Iconography of power Case Study Example | Topics and Well Written Essays - 500 words

Iconography of intensity - Case Study Example Old craftsmanship utilizes chain of importance of scale to support pictures of intensity. It very well may be characterized as explicit control with the measures of items and space so as to pressure the most significant ones of every a structure. For example, in the Standard of Ur individuals of high economic wellbeing are essentially greater than their workers. The equivalent applies to Naram-Sin's delineation since it is greater than some other article in the structure. Significant figures are regularly portrayed in applied stances which add exceptional importance to a fine art. In the Naram-Sin triumph stele, the lord remains over the entirety of his devotees to introduce his control over them. The leaders of the adherents are gone to Naram-Sin to show their regard. In the Standard of Ur, all lords sit while their slaves stand. Sitting is a benefit as it focuses on individuals' high societal position contrasted with the individuals who stand near them. Account arrangement is an or ganization which recounts to a story by putting objects in their connection to each other. For example, Warka jar is a genuine case of an account creation; it shows the relations between individuals, divinities, creatures, water and plants. All items have similar extents; associations between them make the story which clarifies numerous insights regarding the way of life that made the jar. Another genuine case of account structure is the Battle of Till Tuba; this stone alleviation portrays a fight scene where all characters are delineated in real life. In contrast to hieratic sythesis, where relations between individuals are rendered.

A survey of one Financial Market Anomaly (e.g. The Momentum Effect and Essay

A study of one Financial Market Anomaly (for example The Momentum Effect and Market Efficiency) - Essay Example Peculiarities indicate either showcase incapability or inadequacies in the principal resource estimating model. Logically, showcase irregularity is viewed as a cost and profit miscount for monetary market which seems to restrict ‘efficient advertise hypotheses’ (Schwert, 2002). This report depends on the study of one money related market oddity named ‘turn-of-the-year’ impact. The target of the report is in this manner to perceive and portray the purposes behind the event of turn-of-the-year peculiarity. Moreover, the report likewise intends to see how this irregularity impacts the part of market effectiveness. Meaning of Turn-of-the-Year Anomaly The turn-of-the-year impact characterizes a diagram of expanded exchanging amount and higher stock costs the year end (for example a week ago of December) and in the start of year (for example the initial fourteen days of January). As per Keim (1983) and Reinganum (1983), lion's share of sporadic incomes created by little associations occurs during the initial fourteen days of January. This peculiarity is perceived as turn-of-the-year impact. In this unique situation, Roll (1983) had estimated that higher eccentrics of little capitalisation stocks cause significant transient capital misfortunes. A large portion of the financial specialists henceforth want to acknowledge annual duty before year end. This pressure prompts more deals of stock toward the finish of year, bringing about significant minimisation of costs of little capitalisation stocks (Schwert, 2002). Example of Turn-of-the-Year Anomaly The investigation of the Return on Investment (ROI) of US alongside other key money related markets continually found vigorous dissimilarities in stock yielding conduct over the year. The accompanying figure therefore outlines the normal ROI on month to month premise from 1927 to 2001 in the US: Source: (Stern School of Business, 2012) From the above figure, it very well may be seen that the profits on interest in January from 1927 to 2001 were impressively higher in the US in contrast with the arrival of different months. This example of profits can be seen in the initial fourteen days of January. To be expressed, the turn of the year impact was significantly more observable for little associations in correlation with huge associations (Stern School of Business, 2012). In any case, the turn-of-the-year abnormality was found out to b just existing in those business sectors where singular personal assessments are dynamic. In the comparable setting, the example of the financial exchanges of Hong Kong revealed a turn-of-the-year impact attributable to the way that there were no capital increases from charges. Also, in China the capital gains on charges are considered as uniform which doesn't offer any sort of affectation for speculators during year closes. Accordingly, turn-of-the-year irregularity is not really seen in China just as in Hong Kong (Ji, 2008). Disclosure of Turn-of- the-Year Anomaly The occasional inconsistency had been first distinguished by Sidney B. Watchel in the year 1942. Sequentially, in the year 1976, Rozeff and Kinney had reported the turn-of-the-year impact in New York Stock Exchange (NYSE) just because. They had discovered that the normal yield of

