﺮض إﻟﻴﻬﺎ اﻟﻤﺮﺿﻰ‬ Patient 3 Patient 4 Patient 5 From EPR Sample at frontal 59 ± 7 Gy position 64 ± 11 Gy 71 ± 3 Gy Sample at Distal 67 ± 8 Gy position 84 ± 19 Gy 68 ± 5 Gy From Ionization chamber 103 ± 9 Gy 83 ± 9 Gy IAEA 103 ± 9 Gy Ossama Anjak 7 Narch 2011 33 ‫ﻧﺘﺎﺋﺞ اﻟﺘﻌﺮض ﻟﺠﺮﻋﺎت ﺗﺰﻳﺪ ﻋﻦ اﻟﺤﺪ اﻟﻄﺒﻴﻌﻲ‬ Results on the overexposure IAEA International Atomic Energy Agency 17 Ossama Anjak, AECS Damascus SYRIA /email: oanjak@gmail.com

Patient 1 Necrosis in area of prior surgical scar June 4, 01 Oct, 01 Dose 50 Gy Co60 + Boost 1x2.5 Gy 8 MeV+ accident IAEA Dec 1, 01 Ossama Anjak 7 Narch 2011 36 Patient 2 Surgical scar June 4, 01 White border of lesion October 2001 Dose 48 Gy 8 MeV + ? IAEA 18 Dec 1, 2001 Ossama Anjak 7 Narch 2011 37 Ossama Anjak, AECS Damascus SYRIA /email: oanjak@gmail.com

Patient 3 June 4, 01 White border October 2001 Scar, future necrosis Dose 25 Gy 8 MeV + ? Dec 1, 2001 IAEA Ossama Anjak 7 Narch 2011 38 Patient 3 - CT of the thoracic wall Necrotic lesion IAEA 19 Ossama Anjak 7 Narch 2011 39 Ossama Anjak, AECS Damascus SYRIA /email: oanjak@gmail.com

Patient 4 Scar, future necrosis October 2001 June 4, 01 Dose 42 Gy 8 MeV +? IAEA Ossama Anjak 7 Narch 2011 40 Patient 5 October 2001 Dec 1, 01 June 4, 01 Dose 5 Gy 8 MeV+ ? IAEA 20 Ossama Anjak 7 Narch 2011 41 Ossama Anjak, AECS Damascus SYRIA /email: oanjak@gmail.com

‫اﻟﺪروس اﻟﻤﺴﺘﻔﺎدة: اﻟﺸﺮآﺔ اﻟﺼﺎﻧﻌﺔ‬ ‫• ﺍﻋﺘﻤﺎﺩ ﻤﻌﺎﻴﻴﺭ ﺍﻻﻤﺎﻥ ﺍﻟﺼﺎﺩﺭﺓ ﻋﻥ ‪IEC safety standards‬‬ ‫.‬ ‫• ﺇﻋﺎﺩﺓ ﺘﻘﻴﻴﻡ ﻨﻅﻡ ﺍﻵﻤﺎﻥ ﻓﻲ ﺍﻟﻤﺴﺭﻋﺎﺕ ﻗﻴﺩ ﺍﻟﺘﺸﻐﻴل ﻋﻨﺩ ﺍﺼﺩﺍﺭ‬ ‫ﻤﻌﺎﻴﻴﺭ ﺠﺩﻴﺩ ﻤﻥ ﻗﺒل ﺍﻟـ ‪.IEC‬‬ ‫• ﺘﻭﺼﻴﺎﺕ ﻭﺍﻀﺤﺔ ﺇﻟﻰ ﺍﻟﻤﺴﺘﺨﺩﻤﻴﻥ ﻓﻲ ﺤﺎل ﺍﻨﻘﻁﺎﻉ ﺍﻟﺘﻐﺫﻴﺔ‬ ‫ﺍﻟﻜﻬﺭﺒﺎﺌﻴﺔ )ﻤﺠﻤﻭﻋﺔ ﻤﻥ ﺍﻻﺨﺘﺒﺎﺭ ﺍﻟﻭﺍﺠﺏ ﺇﺠﺭﺍﺀﺍﻫﺎ ﻗﺒل ﺍﻟﺒﺩﺀ‬ ‫ﻓﻲ ﻤﻌﺎﻟﺠﺔ ﺍﻟﻤﺭﻀﻰ(.‬ ‫• ﺇﺠﺭﺍﺀ ﺘﺩﺭﻴﺏ ﻤﻬﻨﺩﺴﻲ ﺍﻟﺼﻴﺎﻨﺔ ﻴﺘﻀﻤﻥ ﺍﻟﺩﺭﻭﺱ ﺍﻟﻤﺴﺘﻔﺎﺩﺓ ﻤﻥ‬ ‫ﺤﻭﺍﺩﺙ ﺍﻟﺘﻌﺭﺽ.‬ ‫24‬ ‫1102 ‪7 Narch‬‬ ‫‪Ossama Anjak‬‬ ‫‪IAEA‬‬ ‫اﻟﺪروس اﻟﻤﺴﺘﻔﺎدة: اﻟﺸﺮآﺔ اﻟﺼﺎﻧﻌﺔ/اﻟﺼﻴﺎﻧﺔ‬ ‫• ﻴﺠﺏ ﺃﻥ ﹸﺤﺩﺩ ﺸﻬﺎﺩﺓ ﻤﻬﻨﺩﺴﻲ ﺍﻟﺼﻴﺎﻨﺔ ﺍﻟﻘﻴﻭﺩ ﻟﻤ َﺎﻟ َﺔ ﺃﻭ ﺘﹶﻌﺩﻴل‬ ‫َ ُﻌ ﹶ ﺠ َ‬ ‫ِ‬ ‫َ ِ ُ َ ْ ﺘ َّ‬ ‫ﺒﻌْﺽ ﺍﻷﺠﺯﺍﺀ ﺍﻟﺤﺭﺠﺔ ﻓﻲ ﺍﻟﻤﺴﺭﻉ، ﺍﻋﺘﻤﺎﺩﺍ ﻋﻠﻰ ﺩﺭﺠﺔ‬ ‫ِ‬ ‫ﹰ‬ ‫ِ‬ ‫ِ‬ ‫ِ‬ ‫َ‬ ‫ﺘﺩﺭﻴﺏ.‬ ‫• ﺘﺜﺒﻴﺕ ﺇﺸﺎﺭﺍﺕ ﺘﺤﺫﻴﺭﻴﺔ ﺤﻭل ﺘﻌﺩﻴل ﺘﻴﺎﺭ ﺍﻟﻔﺘﻴل ‪filament‬‬ ‫‪ current‬ﻭﺃﻱ ﻋﻨﺎﺼﺭ ﺃﺨﺭﻯ ﻴﻤﻜﻥ ﺃﻥ ﺘﺅﺜﺭ ﻋﻠﻰ ﻨﻅﻡ ﺍﻵﻤﺎﻥ.‬ ‫• ﺡﺼﺮ إﺝﺮاءات اﻟﺼﻴﺎﻧﺔ ﻓﻲ اﻷﺝﺰاء اﻟﺨﺎﺹﺔ ﺑﻨﻈﻢ اﻷﻣﺎن‬ ‫ﺑﻤﻬﻨﺪﺱﻲ اﻟﺼﻴﺎﻧﺔ اﻟﻤﺆهﻠﻴﻦ ﻓﻲ اﻟﺸﺮآﺔ اﻟﺼﺎﻧﻌﺔ .‬ ‫34‬ ‫1102 ‪7 Narch‬‬ ‫‪Ossama Anjak‬‬ ‫‪Ossama Anjak, AECS Damascus SYRIA /e‬‬‫‪mail: oanjak@gmail.com‬‬ ‫‪IAEA‬‬ ‫12‬

‫اﻟﺪروس اﻟﻤﺴﺘﻔﺎدة:‬ ‫ﻗﺴﻢ اﻟﻤﻌﺎﻟﺠﺔ اﻹﺵﻌﺎﻋﻴﺔ‬ ‫• اﻟﻤﺮاﻗﺒﺔ اﻟﻔﻮرﻳﺔ ﻋﻠﻰ:‬ ‫• اﻟﺘﻐﺬﻳﺔ اﻟﻜﻬﺮﺑﺎﺉﻴﺔ ﻋﻘﺐ اﻧﻘﻄﺎع اﻟﺘﻴﺎر.‬ ‫• أي ﻣﻼﺡﻈﺎت ﻏﻴﺮ ﻋﺎدﻳﺔ ﻓﻲ ﻣﻌﺪل اﻟﺠﺮﻋﺔ أو ﺗﻨﺎﻇﺮ/ﺗﺠﺎﻧﺲ اﻟﺤﺰﻣﺔ‬ ‫....‬ ‫• وﺿﻊ إﺝﺮاءات ﻋﻤﻞ ﻣﻜﺘﻮﺑﺔ )‪ (Written procedure‬ﻟﻠﺘﺤﻘﻖ ﻣﻦ‬ ‫اﻻﺧﺘﺒﺎرات ﻗﺪ أﺝﺮﻳﺖ ﻓﻌﻼ.‬ ‫ً‬ ‫• ﻓﻲ ﺡﺎل وﺝﻮد ﻣﻬﻨﺪس ﺹﻴﺎﻧﺔ ﻓﻲ اﻟﻤﺴﺘﺸﻔﻰ ﻟﺼﻴﺎﻧﺔ اﻟﻤﺴﺮع‬ ‫اﻟﺨﻄﻲ:‬ ‫• ﻳﺠﺐ اﻟﺘﺤﻘﻖ ﻣﻦ اﻟﺼﻼﺡﻴﺎت اﻟﻤﻨﻮﺡﺔ ﻟﻪ ﻃﺒﻘﺎ ﻟﻤﺎ هﻮ وارد ﻓﻲ ﺵﻬﺎدة‬ ‫ً‬ ‫اﻟﺘﺪرﻳﺐ اﻟﻤﻨﻮﺡﺔ ﻣﻦ ﻗﺒﻞ اﻟﺸﺮآﺔ اﻟﺼﺎﻧﻌﺔ‬ ‫44‬ ‫1102 ‪7 Narch‬‬ ‫‪Ossama Anjak‬‬ ‫‪IAEA‬‬ ‫اﻟﺪروس اﻟﻤﺴﺘﻔﺎدة: ﺏﺎﺥﺘﺼﺎر‬ ‫• ﺇﺫﺍ ﺃﺨﺒﺭﻙ ﺍﻟﻤﺭﻴﺽ ﻋﻥ ﺃﻴﺔ ﺃﻋﺭﺍﺽ ﻏﻴﺭ ﻤﺄﻟﻭﻓﺔ ﺨﻼل‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ ﻋﻠﻴﻙ ﺍﻻﺴﺘﺠﺎﺒﺔ ﻭﺍﻟﺘﺤﺭﻱ ﻋﻥ ﺍﻷﺴﺒﺎﺏ.‬ ‫• ﻴﺠﺏ ﺇﺠﺭﺍﺀ ﺍﺨﺘﺒﺎﺭﺍﺕ ﻀﺒﻁ ﺍﻟﺠﻭﺩﺓ ﻟﻠﺘﺤﻘﻕ ﻤﻥ ﺃﺩﺍﺀ ﺍﻟﻤﺴﺭﻉ‬ ‫ﺍﻟﺨﻁﻲ ﻋﻘﺏ ﺍﻨﻘﻁﺎﻉ ﺍﻟﺘﻴﺎﺭ ﺍﻟﻜﻬﺭﺒﺎﺌﻲ ﺃﻭ ﺤﺩﻭﺙ ﻋﻁل ﻓﻲ‬ ‫ﺇﺤﺩﻯ ﺍﻟﺩﺍﺭﺍﺕ ﺍﻹﻟﻜﺘﺭﻭﻨﻴﺔ.‬ ‫• ﻴﺠﺏ ﺍﺴﺘﺒﺩﺍل ﺍﻟﺘﺠﻬﻴﺯﺍﺕ ﺍﻟﻘﺩﻴﻤﺔ ﻭﺨﺎﺼﺔ ﻋﻨﺩﻤﺎ ﺘﺼﺒﺢ ﻗﺩﻴﻤﺔ‬ ‫ﺃﻭ ﻤﻊ ﺩﺨﻭل ﺘﻘﻨﻴﺎﺕ ﺤﺩﻴﺜﺔ )ﻤﻌﺎﻴﻴﺭ ﺃﺩﺍﺀ ﺤﺩﻴﺜﺔ(:‬ ‫• ﺒﺎﻟﺤﻘﻴﻘﺔ ﻫﺫﻩ ﻋﻤﻠﻴﺔ ﻤﻌﻘﺩﺓ ﺠﺩﺍ.‬ ‫ﹰ‬ ‫• ﻤﻥ ﻴﺘﺨﺫ ﺍﻟﻘﺭﺍﺭ ﻭﻤﺘﻰ ﻴﺘﺨﺫ ﺍﻟﻘﺭﺍﺭ.‬ ‫54‬ ‫1102 ‪7 Narch‬‬ ‫‪Ossama Anjak‬‬ ‫‪Ossama Anjak, AECS Damascus SYRIA /e‬‬‫‪mail: oanjak@gmail.com‬‬ ‫‪IAEA‬‬ ‫22‬

