Breast Cancer Essay - 993 Words

Breast cancer’s a group of cells that are cancer cells called malignant. Malignant is a tumor, which starts in parts of the breast. Breast cancer is the second leading cause of death for women but not as bad of a death for men. Males or females, are born with some breast cells and tissues that have the possibility to turn into cancer cells. (â€Å"Definition.†) Any type of cancer begins in the cells. The cells are the basic building blocks that’ll make the tissue. If the process of cell growth goes wrong then new cells will form with in the body. Whenever the cells form within the body it’s because the body no longer needs them cells because they’ve became old and damaged, and old and damaged cells won’t die. When the damaged cells won’t†¦show more content†¦(â€Å"Found.†) Their’s four phases to knowing what phase of breast cancer you have. Phase one is the lowest phase you’ll have if diagnosed with breas t cancer. Phase one is in the earliest detection of the breast cancer development. Phase two breast cancer is still at it’s earliest stage, but evidence shows that cancer is starting to spread. Cancer is still contained to the breast cancer area, and is needing treatment. Phase three breast cancer is advanced with evidence of the cancer that has invaded the surround tissues nearly at the breast. Phase four indicated that breast cancer has begun to spread through the entire breast then to other parts of the human body. (â€Å"Stages.†) Operating with a doctor to help guide your breast treatment plan is the key to understanding what you need to do while diagnosed with breast cancer. Determining what’s needed to improve a great relationship with your doctor is great because it’s good to be able to be open to your doctor and ask as many questions. Seeking a second opinion is recommended. Seeking a second opinion will insure you that you have breast cancer bec ause doctors aren’t always right and it’s better to make sure by having another opinion. The common form of treatment for any type of cancer is surgery. Surgery removes the tumor and near margins. Surgical options are lumpectomy, particle mastectomy, radical mastectomy, and reconstruction. (â€Å"Treatment.†) There’s numerous typesShow MoreRelatedBreast Cancer And Cancer Prevention2347 Words   |  10 Pages INTRODUCTION Statistics indicate that breast cancer-related complications are among the top causes of death among women for over 23% of all women’s deaths in the world (Donepudi et al., 2014). The great cases of breast cancer are attributed to lack of information on and hard data on the disease, especially on early diagnosis and treatment options. In America, breast cancer is among the top causes of cancer-related deaths, and the mortality rate is relatively high as compared to the neighboring countriesRead MoreThe For Breast Cancer Action1612 Words   |  7 Pagesintention to give some part of the profit towards breast cancer causes. Ironically, the money made from this marketing will often not significantly benefit somebody with breast cancer. The pink ribbon was originally created by the Susan G Komen foundation yet anybody can use this symbol, because there is no intellectual copyright on it. Pinkwashing is term was first coined by the organization called breast cancer action, whose m ission is to â€Å"Breast Cancer Action’s mission is to achieve health justiceRead MoreBreast Cancer : Cancer And Cancer Essay1433 Words   |  6 PagesBreast cancer is a carcinoma that develops due to malignant cells in the breast tissue. Cancerous cells are more likely to produce in the milk-producing ducts and the glands, ductal carcinoma, but in rare cases, breast cancer can develop in the stromal, fatty, tissues or surrounding lymph nodes, especially in the underarm (Breast Cancer). For women, breast cancer is the most commonly diagnosed cancer and the 2nd leading cause of cancer death – behind skin cancer. While treatment or surgeries canRead MoreBreast Cancer : Cancer And Cancer1346 Words   |  6 Pagesinternational symbol for breast cancer support and awareness. Breast cancer knows neither racial boundaries nor age restrictions. Females of all ages and ethnicities can develop breast cancer and it is the leading most common cancer among women. Calling at tention to this often fatal disease is important by supporting its victims, families and friends of victims, as well as raising funds for breast cancer research. Though males are not immune from developing a breast cancer, for the purposes of thisRead MoreBreast Cancer : Cancer And Cancer946 Words   |  4 PagesSkylar Steinman Period 6 Ms. Jobsz 12 February , 2016 Breast Cancer It is commonly known that Breast Cancer is one of the most insidious diseases that mankind has had to deal with. With the discovery of the BRCA1( BReast Cancer gene one) and BRCA2 (BReast Cancer gene two) genes, breast cancer can be detected with a great amount of certainty on a genetic level in some women and men. 40,000 women and men die of breast cancer each year. Knowing this it is very important to try to detect the mutationRead MoreBreast Cancer : Cancer And Cancer1530 Words   |  7 Pagesâ€Å"Cancer† is the name for a group of diseases that start in the body at the cellular level. Even though there are many different kinds of cancer, they all begin with abnormal cell growth with the potential to invade or spread to other parts of the body. These abnormal cells lump together to form a mass of tissue or â€Å"malignant tumor†. Malignant means that it can spread to other parts of the body or Metastasize . If the breast is the original location of the cancer gr owth or malignant tumor, the tumorRead MoreBreast Cancer : Cancer And Cancer Essay1741 Words   |  7 Pages Internationally, breast cancer is the most commonly diagnosed cancer and the leading cause of cancer related death amongst women. (CITE) Each year an estimated 1.7 million new cases are diagnosed worldwide, and more than 500,000 women will die of the disease. (CITE) According to (CITE), somewhere in the world one woman is diagnosed with breast cancer every 19 seconds and more than three women die of breast cancer every five minutes worldwide. (CITE) Breast cancer is a heterogeneous condition thatRead MoreBreast Cancer : Cancer And Cancer1372 Words   |  6 PagesBreast Cancer Disease Overview Breast cancer is a disease in which certain cells in the breast become abnormal and multiply uncontrollably to form a tumor. Breast cancer is the second most commonly diagnosed cancer in women. (Only skin cancer is more common.) About one in eight women in the United States will develop invasive breast cancer in her lifetime. Researchers estimate that more than 230,000 new cases of invasive breast cancer will be diagnosed in U.S. women in 2015. Cancers occur when aRead MoreBreast Cancer : Cancer And Cancer1471 Words   |  6 PagesBreast cancer Introduction to Breast cancer Breast cancer is one of the most common forms of cancer only surpassed by lung cancer. It involves a cancerous tumour located inside the breast but spreads if treatment is not administered. (Evert et al 2011) Breast cancer can be treated if diagnosed in its early stages but becomes progressively more difficult upon reaching more advancing malignant stages. Breast cancer can be confused with being a female only disease however both sexes suffer. AccordingRead MoreBreast Cancer : Cancer And Cancer1921 Words   |  8 PagesIntroduction Cancer is a term that every individual on this planet wants to avoid hearing when they go to their yearly check up at the doctors. However, as person ages, they are prone to develop some sort of sickness and most of the time, they could develop cancer of some sort. For this research paper, I am going to go over breast cancer. Breast cancer is a well-known type of cancer with awareness events going on to support both women and men who has breast cancer. According to American Cancer Society

The Bahamas A Thriving Nation - 1296 Words

The Bahamas: A Thriving Nation The Bahamas is a thriving nation! The British controlled the Bahamas until it won its independence in 1973. (â€Å"Remembering Our Past† 2014) Bahaman culture is very diverse, with intriguing cuisine; many represented religions, interesting and familiar holidays, beautiful clothing, and much more. In the Bahamas the economy is steadily developing, it is dependent on tourism and offshore banking. Bahaman resources include salt, aragonite, and timber. (â€Å"Central America a Caribbean: Bahamas, The† 2014) The Bahamas is a vigorously growing and culturally changing nation. The Bahamas has a complicated history. Columbus discovered the Bahamas in 1492 when he landed in San Salvador on his journey westward. The British made the Bahamas a colony in the year 1649 nearly 157 years after Columbus landed in San Salvador. English Puritans were among the first to land and colonize the Bahamas on their quest for religious freedom. All the settlers fou nd was a lack of food. They where led by Captain William Sayles and known as the â€Å"Eleutheran Adventurers.† The captain of the Eleutheran Adventures sailed to Massachusetts Bay colony to get food; as a way of saying â€Å"thank you† the settlers sent the colony some brasileto wood, that the money from would help purchase the land for Harvard University. (â€Å"Remembering Our Past† 2014) In the 1600s through the early 1700s the Bahamas had many pirates and privateer. The most famous ones were Calico Jack and Blackbeard. TheShow MoreRelatedNew World Beginnings ( 33000 B.c1770 Words   |  8 Pagesagricultural villagers, but this process went forward slowly and unevenly Corn planting reached the present-day American Southwest by about 1200 B.C. and powerfully molded Pueblo culture. Along with corn, other crops began to be cultivated by the thriving tribes and cultures of the early Americas The cultivation of maize, as well as of high-yielding strains of beans and squash, reached the southeastern Atlantic seaboard region of North America about A.D. 1000. After maintaining a consistent foodRead MoreThe Treaty Of The Declaration Of Independence Essay2183 Words   |  9 Pagesgovernments and People vs the federal government, immutable liberties for Indigenous Americans, and abolition of slavery are issues among America’s earliest problems after the ratification of the declaration of independence in 1776. In 1776, The fledging nation was without a government so they enacted the Articles of Confederation, in 1781 – which gave states the right to legislate over themselves. For 10 years this system was imposed until the Constitution was finally drafted in 1787. The constitution wasRead MoreWorld Cultures : North And South America And Europe2266 Words   |  10 Pagesanywhere in the world, it would probably be the proud and independent island nation of Jamaica. The island-nation of Jamaica is the third largest island of the â€Å"Greater Antilles,† a collection of larger islands in the Caribbean Sea, which is a specifi c section of the North Atlantic Ocean of the Western Hemisphere, specifically off the east coast of the continent of North America. To the north, lie the countries of Cuba, the Bahamas, Crooked Island, Cat Island, Great Inagua, Nassau, Andrea, Key West, andRead MoreInternational Political Economy : Cuba s Economic Sanction2046 Words   |  9 Pagesor goods are allowed to be transported via a vessels to Cuba prior to the authorization of the OFAC. Some individuals have attempted to by pass the travel restrictions by going through a third country such as Mexico, Grand Cayman Island, Canada or Bahamas to avoid the direct flight from the US. Once in Cuba, they requested the Cuban custom authorities to not stamp their US passport in order to avoid any problems with the United States Customs once they return. This was an issue and since then has beenRead MoreAp Us History 52969 Words   |  12 Pagesa war to free the slaves, made living from factories and trade, wanted to higher taxes o n Europeans goods so Southerners would buy Northern products, and believed that the Union must be saved above all else. With these different views on what the nation should look like, they both came up with new strategies that would favor their side. They came up with defense mechanisms and plans that were supposed to be a help into their victory. Unfortunately, some of their plans and strategies failed whileRead MoreNative American Genocide5146 Words   |  21 Pagesof Expansion, Colonization, and Early U.S. an act of Genocide ? â€Å"To conquer a nation, one must first disarm its citizens.† - Adolf Hitler, 1933 Abiona Yemane US History Ms.Brown Section F Independent Research Project 4 June 2014 Introduction In August of 1492 Columbus set sail from Spain hoping to soon arrive in Asia, but a few months later he arrived in the Bahamas and claimed it as new land. He thought he had discovered a new land, but little did he know—Read MoreUnited Arab of Emirates Country Notebook18844 Words   |  76 Pagessquare miles (83,600 square kilometers). The Seven Emirates vary greatly in size. Abu Dhabi represents 85% of the land, and the smallest Emirate is Ajman. Each Emirate is named after its capital city, and Abu Dhabi city is the permanent capital of the nation. B- Climate The UAE generally has a dry climate with very high temperature and humidity in the summer. The hottest months are July and August when average maximum temperatures reach above 40  Ã‚ °C on the coastal Plain. Average minimum temperaturesRead MoreUnited Arab of Emirates Country Notebook18844 Words   |  76 Pagessquare miles (83,600 square kilometers). The Seven Emirates vary greatly in size. Abu Dhabi represents 85% of the land, and the smallest Emirate is Ajman. Each Emirate is named after its capital city, and Abu Dhabi city is the permanent capital of the nation. B- Climate The UAE generally has a dry climate with very high temperature and humidity in the summer. The hottest months are July and August when average maximum temperatures reach above 40  Ã‚ °C on the coastal Plain. Average minimum temperatures