Opinion 4 ways to bring human rights into development work (via APSIA) COLUMBIA UNIVERSITY - SIPA Admissions Blog

Opinion 4 ways to bring human rights into development work (via APSIA) COLUMBIA UNIVERSITY - SIPA Admissions Blog 4 ways to bring human rights into development work Were resharing this post by the Association of Professional Schools of International Affairs (APSIA), originally posted here. APSIA brings leading graduate schools around the world which specialize in international affairs including SIPA! Well be at the APSIA graduate fairs in Madrid, Paris and London this week. If youre in the area, come meet SIPA admissions and find out more about an advanced career in public policy and international affairs. 4 ways to bring human rights into development work Seventy years ago, the world laid out a common standard of fundamental rights for all people, which they said should be universally defended. Now, the global environment is shifting. Nations that once led the way in promoting cross-border protections are retrenching. Scandals undercut major international development agencies when they fail to uphold these sentiments. Meanwhile, corporations â€" once vilified for their behavior â€" are building human rights into their work. “Human rights touches every aspect of a company’s operations,” Margaret Jungk, managing director for human rights at  Business for Social Responsibility, said in 2016. Today, corporations such as  Facebook  see “the responsibility [they] have to respect the individual and human rights of the … global community”  â€" and  hire accordingly, as stated in a recent job vacancy at the social media network. Incorporating human rights into development work may require you to consider national politics, social media, sexual discrimination, and everything in between. To successfully navigate a new public, private, and nonprofit development landscape, four traits will be critical. 1. Context is key Just as in broader questions of global development, human rights considerations are rarely clear-cut. Context matters. Are you trained to understand the economic, political, social, cultural, and historical factors at play? Can you identify the forces influencing a situation? Are you qualified to perform proper due diligence? Human rights work has to be focused within the contexts where development is playing out, said Francisco Bencosme, Asia-Pacific advocacy manager at Amnesty International. In Myanmar, an entrenched system of apartheid can change the analysis of a seemingly positive housing project. [For example, under] the guise of development for Rakhine State, we have in the past seen new homes constructed for ethnic minorities on top old homes that used to belong to the Rohingya. It is these kind of development practices that need to take human rights contexts into account, Bencosme said. Seek out educational and professional opportunities that develop a flexible framework for evaluating decisions. One size will not fit all. Mark Maloney, vice dean at the  Sciences Po  Paris School of International Affairs, explained: “Adaptability is a key skill [one] even more important in humanitarian work because the stakes can be considerably higher when things go wrong.” “For that reason, understanding the context, including relationships within and between parties, is a fundamental skill we try to develop through our  Master in Human Rights and Humanitarian Action” he added. “This skill also maximizes the likelihood that our graduates will make the right decision at the right moment when undertaking action on the ground.” 2. Be ‘client-ready’ Development professionals must tailor their work to many constituencies. Have you practiced framing a discussion to make sense to diverse groups? Have you learned to persuade people while recognizing their different needs? Do you have the credentials to make people listen to what you have to say? Learn to write and present arguments in clear, concise, and compelling ways. Work to improve your cross-cultural competencies. Expand proficiency in different languages. Look for opportunities to get close to the communities you want to serve, as well as to the funders, governments, and companies working on the ground. “The human rights framework brings a human-centered analysis to the work of development professionals,” said Barbara Frey, director of the  human rights program  at the University of Minnesota  Humphrey School of Public Affairs. “This analysis starts with the question: Who is the rights bearer and who is the duty bearer in a situation? [It] tests how the consequences of actions can help or harm the clients [you] seek to serve.” 3. Develop connections Access to individuals and information is critical to getting the job done. With whom have you cultivated connections? From whom can you get critical information? Have you developed academic and professional networks to open doors? Maintain relationships throughout your career via social media and in-person ties. Seek the counsel of former classmates, professors, or colleagues. Look for undergraduate or graduate schools with close ties to the field. For example, students at the  International Human Rights Center  at Korea University’s  Graduate School of International Studies  incorporate concern for human rights into a wide range of activities. They build networks, workshops, and symposia in partnership with Human Asia, a human rights NGO in South Korea. According to the school, these opportunities prepare students to “serve as productive members of their organizations and to play leadership roles in the international community.” 4. Character is destiny Easy answers do not always present themselves. Are you bold enough to choose the difficult route? Can you withstand criticism from naysayers who cannot or will not envision anything beyond the status quo? Do you know how to rejuvenate your spirit when things look bleak? “Forces larger than yourself will make you face some tough moral choices,” said Reuben Brigety, dean of  George Washington University’s  Elliott School of International Affairs. From his time at  Human Rights Watch  and the  U.S. State Department, he has counseled young professionals to realize that “your character is your destiny. Have courage!” To succeed at the intersection of human rights and development, you must ask good questions. Tailor your approach; build diverse networks; and, cultivate an internal moral compass to navigate the changing human rights and global development landscape.