‫ﻟﻠﻤﺰﻳﺪ ﻡﻦ اﻟﻤﻌﻠﻮﻡﺎت‬ • IAEA: Accidental Overexposure of Radiotherapy Patients in Białystok (2004) IAEA Ossama Anjak 7 Narch 2011 46 17 ‫ﺳﻠﺴﻠﺔ وﺛﺎﺋﻖ اﻷﻡﺎن: اﻟﺘﻘﺮﻳﺮ‬ Safety Reports Series No.17: • Lessons Learned From Accidental Exposures in Radiotherapy. IAEA, Vienna 2000. ‫• ﻴﻀﻡ ﻫﺫﺍ ﺍﻟﺘﻘﺭﻴﺭ 39 ﺤﺎﺩﺙ ﺇﺸﻌﺎﻋﻲ ﻓﻲ‬ ‫ﻤﺠﺎﻻﺕ ﺍﻟﻤﻌﺎﻟﺠﺔ ﺍﻹﺸﻌﺎﻋﻴﺔ ﺍﻟﻤﺨﺘﻠﻔﺔ‬ 7 Narch 2011 23 Ossama Anjak Slide 47 Ossama Anjak, AECS Damascus SYRIA /email: oanjak@gmail.com

‫اﻟﺤﻮادث اﻟﺮﺋﻴﺴﻴﺔ‬ Country USA approx. dates 1974-76 patients affected 450 probable cause Germany 1986-87 86 United Kingdom 1988 207 Spain 1990 27 Wrong repair (maintenance LINAC) Failure of communication United Kingdom 1982-91 1045 Error in the use of a treatment planning system (TPS) (5-30% underdoses) Mistake in drawing decay curves for 60Co Error in dose tables 60Co for treatment planning (varying overdoses) Mistake in calibration 60Co beam (25% overdoses) Ossama Anjak 7 Narch 2011 Slide 48 ‫ﺡﻮادث ﻓﻲ اﻟﻤﻌﺎﻟﺠﺔ اﻟﺨﺎرﺝﻴﺔ‬ Accidents in EBT Category Equipment design Calibration Maintenance Planning Simulation Set-up 7 Narch 2011 24 No of cases % 3 7 14 3 13 4 9 30 7 28 9 20 Ossama Anjak Slide 49 Ossama Anjak, AECS Damascus SYRIA /email: oanjak@gmail.com

‫ﺡﻮادث ﻓﻲ اﻟﻤﻌﺎﻟﺠﺔ ﻋﻦ ﻗﺮب‬ Accidents in Brachytherapy Category No of cases % Equipment design Source order and delivery Calibration 5 15 3 9 5 15 Preparation 6 18 11 34 3 9 Planning and dose calculation Source removal Ossama Anjak 7 Narch 2011 : ‫א‬ ‫א‬ ‫א‬ Slide 50 ‫א‬ ‫א‬ :‫ﺘﺘﻭﺯﻉ ﺍﻟﺩﺭﻭﺱ ﺍﻟﻤﺴﺘﻔﺎﺩﺓ ﻤﻥ ﺍﻟﺤﻭﺍﺩﺙ ﻋﻠﻰ ﺍﻟﻤﺤﺎﻭﺭ ﺍﻟﺘﺎﻟﻴﺔ‬ • .Workers and Equipment ‫1. ﺍﻟﻌﺎﻤﻠﻭﻥ ﻭﺍﻟﺘﺠﻬﻴﺯﺍﺕ‬ .Human Factors ‫2. ﺍﻟﻌﻭﺍﻤل ﺍﻟﺒﺸﺭﻴﺔ‬ .Training ‫3. ﺍﻟﺘﺩﺭﻴﺏ‬ 7 Narch 2011 25 Ossama Anjak Slide 51 Ossama Anjak, AECS Damascus SYRIA /email: oanjak@gmail.com

‫1. א‬ ‫א‬ ‫א‬ ‫‪Equipment &Workers‬‬ ‫• ﻴﺤﺘﺎﺝ ﻗﺴﻡ ﺍﻟﻤﻌﺎﻟﺠﺔ ﺍﻹﺸﻌﺎﻋﻴﺔ ﻋﻠﻰ ﻁﺎﻗﻡ ﻤﺩﺭﺏ ﻭﻤﺅﻫل ﺠﻴﺩﺍ ﻭﻴﺠﺏ ﺃﻥ‬ ‫ﹰ‬ ‫ﻴﺘﻭﺍﻓﻕ ﻋﺩﺩ ﺍﻟﻌﺎﻤﻠﻴﻥ ﻭﺍﻷﺠﻬﺯﺓ ﻤﻊ ﻋﺩﺩ ﺍﻟﻤﺭﻀﻰ ﻭﻁﺒﻴﻌﺔ ﺍﻟﻤﻌﺎﻟﺠﺔ ﻭﻓﻘﺎ‬ ‫ﹰ‬ ‫ﻟﺘﻭﺼﻴﺎﺕ ﺍﻟﻬﻴﺌﺎﺕ ﻭﺍﻟﻤﻨﻅﻤﺎﺕ ﺍﻟﺩﻭﻟﻴﺔ ﻓﻲ ﻫﺫﺍ ﺍﻟﻤﺠﺎل.‬ ‫• ﺇﻥ ﺘﻘﻠﻴل ﻋﺩﺩ ﺍﻟﻌﺎﻤﻠﻴﻥ ﻭﺍﻷﺠﻬﺯﺓ ﻴﻤﻜﻥ ﺃﻥ ﻴﺯﻴﺩ ﻤﻥ ﺍﺤﺘﻤﺎل ﻭﻗﻭﻉ ﺍﻟﺤﻭﺍﺩﺙ‬ ‫ﺍﻹﺸﻌﺎﻋﻴﺔ ﻭﺍﺭﺘﻜﺎﺏ ﺍﻷﺨﻁﺎﺀ ﻭﺫﻟﻙ ﺒﺴﺏ ﻀﻐﻁ ﺍﻟﻌﻤل.‬ ‫– ﻤﻥ ﺍﻟﻀﺭﻭﺭﻱ ﺇﻋﺎﺩﺓ ﺘﻘﻴﻡ ﺍﻟﻌﺎﻤﻠﻴﻥ ﻭﺘﺩﺭﻴﺒﻬﻡ ﻭﺨﺎﺼﺔ ﻋﻨﺩ ﺯﻴﺎﺩﺓ ﻋﺩﺩ‬ ‫ﺍﻟﻤﺭﻀﻰ ﺃﻭ ﺘﺭﻜﻴﺏ ﺘﺠﻬﻴﺯﺍﺕ ﺠﺩﻴﺩﺓ ﺃﻭ ﺍﻟﺒﺩﺀ ﺒﺘﻁﺒﻴﻕ ﺘﻘﻨﻴﺎﺕ ﺠﺩﻴﺩﺓ ﻓﻲ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ ﺃﻭ ﺇﺠﺭﺍﺀ ﺘﻌﺩﻴل ﻓﻲ ﺒﻌﺽ ﺤﺎﻻﺕ ﺍﻟﻤﻌﺎﻟﺠﺔ.‬ ‫‪Ossama Anjak‬‬ ‫25 ‪Slide‬‬ ‫2. א‬ ‫א א‬ ‫1102 ‪7 Narch‬‬ ‫‪Human Factors‬‬ ‫• ﺘﻌﺘﻤﺩ ﺍﻟﻤﻌﺎﻟﺠﺔ ﺍﻹﺸﻌﺎﻋﻴﺔ ﻜﺜﻴﺭﺍ ﻋﻠﻰ ﺃﺩﺍﺀ ﺍﻟﻌﺎﻤﻠﻴﻥ.‬ ‫ﹰ‬ ‫• ﺘﺘﻀﻤﻥ ﺍﻟﻤﻌﺎﻟﺠﺔ ﺍﻹﺸﻌﺎﻋﻴﺔ ﻜﺜﻴﺭﺍ ﻤﻥ ﺍﻟﺨﻁﻭﺍﺕ ﻭﺍﻟﻤﺭﺍﺤل ﺍﻟﺘﻲ‬ ‫ﹰ‬ ‫ﻴﺠﺏ ﺇﻨﺠﺎﺯﻫﺎ ﻴﻭﻤﻴﺎ ﺃﻭ ﻋﺩﺩ ﻤﻥ ﺍﻟﻤﺭﺍﺕ ﻓﻲ ﺍﻟﻴﻭﻡ ﺍﻟﻭﺍﺤﺩ ﻭﻫﻲ‬ ‫ﹰ‬ ‫ﺘﺨﺘﻠﻑ ﻤﻥ ﻤﺭﻴﺽ ﻵﺨﺭ ﻭﺃﺤﻴﺎﻨﺎ ﻴﻜﻭﻥ ﺍﻻﺨﺘﻼﻑ ﻁﻔﻴﻔﺎ ﻓﻲ ﺒﻌﺽ‬ ‫ﹰ‬ ‫ﹰ‬ ‫ﺍﻟﺤﺎﻻﺕ.‬ ‫• ﻴﺠﺏ ﻓﻲ ﻜﺎﻓﺔ ﺍﻟﻤﺭﺍﺤل ﺘﻭﻓﺭ ﻁﺎﻗﻡ ﻤﻥ ﺍﻟﻌﺎﻤﻠﻴﻥ ﻹﻨﺠﺎﺯ ﺍﻟﻌﻤل ﻜل‬ ‫ﻤﻨﻬﻡ ﻴﺴﺎﻫﻡ ﺒﺈﻨﺠﺎﺯ ﺠﺯﺀ ﻤﻨﻪ ﻭﻓﻘﺎ ﻻﺨﺘﺼﺎﺼﻪ ﻭﺍﻟﻌﻤل ﺍﻟﻤﻜﻠﻑ ﺒﻪ‬ ‫ﹰ‬ ‫ﻭﻴﺠﺏ ﻋﻠﻴﻬﻡ ﺇﻨﺠﺎﺯ ﺃﻋﻤﺎﻟﻬﻡ ﺒﺩﻗﺔ ﻋﺎﻟﻴﺔ.‬ ‫35 ‪Slide‬‬ ‫‪Ossama Anjak, AECS Damascus SYRIA /e‬‬‫‪mail: oanjak@gmail.com‬‬ ‫‪Ossama Anjak‬‬ ‫1102 ‪7 Narch‬‬ ‫62‬