Saussure and Derrida Free Essays

string(34) " process of aesthetic negativity\." A science that studies the life of signs within society is conceivable; . . . We will write a custom essay sample on Saussure and Derrida or any similar topic only for you Order Now I shall call it semiology (from Greek semeion ‘sign’). Semiology would show what constitutes signs, what laws govern them. Since the science does not yet exist, no one can say what it would be. . . . (Saussure, 1960:16) In this statement Ferdinand de Saussure (1857-1913), the twentieth-century father of the science of signs, presents his theory about language and gives a Greek name. This enterprise has considerably affected most discussions about language and of interpretation since its inauguration. Saussure presents the linguistic system as the place of the sign. Signs don’t exist apart from a system. And it is every time a system of differences. Unavoidably, the theory of signs leads Saussure to the theory of language as system. Later, Jacques Derrida (1930-2004) discovers the logocentric dynamic in Saussure’s new theory. Referring to the father of structural linguistics and semiology, Derrida leads readers beyond Saussure toward a poststructuralist future. It is this logocentrism which, limiting the internal system of language in general by a bad abstraction, prevents Saussure and the majority of his successors from determining fully and explicitly that which is called ‘the integral and concrete object of linguistics† (Cours 23). Both Ferdinand de Saussure – father of 20th-century linguistics and Jacques Derrida – founder of deconstruction made profound impact upon language theory; their ideas laid the basis for considerable development s in linguistics in the 20th century. Saussure on Language In itself, thought is like a swirling cloud, where no shape is intrinsically determinate. No ideas are established in advance, and nothing is distinct, before the introduction of linguistic structure. [†¦] Just as it is impossible to take a pair of scissors and cut one side of paper without at the same time cutting the other, so it is impossible in a language to isolate sound from thought, or thought from sound. To separate the two for theoretical purposes takes us into either pure psychology or pure phonetics, not linguistics. Linguistics, then, operates along this margin, where sound and thought meet. The contact between them gives rise to a form, not a substance (Cours 155-7). This impressive statement from the posthumously published Cours de linguistique generale of Ferdinand de Saussure (1857-1913) introduces readers in what was later called as a ‘Copernican revolution’ in Western thought relating to language. Why ‘Copernican’? Because just as Copernicus had asserted that the Earth revolved around the Sun, instead of the Sun revolving around the Earth, Saussure asserts something similar on the subject of language. His theory claimed that languages are the instruments that give human beings opportunity to achieve a rational understanding of the world in which they live. Rather than considering words as mere addition to human comprehension of reality, Saussure considered comprehension of reality as depending substantially upon human use of the verbal signs that form the language people use. Language is not secondary but, quite the reverse, central to human life. As a result, human life is linguistically constructed life. Saussure’s theory goes far beyond the traditional theory of language as something communicated. It also goes beyond Locke’s theory of words as symbols that stand for ideas. Many linguistic philosophers had claimed that without language human reason would be lacking its principal instrument of transformation ideas into words. But Saussure’s theory goes further and deeper. Saussure indicates the phonetic and conceptual aspects of language. Linguistics was for Saussure only one subdivision of a relating to various branches science of signs that he proposed to call ‘semiology’ (semiologie). Each branch of semiology had a theory of the signs which it studied. Consequently, linguistics would need a theory of the linguistic sign, the fundamental unit of langue. Such a theory of language Saussure proceeds to offer. As his paper-cutting analogy shows, he deals with the linguistic sign as a unit determined merely by its form. Its form has two facets, or ‘opposite sides’. The Saussurean technical identifications for these two facets of the sign are signifiant and signifie (the ‘signifying’ plane and the ‘signified’ plane) (Matthews 21). Every langue includes semiological system of bi-planar signs. Each sign has its signifiant and its signifie. Despite the fact that each plane may, for convenience, be analyzed one by one, no linguistic sign can be determined without considering both planes that are equally important. The published in 1916 text of the Cours faithfully reflects Saussure’s theory about language. That text became the subsequent chapter in the history of ideas about language theory. The text became a cornerstone of modern linguistic theory, as well as the public declaration of a more general intellectual movement of the 20th century that had effect on such diverse disciplines as psychology, social anthropology and literary criticism. This all-round movement is today known as ‘structuralism’. The whole question that the Saussurean theory of linguistic structure gives rise is this: ‘If our langue is a structure, then a structure of what exactly? ‘ (Matthews 69) Saussure’s answer to this question is problematic. He identified langue as being at the same time a structure of the mental operations of the human beings, and also a structure of the communicational processes by means of which human beings perform their roles as a cultural constitution. So langue is finally supra-individual in the relation that it is placed in society and depends for its existence on cultural relations; yet it assumes in each individual the power of an internally created system of linguistic signs. More exactly, langue, Saussure claims, ‘is never complete in any single individual, but exists perfectly only in the collectivity’ (Cours 30). Derrida’s Theory of Language The theory of language to which Derrida wants to turn attention is connected with the method linguistic meaning is produced. More exactly, the method what there is of linguistic meaning and nonmeaning in their interconnection is presented. Derrida, in his theory of deconstruction, presents the same structure for both the process of nonaesthetic negativity and the process of aesthetic negativity. You read "Saussure and Derrida" in category "Papers" â€Å"Deconstruction† is connected with an analysis of the theory of language that, similar to the process of aesthetic negativity, discovers within this theory the seeds of its own downfall. Derrida presents a theory of meaning that reflects the idea of the â€Å"iterability† of signs and what he calls their â€Å"supplementary† status. Jonathan Culler summarized Derrida’s central idea in this regard in the following way: Our earlier formula, â€Å"meaning is context-bound, but context is boundless,† helps us recall why both projects fail: meaning is context-bound, so intentions do not in fact suffice to determine meaning; context must be mobilized. But context is boundless, so accounts of context never provide full determinations of meaning. Against any set of formulations, one can imagine further possibilities of context, including the expansion of context produced by reinscription within a context of the description of it (Menke 96). Considering Culler’s interpretation, Derrida’s thesis of the uncircumventable proclivity of language for crisis is based on the difference between what one expects context to offer and what it can really do, when correctly viewed. The nonetheless inevitable recourse to context in the determination of meaning thus results in a crisis for every attempt to comprehend language. What is supposed to generate definitiveness is itself unlimited and thus the source of unmanaged difference. Derrida’s general thesis thus is based on the idea that the understanding of the meaning of signs can only function in a context-bound way. At the same time that contexts cannot define the meaning of signs since they are themselves boundless. The boundlessness that meaning opens itself to in its context-boundedness is in no way eo ipso the boundlessness of a difference that is inconsistent with any identity of meaning (Menke 90). Derrida himself realizes his argument that a â€Å"thousand possibilities will always remain open even if one understands something in this phrase that makes sense† (Menke 96) in an equivocal fashion. On the one hand this idea means: every sign can function in different and boundlessly many contexts. This is precisely what determines the iterability of signs: their reusability in contexts that are not actually those in which they were first placed. The usability of signs in boundlessly many contexts in itself, though, in no way is opposite to the definitiveness of its use and meaning as determined by rules of language. Although one might note, with Derrida, that the deconstruction of logocentrism is a search for â€Å"the other of language† (Derrida 1984, 123), this does not contribute to the statement that deconstruction is originally concerned with a linguistic theory. This is first and foremost the question of the concrete instance, of â€Å"the other, which is beyond language† (Derrida 1984,123). Far, then, from being a philosophy that according to its critics, states that there is nothing beyond language and that one is confined within language, deconstruction can be considered as a response. â€Å"Deconstruction is, in itself, a positive response to an alterity which necessarily calls, summons or motivates it. Deconstruction is therefore vocation – a response to a call† (Derrida 1984,118). Derrida claims that the character of deconstruction is not solely positive, that is not merely an assertion of what already exists and is known, but that it is an assertion of what is wholly other (tout autre) (Derrida 1992, 27). Derrida claims that difference is not something that can appear in logocentric discourse: â€Å"differance is not,† Derrida explains, â€Å"preceded by the originary and indivisible unity of a present possibility that I could reserve†¦. What defers presence, on the contrary, is the very basis on which presence is announced or desired in what represents it, its sign, its trace†¦. Differance is â€Å"that which produces different things, that which differentiates, is the common root of all the oppositional concepts that mark our language†¦ † (Positions, 89). Differance is neither structure nor origin, â€Å"such an alternative itself being an ‘effect’ of differance. † Even so, studying the operations of differance requires that the writer use such concepts as structure and origin and â€Å"borrow the syntaxic and lexical resources of the language of metaphysics† even if the writer wishes to deconstruct this language ( Positions, pp. -10). Derrida indicates that differance is not an origin. Neither language nor writing springs in differance. Instead, Derrida says, differance allows the play of absence and presence, writing and thought, structure and force by means of which the question of origin comes to know itself. Saussure and Derrida Exactly at this point one is faced with one of the most problematic though fascinating dimensions of Derrida’s theory. The problem, stated above, is that, as soon as it is recognized that there are no simple, unsignified, transcendental signifiers that fix and warrant the meaning of the words, that there exist no originals to which the words can be attributed, one comes to conditions where even this acknowledgement itself seems to have become â€Å"floating† (May 125). Derrida resolves this difficult situation with the help of above discussed theory of signs and of language developed by Ferdinand de Saussure. Despite the idea that language is in a fundamental way a naming process, attaching words to things, Saussure had claimed that language is a system, or a structure. In the structure any individual element is meaningless outside the boundaries of that structure. In language, he asserts, there are only differences. But – and here the ideas of Saussure are basic for Derrida’s deconstruction of the metaphysics of presence – these differences are not differences between positive terms, that is between terms that in and by themselves are connected with objects or things outside the system. Accordingly, in language, Saussure indicates, there are only differences without positive terms (May 127). But if this is true, if there are no positive terms, then it means that one can no longer define the differential position of language itself by means of a positive term either. Difference without positive terms indicates that this dimension must itself always be left unperceived for, roughly speaking, it is unconceptualizable. It is a difference that cannot be returned into the order of the same and, through a signifier, given individual characteristics. This suggests, then, that â€Å"the play of difference, which, as Saussure reminded us, is the condition for the possibility and functioning of every sign, is in itself a silent play† (Derrida 1982, 5). If, however, one wants to articulate that – one must first of all admit that there can never be a word or a concept to correspond to this silent play. One must also admit that this play cannot merely be exposed, for â€Å"one can expose only that which at a certain moment can become present† (Derrida 1982, 5). And one must ultimately admit that there is nowhere to begin, â€Å"for what is put into question is precisely the quest for a rightful beginning, an absolute point of departure† (Derrida 1982, 6). All this, and more, is acknowledged in the new â€Å"word† or â€Å"concept† – â€Å"which is neither a word nor a concept† (Derrida 1982:7) but a â€Å"neographism† (Derrida 1982:13) – of differance. The motive why Derrida uses â€Å"what is written as difference† (Derrida 1982, 11) is not difficult to understand. For although â€Å"the play of difference† (Derrida 1982, 11) is introduced as something for the opportunity of all conceptuality, one should not make the mistaken opinion to think that one has finally discovered the real origin of conceptuality. That, expressing the same idea but differently, this play is a playful but despite that transcendental signified. Strictly speaking, in order to avoid this mistake one must acknowledge that the differences that make up the play of difference â€Å"are themselves effects† (Derrida 1982:11, original emphasis). As Derrida claims, What is written as differance, then, will be the playing movement that â€Å"produces† – by means of something that is not simply an activity – these differences, these effects of difference. This does not mean that the differance that produces differences is somehow before them, in a simple and unmodified – in-different – present. Differance is the non-full, non-simple, structured and differentiating origin of differences. Thus, the name â€Å"origin† no longer suits. (Derrida 1982, 11) Although differance is straightforwardly connected with a structuralist idea of meaning – that Derrida recognizes when he indicates that he sees no reason to question the truth of what Saussure proposes (Derrida 1976, 39), there is one important aspect in which differance is outside the scope of structuralism. The point here is that Derrida clearly refuses to accept the primary character of structure itself. Structure is not a transcendental represented (for which reason Derrida notes that he does not want to question the truth of what Saussure proposes â€Å"on the level on which he says it [original emphasis] â€Å"but does want to question the logocentric way in which Saussure says it (Derrida 1976, 39). Structure is even less the effect of an original presence coming before and causing it (Derrida 1978, 278-9). What differance tries to express is the differential character of the â€Å"origin† of structure itself. It is in this relation that one might observe that Derrida’s writing is poststructural. To some degree, surely, differance appears when Saussure’s examination of how language operates. â€Å"In language,† Saussure indicates, â€Å"there are only differences. Even more important: a difference generally implies positive terms between which the difference is set up; but in language there are only differences without positive terms† (Positions, 120). Derrida’s differance in an obvious manner is like Saussure’s differences. At the end of Positions, for instance, Derrida specifies â€Å"as differance the movement according to which language, or any other code, any system of reference in general, is constituted ‘historically’ as a tissue of differences† (Positions, 104). But Derrida makes an effort to go further. Whereas Saussure considers the differences in a semiotic system as the set of constantly changing relationships the speaker manipulates in order to produce meaning, Derrida defines differance as the boundless disappearance of either an origin of or a final place for meaning. When Derrida describes differance, he always does so by examining what it is not. Rather than considering language in the traditional way, as a set of external signs of already farmed internal thoughts (characteristic of â€Å"logocentrism†), Derrida, like Saussure and modern linguistics, thinks of users of language producing coded, that is, repeatable, marks or traces that originate from within certain unities of meaning as â€Å"effects† of the code. These traces are not fundamentally meaningful in themselves but â€Å"arbitrary† and â€Å"conventional† (Menke 96). Thus there is no difference whether one says â€Å"rex,† â€Å"rol,† or â€Å"king† so long as â€Å"we† – those who share these conventions – can tell the difference between rex and lex, roi and loi, and king and sing (Menke 96). The meaning – is a process of the difference, of the distance or the â€Å"spacing† between the traces, what is called, in an absolutely serious way, the â€Å"play† of differences or traces. By the â€Å"play of differences† Derrida defines the differential spacing, the recognized distance, the recognized (heard, seen) intervals between traces first analyzed in structural linguistics (Menke 97). Conclusion A comprehensive historical examination of deconstruction would necessarily include numerous precursors and forerunners: Freud, Hegel, Heidegger, Husserl, Lacan, Levi-Strauss, Marx, Nietzsche, Saussure. . . . However, it can be said that the history of contemporary deconstruction begins with Jacques Derrida De la grammatologie (1967) that opens with a critique of Saussure. Saussure’s theory of language is here framed within a metaphysical system that extends from Plato and Aristotle to Heidegger and Levi-Strauss. By Derrida this theory is called â€Å"logocentric. † Saussure marks a concluding stage of the long logocentric epoch. Derrida indicates that logocentrism imposed itself upon the world and controlled the theory of language. Derrida’s contributions laid ground for future epoch. In the role of prophet, Derrida concludes his â€Å"Exergue† indicating: â€Å"The future can only be anticipated in the form of an absolute danger. It is that which breaks absolutely with constituted normality and can only be proclaimed, presented, as a sort of monstrosity. For that future world and for that within it which will have put into question the values of sign, word, and writing, for that which guides our future anterior, there is as yet no exergue† (Derrida 1967). How to cite Saussure and Derrida, Papers