The Pharaohs Double Crown of Egypt

Ancient Egyptian pharaohs are usually depicted wearing a crown or a head-cloth. The most important of these was the double crown, which symbolizes the unification of Upper and Lower Egypt and was worn by pharaohs starting with the First Dynasty around the year 3000 BCE. Its ancient Egyptian name is the pschent. The double crown was an amalgamation of the white crown (Ancient Egyptian name hedjet) of Upper Egypt and the red crown (Ancient Egyptian name deshret) of Lower Egypt. Another name for it is shmty, meaning the two powerful ones, or sekhemti. The crowns are seen only in artwork and no specimen of one has been preserved and discovered.  In addition to the  pharaohs, the gods Horus and Atum are depicted wearing the double crown. These are gods that are closely allied with the pharaohs. Symbols of the Double Crown The combination of the two crowns into one represented the rule of the pharaoh over his united kingdom. The red deshret  of Lower Egypt is the outer portion of the crown with cutouts around the ears. It has a curled projection in front that represents the proboscis of a honeybee, and a spire in the back  and an extension down the back of the neck. The name deshret  is also applied to the honeybee. The red color represents the fertile land of the Nile delta. It was believed to have been giving by Get to Horus, and the pharaohs were the successors of Horus. The white crown is the interior crown, which was more conical or bowling pin shaped, with cutouts for the ears. It may have been assimilated from the Nubian rulers before being worn by rulers of Upper Egypt. Animal representations were fastened to the front of the crowns, with a cobra in attack position for Lower Egyptian goddess Wadjet and a vulture head for the goddess Nekhbet of Upper Egypt. It isnt known what the crowns were made of, they could have been made of cloth, leather, reeds, or even metal.  Because no crowns have been found in burial tombs, even in those that were undisturbed, some historians speculate they were passed from pharaoh to Pharaoh. History of the Double Crown of Egypt Upper and Lower Egypt were united around the year 3150 BCE with some historians naming Menes as the first pharaoh and crediting him for inventing the pschent. But the double crown was first seen on a Horus of the pharaoh  Djet  of the First Dynasty, around 2980 BCE. The double crown is found in the Pyramid Texts. Nearly every pharaoh from 2700 through 750 BCE was depicted wearing the pschent in hieroglyphs preserved in tombs. The Rosetta Stone and the king list on the Palermo stone are other sources showing the double crown associated with pharaohs. Statues of Senusret II and Amenhotep  III are among many showing the double crown. The Ptolemy rulers wore the double crown when they were in Egypt but when they left the country they wore a diadem instead.