‫2. א‬ ‫א א‬ ‫• ﻓﻲ ﺤﺎل ﺍﻻﻋﺘﻤﺎﺩ ﻋﻠﻰ ﺍﻵﺨﺭﻴﻥ ﻓﻲ‬ ‫ﺇﻨﺠﺎﺯ ﺍﻷﻋﻤﺎل ﻭﺒﺭﻭﺯ ﻋﻨﺼﺭ ﺍﻹﺘﻜﺎﻟﻴﺔ‬ ‫ﺒﻴﻥ ﻤﺠﻤﻭﻋﺔ ﺍﻟﻌﺎﻤﻠﻴﻥ‬ ‫• ﻋﺩﻡ ﺇﻨﺠﺎﺯ ﺍﻷﻋﻤﺎل ﺒﺩﻗﺔ ﻋﻠﻴﺔ.‬ ‫‪Human Factors‬‬ ‫ً‬ ‫ﻳﺼﺒﺢ ﺍﺣﺘﻤﺎﻝ ﻭﻗﻮﻉ ﺍﳊﻮﺍﺩﺙ ﻛﺒﲑﺍ‬ ‫• ﻀﻐﻁ ﺍﻟﻌﻤل ﻋﻠﻴﻬﻡ ﻜﺒﻴﺭﺍ‬ ‫ﹰ‬ ‫• ﺍﻟﺘﻜﻠﻴﻑ ﺒﺄﻋﻤﺎل ﺇﻀﺎﻓﻴﺔ ﺒﻌﻴﺩﺓ ﻋﻥ‬ ‫ﺍﺨﺘﺼﺎﺼﻬﻡ ﺍﻷﺴﺎﺴﻲ‬ ‫• وﻏﺎﻟﺒﺎ ﻡﺎ ﻳﻼﺡﻆ أن اﻷﺵﺨﺎص اﻟﻤﺪرﺏﻴﻦ واﻟﻤﺆهﻠﻴﻦ ﺝﻴﺪا ﻳﻤﻜﻦ أن ﻳﺮﺗﻜﺒﻮا‬ ‫ً‬ ‫ً‬ ‫اﻷﺥﻄﺎء وﺥﺎﺹﺔ ﻋﻨﺪ اﻻﻋﺘﻤﺎد ﻋﻠﻰ اﻟﺬات وﻋﺪم اﻟﺘﺪﻗﻴﻖ ﺝﻴﺪا ﻓﻲ اﻷﻋﻤﺎل‬ ‫ً‬ ‫اﻟﺘﻲ ﻳﻘﻮﻡﻮن ﺏﻬﺎ‬ ‫‪Ossama Anjak‬‬ ‫45 ‪Slide‬‬ ‫א‬ ‫א‬ ‫1102 ‪7 Narch‬‬ ‫א‬ ‫א‬ ‫א‬ ‫1. ﺍﺴﺘﻼﻡ ﺍﻟﺘﺠﻬﻴﺯﺍﺕ ﺒﺸﻜل ﺠﻴﺩ ﻭﺇﺠﺭﺍﺀ ﺍﺨﺘﺒﺎﺭﺍﺕ ﺍﻟﻘﺒﻭل ﻭﺍﻟﺘﺄﻜﺩ ﻤﻥ‬ ‫ﺩﻗﺔ ﺃﺩﺍﻫﺎ ﻭﺠﺎﻫﺯﻴﺘﻬﺎ ﻟﻠﻌﻤل.‬ ‫2. ﺇﺠﺭﺍﺀ ﺍﻟﻤﻌﺎﻴﺭﺍﺕ ﺍﻟﺩﻭﺭﻴﺔ ﻟﻠﻤﺼﺎﺩﺭ ﺍﻟﻤﺸﻌﺔ ﻭﺍﻟﺤﺯﻡ ﺍﻹﺸﻌﺎﻋﻴﺔ‬ ‫3. ﻋﺩﻡ ﺇﺠﺭﺍﺀ ﺍﻟﻤﻌﺎﻟﺠﺔ ﺇﻻ ﺒﻌﺩ ﺍﻟﺘﺄﻜﺩ ﻤﻥ ﺍﻟﺠﺭﻋﺔ ﻭﻁﺎﻗﺔ ﺍﻟﺤﺯﻤﺔ‬ ‫ﺍﻹﺸﻌﺎﻋﻴﺔ ﺍﻟﻤﺴﺘﺨﺩﻤﺔ ﻓﻲ ﺍﻟﻤﻌﺎﻟﺠﺔ.‬ ‫4. ﺍﻟﺘﺨﻠﺹ ﻤﻥ ﺍﻟﻤﺼﺎﺩﺭ ﺍﻟﻤﺸﻌﺔ ﺃﻭ ﺍﻟﺘﺠﻬﻴﺯﺍﺕ ﺍﻟﺘﻲ ﺘﺤﺘﻭﻱ ﻋﻠﻰ‬ ‫ﻤﺼﺎﺩﺭ ﻤﺸﻌﺔ.‬ ‫5. ﺍﻋﺘﻤﺎﺩ ﺨﻁﺔ )ﺒﺭﺘﻭﻜﻭل( ﺍﻟﻤﻌﺎﻟﺠﺔ.‬ ‫6. ﺍﻟﺘﺤﻘﻕ ﻤﻥ ﻫﻭﻴﺔ ﺍﻟﻤﺭﻴﺽ ﺍﻟﻤﻌﺎﻟﺞ ﻗﺒل ﺍﻟﺒﺩﺀ ﺒﺘﻁﺒﻴﻕ ﺍﻟﻤﻌﺎﻟﺠﺔ.‬ ‫55 ‪Slide‬‬ ‫‪Ossama Anjak, AECS Damascus SYRIA /e‬‬‫‪mail: oanjak@gmail.com‬‬ ‫‪Ossama Anjak‬‬ ‫1102 ‪7 Narch‬‬ ‫72‬

‫א‬ ‫6.‬ ‫7.‬ ‫8.‬ ‫9.‬ ‫א‬ ‫א‬ ‫א‬ ‫א‬ ‫ﺍﻟﺘﺤﻘﻕ ﻤﻥ ﻤﻜﺎﻥ ﺍﻟﻤﻌﺎﻟﺠﺔ )ﺴﺎﺤﺔ ﺍﻟﻤﻌﺎﻟﺠﺔ(.‬ ‫ﺘﺨﻁﻴﻁ ﺴﺎﺤﺔ ﺍﻟﻤﻌﺎﻟﺠﺔ ﺒﺎﺴﺘﻌﻤﺎل ﺍﻟﻤﺤﺎﻜﻲ ‪ Simulator‬ﻭﻭﻀﻊ‬ ‫ﻋﻼﻤﺎﺕ ﻓﺎﺭﻗﺔ ﻋﻠﻰ ﺠﺴﻡ ﺍﻟﻤﺭﻴﺽ ﺘﺩل ﻋﻠﻰ ﺴﺎﺤﺔ ﺍﻟﻤﻌﺎﻟﺠﺔ.‬ ‫ﺘﺩﻭﻴﻥ ﺍﻟﺠﺭﻋﺎﺕ ﺍﻟﻴﻭﻤﻴﺔ ﺍﻟﺘﻲ ﻴﺘﻠﻘﺎﻫﺎ ﺍﻟﻤﺭﻴﺽ ﻭﻋﻘﺏ ﺍﻨﺘﻬﺎﺀ ﺠﻠﺴﺔ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ ﻤﺒﺎﺸﺭﺓ‬ ‫ﹰ‬ ‫ﻨﺯﻉ ﺍﻟﻤﺼﺎﺩﺭ ﺍﻟﻤﺸﻌﺔ ﻤﻥ ﺍﻟﻤﺭﻴﺽ ﻓﻲ ﺍﻟﻭﻗﺕ ﺍﻟﻤﺤﺩﺩ ﺃﻱ ﻋﻨﺩ ﺍﻨﺘﻬﺎﺀ‬ ‫ﺯﻤﻥ ﺍﻟﻤﻌﺎﻟﺠﺔ ﻋﻥ ﻗﺭﺏ. ﻭﻴﺠﺏ ﺇﻋﺎﺩﺘﻬﺎ ﺇﻟﻰ ﺍﻟﺤﺎﻭﻴﺔ ﺍﻟﻤﺨﺼﺼﺔ ﻟﺫﻟﻙ‬ ‫ﻤﺒﺎﺸﺭﺓ.‬ ‫‪Ossama Anjak‬‬ ‫65 ‪Slide‬‬ ‫א‬ ‫א‬ ‫1102 ‪7 Narch‬‬ ‫א‬ ‫א‬ ‫א‬ ‫01. ﺍﻟﺘﺄﻜﺩ ﻤﻥ ﺘﺨﺯﻴﻥ ﺍﻟﻤﺼﺎﺩﺭ ﺍﻟﻤﺸﻌﺔ ﻭﺨﺎﺼﺔ ﺍﻟﻤﻨﺎﺒﻊ ﺫﺍﺕ ﻨﺼﻑ ﺍﻟﻌﻤﺭ‬ ‫ﺍﻟﻁﻭﻴل )731-‪ Cs‬ﻤﺜﻼ(.‬ ‫ﹰ‬ ‫11. ﻗﻴﺎﺱ ﻤﻌﺩل ﺍﻟﺠﺭﻋﺔ ﺍﻹﺸﻌﺎﻋﻴﺔ ﺃﻭ ﺍﻟﻨﺸﺎﻁ ﺍﻹﺸﻌﺎﻋﻲ ﻟﻠﻤﻨﺎﺒﻊ ﺫﺍﺕ‬ ‫ﻨﺼﻑ ﺍﻟﻌﻤﺭ ﺍﻟﻘﺼﻴﺭ ﻗﺒل ﺍﺴﺘﻌﻤﺎﻟﻬﺎ.‬ ‫21. ﻴﺠﺏ ﺍﻟﻌﻨﺎﻴﺔ ﻭﺍﻻﻫﺘﻤﺎﻡ ﻓﻲ ﺒﻌﺽ ﺍﻟﺤﺎﻻﺕ ﺍﻟﺨﺎﺼﺔ ﺃﻭ ﺍﻟﻤﻌﺎﻟﺠﺎﺕ‬ ‫ﺍﻟﻤﻌﻘﺩﺓ ﺃﻭ ﻏﻴﺭ ﺍﻟﻤﺄﻟﻭﻓﺔ ﻓﻲ ﺍﻟﻘﺴﻡ‬ ‫75 ‪Slide‬‬ ‫‪Ossama Anjak, AECS Damascus SYRIA /e‬‬‫‪mail: oanjak@gmail.com‬‬ ‫‪Ossama Anjak‬‬ ‫1102 ‪7 Narch‬‬ ‫82‬