Effects of Drug Abuse free essay sample

Drug abuse is a growing issue all over the world, and while the concentration on drug awareness has dramatically increased over the years, the number of families effected by drug use continues to rise at an alarming rate. Drugs are defined as â€Å": a substance that is used as a medicine: an illegal and often harmful substance (such as heroin, cocaine, LSD, or marijuana) that people take for pleasure. † (Merriam-Webster, n. d). People that abuse drugs and the effects of this abuse can happen to anyone, in any walk of life and it happens all over the world every day. Drug abuse has happened to a great deal of people regardless of social status, financial stability, gender, or race. Drug abuse has been in in all societies for ages and it seems that the number of people effected by drug abuse continues to grow more each day. More and more people are becoming addicted to drugs and more and more families are being effected. Just as we start to learn about a one type of drug, another one is created. Drugs are imported into countries, exported out, smuggled in and out and some drugs are made at home and could be the house right next door. Drug abuse not only effects the person abusing the drugs but the people around them as well. The effects of drug abuse has many layers and sometimes can be a vicious cycle that lasts for generations. I grew up as a child that was around drugs from the day I was born. There is not a time in my childhood that drugs were not involved at some point. I was around so many different things that I actually thought it was normal. As I got older I realized that it was not right, but it was what I had always known so I didn’t think it was a big deal. When I moved out of my mother’s house at the age of 15 it was then that I realized just how abnormal my childhood was. My mother abused heroin, cocaine, marijuana and alcohol throughout my childhood. When I was 11 years old I walked in on my mother shooting up heroin. That day was a very devastating day for me as a child, however it was a day I will never forget because that was when I set it in my mind that I would never touch drugs. When I was 26 my mother passed away due to the long-term abuse she caused her body. When I became a parent myself I held on to a great deal of anger against my mother for exposing me to the drugs, but I realized that I although my mother subjected me to many harmful things it gave me knowledge to know firsthand what drug abuse does to the person and their family. I have been tempted to try drugs many times but each time I would think about the hardships I went through due to drugs and have always stopped myself from even trying them. I have seen how using a drug recreationally can turn into a habit and I would never want to put my child through the things I was subjected to. The medical effects of drug abuse can damage the human mind and body. There are numerous effects on the human body regardless of the type of drug used or the way it is used. Sometimes, the effects are short term such as memory loss or nausea, however there can also be long term effects that could damage your body and/or ultimately lead to death. Alcohol, amphetamines, and marijuana all have tremendous side effects and they can all damage your body. Some of the health issues related to drug abuse include cancer, stroke, lung disease, cardiovascular disease, hepatitis and even HIV/AIDS. Some of the dangers of abuse can happen with high doses of drugs or prolonged use of the drugs, however these dangers as well as death can still happen in just one use. Drug abuse not only effects the body, but the mind as well. Some of the mental effects of drug abuse can cause long term changes in the brain that can cause depression, anxiety, paranoia, hallucinations and anger issues. Drug addiction is a brain disease. Although initial drug use might be voluntary, drugs of abuse have been shown to alter gene expression and brain circuitry, which in turn affect human behavior. Once addiction develops, these brain changes interfere with an individual’s ability to make voluntary decisions, leading to compulsive drug craving, seeking and use. † (National Institute on Drug Abuse, n. d). There are many effects on society from drug abuse as well. Drug abuse effects the crime rate in many ways. With the number of drug users and drug distributors on the streets the use and distribution of illegal drugs causes huge crime problems. There is violence that comes from the lifestyle lead by those that sell the illegal drugs as well as from those that use the drugs. People that use illegal drugs are more likely to commit crimes and it is usual for many different offences including violent crimes. There are a large number of these offences that are committed my people using drugs or alcohol or ones that had used them previous to the offence. People that abuse the illegal drugs are often committing crimes like burglary and assault to get money to buy the drugs. This is an increasing problem in every society all over the world. According to Bureau Of Justice Statistics (n. d), and FBI Uniform Crime Report† (n.d), In 1973, there were 328,670 arrests reported by the FBIs Uniform Crime Reports (UCR) for drug law violations, out of a total 9,027,700 arrests nationwide for all offenses. Also that year, authorities reported 380,560 arrests for all violent crimes and 1,448,700 arrests for all property offenses. In 2012, the number of arrests for drug law violations rose to 1,552,432 out of a total 12,196,959 arrests nationwide for all offenses. Also in 2012, authorities reported 521,196 arrests for all violent crimes and 1,646,212 for all property offenses. Due to the number of children that are starting to use drugs, drug education is now more important than ever. â€Å"Adolescent Substance Abuse: Americas #1 Public Health Problem, † (2011) Teen users are at significantly higher risk of developing an addictive disorder compared to adults, and the earlier they began using, the higher their risk. Nine out of 10 people who meet the clinical criteria for substance use disorders involving nicotine, alcohol or other drugs began smoking, drinking or using other drugs before they turned 18. People who begin using any addictive substance before age 15 are six and a half times as likely to develop a substance use disorder as those who delay use until age 21 or older (28. 1 percent vs. 4. 3 percent). Drugs is an uncomfortable thing for parents to talk to their children about, but with the ease of access to drugs and alcohol it can make or break a child’s future. The age that children can access different types of drugs can start as early as 10 years old so drug awareness has to be started at an earlier age. Drug education has to start with the adults, parents and teachers. I feel that if this education were taught with more openness within adults then the effects of the education taught would affect layers of people. The effects of drug education would also trickle down through generations as well, just as the drug abuse itself effects families for generations. I feel that every person in all walks of life can relate to the effects of drug abuse on society in one way or another, almost everyone has had a loved one addicted to drugs or knows someone who has. I feel that awareness is the main key to decreasing the effects of drug abuse. I also feel that the awareness must be taught at an earlier age and without an age limit. People of all ages are tempted by the excitement or escape that drugs seem to offer and the effects of drug abuse can be endless. Drug abuse can affect the human body, human mind and can be fatal in many cases. Drug abuse can also affect the quality of life for the person abusing the drugs as well as the quality of life of loved ones. This battle is ongoing and must be fought restlessly to see results. This is a battle that society as a whole has to decide to fight in order for society as a whole to overcome.