Steroids in Professional Baseball Essay - 1185 Words

Perhaps one of the most controversial topics in Major League Baseball is the discussion of the use of steroids and human growth hormones. Both are completely illegal in the sport, and come with drastic consequences. One would think a fifty game suspension as a first offense would scare players away, but for some reason steroids in baseball is occurring more and more often to the disappointment of Major League Baseball. The reason players take steroids in the first place is to enhance their performance on the field. Steroids make players stronger and they perform at a higher rate. Another use for steroids is to help the players on certain rehab assignments for injuries. Either way, it is still illegal and banned in the sport. One†¦show more content†¦Before steroids Barry Bonds was a lock for the Hall of Fame, now it is believed he will not even get in because he cheated. â€Å"Bonds gulped as many as 20 pills at a time and was so deeply reliant on his regimen that h e ordered Anderson to start cycles -- a prescribed period of steroid use lasting about three weeks -- even when he was not due to begin one†(Williams). Some extreme fans are calling for an asterisk next to his statistics in the record books. Barry still played after the news came out, and the harassment got so bad, that Barry eventually retired. When he went to opposing stadiums fans would hold up signs with an asterisk mark, or they would throw toy syringes at him while he was in the field. Chants of â€Å"who’s you’re dealer?† also surfaced at opposing ball parks. The fans took harassment to the next level on Barry Bonds. Another steroid controversy was when the Mitchell Report was released. The Mitchell Report was created by George Mitchell, a former US Senator. The report took over twenty months to complete, and it was commissioned by not only Mitchell, but Major League Baseball as well. Major League Baseball has occasional, random, steroid te sting and the players that tested positive were named in the Mitchell Report. The report released the names ofShow MoreRelatedSteroids in Professional Baseball2189 Words   |  9 Pagessurveyed that all the athletes in baseball that were tested for steroids and shown positive should have been banned from the game. In the year 2005 it was discovered that two out of three people agreed with banning the players who made it to the Hall of Fame but tested positive for steroids. Most if not all people consider this action cheating and frown upon its use. How could this be? In today’s readings of sports articles and papers, fans tend to think that steroids give other players an unfair advantageRead MoreThe Media Of Baseball And The Case Against Roger Clemens Essay1560 Words   |  7 Pagesrole in the development of people perceptions and attitudes towards certain things that occur in the modern history. The link between the growing popularity of the baseball as well as increased attention to the steroids used represent topics that were highly affected by the media. The article by Healey Fall Of The Rocket: Steroids In Baseball And The Case Against Roger Clemens (2008) reveals how the drug policy has developed over time. This source explains and examines Major League Baseball’s drug policyRead MoreSpeech On Steroids And Major League Baseball1638 Words   |  7 Pagesthis record is controversial, due to steroid use. B. Thesis: Today I am going to persuade you all about the use of steroids in Major League Baseball, persuading you why steroids should not be allowed in Major League Baseball. I have a call to action for all of you to help others if they are considering using steroids, and next time you watch a MLB game to realize the impact of steroids. C. Credibility: Gave my informative speech on Steroids in Major League Baseball D. WIIFM: My survey stated you allRead More Steroid Use in Major League Baseball Essay example1596 Words   |  7 PagesSteroid Use in Major League Baseball Steroids are unhealthy for baseball players and they are giving the game of baseball a bad reputation. Since steroids have become such a hot topic in Major League Baseball (MLB) fans have had nothing but bad things to say about the sport and its players. When sports illustrated asked some of its readers to give reaction to the steroid controversy in the MLB here is what baseball fan Howard Langsner from New York had to say Horrible, just horrible. We takeRead MoreWhat Performance Enhacing Drugs Have Done to Sports1219 Words   |  5 PagesProfessional athletes are competitive by nature and will do what it takes to win. Sports have been used as not only entertainment but a way for a person to show off their athletic ability. Due to uncontrollable factors people may find it harder to compete or surpass other’s performance. Even