‫א‬ ‫‪:Training‬‬ ‫• ﻴﻌﺩ ﺍﻟﺘﺩﺭﻴﺏ ﺍﻟﻤﺴﺘﻤﺭ ﻤﻥ ﺍﻷﻋﻤﺎل ﺍﻟﻀﺭﻭﺭﻴﺔ ﺠﺩﺍ ﻭﻫﻭ ﺃﺤﺩ ﺍﻟﻌﻨﺎﺼﺭ‬ ‫ﹰ‬ ‫ﺍﻷﺴﺎﺴﻴﺔ ﻓﻲ ﺒﺭﻨﺎﻤﺞ ﺍﻟﻭﻗﺎﻴﺔ ﺍﻹﺸﻌﺎﻋﻴﺔ.‬ ‫• ﻴﺠﺏ ﺃﻥ ﻻ ﻨﻜﺘﻔﻲ ﺒﺎﻟﺘﺩﺭﻴﺏ ﺍﻟﺫﻱ ﺘﻠﻘﺎﻩ ﺍﻟﻌﺎﻤل ﻗﺒل ﺍﻟﺒﺩﺀ ﻓﻲ ﺍﻟﻌﻤل ﺃﻭ ﻓﻲ‬ ‫ﻤﺭﺍﺤل ﺍﻟﺩﺭﺍﺴﺔ، ﻭﻤﻥ ﺍﻟﻀﺭﻭﺭﻱ ﺇﺠﺭﺍﺀ ﺘﺩﺭﻴﺏ ﻟﻜﺎﻓﺔ ﺍﻟﻌﺎﻤﻠﻴﻥ، ﺍﻷﻁﺒﺎﺀ‬ ‫ﻭﺍﻟﻔﻴﺯﻴﺎﺌﻴﻴﻥ ﻭﺍﻟﻔﻨﻴﻴﻥ ﺍﻹﺸﻌﺎﻋﻴﻴﻥ ﻭﺍﻟﺘﻤﺭﻴﺽ ﻭﺫﻟﻙ ﻹﻨﺠﺎﺯ ﺍﻷﻋﻤﺎل ﺍﻟﻤﻜﻠﻔﻴﻥ‬ ‫ﺒﻬﺎ ﻭﺍﻹﻁﻼﻉ ﻋﻠﻰ ﻤﺎ ﻫﻭ ﺤﺩﻴﺙ ﻓﻲ ﻤﺠﺎل ﺍﺨﺘﺼﺎﺼﻬﻡ.‬ ‫• ﺃﻴﻀﺎ ﻴﺠﺏ ﺍﻟﺴﻤﺎﺡ ﻟﻬﻡ ﺒﺤﻀﻭﺭ ﺍﻟﻤﺅﺘﻤﺭﺍﺕ ﺍﻟﻌﻠﻤﻴﺔ ﻭﺍﻻﺠﺘﻤﺎﻋﺎﺕ ﺍﻟﻤﻬﻨﻴﺔ‬ ‫ﹰ‬ ‫ﻭﺍﻟﺩﻭﺭﺍﺕ ﺍﻟﺘﺩﺭﻴﺒﻴﺔ‬ ‫‪Ossama Anjak‬‬ ‫85 ‪Slide‬‬ ‫א‬ ‫•‬ ‫•‬ ‫•‬ ‫•‬ ‫א‬ ‫א‬ ‫1102 ‪7 Narch‬‬ ‫א‬ ‫؟‬ ‫א‬ ‫ﺗﺠﻬﻴﺰات ﻗﻴﺎس اﻟﺠﺮع اﻹﺵﻌﺎﻋﻴﺔ‬ ‫– ﻣﻌﺎﻳﺮة أﺝﻬﺰة اﻟﻤﻌﺎﻟﺠﺔ ﻋﻦ ﺑﻌﺪ ‪. Teletherapy‬‬ ‫ﺝﻬﺎز اﻟﻤﺤﺎآﺎة ‪Treatment simulator‬‬ ‫ﻧﻈﺎم ﺗﺨﻄﻴﻂ اﻟﻤﻌﺎﻟﺠﺔ ‪Treatment planning system‬‬ ‫– إدﺧﺎل اﻟﻤﻌﻠﻮﻣﺎت ﺑﺸﻜﻞ ﺧﺎﻃﺊ، ﻧﻘﺺ ﻓﻲ ﻓﻬﻢ اﻟﺒﺮﻣﺠﻴﺎت ...‬ ‫ﺝﻬﺎز اﻟﻤﻌﺎﻟﺠﺔ ‪Treatment machine‬‬ ‫– ﺧﻠﻞ ﻓﻲ أﻧﻈﻤﺔ اﻟﺘﺮاﺑﻂ ‪Malfunction of interlocks‬‬ ‫95 ‪Slide‬‬ ‫‪Ossama Anjak, AECS Damascus SYRIA /e‬‬‫‪mail: oanjak@gmail.com‬‬ ‫‪Ossama Anjak‬‬ ‫1102 ‪7 Narch‬‬ ‫92‬

‫؟‬ ‫א‬ ‫اﻟﺤﻮادث اﻟﻤﺮﺗﺒﻄﺔ ﺑﻨﻈﺎم اﻟﻘﻴﺎس:‬ ‫1. اﺱﺘﻌﻤﺎل ﻏﻴﺮ ﺹﺤﻴﺢ ﻟﻤﻌﺎﻣﻞ اﻟﻤﻌﺎﻳﺮة ﻟﻤﻘﻴﺎس اﻟﺠﺮﻋﺔ‬ ‫اﻟﻤﺮﺝﻌﻲ ‪.Reference dosimeter‬‬ ‫2. ﻣﻘﺎرﻧﺔ داﺧﻠﻴﺔ ﻣﻊ ﻣﻌﻴﺎر ﺛﺎﻧﻮي ﺑﺸﻜﻞ ﺧﺎﻃﺊ.‬ ‫3. اﺱﺘﻌﻤﺎل ﻣﻘﻴﺎس اﻟﺠﺮﻋﺔ ﺑﺸﻜﻞ ﺧﺎﻃﺊ.‬ ‫‪Ossama Anjak‬‬ ‫06 ‪Slide‬‬ ‫מ‬ ‫•‬ ‫•‬ ‫•‬ ‫•‬ ‫א‬ ‫1102 ‪7 Narch‬‬ ‫؟‬ ‫إدﺧﺎل اﻟﻤﻌﻠﻮﻣﺎت ﺑﺸﻜﻞ ﺧﺎﻃﺊ.‬ ‫ﻋﺪم ﻓﻬﻢ اﻟﺨﻮارزﻣﻴﺔ )اﻟﺒﺮﻣﺠﻴﺎت(.‬ ‫ﺗﺪرﻳﺐ ﻏﻴﺮ آﺎف.‬ ‫ٍ‬ ‫اﺱﺘﺨﺪام اﻟﻨﻈﺎم ﻣﻦ ﻗﺒﻞ ﺵﺨﺺ ﻏﻴﺮ ﻣﺆهﻞ.‬ ‫16 ‪Slide‬‬ ‫‪Ossama Anjak, AECS Damascus SYRIA /e‬‬‫‪mail: oanjak@gmail.com‬‬ ‫‪Ossama Anjak‬‬ ‫1102 ‪7 Narch‬‬ ‫03‬

‫א‬ ‫?‬ ‫ﺍﺨﺘﺒﺎﺭﺍﺕ ﺍﻻﺴﺘﻼﻡ ﺃﻭ ﺍﺨﺘﺒﺎﺭﺍﺕ ﺍﻟﻘﺒﻭل.‬ ‫ﻤﻌﺎﻴﺭﺓ ﺠﻬﺎﺯ ﺍﻟﻤﻌﺎﻟﺠﺔ.‬ ‫ﺍﺨﺘﺒﺎﺭ ﺜﺒﺎﺘﻴﺔ ﺍﻟﺨﺭﺝ )ﺍﻟﻴﻭﻤﻲ، ﺍﻷﺴﺒﻭﻋﻲ(.‬ ‫ﺤﺩﻭﺙ ﺨﻠل ﻁﺎﺭﺉ ﻓﻲ ﺍﻟﺠﻬﺎﺯ.‬ ‫ﺍﺴﺘﻌﻤﺎل ﺍﻟﺠﻬﺎﺯ ﺒﺸﻜل ﺨﺎﻁﺊ.‬ ‫ﺨﻠل ﻓﻲ ﺃﺠﻬﺯﺓ ﺍﻟﻘﻴﺎﺱ.‬ ‫•‬ ‫•‬ ‫•‬ ‫•‬ ‫•‬ ‫•‬ ‫26 ‪Slide‬‬ ‫36‬ ‫‪Ossama Anjak, AECS Damascus SYRIA /e‬‬‫‪mail: oanjak@gmail.com‬‬ ‫‪Ossama Anjak‬‬ ‫‪Ossama Anjak‬‬ ‫1102 ‪7 Narch‬‬ ‫1102 ‪7 Narch‬‬ ‫13‬

‫א‬ ‫א‬ ‫א‬ ‫א‬ ‫א‬ ‫א‬ ‫א‬ ‫א‬ ‫מ 71‬ ‫א‬ ‫:א‬ ‫• ﺠﺭﺕ ﻤﻌﺎﻴﺭﺓ ﻤﻘﻴﺎﺱ ﺍﻟﺠﺭﻉ ﺍﻹﺸﻌﺎﻋﻴﺔ )ﺤﺠﻴﺭﺓ ﺍﻟﺘﺄﻴﻥ+ ﺍﻟﻤﻘﻴﺎﺱ( ﻓﻲ‬ ‫ﺇﺤﺩﻯ ﻤﺨﺎﺒﺭ ﺍﻟﻤﻌﺎﻴﺭﺓ ﺍﻟﺜﺎﻨﻭﻴﺔ ‪ SSDL‬ﻭﻗﺩ ﻭﺭﺩ ﻓﻲ ﺸﻬﺎﺩﺓ ﺍﻟﻤﻌﺎﻴﺭﺓ‬ ‫ﺃﻥ ﺍﻟﻤﻌﺎﻴﺭﺓ ﺠﺭﺕ ﻓﻲ ﺍﻟﻤﺎﺀ ﺒﺤﺯﻤﺔ ﺇﺸﻌﺎﻋﻴﺔ ﺼﺎﺩﺭﺓ ﻋﻥ ﻤﻨﺒﻊ‬ ‫ﻜﻭﺒﺎﻟﺕ-06‬ ‫• ﻗﺎﻡ ﺍﻟﻔﻴﺯﻴﺎﺌﻲ ﺒﻤﻌﺎﻴﺭﺓ ﺘﺠﻬﻴﺯﺍﺕ ﺍﻟﻤﻌﺎﻟﺠﺔ )ﻗﻴﺎﺱ ﻤﻌﺩل ﺍﻟﺠﺭﻋﺔ(‬ ‫ﺒﺎﺴﺘﻌﻤﺎل ﺍﻟﻤﻘﻴﺎﺱ ﺍﻟﺴﺎﺒﻕ ﻭﻟﻜﻥ ﺍﺴﺘﻌﻤل ﺍﻟﻤﻌﺎﻤل ﻋﻠﻰ ﺃﺴﺎﺱ ﺃﻥ‬ ‫ﺍﻟﻤﻌﺎﻴﺭﺓ ﺠﺭﺕ ﺒﺎﻟﻬﻭﺍﺀ ﻭﺒﺎﻟﺘﺎﻟﻲ ﻴﻭﺠﺩ ﺯﻴﺎﺩﺓ ﻓﻲ ﺍﻟﺠﺭﻋﺔ ﺍﻹﺸﻌﺎﻋﻴﺔ‬ ‫ﺒﻤﻘﺩﺍﺭ 11% ﻟﻤﺩﺓ ﺴﻨﺔ ﻜﺎﻤﻠﺔ.‬ ‫56 ‪Slide‬‬ ‫‪Ossama Anjak, AECS Damascus SYRIA /e‬‬‫‪mail: oanjak@gmail.com‬‬ ‫‪Ossama Anjak‬‬ ‫1102 ‪7 Narch‬‬ ‫23‬