McClellan Genealogy Essay Example

McClellan Genealogy Essay Name: Course: Lecturer: Date: We will write a custom essay sample on McClellan Genealogy specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on McClellan Genealogy specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on McClellan Genealogy specifically for you FOR ONLY $16.38 $13.9/page Hire Writer McClellan Genealogy The McClellan genealogy is among the earliest recorded family trees, dating back to the 14th century. Its name was a combination of Scottish names, Gaelic Mac Gille Fhaolain and Irish names, Mac Giolla Fhaolain. The name represented the surname of the family. The family was quite extensive in numbers across the Galloway area during the 14th century. As was the tradition for most families, McClellan family had a coat of arms or family crest with its meaning and significance. At first, the coat of arms was meant for identification during battles and tournaments. At the time, reading was hard for most people. Considering that the men were armored from head to toe, the need for identification arose in order to identify each other on battlefields. Therefore, coat of arms was inscribed on the helmets and their shields colored the same for identification. This was necessary since they covered their heads as well, making it hard to notice who was the enemy. Soon, the crests were used for fa mily purposes for identification including surnames. Thus, this heredity of the surname and the coat of arms came into existence with an aim of identifying a family in a unique way (4crests.com n.d). In a similar manner, the McClellan had its crest that identified them as well as described their attributes. The coat of arms has additional meaning and significance. The color of the coat of arms on the shield signifies generosity, implying that the family was munificent. The two arrow shaped lines looking upwards symbolized the roof of a house that, according to the family, signifies protection and faithful service (irishsurnames.com 2009). The hand at the top of the court of arms represents a person fit for high and mighty deeds, which signifies the ability of the McClellan family. The helmet on top of the shield signifies wisdom in defense. Leaves surrounding the court of arms signify strength and antiquity. Work cited Irishsurnames.com. Heraldic Charges. irishsurnames.com, 2009. Web. January 11, 2013. 4crests.com. Coat of Arms Family Crests Store: McClellan Coat of Arms / McClellan Family Crest. 4crests.com, n.d. Web. January 11, 2013.

Charles Babbage essays

Charles Babbage essays Charles Babbage is often called the "father of computing" because of his invention of the Analytical Engine. However, many people do not know the details of this very important mans life. Charles Babbage was born on December 26, 1792, just about that same time that the industrial revolution was beginning. He was born in Teignmouth, Devon shire. Although not much is really known about his childhood, it is known that he had many brothers and sisters, but many of them died before adulthood. It is also known that Babbage never really played with his toys, instead, he would dissect them. When Babbage grew up he attended many new schools. He ended up at Forty Hill, where he was famous for mischief but for some reason or another Babbage still studied. He did bad things like carved his name in his desks, violated his curfew, and insult the minister's sermons. He still found time to wake up with a friend at three in the morning and study in the library until five-thirty. Frederick Marryat, Babbages roommate and a future novelist, joined his morning study group. When Marryat began to attend regularly he started to bring more and more friends. And the once study group now became wild parties that were eventually broken up by the schools head master. After both Marryat and Babbage had become famous they loved to tell how they were deemed the two students most likely never to amount to anything. Babbage created his first invention, a type of shoes make of books that helped one walk on water, at his fathers summer home. This idea was good, but it didnt work, because he would weave too much from side to side and eventually fall over. It is told that in 1810, at the age of nineteen, Babbage went up to Trinity College, Cambridge with some friends. Babbage studied grammar, literature, and many other important lessons, but he found his obsession to be mathematics. He read many books on the subject. Bab...

Barriers Impeding Technology Integration in Education Dissertation - 1

Barriers Impeding Technology Integration in Education - Dissertation Example The research question that directed the whole research is What are the barriers hindering teachers in adopting technological integration in their classroom pedagogy? From this issue, several sub-questions have been posed to clarify the various concepts embedded in the research. These questions are 1. What is technological integration? What are the stages of technological integration? 2. What are the effects of technological integration to students learning process? 3. What are some of the current best practices used for the integration of technology in classroom pedagogy? 4. How does the issue of funding affect the integration of technology in classroom pedagogy? To answer these questions, both primary data and secondary data have been generated and collected. For the collection of primary data, a qualitative research using in-depth interview of nine participants and group discussion/sharing with four participants have been conducted. The collected data collected data have been exami ned, coded, evaluated, assessed and analyzed several times to find themes, patterns and relationships in each case and across other cases. Moreover, to ensure the validity, reliability and integrity of all the data the following strategies have been used. These are the ethical consideration in securing the consent of the participants have been rigorously observed. Triangulation, member checking, thick rich description, and management of the researcher’s personal bias have been adopted. For the collection of secondary data, which includes scholarly journals, notes from the interviews and reflection, a library research had been performed. Meanwhile, for the notes and reflection, a journal had been maintained in the course of the research. The themes that have emerged in the study are teaching ethos, benefits of technology in education, approaches to integration of technology in classroom pedagogy, concept of barrier clarified, and identified existing barriers to integration of technology in classroom pedagogy. Some of the findings of the research includes: a table and list of identified existing barriers, the categorization of existing barriers, the study offers conceptual clarifications of ideas embedded in the issue and finally it proffers the supposition that there is no one penultimate reason for the problem, but that the issue is a result of the combination of various factors. Section 4 Findings In response to the challenges and demands of the contemporary period to education, the research has looked into one of the most challenging and invigorating demands of the time – the integration of technology in classroom pedagogy. Challenging, because, the necessity for the integration of technology in classroom pedagogy is a response to the current human condition. Likewise, it is a reflection of the initiative to improve the educational institution towards academic excellence and a drive towards enabling children in becoming responsible global citiz ens. In this regard, integration of technology in classroom pedagogy is invigorating for it requires innovation, creativeness and a new approach in classroom pedagogy. In the face of these challenges and changes in education and technology, both scholars and the teachers agree that technology in edu

Broadcast news story Essay Example | Topics and Well Written Essays - 250 words

Broadcast news story - Essay Example Fox Sports 1 appears to have accepted the challenge and it aims to set new standards of sports telecast by introducing the newly emerging idea of â€Å"Jockularity† as part of their regular telecasts. The new channel aims to establish its reputation as a funny, irreverent and so called ‘less-serious’ sport channel. They say that they will engage the services of some really famous Canadian pranksters to anchor the network’s flagship programs. Regis Philbin is also expected to host a show at the new sports network. â€Å"What we are fighting is inertia. ESPN has a 30-year head start, and they are doing a remarkable job. We are very much the underdog, and we have to convince the sports-viewing public that what we have on offer is better—or as good as—what ESPN has been offering. We have to create a personality.† (Greenfeld) Greenfeld,  K.  T. (2013, July 18). Fox Sports 1s Strategy vs. ESPN: Jockularity - Businessweek. Retrieved  May  18, 2015, from

Saudi Arabia Essay Example | Topics and Well Written Essays - 1750 words

Saudi Arabia - Essay Example The most difficult duty that the King has to perform is to maintain a balanced and harmonious relationship among the Royal Family members, the upper-class people of the society and the Ulama, an Islamic religious community (Lacey 39). The difficulty mainly arises from the conflict of interests between the religious community and the other bourgeois class people, as in this regard, Matthes et al says that the king’s decision-making often involves maintaining balance and mitigating â€Å"conflict between religious and power interests† (3). Due to the tribal pattern of the Saudi Arabian society, the King often needs to interfere into tribal agreements, and at the same time, to renew the government’s agreements with the Arabian tribes. It is mutually agreed that, unlike a democratic political system the Saudi Royal Family is endowed with the power to dethrone the King. Overview of Saudi Arabian Government From the very beginning of the establishment of the Kingdom of Saudi Arabia in 1932, the country is being ruled under monarchy, as Gerald Butt, a middle East Analyst, says, â€Å"The history of Saudi Arabia is entwined - as much as its name is - with the fate and fortunes of the House of Saud, which traces its origins back to the 18th Century† (2). ... t, Matthes et al says, â€Å"Occupying nearly all the important state positions, the large Al Saud family dominates Saudi-Arabian politics as well as parts of the economy making the desert kingdom a â€Å"family firm†(4). The country’s high authoritative decisions come from a cabinet of 15 members. Since the cabinet primarily consists of members who are close in kinship to the King, it becomes often difficult to take a decision by fulfilling all of the members’ interests. The decisions are often deterred and protracted. Constitution of Saudi Arabia: Interests of Royal Family, Islam, and the Leading Technocrat in it Since Saudi Arabia’s constitution consists of the Koran, Allah’s laws and Sunnah, the explanation of the Koran, the country does not have any constitution in traditional sense, rather it has some 83 operational laws on which the kingdom is expected to be operated. Since the state is responsible for the enforcement of Islamic law or Shari ah, the Saudi constitution does not consider the existence of religious organizations. Also Article 5 declares the political system of the country as monarchy and also it does not permit any political organizations in the country. According to article 5c, the King can choose his heir. Though the King is considered to be endowed with unfettered power, he is expected to respect Islamic Laws and Values. According to Article 44, three types of authorities are considered to function as parts of the state, while the King preserves the supreme power to interfere into any of these authoritative powers. According to the Saudi Constitution, the monarchy is considered as the key source of power with the right to interfere into any level of the government. The Council of Ministers and its Functions during the Years Prior to 1990

Radiation Protection for Angiography Procedure.