‫א‬ ‫• ﺍﻟﺤﺩﺙ ﺍﻷﻭﻟﻲ:‬ ‫– ﺨﻁﺄ ﻓﻲ ﺍﻟﻤﻌﺎﻴﺭﺓ ﺒﺴﺒﺏ ﺍﺴﺘﻌﻤﺎل ﺨﺎﻁﺊ ﻟﺸﻬﺎﺩﺓ ﺍﻟﻤﻌﺎﻴﺭﺓ.‬ ‫• ﺍﻷﺴﺒﺎﺏ ﺍﻟﺘﻲ ﺃﺩﺕ ﻟﻭﻗﻭﻉ ﺍﻟﺤﺎﺩﺙ:‬ ‫– ﻀﻌﻑ ﺍﻟﺨﺒﺭﺍﺕ ﺍﻟﻌﻠﻤﻴﺔ ﻭﺍﻟﻌﻤﻠﻴﺔ ﻭﺘﻘﺼﻴﺭ ﻓﻲ ﺍﻟﺘﺩﺭﻴﺏ، ﻭﺍﻟﻔﻴﺯﻴﺎﺌﻲ‬ ‫ﻏﻴﺭ ﻗﺎﺩﺭ ﻋﻠﻰ ﺍﺴﺘﻴﻌﺎﺏ ﻤﻀﻤﻭﻥ ﺸﻬﺎﺩﺓ ﺍﻟﻤﻌﺎﻴﺭﺓ ﻭﻜﺫﻟﻙ ﻻ‬ ‫ﻴﺴﺘﻁﻴﻊ ﺍﻟﺘﻤﻴﺯ ﺒﻴﻥ ﻤﻌﺎﻤﻼﺕ ﺍﻟﻤﻌﺎﻴﺭﺓ.‬ ‫– ﻋﺩﻡ ﺇﺠﺭﺍﺀ ﻤﻌﺎﻴﺭﺓ ﻤﻥ ﻗﺒل ﺸﺨﺼﻴﻥ ﻜل ﻋﻠﻰ ﺤﺩﻩ ﻭﻤﻘﺎﺭﻨﺔ ﺍﻟﻨﺘﺎﺌﺞ‬ ‫ﻓﻴﻤﺎ ﺒﻌﺩ‬ ‫‪Ossama Anjak‬‬ ‫66 ‪Slide‬‬ ‫א‬ ‫:א‬ ‫1102 ‪7 Narch‬‬ ‫א‬ ‫• ﺍﺴﺘﻌﻤل ﻓﻴﺯﻴﺎﺌﻲ ﺤﺩﻴﺙ ﺍﻟﻌﻬﺩ ﻓﻲ ﺍﻟﻌﻤل ﺤﺠﻴﺭﺓ‬ ‫ﺘﺄﻴﻥ ﻤﺴﺘﻭﻴﺔ ﺍﻟﻭﺠﻬﻴﻥ ﻟﻤﻌﺎﻴﺭﺓ ﺤﺯﻡ ﺍﻹﻟﻜﺘﺭﻭﻨﺎﺕ‬ ‫ﺍﻟﺼﺎﺩﺭﺓ ﻋﻥ ﺠﻬﺎﺯ ﺍﻟﻤﺴﺭﻉ ﺍﻟﺨﻁﻲ،‬ ‫• ﻜﺎﻥ ﻴﻭﺠﺩ ﻋﻠﻰ ﺤﺠﻴﺭﺓ ﺍﻟﺘﺄﻴﻥ ﺇﺸﺎﺭﺓ ﻭﻀﻌﺕ‬ ‫ﻤﻥ ﻗﺒل ﺍﻟﻔﻴﺯﻴﺎﺌﻲ ﺍﻟﺴﺎﺒﻕ ﺘﺩل ﻋﻠﻰ ﺠﻬﺔ ﺤﺠﻴﺭﺓ‬ ‫ﺍﻟـﺘﺄﻴﻥ ﺒﺎﺘﺠﺎﻩ ﺍﻹﺸﻌﺎﻉ ﻭﺘﺒﻴﻥ ﻓﻴﻤﺎ ﺒﻌﺩ ﺃﻥ ﺘﻠﻙ‬ ‫ﺍﻹﺸﺎﺭﺓ ﻭﻀﻌﺕ ﺒﺸﻜل ﻏﻴﺭ ﺼﺤﻴﺢ.‬ ‫76 ‪Slide‬‬ ‫‪Ossama Anjak, AECS Damascus SYRIA /e‬‬‫‪mail: oanjak@gmail.com‬‬ ‫‪Ossama Anjak‬‬ ‫1102 ‪7 Narch‬‬ ‫33‬

‫א‬ ‫ﻁﺎﻗﺔ ﺍﻟﺤﺯﻤﺔ‬ ‫ﺍﻟﻔﺭﻕ ﻓﻲ ﺍﻟﺠﺭﻋﺔ ﺍﻹﺸﻌﺎﻋﻴﺔ‬ ‫ﺯﻴﺎﺩﺓ ﻓﻲ ﺍﻟﺠﺭﻋﺔ ﺍﻹﺸﻌﺎﻋﻴﺔ ﺒﻤﻘﺩﺍﺭ 02 %‬ ‫ﺯﻴﺎﺩﺓ ﻓﻲ ﺍﻟﺠﺭﻋﺔ ﺍﻹﺸﻌﺎﻋﻴﺔ ﺒﻤﻘﺩﺍﺭ 01%‬ ‫ﺯﻴﺎﺩﺓ ﻓﻲ ﺍﻟﺠﺭﻋﺔ ﺍﻹﺸﻌﺎﻋﻴﺔ ﺒﻤﻘﺩﺍﺭ 8 %‬ ‫ﺍﻟﺠﺭﻋﺔ ﺍﻹﺸﻌﺎﻋﻴﺔ ﺼﺤﻴﺤﺔ‬ ‫ﻨﻘﺼﺎﻥ ﻓﻲ ﺍﻟﺠﺭﻋﺔ ﺍﻹﺸﻌﺎﻋﻴﺔ ﺒﻤﻘﺩﺍﺭ 1%‬ ‫‪6 MeV‬‬ ‫‪9 MeV‬‬ ‫‪12 MeV‬‬ ‫‪16 MeV‬‬ ‫‪20 MeV‬‬ ‫ﺠﺭﻯ ﺍﻜﺘﺸﺎﻑ ﺍﻟﺨﻁﺄ ﻓﻲ ﺍﻟﻤﻌﺎﻴﺭﺓ ﻤﻥ ﺨﻼل ﻗﻴﺎﺴﺎﺕ ﻤﺴﺘﻘﻠﺔ ﺃﺠﺭﻴﺕ ﺒﺎﺴﺘﻌﻤﺎل‬ ‫ﻤﻘﺎﻴﻴﺱ ﺍﻟﺠﺭﻋﺔ ﺒﺎﻟﻭﻤﻴﺽ ﺍﻟﻀﻭﺌﻲ ‪ TLD‬ﻤﻥ ﻗﺒل ﻓﻴﺯﻴﺎﺌﻲ ﻤﺴﺘﻘل ﻜﺎﻥ ﻤﻜﻠﻔﺎ ﺒﺎﻟﻘﻴﺎﻡ‬ ‫ﹰ‬ ‫ﺒﺈﺠﺭﺍﺀ ﻀﺒﻁ ﺍﻟﺩﻭﺭﻴﺔ ﻟﺠﻬﺎﺯ ﺍﻟﻤﺴﺭﻉ.‬ ‫ﺨﻼل ﺍﻟﻔﺘﺭﺓ ﺍﻟﺯﻤﻨﻴﺔ ﺍﻟﻔﺎﺼﻠﺔ ﺒﻴﻥ ﺍﻟﻤﻌﺎﻴﺭﺓ ﺍﻷﻭﻟﻰ ﻭﺍﻟﺜﺎﻨﻴﺔ ﺠﺭﻯ ﻤﻌﺎﻟﺠﺔ ﻋﺩﺩ ﻗﻠﻴل‬ ‫ﻤﻥ ﺍﻟﻤﺭﻀﻰ ﺒﺸﻜل ﺨﺎﻁﺊ.‬ ‫‪Ossama Anjak‬‬ ‫86 ‪Slide‬‬ ‫1102 ‪7 Narch‬‬ ‫א‬ ‫•‬ ‫•‬ ‫•‬ ‫ﺍﻟﺤﺩﺙ ﺍﻷﻭﻟﻲ:‬ ‫– ﺨﻁﺄ ﻓﻲ ﺍﻟﻤﻌﺎﻴﺭﺓ ﺒﺴﺒﺏ ﺍﺴﺘﻌﻤﺎل ﺨﺎﻁﺊ ﻟﺤﺠﻴﺭﺓ ﺘﺄﻴﻥ ﻤﺴﺘﻭﻴﺔ ﺍﻟﻭﺠﻬﻴﻥ ﻓﻲ‬ ‫ﻤﻌﺎﻴﺭﺓ ﺤﺯﻡ ﺍﻹﻟﻜﺘﺭﻭﻨﺎﺕ.‬ ‫ﺍﻷﺴﺒﺎﺏ ﺍﻟﺘﻲ ﺃﺩﺕ ﻟﻭﻗﻭﻉ ﺍﻟﺤﺎﺩﺙ:‬ ‫– ﻀﻌﻑ ﺍﻟﺨﺒﺭﺍﺕ ﺍﻟﻌﻠﻤﻴﺔ ﻭﺍﻟﻌﻤﻠﻴﺔ ﻭﺘﻘﺼﻴﺭ ﻓﻲ ﺍﻟﺘﺩﺭﻴﺏ، ﻭﺍﻟﻔﻴﺯﻴﺎﺌﻲ ﺍﺴﺘﻌﻤل‬ ‫ﺤﺠﻴﺭﺓ ﺘﺄﻴﻥ ﻏﻴﺭ ﻤﺄﻟﻭﻓﺔ ﺒﺎﻟﻨﺴﺒﺔ ﻟﻪ ﺩﻭﻥ ﺃﻥ ﻴﺘﺤﻘﻕ ﻤﻥ ﻜﻴﻔﻴﺔ ﺍﺴﺘﻌﻤﺎﻟﻬﺎ.‬ ‫– ﺍﻟﻔﻴﺯﻴﺎﺌﻲ ﺍﻟﺴﺎﺒﻕ ﻭﻀﻊ ﺇﺸﺎﺭﺓ ﻋﻠﻰ ﺤﺠﻴﺭﺓ ﺍﻟﺘﺄﻴﻥ ﺒﺸﻜل ﺨﺎﻁﺊ.‬ ‫– ﻋﺩﻡ ﺍﻟﺘﻭﺍﺼل ﺍﻟﻌﻠﻤﻲ ﺒﻴﻥ ﺍﻟﻔﻴﺯﻴﺎﺌﻴﻴﻥ ﻟﻨﻘل ﺍﻟﺨﺒﺭﺓ ﺍﻟﻌﻤﻠﻴﺔ.‬ ‫ﺍﻹﺠﺭﺍﺀ ﺍﻟﺫﻱ ﺠﺭﻯ ﺘﻁﺒﻴﻘﻪ:‬ ‫– ﺇﻋﺎﺩﺓ ﺍﻟﻤﻌﺎﻴﺭﺓ ﺒﻭﺍﺴﻁﺔ ﻤﻘﻴﺎﺱ ﺁﺨﺭ ﻭﺠﺭﻯ ﺘﺼﺤﻴﺢ ﺍﻹﺸﺎﺭﺓ ﺍﻟﻤﻭﻀﻭﻋﺔ‬ ‫ﻋﻠﻰ ﺤﺠﻴﺭﺓ ﺍﻟﺘﺄﻴﻥ.‬ ‫96 ‪Slide‬‬ ‫‪Ossama Anjak, AECS Damascus SYRIA /e‬‬‫‪mail: oanjak@gmail.com‬‬ ‫‪Ossama Anjak‬‬ ‫1102 ‪7 Narch‬‬ ‫43‬

‫א‬ ‫אא א‬ ‫:‬ ‫• ﻗﺎﻡ ﻓﻴﺯﻴﺎﺌﻲ ﺠﺩﻴﺩ ﺒﺘﻁﺒﻴﻕ ﺨﺎﻁﺊ ﻟﺒﺭﻭﺘﻭﻜﻭل ﺍﻟﻤﻌﺎﻴﺭﺓ ﺍﻟﻤﻌﺘﻤﺩ ﻓﻲ ﻤﻥ ﻗﺒل‬ ‫ﺍﻟﻔﻴﺯﻴﺎﺌﻲ ﺍﻟﺴﺎﺒﻕ ﺍﻟﺫﻱ ﻜﺎﻥ ﻴﺠﺭﻱ ﻤﻌﺎﻴﺭﺓ ﻟﺠﻬﺎﺯ ﺍﻟﻤﺴﺭﻉ ﺍﻟﺨﻁﻲ ﺒﺎﺴﺘﻌﻤﺎل‬ ‫ﻤﻌﺩل ﺠﺭﻋﺔ 002 ‪ MU/min‬ﻟﻜﺎﻓﺔ ﺍﻟﺤﺯﻡ ﺍﻹﺸﻌﺎﻋﻴﺔ ﺒﺎﺴﺘﺜﻨﺎﺀ ﻭﺍﺤﺩﺓ ﻴﺘﻡ‬ ‫ﻤﻌﺎﻴﺭﺘﻬﺎ ﻋﻠﻰ ﺃﺴﺎﺱ 003 ‪ MU/min‬ﺜﻡ ﻴﻁﺒﻕ ﻤﻌﺎﻤل ﺘﺤﻭﻴل ﻤﻥ 003‬ ‫‪ MU/min‬ﺇﻟﻰ 002 ‪.MU/min‬‬ ‫• ﻟﻜﻥ ﺍﻟﻔﻴﺯﻴﺎﺌﻲ ﺍﻟﺠﺩﻴﺩ ﺃﺠﺭﻯ ﺍﻟﻤﻌﺎﻴﺭﺓ ﻟﻜﺎﻓﺔ ﺍﻟﺤﺯﻡ ﺍﻹﺸﻌﺎﻋﻴﺔ ﻋﻠﻰ ﺃﺴﺎﺱ 002‬ ‫‪ MU/min‬ﺜﻡ ﻗﺎﻡ ﺒﺘﻁﺒﻴﻕ ﻤﻌﺎﻤل ﺍﻟﺘﺤﻭﻴل ﻤﻤﺎ ﺃﺩﻯ ﺇﻟﻰ ﺯﻴﺎﺩﺓ ﻓﻲ ﺍﻟﺠﺭﻋﺔ‬ ‫ﺍﻹﺸﻌﺎﻋﻴﺔ ﺒﻤﻘﺩﺍﺭ 05%‬ ‫07 ‪Slide‬‬ ‫‪Ossama Anjak‬‬ ‫1102 ‪7 Narch‬‬ ‫א‬ ‫• ﺍﻟﺤﺩﺙ ﺍﻷﻭﻟﻲ:‬ ‫– ﺨﻁﺄ ﻓﻲ ﺍﻟﻤﻌﺎﻴﺭﺓ ﺒﺴﺒﺏ ﺘﻁﺒﻴﻕ ﻤﻌﺎﻤل ﺍﻟﺘﺤﻭﻴل ﺒﻁﺭﻴﻘﺔ ﺨﺎﻁﺌﺔ‬ ‫• ﺍﻷﺴﺒﺎﺏ ﺍﻟﺘﻲ ﺃﺩﺕ ﻟﻭﻗﻭﻉ ﺍﻟﺤﺎﺩﺙ:‬ ‫– ﻗﺎﻡ ﺍﻟﻔﻴﺯﻴﺎﺌﻲ ﺒﺘﻁﺒﻴﻕ ﺍﻹﺠﺭﺍﺀﺍﺕ ﺍﻟﻤﻭﻀﻭﻋﺔ ﻤﻥ ﻗﺒل ﺍﻟﻔﻴﺯﻴﺎﺌﻲ‬ ‫ﺍﻟﺴﺎﺒﻕ ﺩﻭﻥ ﻓﻬﻡ ﻜﺎﻑ ﻟﻤﻀﻤﻭﻥ ﺍﻹﺠﺭﺍﺀ.‬ ‫– ﻋﺩﻡ ﻭﺠﻭﺩ ﺃﻱ ﺘﻭﺍﺼل ﺒﻴﻥ ﺍﻟﻔﻴﺯﻴﺎﺌﻲ ﺍﻟﻘﺩﻴﻡ ﻭﺍﻟﺤﺩﻴﺙ ﻭﺠﺭﻯ ﻨﻘل‬ ‫ﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﻤﻌﺎﻴﺭﺓ ﺒﺸﻜل ﻀﻌﻴﻑ.‬ ‫– ﻨﻘﺹ ﻓﻲ ﻋﻭﺍﻤل ﺍﻷﻤﺎﻥ، ﻻ ﻴﻭﺠﺩ ﻤﻌﺎﻴﺭﺓ ﻤﺴﺘﻘﻠﺔ ﻤﻥ ﻓﺒل ﺸﺨﺹ‬ ‫ﺃﺨﺭ.‬ ‫17 ‪Slide‬‬ ‫‪Ossama Anjak, AECS Damascus SYRIA /e‬‬‫‪mail: oanjak@gmail.com‬‬ ‫‪Ossama Anjak‬‬ ‫1102 ‪7 Narch‬‬ ‫53‬

‫א‬ ‫א‬ ‫א‬ ‫–‬ ‫1−‬ ‫א‬ ‫• ﺍﻟﺤﺎﺩﺜﺔ: ﺠﺭﻯ ﻤﻌﺎﻴﺭﺓ ﺍﻟﺠﻬﺎﺯ ﺍﻟﻌﻴﺎﺭﻱ ﺍﻟﻤﺤﻠﻲ ﻋﻠﻰ‬ ‫ﺃﺴﺎﺱ ﺠﺭﻋﺔ ﻓﻲ ﺍﻟﻤﺎﺀ ‪ .dose to water‬ﻭﻟﻜﻥ ﺒﺸﻜل‬ ‫ﺨﺎﻁﺊ ﻓﺴﺭﺕ ﻋﻠﻰ ﺃﻨﻬﺎ ﺠﺭﻋﺔ ﺒﺎﻟﻬﻭﺍﺀ ‪.dose in air‬‬ ‫– ﻫﺫﺍ ﺍﻟﺨﻁﺄ ﺃﺤﺩﺙ ﺯﻴﺎﺩﺓ ﻓﻲ ﺍﻟﺠﺭﻋﺔ ﺒﻤﻘﺩﺍﺭ 11%‬ ‫• ﺍﻟﺴﺒﺏ: ﻀﻌﻴﻑ ﻭﺘﻘﺼﻴﺭ ﻤﻥ ﺤﻴﺙ ﺍﻟﺘﺩﺭﻴﺏ ﻭﺍﻟﺘﻌﻠﻴﻡ ،‬ ‫ﺒﺎﻹﻀﺎﻓﺔ ﺇﻟﻰ ﺍﺴﺘﻌﻤﺎل ﺨﺎﻁﺊ ﻟﺸﻬﺎﺩﺓ ﺍﻟﻤﻌﺎﻴﺭﺓ ﺍﻟﻤﺭﻓﻘﺔ ﻤﻊ‬ ‫ﺍﻟﺠﻬﺎﺯ ﺍﻟﻌﻴﺎﺭﻱ ﺍﻟﻤﺤﻠﻲ ‪local standard‬‬ ‫‪.dosimeter‬‬ ‫‪Ossama Anjak‬‬ ‫27 ‪Slide‬‬ ‫א‬ ‫•‬ ‫•‬ ‫•‬ ‫א‬ ‫א‬ ‫–‬ ‫2−‬ ‫1102 ‪7 Narch‬‬ ‫א‬ ‫ﺍﻟﺤﺎﺩﺜﺔ: ﺍﺴﺘﻌﻤﺎل ﺨﺎﻁﺊ ﻟﺤﺠﻴﺭﺓ ﺍﻟﺘﺄﻴﻥ ﻤﺘﻭﺍﺯﻴﺔ ﺍﻟﻭﺠﻬﻴﻥ ﺍﻟﺘﻲ ﺍﺴﺘﻌﻤﻠﺕ‬ ‫ﻟﻤﻌﺎﻴﺭﺓ ﺤﺯﻡ ﺍﻹﻟﻜﺘﺭﻭﻨﺎﺕ.‬ ‫ﺍﻟﺴﺒﺏ: ﻭﻗﻌﺕ ﺍﻟﺤﺎﺩﺜﺔ ﺒﺴﺒﺏ ﺍﺸﺎﺭﺓ ﻭﻀﻌﺕ ﺒﺸﻜل ﺨﺎﻁﺊ ﻟﻠﺩﻻﻟﺔ ﻋﻠﻰ ﺠﻬﺔ‬ ‫ﺍﻟﺤﺯﻤﺔ ﺍﻹﺸﻌﺎﻋﻴﺔ ﺒﺎﻟﻨﺴﺒﺔ ﻟﻠﺤﺠﻴﺭﺓ.‬ ‫ﺍﻟﻨﺘﺎﺌﺞ: ﻨﺘﻴﺠﺔ ﻟﺫﻟﻙ ﻜﺎﻨﺕ ﻨﺘﺎﺌﺞ ﺍﻟﻤﻌﺎﻴﺭﺓ:‬ ‫– ‪6MeV 20% overdose‬‬ ‫– ‪9MeV 10% overdose‬‬ ‫– ‪12MeV 8% overdose‬‬ ‫• ﻜﺸﻑ ﺍﻟﺨﻁﺄ: ﺘﻡ ﺍﻜﺘﺸﺎﻑ ﺍﻟﺨﻁﺄ ﻤﻥ ﺨﻼل ﺇﺠﺭﺍﺀ ﻤﻘﺎﺭﻨﺎﺕ-‪TLD‬‬ ‫• ﺍﻟﻌﻤل ﺍﻟﻤﺘﺨﺫ: ﺇﻋﺎﺩﺓ ﺍﻟﻤﻌﺎﻴﺭﺓ.‬ ‫37 ‪Slide‬‬ ‫‪Ossama Anjak, AECS Damascus SYRIA /e‬‬‫‪mail: oanjak@gmail.com‬‬ ‫‪Ossama Anjak‬‬ ‫1102 ‪7 Narch‬‬ ‫63‬

‫א‬ ‫א‬ ‫א‬ ‫3−‬ ‫–‬ ‫א‬ ‫• اﻟﺤﺎدث: اﺱﺘﻌﻤﺎل ﺧﺎﻃﺊ ﻟﻤﻘﻴﺎس اﻟﻀﻐﻂ اﻟﺠﻮي ﺧﻼل إﺝﺮاء ﻣﻌﺎﻳﺮة اﻟﺨﺮج‬ ‫اﻹﺵﻌﺎﻋﻲ ﻟﺠﻬﺎز آﻮﺑﺎﻟﺖ-06 ﻓﻲ ﻣﺮآﺰ ﻣﻌﺎﻟﺠﺔ ﻳﺮﺗﻔﻊ 0001م ﻋﻦ ﺱﻄﺢ اﻟﺒﺤﺮ.‬ ‫• اﻟﻨﺘﻴﺠﺔ:‬ ‫– ﺗﻌﺮض اﻟﻤﺮﺿﻰ ﻟﺠﺮﻋﺔ أﻋﻠﻰ ﻣﻦ اﻟﺠﺮﻋﺔ اﻟﻤﻘﺮرة ﻟﻬﻢ ﺑﻤﻘﺪار 12%‬ ‫• اﻟﺴﺒﺐ:‬ ‫– ﻻ ﻳﻮﺝﺪ ﻣﻘﻴﺎس ﺿﻐﻂ ﺝﻮي ﻟﻘﻴﺎس اﻟﻀﻐﻂ اﻟﺠﻮي ﻓﻲ ﻣﻜﺎن اﻟﻘﻴﺎس‬ ‫– ﺡﺼﻞ اﻟﻔﻴﺰﻳﺎﺉﻲ ﻋﻠﻰ ﻗﻴﻤﺔ اﻟﻀﻐﻂ اﻟﺠﻮي ﻣﻦ ﻣﺮآﺰ اﻷرﺹﺎد اﻟﺠﻮﻳﺔ ﻓﻲ‬ ‫اﻟﻤﻄﺎر وآﺎﻧﺖ اﻟﻘﻴﻤﺔ ﻣﺼﺤﺤﺔ ﺑﺎﻟﻨﺴﺒﺔ ﻟﻤﺴﺘﻮى ﺱﻄﺢ اﻟﺒﺤﺮ.‬ ‫‪Ossama Anjak‬‬ ‫47 ‪Slide‬‬ ‫מ‬ ‫א א‬ ‫1102 ‪7 Narch‬‬ ‫؟‬ ‫א‬ ‫)‪p o 273.2 + T( o C‬‬ ‫×‬ ‫‪P‬‬ ‫‪273.2 + To‬‬ ‫= ‪K TP‬‬ ‫ﺡﻴﺚ ‪ P & T‬هﻤﺎ درﺝﺔ اﻟﺤﺮارة واﻟﻀﻐﻂ اﻟﺠﻮي ﻓﻲ ﻡﻜﺎن إﺝﺮاء اﻟﻘﻴﺎس.‬ ‫و ‪ Po & To‬هﻤﺎ درﺝﺔ اﻟﺠﺮارة واﻟﻀﻐﻂ اﻟﺠﻮي اﻟﻨﻈﺎﻡﻴﻴﻦ‬ ‫]‪[usually 760mmHg and 20oC‬‬ ‫ﺑﻔﺮض أن اﻟﻀﻐﻂ ‪ P‬ﻳﺴﺎوي ‪1000m] 630mmHg‬ﻓﻮق ﻣﺴﺘﻮى اﻟﺒﺤﺮ[ و اﻟﺤﺮارة‬ ‫‪ 20oC‬ﻓﻨﺠﺪ أن:‬ ‫602.1 = 036 *)02+2.372( / 067 *)02+2.372( = ‪KTP‬‬ ‫إذا ﻓﺮﺿﻨﺎ أن اﻟﻀﻐﻂ ‪ P‬ﻳﺴﺎوي ‪ ] 760mmHg‬ﻣﺴﺘﻮى اﻟﺒﺤﺮ[ واﻟﺤﺮارة ‪ 20oC‬ﻋﻨﺪﺉﺬ ﻧﺠﺪ أن:‬ ‫1 = )067 *)02+2.372(( /067 *)02+2.372( = ‪KTP‬‬ ‫ﻫﺫﺍ ﺍﻟﺨﻁﺄ ﺘﻘﺭﻴﺒﺎ ﻴﻌﺎﺩل 02 % ﺃﻗل ﻭﺒﺎﻟﺘﺎﻟﻲ ﺴﻴﺅﺩﻱ ﺇﻟﻰ ﺯﻴﺎﺩﺓ ﻓﻲ ﺠﺭﻋﺔ ﺍﻟﻤﺭﻴﺽ ﺒﻤﻘﺩﺍﺭ 02%‬ ‫ﹰ‬ ‫57 ‪Slide‬‬ ‫‪Ossama Anjak, AECS Damascus SYRIA /e‬‬‫‪mail: oanjak@gmail.com‬‬ ‫‪Ossama Anjak‬‬ ‫1102 ‪7 Narch‬‬ ‫73‬