Radiation Protection for Angiography Procedure. Fluoroscopic procedure produces the greatest patient radiation exposure rate in diagnostic radiology. Therefore the radiation protection in fluoroscopy is very important. Several feature and techniques in fluoroscopy are designed for protection to the patient during fluoroscopic procedure. a) Protection to Patient * A dead-man switch is a device (switch) constructed so that a circuit closing contact can only be maintained by continuous pressure on the switch by the operator. Therefore, when the machine is turned on by any means, whether by the push button at the control panel, or by the foot pedal, this switch must be held in for the machine to remain on. * The on-time of the fluoroscopic tube must be controlled by a timing device, and must end alarm when the exposure exceeds 5 minutes. An audible signal must alert the user to the completion of the preset on time. This signal will remain on until the timing device is reset. * The X-ray tube used for fluoroscopic must not produce X-rays unless a barrier is in position to intercept the entire cross-section of the useful beam. The fluoroscopic imaging assembly must be provided with shielding sufficient that the scatter radiation from the useful beam is minimized. * Protective barriers of at least 0.25 mm lead equivalency must be used to attenuate scatter radiation above the tabletop. This shielding does not replace the lead garments worn by personnel. Scattered radiation under the table must be attenuated by at least 0.25 mm lead equivalency shielding. * Additionally, most c-arm fluoroscopes have a warning beeper or light that activate when the beam is on, some have both. Never inactivate any warning devices, and keep ones foot off the foot pedal whenever possible. * Methods of limiting radiation exposure include: o making certain that the fluoroscopy unit is functioning properly through routine maintenance, o limiting fluoroscopic exposure time, o reducing fields of exposure through collimation, o keeping the X-ray source under the table by avoiding cross-table lateral visualization when possible, and o bringing the image intensifier down close to the patient b) Protection to personnel There are therefore three basic ways to minimize dose: * Reduce time of exposure * Use the inverse square law-doubling your distance away quarter your exposure * Use shielding by barrier These basics known as Cardinal Principle which is important to achieved ALARA. i) Time Radiation dose is directly proportional to the time, those by doubling the radiation time the dose is doubled and by having the radiation time the doses halved. Many factors impact the on time of a fluoroscopic procedure. The exposure time is related to radiation exposure and exposure rate (exposure per unit time) as follows: Exposure time = Exposure/Exposure rate Exposure = Exposure rate x time The algebraic expressions simply imply that if the exposure time is kept short, then the resulting dose to the individual is small. Method of reducing exposure time include meticulous advanced planning of the procedure, judicious use of contrast enhancement, appropriate positioning of the patient, orientation of the fluoroscope unit prior to beginning the procedure. ii) Distance The second radiation protection action relates to the distance between the source of radiation and the exposed individual. The exposure to the individual decreases inversely as the square of the distance. This is known as the inverse square law, which is stated mathematically as: where I is the intensity of radiation and d is the distance between the radiation source and the exposed individual. For example, when the distance is doubled the exposure is reduced by a factor of four. In mobile radiography, where there is no fixed protective control booth, the technologist should remain at least 2 m from the patient, the x-ray tube, and the primary beam during the exposure. In this respect, the ICRP (1982), as well as the NCRP (1989a), recommended that the length of the exposure cord on mobile radiographic units be at least 2 m long. Another important consideration with respect to distance relates to the source-to-image receptor distance (SID). The appropriate SIDs for various examinations must always be maintained because an incorrect SID could mean a second exposure to the patient. Long SID results in less divergent beam and thus decreases the concentration of photons in the patients. Short SID results in the reverse action and increases the patient dose. Hence the longest possible SID should be employed in examinations. However, if a greater than standard SID is used then greater intensity of radiation would be required to produce the same film density. Therefore it is recommended that only standard SIDs should be used. iii) Shielding Shielding procedure the most utilitarian results in the reduction of staff dose as there are times when the procedure list simply must function in close proximity, even directly cines fluoroscopy. In these circumstances there simply is no substitute for the best modern flexible lead gloves, lead glasses, lightweight lead apron and lead lined thyroid shield available. Appropriate shielding is mandatory for the safe use of ionizing radiation for medical imaging. Other method of shielding includes beam collimation, protective drapes and panels. Shielding of occupational workers can be achieved by following methods: * Personnel should remain in the radiation environment only when necessary (step behind the control booth, or leave the room when practical) * The distance between the personnel and the patient should be maximized when practical as the intensity of radiation decreases as the square of distance (inverse square law). * Shielding apparel should be used as and when necessary which comprise of lead aprons, eye glasses with side shields, hand gloves and thyroid shields. Lead aprons are shielding apparel recommended for use by radiation workers. These are classified as a secondary barrier to the effects of ionizing radiation. These aprons protect an individual only from secondary (scattered) radiation, not the primary beam. The thickness of lead in the protective apparel determines the protection it provides. It is known that 0.25 mm lead thickness attenuates 66% of the beam at 75kVp and 1mm attenuates 99% of the beam at same kVp. It is recommended that for general purpose radiography the minimum thickness of lead equivalent in the protective apparel should be 0.5mm. It is recommended that women radiation workers should wear a customized lead apron that reaches below mid thigh level and wraps completely around the pelvis. This would eliminate an accidental exposure to a concept us. Other protective apparel included eye glasses with side shields, thyroid shields and hand gloves. The minimum protective lead equivalents in hand gloves and thyroid shields should be 0.5mm. Lead lined glass and thyroid shield likewise reduce 90% of the exposure to the eyes and thyroid respectively. Lead lined gloves reduce radiation exposure to the hands; however they are no substitute for strict observation of appropriate fluoroscopic hygiene. Gloves should be considered as an effective means of reducing scatter radiation only. 2. State five clinical indications for the patient undergo the angiography procedure. 3. Explain the patient care management before, during and after the procedure Before a procedure: * Patients undergoing an angiogram are advised to stop eating and drinking eight hours prior to the procedure. * They must remove all jewelry before the procedure and change into a hospital gown. * If the arterial puncture is to be made in the armpit or groin area, shaving may be required. * A sedative may be administered to relax the patient for the procedure. * An IV line will also be inserted into a vein in the patients arm before the procedure begins in case medication or blood products are required during the angiogram. * Be aware of and follow all Local Rules and protocols * Prior to the angiography procedure, patients will be briefed on the details of the test, the benefits and risks, and the possible complications involved, and asked to sign an informed consent form. * Ensure that all exposures are justified and there is informed consent * Check patient identity * Position patient comfortably flat, with arm above head where possible * Ensure all members of staff in room are wearing suitable. For operations this should be lead glasses, thyroid collar and wrap-around lead apron * Check all staff are wearing radiation monitors correctly * Use all available lead shielding appropriately sited * Position table before screening * Keep tube current as low as possible and kVp as high as possible for cardiac studies, 60 – 90 kV is appropriate * Keep x ray tube at maximum and image intensifier / receptor at minimum distance from patient * Check all staff are as far away as possible in their role * Use dose reduction programmers when possible * Perform acquisitions on full inspiration where possible * Collimate closely to area of interest * Prolonged procedures: reduce dose to the irradiated skin eg. Change beam angulations * Minimize fluoroscopy time, high dose rate time and no of acquisitions * Remember software features, such as replay fluoro to minimize dose * Dont over use geometric magnification * Remove grid for small patients or when image intensifier / detector cannot be placed close to patient * Check and record screening time and DAP at the end of the case and review against the DRL. During the procedure: * The radiologic technologist will position you on the exam table. A radiologist a physician who specializes in the diagnostic interpretation of medical images will administer a local anesthetic and then make a small nick in your skin so that a thin catheter can be inserted into an artery or vein. The catheter is a flexible, hollow tube about the size of a strand of spaghetti. It usually is inserted into an artery in your groin, although in some cases your arm or another site will be selected for the catheter. * The radiologist will ease the catheter into the artery or vein and gently guide it to the area under investigation. The radiologist will be able to watch the movement of the catheter on a fluoroscope, which is an x-ray unit combined with a television monitor. * When the catheter reaches the area under study, the contrast agent will be injected through the catheter. By watching the fluoroscope screen, the radiologist will be able to see the outline of your blood vessels and identify any blockages or other irregularities. * Angiography procedures can range in time from less than an hour to three hours or more. It is important that you relax and remain as still as possible during the examination. The radiologic technologist and radiologist will stay in the room with you throughout the procedure. If you experience any difficulty, let them know. * Angiography also can be performed using magnetic resonance instead of x-rays to produce images of the blood vessels; this procedure is known as magnetic resonance angiography (MRA) or magnetic resonance venography (MRV). After the procedure: * Because life-threatening internal bleeding is a possible complication of an arterial puncture, an overnight stay in the hospital is sometimes recommended following an angiography procedure, particularly with cerebral and coronary angiograms. * If the procedure is performed on an outpatient basis, the patient is typically kept under close observation for a period of at six to 12 hours before being released. * If the arterial puncture was performed in the femoral artery, the patient will be instructed to keep his leg straight and relatively immobile during the observation period. * The patients blood pressure and vital signs will be monitored and the puncture site observed closely. Pain medication may be prescribed if the patient is experiencing discomfort from the puncture, and a cold pack is applied to the site to reduce swelling. It is normal for the puncture site to be sore and bruised for several weeks. * The patient may also develop a hematoma, a hard mass created by the blood vessels broken during the procedure. Hematomas should be watched carefully, as they may indicate continued bleeding of the arterial puncture site. * Angiography patients are also advised to enjoy two to three days of rest and relaxation after the procedure in order to avoid placing any undue stress on the arterial puncture. Patients who experience continued bleeding or abnormal swelling of the puncture site, sudden dizziness, or chest pains in the days following an angiography procedure should seek medical attention immediately. * Patients undergoing a fluorescein angiography should not drive or expose their eyes to direct sunlight for 12 hours following the procedure. 4. Identify the type of contrast medium, the dose and delivering technique in angiography procedure. * Reducing radiation doses to the patient also generally reduces doses to the medical personnel. Â · Angiography procedure is using fluoroscopy imaging technique which is a real-time imaging technique. 5. List down the catheters and guide wires inclusive of size, shape and the hole type that are used in angiography procedures. The use of lead gloves during procedures is unusual as they are cumbersome and difficult to work in. The automatic brightness control will increase the exposure to go through two layers and one only protects the hand, so if they are going to be used a programme that sets the radiation factors rather than allowing adjustment may be appropriate. In practice, with careful collimation and attenuation to detail it should not necessary for the operators hand to be in the primary beam and only close to it for short periods. While doing catheterization, radiologist should do it behind the lead glass viewer which consists of lead equivalent glass of 0.25mm thickness. Geometric consideration is one of the important things in angiography because source of exposure to personnel is mainly from scattered radiation from the patient. So, it is important to minimize the amount of scattered radiation to personnel. This can be achieved by geometric consideration involving the x-ray tube, patient and image intensifier. The image intensifier should be as close as possible to patient to minimize the amount of scattered radiation hitting personnel. Because in angiography room is sterile for all things, personnel such as radiologist, nurses, radiographer or student should wear shoes which are prepared only. Make sure that film badges always outside personnel body to measure the dose receive to the personnel. The most important thing to remember is that all individuals should be fully trained and learned to be responsible for radiation safety. Involvement of a radiation expert is essential and is particularly useful in equipment specification, assessment and quality assurance, but also in the formulation of Local Rules. Technique Reduces Physician Radiation Exposure During Angiography Current technique requires that physicians performing radiation procedures wear lead gowns. The new technique involves use of a body length floor mounted lead plastic panel to protect to physicians as they monitor patients angiograms and control exam table movement. An extension bar allows the physician to remain safely behind the shield and still retain table control for panning. In the study, researchers recorded radiation exposure to various parts of a physicians body during 25 coronary angiography procedures and compared those results with radiation exposure during angiography on 25 patients using conventional radiation protection. A lead apron, thyroid shield, eyeglasses and facemask were used in both techniques, but a ceiling mounted shield was used in the conventional technique. The researchers placed radiation badges outside and inside the facemask; outside and inside the thyroid shield; on the right and left arm; outside and inside the lead apron; and on the right and left leg. The new equipment resulted in a 90 percent reduction in radiation exposure to the physicians head, arms, and legs. Exposure of the thyroid and torso was minimal with both techniques. Enhanced physician radiation protection during coronary angiography is readily achievable with this new technique, said Martin Magram, M.D., of the University of Maryland Medical Center in Baltimore, Md. Dr. Magram presented the study results on May 3 at the American Roentgen Ray Society Annual Meeting in Vancouver, British Columbia. Dr. Magram pointed out that by freeing physicians from the need to wear lead gowns, the new technique could preserve their ability to benefit patients. It may extend by years their ability to apply the skills they have developed over long careers of serving patients, noted Dr. Magram. New methods of radiation protection must parallel the development of new radiation techniques, added Dr. Magram. The key is to limit medical workers radiation exposure with effective and easy-to-use techniques, and the use of this extension bar and lead plastic shield may be such a technique. Definition Angiography is the x-ray study of the blood vessels. An angiogram uses a radiopaque substance, or dye, to make the blood vessels visible under x ray. Arteriography is a type of angiography that involves the study of the arteries. Purpose Angiography is used to detect abnormalities or blockages in the blood vessels (called occlusions) throughout the circulatory system and in some organs. The procedure is commonly used to identify atherosclerosis; to diagnose heart disease; to evaluate kidney function and detect kidney cysts or tumors; to detect an aneurysm (an abnormal bulge of an artery that can rupture leading to hemorrhage), tumor, blood clot, or arteriovenous malformations (abnormals tangles of arteries and veins) in the brain; and to diagnose problems with the retina of the eye. It is also used to give surgeons an accurate map of the heart prior to open-heart surgery, or of the brain prior to neurosurgery. Precautions Patients with kidney disease or injury may suffer further kidney damage from the contrast mediums used for angiography. Patients who have blood clotting problems, have a known allergy to contrast mediums, or are allergic to iodine, a component of some contrast mediums, may also not be suitable candidates for an angiography procedure. Because x rays carry risks of ionizing radiation exposure to the fetus, pregnant women are also advised to avoid this procedure. Description Angiography is usually performed at a hospital by a trained radiologist and assisting technician or nurse. It takes place in an x-ray or fluoroscopy suite, and for most types of angiograms, the patients vital signs will be monitored throughout the procedure. Angiography requires the injection of a contrast dye that makes the blood vessels visible to x ray. The dye is injected through a procedure known as arterial puncture. The puncture is usually made in the groin area, armpit, inside elbow, or neck. The site is cleaned with an antiseptic agent and injected with a local anesthetic. First, a small incision is made in the skin to help the needle pass. A needle containing an inner wire called a stylet is inserted through the skin into the artery. When the radiologist has punctured the artery with the needle, the stylet is removed and replaced with another long wire called a guide wire. It is normal for blood to spout out of the needle before the guide wire is inserted. The guide wire is fed through the outer needle into the artery and to the area that requires angiographic study. A fluoroscopic screen that displays a view of the patients vascular system is used to pilot the wire to the correct location. Once it is in position, the needle is removed and a catheter is slid over the length of the guide wire until it to reaches the area of study. The guide wire is removed and the catheter is left in place in preparation for the injection of the contrast medium, or dye. Depending on the type of angiography procedure being performed, the contrast medium is either injected by hand with a syringe or is mechanically injected with an automatic injector connected to the catheter. An automatic injector is used frequently because it is able to propel a large volume of dye very quickly to the angiogram site. The patient is warned that the injection will start, and instructed to remain very still. The injection causes some mild to moderate discomfort. Possible side effects or reactions include headache, dizziness, irregular heartbeat, nausea, warmth, burning sensation, and chest pain, but they usually last only momentarily. To view the area of study from different angles or perspectives, the patient may be asked to change positions several times, and subsequent dye injections may be administered. During any injection, the patient or the camera may move. Throughout the dye injection procedure, x-ray pictures and/or fluoroscopic pictures (or moving x rays) will be taken. Because of the high pressure of arterial blood flow, the dye will dissipate through the patients system quickly, so pictures must be taken in rapid succession. An automatic film changer is used because the manual changing of x-ray plates can eat up valuable time. Once the x rays are complete, the catheter is slowly and carefully removed from the patient. Pressure is applied to the site with a sandbag or other weight for 10-20 minutes in order for clotting to take place and the arterial puncture to reseal itself. A pressure bandage is then applied. Most angiograms follow the general procedures outlined above, but vary slightly depending on the area of the vascular system being studied. A variety of common angiography procedures are outlined below: Cerebral angiography Cerebral angiography is used to detect aneurysms, blood clots, and other vascular irregularities in the brain. The catheter is inserted into the femoral or carotid artery and the injected contrast medium travels through the blood vessels on the brain. Patients frequently experience headache, warmth, or a burning sensation in the head or neck during the injection portion of the procedure. A cerebral angiogram takes two to four hours to complete. Coronary angiography Coronary angiography is administered by a cardiologist with training in radiology or, occasionally, by a radiologist. The arterial puncture is typically given in the femoral artery, and the cardiologist uses a guide wire and catheter to perform a contrast injection and x-ray series on the coronary arteries. The catheter may also be placed in the left ventricle to examine the mitral and aortic valves of the heart. If the cardiologist requires a view of the right ventricle of the heart or of the tricuspid or pulmonic valves, the catheter will be inserted through a large vein and guided into the right ventricle. The catheter also serves the purpose of monitoring blood pressures in these different locations inside the heart. The angiogram procedure takes several hours, depending on the complexity of the procedure. Pulmonary angiography Pulmonary, or lung, angiography is performed to evaluate blood circulation to the lungs. It is also considered the most accurate diagnostic test for detecting a pulmonary embolism. The procedure differs from cerebral and coronary angiograms in that the guide wire and catheter are inserted into a vein instead of an artery, and are guided up through the chambers of the heart and into the pulmonary artery. Throughout the procedure, the patients vital signs are monitored to ensure that the catheter doesnt cause arrhythmias, or irregular heartbeats. The contrast medium is then injected into the pulmonary artery where it circulates through the lung capillaries. The test typically takes up to 90 minutes. Kidney angiography Patients with chronic renal disease or injury can suffer further damage to their kidneys from the contrast medium used in a kidney angiogram, yet they often require the test to evaluate kidney function. These patients should be well-hydrated with a intravenous saline drip before the procedure, and may benefit from available medications (e.g., dopamine) that help to protect the kidney from further injury due to contrast agents. During a kidney angiogram, the guide wire and catheter are inserted into the femoral artery in the groin area and advanced through the abdominal aorta, the main artery in the abdomen, and into the renal arteries. The procedure will take approximately one hour. Fluorescein angiography Fluorescein angiography is used to diagnose retinal problems and circulatory disorders. It is typically conducted as an outpatient procedure. The patients pupils are dilated with eye drops and he rests his chin and forehead against a bracing apparatus to keep it still. Sodium fluorescein dye is then injected with a syringe into a vein in the patients arm. The dye will travel through the patients body and into the blood vessels of the eye. The procedure does not require x rays. Instead, a rapid series of close-up photographs of the patients eyes are taken, one set immediately after the dye is injected, and a second set approximately 20 minutes later once the dye has moved through the patients vascular system. The entire procedure takes up to one hour. Celiac and mesenteric angiography Celiac and mesenteric angiography involves x-ray exploration of the celiac and mesenteric arteries, arterial branches of the abdominal aorta that supply blood to the abdomen and digestive system. The test is commonly used to detect aneurysm, thrombosis, and signs of ischemia in the celiac and mesenteric arteries, and to locate the source of gastrointestinal bleeding. It is also used in the diagnosis of a number of conditions, including portal hypertension, and cirrhosis. The procedure can take up to three hours, depending on the number of blood vessels studied. Splenoportography A splenoportograph is a variation of an angiogram that involves the injection of contrast medium directly into the spleen to view the splenic and portal veins. It is used to diagnose blockages in the splenic vein and portal vein thrombosis and to assess the strength and location of the vascular system prior to liver transplantation. Most angiography procedures are typically paid for by major medical insurance. Patients should check with their individual insurance plans to determine their coverage. Aftercare Risks Because angiography involves puncturing an artery, internal bleeding or hemorrhage are possible complications of the test. As with any invasive procedure, infection of the puncture site or bloodstream is also a risk, but this is rare. A stroke or heart attack may be triggered by an angiogram if blood clots or plaque on the inside of the arterial wall are dislodged by the catheter and form a blockage in the blood vessels or artery. The heart may also become irritated by the movement of the catheter through its chambers during pulmonary and coronary angiography procedures, and arrhythmias may develop. Patients who develop an allergic reaction to the contrast medium used in angiography may experience a variety of symptoms, including swelling, difficulty breathing, heart failure, or a sudden drop in blood pressure. If the patient is aware of the allergy before the test is administered, certain medications can be administered at that time to counteract the reaction. Angiography involves minor exposure to radiation through the x rays and fluoroscopic guidance used in the procedure. Unless the patient is pregnant, or multiple radiological or fluoroscopic studies are required, the small dose of radiation incurred during a single procedure poses little risk. However, multiple studies requiring fluoroscopic exposure that are conducted in a short time period have been known to cause skin necrosis in some individuals. This risk can be minimized by careful monitoring and documentation of cumulative radiation doses administered to these patients. Normal results The results of an angiogram or arteriogram depend on the artery or organ system being examined. Generally, test results should display a normal and unimpeded flow of blood through the vascular system. Fluorescein angiography should result in no leakage of fluorescein dye through the retinal blood vessels. Abnormal results Abnormal results of an angiography may display a restricted blood vessel or arterial blood flow (ischemia) or an irregular placement or location of blood vessels. The results of an angiography vary widely by the type of procedure performed, and should be interpreted and explained to the patient by a trained radiologist. Arteriosclerosis A chronic condition characterized by thickening and hardening of the arteries and the build-up of plaque on the arterial walls. Arteriosclerosis can slow or impair blood circulation. Carotid artery An artery located in the neck. Catheter A long, thin, flexible tube used in angiography to inject contrast material into the arteries. Cirrhosis A condition characterized by the destruction of healthy liver tissue. A cirrhotic liver is scarred and cannot break down the proteins in the bloodstream. Cirrhosis is associated with portal hypertension. Embolism A blood clot, air bubble, or clot of foreign material that travels and blocks the flow of blood in an artery. When blood supply to a tissue or organ is blocked by an embolism, infarction, or death of the tissue the artery feeds, occurs. Without immediate and appropriate treatment, an embolism can be fatal. Femoral artery An artery located in the groin area that is the most frequently accessed site for arterial puncture in angiography. Fluorescein dye An orange dye used to illuminate the blood vessels of the retina in fluorescein angiography. Fluoroscopic screen A fluorescent screen which displays moving x-rays of the body. Fluoroscopy allows the radiologist to visualize the guide wire and catheter he is moving through the patients artery. Guide wire A wire that is inserted into an artery to guides a catheter to a certain location in the body. Iscehmia A lack of normal blood supply to a organ or body part because of blockages or constriction of the blood vessels. Necrosis Cellular or tissue death; skin necrosis may be caused by multiple, consecutive doses of radiation from fluoroscopic or x-ray procedures. Plaque Fatty material that is deposited on the inside of the arterial wall. Portal hypertension A condition caused by cirrhosis of the liver. It is characterized by impaired or reversed blood flow from the portal vein to the liver, an enlarged spleen, and dilated veins in the esophagus and stomach. Portal vein thrombosis The development of a blood clot in the vein that brings blood into the liver. Untreated portal vein thrombosis causes portal hypertension. For Your Information Books * Baum, Stanley, and Michael J. Pentecost, eds. Abrams Angiography. 