‫א‬ ‫א‬ ‫א‬ ‫א‬ ‫–‬ ‫•‬ ‫•‬ ‫•‬ ‫•‬ ‫א‬ ‫מ‬ ‫מ‬ ‫א‬ ‫4−‬ ‫ﺍﻟﺤﺎﺩﺙ: ﺘﻁﺒﻴﻕ ﻤﻌﺎﻤل ﺘﻭﻫﻴﻥ ﺍﻹﺴﻔﻴﻥ ‪ Wedge factor‬ﻤﺭﺘﻴﻥ.‬ ‫ﺍﻟﺘﺴﻠﺴل ‪: Sequence‬‬ ‫– ﻴﺘﻀﻤﻥ ﻨﻅﺎﻡ ﺘﺨﻁﻴﻁ ﺘﻭﺯﻉ ﺍﻟﺠﺭﻋﺔ ﺍﻹﺸﻌﺎﻋﻴﺔ ‪Treatment‬‬ ‫‪ planning system‬ﺘﺼﺤﻴﺢ ﺘﻭﺯﻉ ﺍﻟﺠﺭﻋﺔ ﺍﻹﺸﻌﺎﻋﻴﺔ ﻋﻨﺩ‬ ‫ﺍﺴﺘﻌﻤﺎل ﺍﻟﻤﺭﺸﺢ ﺍﻹﺴﻔﻴﻨﻲ‬ ‫– ﺠﺭﻯ ﺘﻁﺒﻴﻕ ﻤﻌﺎﻤل ﺍﻟﺘﺼﺤﻴﺢ ﻤﺭﺓ ﺜﺎﻨﻴﺔ ﻋﻨﺩ ﺇﺠﺭﺍﺀ ﺍﻟﺤﺴﺎﺒﺎﺕ ﻴﺩﻭﻴﺎ‬ ‫ﹰ‬ ‫ﻟﺤﺴﺎﺏ ﺯﻤﻥ ﺍﻟﻤﻌﺎﻟﺠﺔ.‬ ‫ﺍﻟﻨﺘﻴﺠﺔ: ﺯﻴﺎﺩﺓ ﻓﻲ ﺍﻟﺠﺭﻋﺔ ﺒﻤﻘﺩﺍﺭ 41 %.‬ ‫‪Do not pay me‬‬ ‫‪twice‬‬ ‫ﺍﻟﺴﺒﺏ:‬ ‫– ﻋﺩﻡ ﻓﻬﻡ ﺨﻭﺍﺭﺯﻤﻴﺔ ﻨﻅﺎﻡ ﺘﺨﻁﻴﻁ ﺘﻭﺯﻉ ﺍﻟﺠﺭﻋﺔ ﺍﻹﺸﻌﺎﻋﻴﺔ ﺒﺸﻜل ﺠﻴﺩ.‬ ‫67 ‪Slide‬‬ ‫‪Ossama Anjak‬‬ ‫–‬ ‫1102 ‪7 Narch‬‬ ‫א‬ ‫5−‬ ‫• ﺍﻟﺤﺎﺩﺙ:‬ ‫– ﻤﺭﻴﺽ ﻋﻤﺭﻩ 13 ﺸﻬﺭ. ﺘﻘﺭﺭ ﺇﻋﻁﺎﺀﻩ ﺠﻠﺴﺘﻲ ﻤﻌﺎﻟﺠﺔ ﻋﻠﻰ‬ ‫ﺠﻬﺎﺯ ﻜﻭﺒﺎﻟﺕ-06 ﻜل ﺠﻠﺴﺔ 051 ﺭﺍﺩ )5.1 ﻏﺭﻱ(‬ ‫ﻭﺍﻟﺠﺭﻋﺔ ﺍﻟﻜﻠﻴﺔ 003 ﺭﺍﺩ )3 ﻏﺭﻱ( ﻭﺫﻟﻙ ﻟﺘﺨﻔﻴﻑ ﺤﺠﻡ‬ ‫ﺍﻨﺘﻔﺎﺥ ﻴﻘﻊ ﺨﻠﻑ ﺍﻟﻌﻴﻥ‬ ‫– ﺍﻟﻤﺴﺅﻭل ﻋﻥ ﻗﻴﺎﺱ ﺍﻟﺠﺭﻋﺔ ﺍﺭﺘﻜﺏ ﺨﻁﺄ ﻓﻲ ﺤﺴﺎﺏ ﺍﻟﺠﺭﻋﺔ‬ ‫ﻭﺃﺠﺭﻯ ﺍﻟﺤﺴﺎﺏ ﻋﻠﻰ ﺃﺴﺎﺱ ﺍﻟﺠﺭﻋﺔ ﺒﺎﻟﺠﻠﺴﺔ 003 ﺭﺍﺩ‬ ‫ﻭﺠﺭﻯ ﻤﻌﺎﻟﺠﺔ ﺍﻟﻤﺭﻴﺽ ﻟﻤﺩﺓ ﻴﻭﻤﻴﻥ ﻭﺒﺎﻟﺘﺎﻟﻲ ﺍﻟﺠﺭﻋﺔ ﺍﻟﻜﻠﻴﺔ‬ ‫006 ﺭﺍﺩ.‬ ‫97 ‪Slide‬‬ ‫‪Ossama Anjak, AECS Damascus SYRIA /e‬‬‫‪mail: oanjak@gmail.com‬‬ ‫‪Ossama Anjak‬‬ ‫1102 ‪7 Narch‬‬ ‫83‬

‫–‬ ‫• ﺍﻟﺴﺒﺏ:‬ ‫א‬ ‫5–‬ ‫• ﻭﻗﻊ ﻫﺫﺍ ﺍﻟﺨﻁﺄ ﻨﺘﻴﺠﺔ ﻟﺨﻁﺄ ﺤﺴﺎﺒﻲ ﺍﺭﺘﻜﺒﻪ ﺍﻟﻤﺴﺅﻭل ﻋﻥ ﻗﻴﺎﺱ‬ ‫ﺍﻟﺠﺭﻋﺎﺕ.‬ ‫• ﺃﺠﺭﻴﺕ ﻨﻅﺭﺓ ﻏﻴﺭ ﻜﺎﻓﻴﺔ ﻟﻠﺤﺴﺎﺏ ﻤﻥ ﻗﺒل ﺍﻟﻁﺒﻴﺏ ﺍﻟﻤﻌﺎﻟﺞ ﻗﺒل‬ ‫ﺃﻥ ﺘﺒﺩﺃ ﺍﻟﻤﻌﺎﻟﺠﺔ.‬ ‫• ﺃﻴﻀﺎ ﻜﺎﻥ ﻫﻨﺎﻙ ﻤﺸﻜﻠﺔ ﻓﻲ ﻭﻀﻭﺡ ﻭﺸﻜل )ﻨﻤﻭﺫﺝ( ﺨﻁﺔ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ )ﻁﺭﻴﻘﺔ ﺘﺩﻭﻴﻥ ﺍﻟﺒﻴﺎﻨﺎﺕ ﻏﻴﺭ ﻭﺍﻀﺤﺔ(.‬ ‫08 ‪Slide‬‬ ‫‪Ossama Anjak‬‬ ‫–‬ ‫1102 ‪7 Narch‬‬ ‫א‬ ‫5–‬ ‫• ﺍﻟﻌﻤل ﺍﻟﻤﺘﺨﺫ ‪:Action taken‬‬ ‫– ﺘﻡ ﺍﻜﺘﺸﺎﻑ ﺍﻟﺨﻁﺄ ﻤﻥ ﻗﺒل ﻁﺎﻟﺏ )ﻴﺩﺭﺱ ﻓﻨﻲ ﺃﺸﻌﺔ( ﺨﻼل ﺍﻟﻤﺭﺍﺠﻌﺔ‬ ‫ﺍﻟﺸﻬﺭﻴﺔ ﻟﺒﻁﺎﻗﺎﺕ ﺍﻟﻤﻌﺎﻟﺠﺔ.‬ ‫– ﻤﻥ ﺃﺠل ﻋﺩﻡ ﺘﻜﺭﺍﺭ ﻤﺜل ﻫﺫﺍ ﺍﻟﺨﻁﺄ ﻗﺎﻡ ﺍﻟﺠﻬﺔ ﺍﻟﻤﺭﺨﺹ ﻟﻬﺎ ﺒﺈﻋﺎﺩﺓ‬ ‫ﺘﺩﺭﻴﺏ ﺍﻟﻌﺎﻤﻠﻴﻥ ﺍﻟﻤﺴﺅﻭﻟﻴﻥ ﻋﻥ ﺍﻟﻤﻌﺎﻟﺠﺔ ﻟﺘﺠﻨﺏ ﺍﻟﻭﻗﻭﻉ ﻓﻲ ﻤﺜل ﻫﺫﻩ‬ ‫ﺍﻟﺤﺎﻻﺕ ﻭﺍﻟﺘﻲ ﻴﻤﻜﻥ ﺘﻌﺯﻯ ﺇﻟﻰ ﻀﻌﻑ ﺍﻹﺩﺍﺭﺓ.‬ ‫18 ‪Slide‬‬ ‫‪Ossama Anjak, AECS Damascus SYRIA /e‬‬‫‪mail: oanjak@gmail.com‬‬ ‫‪Ossama Anjak‬‬ ‫1102 ‪7 Narch‬‬ ‫93‬