4th ed. Radiation Protection for Angiography Procedure. Radiation Protection for Angiography Procedure. Fluoroscopic procedure produces the greatest patient radiation exposure rate in diagnostic radiology. Therefore the radiation protection in fluoroscopy is very important. Several feature and techniques in fluoroscopy are designed for protection to the patient during fluoroscopic procedure. a) Protection to Patient * A dead-man switch is a device (switch) constructed so that a circuit closing contact can only be maintained by continuous pressure on the switch by the operator. Therefore, when the machine is turned on by any means, whether by the push button at the control panel, or by the foot pedal, this switch must be held in for the machine to remain on. * The on-time of the fluoroscopic tube must be controlled by a timing device, and must end alarm when the exposure exceeds 5 minutes. An audible signal must alert the user to the completion of the preset on time. This signal will remain on until the timing device is reset. * The X-ray tube used for fluoroscopic must not produce X-rays unless a barrier is in position to intercept the entire cross-section of the useful beam. The fluoroscopic imaging assembly must be provided with shielding sufficient that the scatter radiation from the useful beam is minimized. * Protective barriers of at least 0.25 mm lead equivalency must be used to attenuate scatter radiation above the tabletop. This shielding does not replace the lead garments worn by personnel. Scattered radiation under the table must be attenuated by at least 0.25 mm lead equivalency shielding. * Additionally, most c-arm fluoroscopes have a warning beeper or light that activate when the beam is on, some have both. Never inactivate any warning devices, and keep ones foot off the foot pedal whenever possible. * Methods of limiting radiation exposure include: o making certain that the fluoroscopy unit is functioning properly through routine maintenance, o limiting fluoroscopic exposure time, o reducing fields of exposure through collimation, o keeping the X-ray source under the table by avoiding cross-table lateral visualization when possible, and o bringing the image intensifier down close to the patient b) Protection to personnel There are therefore three basic ways to minimize dose: * Reduce time of exposure * Use the inverse square law-doubling your distance away quarter your exposure * Use shielding by barrier These basics known as Cardinal Principle which is important to achieved ALARA. i) Time Radiation dose is directly proportional to the time, those by doubling the radiation time the dose is doubled and by having the radiation time the doses halved. Many factors impact the on time of a fluoroscopic procedure. The exposure time is related to radiation exposure and exposure rate (exposure per unit time) as follows: Exposure time = Exposure/Exposure rate Exposure = Exposure rate x time The algebraic expressions simply imply that if the exposure time is kept short, then the resulting dose to the individual is small. Method of reducing exposure time include meticulous advanced planning of the procedure, judicious use of contrast enhancement, appropriate positioning of the patient, orientation of the fluoroscope unit prior to beginning the procedure. ii) Distance The second radiation protection action relates to the distance between the source of radiation and the exposed individual. The exposure to the individual decreases inversely as the square of the distance. This is known as the inverse square law, which is stated mathematically as: where I is the intensity of radiation and d is the distance between the radiation source and the exposed individual. For example, when the distance is doubled the exposure is reduced by a factor of four. In mobile radiography, where there is no fixed protective control booth, the technologist should remain at least 2 m from the patient, the x-ray tube, and the primary beam during the exposure. In this respect, the ICRP (1982), as well as the NCRP (1989a), recommended that the length of the exposure cord on mobile radiographic units be at least 2 m long. Another important consideration with respect to distance relates to the source-to-image receptor distance (SID). The appropriate SIDs for various examinations must always be maintained because an incorrect SID could mean a second exposure to the patient. Long SID results in less divergent beam and thus decreases the concentration of photons in the patients. Short SID results in the reverse action and increases the patient dose. Hence the longest possible SID should be employed in examinations. However, if a greater than standard SID is used then greater intensity of radiation would be required to produce the same film density. Therefore it is recommended that only standard SIDs should be used. iii) Shielding Shielding procedure the most utilitarian results in the reduction of staff dose as there are times when the procedure list simply must function in close proximity, even directly cines fluoroscopy. In these circumstances there simply is no substitute for the best modern flexible lead gloves, lead glasses, lightweight lead apron and lead lined thyroid shield available. Appropriate shielding is mandatory for the safe use of ionizing radiation for medical imaging. Other method of shielding includes beam collimation, protective drapes and panels. Shielding of occupational workers can be achieved by following methods: * Personnel should remain in the radiation environment only when necessary (step behind the control booth, or leave the room when practical) * The distance between the personnel and the patient should be maximized when practical as the intensity of radiation decreases as the square of distance (inverse square law). * Shielding apparel should be used as and when necessary which comprise of lead aprons, eye glasses with side shields, hand gloves and thyroid shields. Lead aprons are shielding apparel recommended for use by radiation workers. These are classified as a secondary barrier to the effects of ionizing radiation. These aprons protect an individual only from secondary (scattered) radiation, not the primary beam. The thickness of lead in the protective apparel determines the protection it provides. It is known that 0.25 mm lead thickness attenuates 66% of the beam at 75kVp and 1mm attenuates 99% of the beam at same kVp. It is recommended that for general purpose radiography the minimum thickness of lead equivalent in the protective apparel should be 0.5mm. It is recommended that women radiation workers should wear a customized lead apron that reaches below mid thigh level and wraps completely around the pelvis. This would eliminate an accidental exposure to a concept us. Other protective apparel included eye glasses with side shields, thyroid shields and hand gloves. The minimum protective lead equivalents in hand gloves and thyroid shields should be 0.5mm. Lead lined glass and thyroid shield likewise reduce 90% of the exposure to the eyes and thyroid respectively. Lead lined gloves reduce radiation exposure to the hands; however they are no substitute for strict observation of appropriate fluoroscopic hygiene. Gloves should be considered as an effective means of reducing scatter radiation only. 2. State five clinical indications for the patient undergo the angiography procedure. 3. Explain the patient care management before, during and after the procedure Before a procedure: * Patients undergoing an angiogram are advised to stop eating and drinking eight hours prior to the procedure. * They must remove all jewelry before the procedure and change into a hospital gown. * If the arterial puncture is to be made in the armpit or groin area, shaving may be required. * A sedative may be administered to relax the patient for the procedure. * An IV line will also be inserted into a vein in the patients arm before the procedure begins in case medication or blood products are required during the angiogram. * Be aware of and follow all Local Rules and protocols * Prior to the angiography procedure, patients will be briefed on the details of the test, the benefits and risks, and the possible complications involved, and asked to sign an informed consent form. * Ensure that all exposures are justified and there is informed consent * Check patient identity * Position patient comfortably flat, with arm above head where possible * Ensure all members of staff in room are wearing suitable. For operations this should be lead glasses, thyroid collar and wrap-around lead apron * Check all staff are wearing radiation monitors correctly * Use all available lead shielding appropriately sited * Position table before screening * Keep tube current as low as possible and kVp as high as possible for cardiac studies, 60 – 90 kV is appropriate * Keep x ray tube at maximum and image intensifier / receptor at minimum distance from patient * Check all staff are as far away as possible in their role * Use dose reduction programmers when possible * Perform acquisitions on full inspiration where possible * Collimate closely to area of interest * Prolonged procedures: reduce dose to the irradiated skin eg. Change beam angulations * Minimize fluoroscopy time, high dose rate time and no of acquisitions * Remember software features, such as replay fluoro to minimize dose * Dont over use geometric magnification * Remove grid for small patients or when image intensifier / detector cannot be placed close to patient * Check and record screening time and DAP at the end of the case and review against the DRL. During the procedure: * The radiologic technologist will position you on the exam table. A radiologist a physician who specializes in the diagnostic interpretation of medical images will administer a local anesthetic and then make a small nick in your skin so that a thin catheter can be inserted into an artery or vein. The catheter is a flexible, hollow tube about the size of a strand of spaghetti. It usually is inserted into an artery in your groin, although in some cases your arm or another site will be selected for the catheter. * The radiologist will ease the catheter into the artery or vein and gently guide it to the area under investigation. The radiologist will be able to watch the movement of the catheter on a fluoroscope, which is an x-ray unit combined with a television monitor. * When the catheter reaches the area under study, the contrast agent will be injected through the catheter. By watching the fluoroscope screen, the radiologist will be able to see the outline of your blood vessels and identify any blockages or other irregularities. * Angiography procedures can range in time from less than an hour to three hours or more. It is important that you relax and remain as still as possible during the examination. The radiologic technologist and radiologist will stay in the room with you throughout the procedure. If you experience any difficulty, let them know. * Angiography also can be performed using magnetic resonance instead of x-rays to produce images of the blood vessels; this procedure is known as magnetic resonance angiography (MRA) or magnetic resonance venography (MRV). After the procedure: * Because life-threatening internal bleeding is a possible complication of an arterial puncture, an overnight stay in the hospital is sometimes recommended following an angiography procedure, particularly with cerebral and coronary angiograms. * If the procedure is performed on an outpatient basis, the patient is typically kept under close observation for a period of at six to 12 hours before being released. * If the arterial puncture was performed in the femoral artery, the patient will be instructed to keep his leg straight and relatively immobile during the observation period. * The patients blood pressure and vital signs will be monitored and the puncture site observed closely. Pain medication may be prescribed if the patient is experiencing discomfort from the puncture, and a cold pack is applied to the site to reduce swelling. It is normal for the puncture site to be sore and bruised for several weeks. * The patient may also develop a hematoma, a hard mass created by the blood vessels broken during the procedure. Hematomas should be watched carefully, as they may indicate continued bleeding of the arterial puncture site. * Angiography patients are also advised to enjoy two to three days of rest and relaxation after the procedure in order to avoid placing any undue stress on the arterial puncture. Patients who experience continued bleeding or abnormal swelling of the puncture site, sudden dizziness, or chest pains in the days following an angiography procedure should seek medical attention immediately. * Patients undergoing a fluorescein angiography should not drive or expose their eyes to direct sunlight for 12 hours following the procedure. 4. Identify the type of contrast medium, the dose and delivering technique in angiography procedure. * Reducing radiation doses to the patient also generally reduces doses to the medical personnel. Â · Angiography procedure is using fluoroscopy imaging technique which is a real-time imaging technique. 5. List down the catheters and guide wires inclusive of size, shape and the hole type that are used in angiography procedures. The use of lead gloves during procedures is unusual as they are cumbersome and difficult to work in. The automatic brightness control will increase the exposure to go through two layers and one only protects the hand, so if they are going to be used a programme that sets the radiation factors rather than allowing adjustment may be appropriate. In practice, with careful collimation and attenuation to detail it should not necessary for the operators hand to be in the primary beam and only close to it for short periods. While doing catheterization, radiologist should do it behind the lead glass viewer which consists of lead equivalent glass of 0.25mm thickness. Geometric consideration is one of the important things in angiography because source of exposure to personnel is mainly from scattered radiation from the patient. So, it is important to minimize the amount of scattered radiation to personnel. This can be achieved by geometric consideration involving the x-ray tube, patient and image intensifier. The image intensifier should be as close as possible to patient to minimize the amount of scattered radiation hitting personnel. Because in angiography room is sterile for all things, personnel such as radiologist, nurses, radiographer or student should wear shoes which are prepared only. Make sure that film badges always outside personnel body to measure the dose receive to the personnel. The most important thing to remember is that all individuals should be fully trained and learned to be responsible for radiation safety. Involvement of a radiation expert is essential and is particularly useful in equipment specification, assessment and quality assurance, but also in the formulation of Local Rules. Technique Reduces Physician Radiation Exposure During Angiography Current technique requires that physicians performing radiation procedures wear lead gowns. The new technique involves use of a body length floor mounted lead plastic panel to protect to physicians as they monitor patients angiograms and control exam table movement. An extension bar allows the physician to remain safely behind the shield and still retain table control for panning. In the study, researchers recorded radiation exposure to various parts of a physicians body during 25 coronary angiography procedures and compared those results with radiation exposure during angiography on 25 patients using conventional radiation protection. A lead apron, thyroid shield, eyeglasses and facemask were used in both techniques, but a ceiling mounted shield was used in the conventional technique. The researchers placed radiation badges outside and inside the facemask; outside and inside the thyroid shield; on the right and left arm; outside and inside the lead apron; and on the right and left leg. The new equipment resulted in a 90 percent reduction in radiation exposure to the physicians head, arms, and legs. Exposure of the thyroid and torso was minimal with both techniques. Enhanced physician radiation protection during coronary angiography is readily achievable with this new technique, said Martin Magram, M.D., of the University of Maryland Medical Center in Baltimore, Md. Dr. Magram presented the study results on May 3 at the American Roentgen Ray Society Annual Meeting in Vancouver, British Columbia. Dr. Magram pointed out that by freeing physicians from the need to wear lead gowns, the new technique could preserve their ability to benefit patients. It may extend by years their ability to apply the skills they have developed over long careers of serving patients, noted Dr. Magram. New methods of radiation protection must parallel the development of new radiation techniques, added Dr. Magram. The key is to limit medical workers radiation exposure with effective and easy-to-use techniques, and the use of this extension bar and lead plastic shield may be such a technique. Definition Angiography is the x-ray study of the blood vessels. An angiogram uses a radiopaque substance, or dye, to make the blood vessels visible under x ray. Arteriography is a type of angiography that involves the study of the arteries. Purpose Angiography is used to detect abnormalities or blockages in the blood vessels (called occlusions) throughout the circulatory system and in some organs. The procedure is commonly used to identify atherosclerosis; to diagnose heart disease; to evaluate kidney function and detect kidney cysts or tumors; to detect an aneurysm (an abnormal bulge of an artery that can rupture leading to hemorrhage), tumor, blood clot, or arteriovenous malformations (abnormals tangles of arteries and veins) in the brain; and to diagnose problems with the retina of the eye. It is also used to give surgeons an accurate map of the heart prior to open-heart surgery, or of the brain prior to neurosurgery. Precautions Patients with kidney disease or injury may suffer further kidney damage from the contrast mediums used for angiography. Patients who have blood clotting problems, have a known allergy to contrast mediums, or are allergic to iodine, a component of some contrast mediums, may also not be suitable candidates for an angiography procedure. Because x rays carry risks of ionizing radiation exposure to the fetus, pregnant women are also advised to avoid this procedure. Description Angiography is usually performed at a hospital by a trained radiologist and assisting technician or nurse. It takes place in an x-ray or fluoroscopy suite, and for most types of angiograms, the patients vital signs will be monitored throughout the procedure. Angiography requires the injection of a contrast dye that makes the blood vessels visible to x ray. The dye is injected through a procedure known as arterial puncture. The puncture is usually made in the groin area, armpit, inside elbow, or neck. The site is cleaned with an antiseptic agent and injected with a local anesthetic. First, a small incision is made in the skin to help the needle pass. A needle containing an inner wire called a stylet is inserted through the skin into the artery. When the radiologist has punctured the artery with the needle, the stylet is removed and replaced with another long wire called a guide wire. It is normal for blood to spout out of the needle before the guide wire is inserted. The guide wire is fed through the outer needle into the artery and to the area that requires angiographic study. A fluoroscopic screen that displays a view of the patients vascular system is used to pilot the wire to the correct location. Once it is in position, the needle is removed and a catheter is slid over the length of the guide wire until it to reaches the area of study. The guide wire is removed and the catheter is left in place in preparation for the injection of the contrast medium, or dye. Depending on the type of angiography procedure being performed, the contrast medium is either injected by hand with a syringe or is mechanically injected with an automatic injector connected to the catheter. An automatic injector is used frequently because it is able to propel a large volume of dye very quickly to the angiogram site. The patient is warned that the injection will start, and instructed to remain very still. The injection causes some mild to moderate discomfort. Possible side effects or reactions include headache, dizziness, irregular heartbeat, nausea, warmth, burning sensation, and chest pain, but they usually last only momentarily. To view the area of study from different angles or perspectives, the patient may be asked to change positions several times, and subsequent dye injections may be administered. During any injection, the patient or the camera may move. Throughout the dye injection procedure, x-ray pictures and/or fluoroscopic pictures (or moving x rays) will be taken. Because of the high pressure of arterial blood flow, the dye will dissipate through the patients system quickly, so pictures must be taken in rapid succession. An automatic film changer is used because the manual changing of x-ray plates can eat up valuable time. Once the x rays are complete, the catheter is slowly and carefully removed from the patient. Pressure is applied to the site with a sandbag or other weight for 10-20 minutes in order for clotting to take place and the arterial puncture to reseal itself. A pressure bandage is then applied. Most angiograms follow the general procedures outlined above, but vary slightly depending on the area of the vascular system being studied. A variety of common angiography procedures are outlined below: Cerebral angiography Cerebral angiography is used to detect aneurysms, blood clots, and other vascular irregularities in the brain. The catheter is inserted into the femoral or carotid artery and the injected contrast medium travels through the blood vessels on the brain. Patients frequently experience headache, warmth, or a burning sensation in the head or neck during the injection portion of the procedure. A cerebral angiogram takes two to four hours to complete. Coronary angiography Coronary angiography is administered by a cardiologist with training in radiology or, occasionally, by a radiologist. The arterial puncture is typically given in the femoral artery, and the cardiologist uses a guide wire and catheter to perform a contrast injection and x-ray series on the coronary arteries. The catheter may also be placed in the left ventricle to examine the mitral and aortic valves of the heart. If the cardiologist requires a view of the right ventricle of the heart or of the tricuspid or pulmonic valves, the catheter will be inserted through a large vein and guided into the right ventricle. The catheter also serves the purpose of monitoring blood pressures in these different locations inside the heart. The angiogram procedure takes several hours, depending on the complexity of the procedure. Pulmonary angiography Pulmonary, or lung, angiography is performed to evaluate blood circulation to the lungs. It is also considered the most accurate diagnostic test for detecting a pulmonary embolism. The procedure differs from cerebral and coronary angiograms in that the guide wire and catheter are inserted into a vein instead of an artery, and are guided up through the chambers of the heart and into the pulmonary artery. Throughout the procedure, the patients vital signs are monitored to ensure that the catheter doesnt cause arrhythmias, or irregular heartbeats. The contrast medium is then injected into the pulmonary artery where it circulates through the lung capillaries. The test typically takes up to 90 minutes. Kidney angiography Patients with chronic renal disease or injury can suffer further damage to their kidneys from the contrast medium used in a kidney angiogram, yet they often require the test to evaluate kidney function. These patients should be well-hydrated with a intravenous saline drip before the procedure, and may benefit from available medications (e.g., dopamine) that help to protect the kidney from further injury due to contrast agents. During a kidney angiogram, the guide wire and catheter are inserted into the femoral artery in the groin area and advanced through the abdominal aorta, the main artery in the abdomen, and into the renal arteries. The procedure will take approximately one hour. Fluorescein angiography Fluorescein angiography is used to diagnose retinal problems and circulatory disorders. It is typically conducted as an outpatient procedure. The patients pupils are dilated with eye drops and he rests his chin and forehead against a bracing apparatus to keep it still. Sodium fluorescein dye is then injected with a syringe into a vein in the patients arm. The dye will travel through the patients body and into the blood vessels of the eye. The procedure does not require x rays. Instead, a rapid series of close-up photographs of the patients eyes are taken, one set immediately after the dye is injected, and a second set approximately 20 minutes later once the dye has moved through the patients vascular system. The entire procedure takes up to one hour. Celiac and mesenteric angiography Celiac and mesenteric angiography involves x-ray exploration of the celiac and mesenteric arteries, arterial branches of the abdominal aorta that supply blood to the abdomen and digestive system. The test is commonly used to detect aneurysm, thrombosis, and signs of ischemia in the celiac and mesenteric arteries, and to locate the source of gastrointestinal bleeding. It is also used in the diagnosis of a number of conditions, including portal hypertension, and cirrhosis. The procedure can take up to three hours, depending on the number of blood vessels studied. Splenoportography A splenoportograph is a variation of an angiogram that involves the injection of contrast medium directly into the spleen to view the splenic and portal veins. It is used to diagnose blockages in the splenic vein and portal vein thrombosis and to assess the strength and location of the vascular system prior to liver transplantation. Most angiography procedures are typically paid for by major medical insurance. Patients should check with their individual insurance plans to determine their coverage. Aftercare Risks Because angiography involves puncturing an artery, internal bleeding or hemorrhage are possible complications of the test. As with any invasive procedure, infection of the puncture site or bloodstream is also a risk, but this is rare. A stroke or heart attack may be triggered by an angiogram if blood clots or plaque on the inside of the arterial wall are dislodged by the catheter and form a blockage in the blood vessels or artery. The heart may also become irritated by the movement of the catheter through its chambers during pulmonary and coronary angiography procedures, and arrhythmias may develop. Patients who develop an allergic reaction to the contrast medium used in angiography may experience a variety of symptoms, including swelling, difficulty breathing, heart failure, or a sudden drop in blood pressure. If the patient is aware of the allergy before the test is administered, certain medications can be administered at that time to counteract the reaction. Angiography involves minor exposure to radiation through the x rays and fluoroscopic guidance used in the procedure. Unless the patient is pregnant, or multiple radiological or fluoroscopic studies are required, the small dose of radiation incurred during a single procedure poses little risk. However, multiple studies requiring fluoroscopic exposure that are conducted in a short time period have been known to cause skin necrosis in some individuals. This risk can be minimized by careful monitoring and documentation of cumulative radiation doses administered to these patients. Normal results The results of an angiogram or arteriogram depend on the artery or organ system being examined. Generally, test results should display a normal and unimpeded flow of blood through the vascular system. Fluorescein angiography should result in no leakage of fluorescein dye through the retinal blood vessels. Abnormal results Abnormal results of an angiography may display a restricted blood vessel or arterial blood flow (ischemia) or an irregular placement or location of blood vessels. The results of an angiography vary widely by the type of procedure performed, and should be interpreted and explained to the patient by a trained radiologist. Arteriosclerosis A chronic condition characterized by thickening and hardening of the arteries and the build-up of plaque on the arterial walls. Arteriosclerosis can slow or impair blood circulation. Carotid artery An artery located in the neck. Catheter A long, thin, flexible tube used in angiography to inject contrast material into the arteries. Cirrhosis A condition characterized by the destruction of healthy liver tissue. A cirrhotic liver is scarred and cannot break down the proteins in the bloodstream. Cirrhosis is associated with portal hypertension. Embolism A blood clot, air bubble, or clot of foreign material that travels and blocks the flow of blood in an artery. When blood supply to a tissue or organ is blocked by an embolism, infarction, or death of the tissue the artery feeds, occurs. Without immediate and appropriate treatment, an embolism can be fatal. Femoral artery An artery located in the groin area that is the most frequently accessed site for arterial puncture in angiography. Fluorescein dye An orange dye used to illuminate the blood vessels of the retina in fluorescein angiography. Fluoroscopic screen A fluorescent screen which displays moving x-rays of the body. Fluoroscopy allows the radiologist to visualize the guide wire and catheter he is moving through the patients artery. Guide wire A wire that is inserted into an artery to guides a catheter to a certain location in the body. Iscehmia A lack of normal blood supply to a organ or body part because of blockages or constriction of the blood vessels. Necrosis Cellular or tissue death; skin necrosis may be caused by multiple, consecutive doses of radiation from fluoroscopic or x-ray procedures. Plaque Fatty material that is deposited on the inside of the arterial wall. Portal hypertension A condition caused by cirrhosis of the liver. It is characterized by impaired or reversed blood flow from the portal vein to the liver, an enlarged spleen, and dilated veins in the esophagus and stomach. Portal vein thrombosis The development of a blood clot in the vein that brings blood into the liver. Untreated portal vein thrombosis causes portal hypertension. For Your Information Books * Baum, Stanley, and Michael J. Pentecost, eds. Abrams Angiography. 4th ed.