‫א‬ ‫א‬ ‫–‬ ‫6−‬ ‫א‬ ‫א‬ ‫• اﻟﺤﺎدث ‪:Incident‬‬ ‫– ﻓﻘﺪان أداة ﺗﺮآﻴﺐ اﻟﻤﺮﺵﺢ اﻹﺱﻔﻴﻨﻲ و اﻟﺠﺮﻋﺔ ﻏﻴﺮ ﺹﺤﻴﺤﺔ ﻋﻠﻰ‬ ‫اﻟﻤﺤﻮر اﻟﻤﺮآﺰي.‬ ‫• اﻟﺴﺒﺐ :‪Cause‬‬ ‫– ﻓﻘﺪان أداة ﺗﺮآﻴﺐ اﻟﻤﺮﺵﺢ اﻹﺱﻔﻴﻨﻲ وﺑﺎﻟﺘﺎﻟﻲ ﻣﻌﺎﻣﻞ اﻟﻤﺮﺵﺤﺎت اﻟﺠﺎﻧﺒﻲ‬ ‫ﻋﻠﻰ اﻟﻤﺤﻮر اﻟﻤﺮآﺰي ﻏﻴﺮ ﺹﺤﻴﺢ وﺑﺎﻟﺘﺎﻟﻲ ﺗﻮزع اﻟﺠﺮﻋﺎت ﻏﻴﺮ‬ ‫ﺹﺤﻴﺢ.‬ ‫– ﻟﻢ ﻳﺘﻢ ﻓﺤﺺ أداة ﺗﺜﺒﻴﺖ اﻟﻤﺮﺵﺢ وآﺬﻟﻚ ﻣﻌﺎﻣﻞ اﻟﻤﺮﺵﺢ ﻟﻠﺤﺰم اﻟﺠﺎﻧﺒﻴﺔ.‬ ‫‪Ossama Anjak‬‬ ‫28 ‪Slide‬‬ ‫א‬ ‫‪t‬‬ ‫}‬ ‫{‬ ‫א‬ ‫‪Lack of‬‬ ‫‪thickness‬‬ ‫1102 ‪7 Narch‬‬ ‫א‬ ‫{‬ ‫{‪t‬‬ ‫‪Excess‬‬ ‫‪attenuation‬‬ ‫• ﺘﺘﻭﻗﻑ ﻗﻴﻤﺔ ﻤﻌﺎﻤل ﺍﻟﻤﺭﺸﺢ ﻋﻠﻰ ﺴﻤﺎﻜﺔ ﺍﻟﻤﺭﺸﺢ ’‪ ‘t‬ﻋﻨﺩ ﺍﻟﻤﺤﻭﺭ‬ ‫ﺍﻟﻤﺭﻜﺯﻱ ﻟﻠﺤﺯﻤﺔ.‬ ‫• ﺍﻟﻨﺘﻴﺠﺔ: ﺘﻌﺭﺽ ﺍﻟﻤﺭﻀﻰ ﻟﺠﺭﻋﺎﺕ ﻋﺎﻟﻴﺔ ﻓﻲ ﺇﺤﺩﻯ ﺠﺎﻨﺒﻲ ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﻭﺠﺭﻋﺔ ﻤﻨﺨﻔﻀﺔ ﻓﻲ ﺍﻟﺠﺎﻨﺏ ﺍﻵﺨﺭ ﺒﺎﻟﻨﺴﺒﺔ ﻟﻤﺤﻭﺭ ﺍﻟﺤﺯﻤﺔ.‬ ‫38 ‪Slide‬‬ ‫‪Ossama Anjak, AECS Damascus SYRIA /e‬‬‫‪mail: oanjak@gmail.com‬‬ ‫‪Ossama Anjak‬‬ ‫1102 ‪7 Narch‬‬ ‫04‬

‫א‬ ‫א‬ ‫א‬ ‫א‬ ‫‪PHSYCAL mode‬‬ ‫−‬ ‫א‬ ‫7−‬ ‫• ﺍﻟﺤﺎﺩﺙ:‬ ‫– ﻤﺸﻜﻠﺔ ﻓﻲ ﺍﺨﺘﻴﺎﺭ ﺤﺯﻤﺔ ﺃﺸﻌﺔ-‪ X‬ﻭﺤﺯﻡ ﺍﻹﻟﻜﺘﺭﻭﻨﺎﺕ ﻋﻨﺩ ﺘﺸﻐﻴل ﺍﻟﻤﺴﺭﻉ ﺒﻨﻤﻁ‬ ‫ﺍﻟﺘﺸﻐﻴل ﺍﻟﺨﺎﺹ ﺒﺎﻟﻤﻌﺎﻟﺠﺔ ‪Clinical mode‬‬ ‫– ﺍﺴﺘﻌﻤل ﺍﻟﻤﺴﺭﻉ ﺍﻟﺨﻁﻲ ﻤﺴﺘﺨﺩﻤﻴﻥ ﺍﻟﺘﺸﻐﻴل ﺒﺎﻟﺤﺎﻟﺔ ﺍﻟﺨﺎﺼﺔ ﺒﺎﻟﺼﻴﺎﻨﺔ‬ ‫‪PHSYCAL mode‬‬ ‫– ﺍﻟﺘﺸﻐﻴل ﺒﺤﺎﻟﺔ ‪ PHYSICAL mode‬ﺨﺎﺼﺔ ﻓﻘﻁ ﺒﺤﺎﻻﺕ ﺇﺠﺭﺍﺀ ﺍﻟﺼﻴﺎﻨﺔ ﺃﻭ‬ ‫ﺇﺠﺭﺍﺀ ﺃﺒﺤﺎﺙ ﻭﻤﻌﻅﻡ ﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﺘﺸﺎﺒﻙ ﻓﻲ ﻫﺫﻩ ﺍﻟﺤﺎﻟﺔ ﺘﻜﻭﻥ ﻤﻔﻘﻭﺩﺓ )ﻻ ﺘﻌﻤل(.‬ ‫– ﺭﺒﻤﺎ ﻻ ﻴﻤﻜﻥ ﻟﻠﻤﺴﺭﻉ ﺇﻴﻘﺎﻑ ﺍﻟﺘﺸﻌﻴﻊ ﻓﻲ ﺤﺎل ﻭﺠﻭﺩ ﺨﻠل ﻓﻲ ﺍﻟﺨﺭﺝ ﺍﻹﺸﻌﺎﻋﻲ ﺃﻭ‬ ‫ﺇﺫﺍ ﻜﺎﻨﺕ ﺍﻟﺤﺭﻜﺔ ﺍﻟﻤﻴﻜﺎﻨﻴﻜﻴﺔ ﻟﻠﻬﺩﻑ ‪ target‬ﺃﻭ ﺍﻟﻭﺸﺎﺌﻊ ‪ foils‬ﺃﻭ ﺍﻟﻤﺭﺸﺤﺎﺕ‬ ‫‪ filters‬ﻜﺎﻨﺕ ﻤﻌﻁﻠﺔ‬ ‫‪Ossama Anjak‬‬ ‫48 ‪Slide‬‬ ‫א‬ ‫א‬ ‫א‬ ‫א‬ ‫‪PHSYCAL mode‬‬ ‫1102 ‪7 Narch‬‬ ‫א‬ ‫7−‬ ‫−‬ ‫• ﺘﺴﻠﺴل ﺍﻷﺤﺩﺍﺙ ‪Sequence‬‬ ‫– ﺠﺭﻯ ﺘﺸﻐﻴل ﺍﻟﻤﺴﺭﻉ ﺒﺎﻟﺤﺎﻟﺔ ‪ PHYSICAL mode‬ﻤﻥ ﻗﺒل‬ ‫ﻤﻬﻨﺩﺱ ﺍﻹﻟﻜﺘﺭﻭﻨﻴﺎﺕ ﺒﺄﻤﺭ ﻤﻥ ﻁﺒﻴﺏ ﺍﻟﻤﻌﺎﻟﺠﺔ ﺍﻹﺸﻌﺎﻋﻴﺔ.‬ ‫– ﺠﺭﻯ ﻗﻴﺎﺱ ﻤﻌﺩل ﺍﻟﺨﺭﺝ ﺍﻹﺸﻌﺎﻋﻲ ﺒﻤﺴﺎﻋﺩﺓ ﻓﻨﻲ ﺍﻷﺸﻌﺔ ﺍﻟﻤﺴﺭﻉ‬ ‫ﻴﻌﻤل ﺒﺎﻟﺤﺎﻟﺔ ‪PHYSICAL mode‬‬ ‫– ﻗﺎﻡ ﺍﻟﻤﻬﻨﺩﺱ ﺒﺘﺩﺭﻴﺏ ﺍﻟﻔﻨﻲ ﻋﻠﻰ ﻁﺭﻴﻘﺔ ﺍﻟﺘﺸﻐﻴل ﻭﻓﻕ ﻟﻬﺫﻩ ﺍﻟﺤﺎﻟﺔ‬ ‫‪ PHYSICAL mode‬ﻭﺭﺍﻗﺏ ﺃﻭ ﺤﺎﻟﺘﻲ ﻤﻌﺎﻟﺠﺔ.‬ ‫58 ‪Slide‬‬ ‫‪Ossama Anjak, AECS Damascus SYRIA /e‬‬‫‪mail: oanjak@gmail.com‬‬ ‫‪Ossama Anjak‬‬ ‫1102 ‪7 Narch‬‬ ‫14‬

‫א‬ ‫א‬ ‫א‬ ‫א‬ ‫‪PHSYCAL mode‬‬ ‫−‬ ‫א‬ ‫7−‬ ‫• ﺠﺭﻯ ﻤﻌﺎﻟﺠﺔ 03 ﻤﺭﻴﺽ ﺩﻭﻥ ﺃﻴﺔ ﻤﺸﻜﻠﺔ ﻭﻜﺎﻥ ﺍﻟﻤﺭﻴﺽ ﺍﻷﺨﻴﺭ ﻴﻌﺎﻟﺞ ﺒﺤﺯﻤﺔ‬ ‫ﺇﻟﻜﺘﺭﻭﻨﺎﺕ ﺒﻁﺎﻗﺔ ‪.10 MeV‬‬ ‫• ﺠﺭﻯ ﺘﺤﻀﻴﺭ ﺍﻟﻤﺭﻴﺽ ﺍﻟﺫﻱ ﻴﻠﻴﻪ ﻟﻠﻤﻌﺎﻟﺠﺔ ﺒﺤﺯﻤﺔ ﻓﻭﺘﻭﻨﺎﺕ ‪20MV x rays‬‬ ‫ﻭﻤﻌﺩل ﺠﺭﻋﺔ ‪ ،300MU/min‬ﺒﺩﺃﺕ ﺍﻟﻤﻌﺎﻟﺠﺔ ﻭﻟﻜﻥ ﺃﻭﻗﻔﺕ ﺒﻌﺩ ‪ 21s‬ﻭﺘﻌﺭﺽ‬ ‫ﺍﻟﻤﺭﻴﺽ ﺇﻟﻰ ﺠﺭﻋﺔ ﻗﻠﻴﻠﺔ ) ‪.(few monitor units‬‬ ‫• ﻋﻨﺩ ﺇﺨﺭﺍﺝ ﺍﻟﻤﺭﻴﺽ ﻤﻥ ﻏﺭﻓﺔ ﺍﻟﻤﻌﺎﻟﺠﺔ ﻻﺤﻅ ﻓﻨﻲ ﺍﻷﺸﻌﺔ ﻭﺠﻭﺩ ﻋﻼﻤﺔ ﻋﻠﻰ ﺠﻠﺩ‬ ‫ﺍﻟﻤﺭﻴﺽ ﺘﺩل ﻋﻠﻰ ﺃﻥ ﺍﻟﻤﺭﻴﺽ ﻗﺩ ﺘﻌﺭﺽ ﻟﺠﺭﻋﺔ ﺇﺸﻌﺎﻋﻴﺔ ﻋﺎﻟﻴﺔ.‬ ‫‪Ossama Anjak‬‬ ‫68 ‪Slide‬‬ ‫א‬ ‫א‬ ‫א‬ ‫1102 ‪7 Narch‬‬ ‫א‬ ‫‪PHSYCAL mode‬‬ ‫−‬ ‫א‬ ‫7–‬ ‫اﻟﻌﻮاﻡﻞ اﻟﻤﺴﺎهﻤﺔ ‪contributing factors‬‬ ‫• ﻟﺩﻯ ﺍﻟﺘﺤﻘﻴﻕ ﻓﻲ ﺍﻟﺤﺎﺩﺜﺔ ﺘﺒﻴﻥ ﺃﻥ ﺍﻟﻤﺭﻴﺽ ﻗﺩ ﺘﻌﺭﺽ ﻟﺠﺭﻋﺔ ﺇﺸﻌﺎﻋﻴﺔ ﻋﺎﻟﻴﺔ‬ ‫ﻓﻲ ﻤﺭﻜﺯ ﺍﻟﺴﺎﺤﺔ ﻨﺎﺘﺠﺔ ﻋﻥ ﻓﺸل ﻓﻲ ﺤ

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