with training people’s bodies respond different to physical stimulation. Professional baseball is an extremely competitive sport with hand-eye coordination and strength being key factors. When the differenceRead MoreSteriods in Sports Should Be Banned1295 Words   |  6 PagesSheila Sim Mrs. Virginia Link-Pease English 122 02 October 2010 Steroid Use in Sports Should Be Banned Day by day professional athletes are being praised for their ability and accomplishments in their respective sports. The professional athletes that are succeeding the most are generally using performance enhancing drugs, other known as anabolic steroids (Mayo Clinic). Anabolic steroids are drugs which imitate the effect of the male sex hormone, Testosterone. The cells producing protein increaseRead MorePED in Sports Essay1644 Words   |  7 Pagesthe honesty of the game, but also can have broader social affects that one may not even realize. The use of performance enhancing drugs is especially apparent in Major League Baseball. This problem can be traced back to the 1980’s when baseball was facing one of its first â€Å"dark periods†. During the 1980’s Major League Baseball was experiencing a home run drought. Home run totals were down as far as they had been since Babe Ruth, and fans were seemingly becoming bored with the sport. The lack of homeRead MoreSteroi ds And Other Performance Enhancing Drugs1678 Words   |  7 PagesSteroids and other performance enhancing drugs have been banned from Major League Baseball since 1991; however, this law was not strictly enforced by the Major League Baseball Players Association (Anabolic Steroids). The MLBPA to date has become much more involved in the issue of PED use in the MLB, and they do test many of the players for traces of steroids. Few players are caught each year, but when a big name pops up, the whole debacle headlines newspapers, constantly talked about on sports networksRead MoreThe Impact of Steroid Allegations on Sports Heroes and Their Fans1037 Words   |  4 Pagesthan at any other time in the history of professional sports, todays contemporary sports climate provides an intimacy of details about the usage of steroids and performance enhancing drugs for some of the worlds most popular athletes. Whereas once the uncovering of an athletes illicit use of such substances was shocking and anomalous, contemporary stories of steroid use are fairly routine and even commonplace in certain sports, such as Major League Baseball. Allegations levied against athletes likeRead MoreAthletes Should Use Performance Enhancing Drugs941 Words   |  4 Pagesyour choosing? Therefore, this is one of the reasons why I think steroids should be able to be used for anything of the professional athletes choosing.. Due to the amount of people using performance enhancing drugs in pro sports today, most people when they hear â€Å"Steroids† they think of huge men or women with big bulging muscles. Steroids have been used throughout sports in every way in almost every sport. I think that the professional athletes that use performance enhancing drugs should be able to

Legal Issues in Interviewing Free Essays

I would never try to pronounce the name the way Lance did. I would simply ask how to pronounce the candidate’s name. I would then ask the candidate to tell me a little about themselves. We will write a custom essay sample on Legal Issues in Interviewing or any similar topic only for you Order Now This is the part the usually will disclose where they are from, if they have children, married or not, where they went to school, and their interests. 2. Incarceration Insult: If I felt that the candidate may have a criminal record I would then discuss the back ground check that will be performed. Hopefully this Is when the candidate will speak up If they do have a criminal back ground. . Elderly Error: I don’t see why this is coming up in the interview anyways. This is an inappropriate question and should never be asked. If the interviewer feels that he or she should know this information then they should have the candidate fill out an application that will have them put their DOBB down and then Just do the math. 4. Medical Muddle: How Lance words this Is again unprofessional and Inappropriate. An easier way to may ask the candidate If there Is anything that may restrict them in doing any of the work duties that they are applying for. . Offspring Offense: This is important i nformation to know but the key is how to word the question without offending anyone. I would explain that the Job will have some demanding hours and shifts. I would further explain that they may have to cover and work doubles or work evening hours. Then I would ask them if there was anything that would prevent them for being able to work these hours. 6. Interview. 7. Language Louse-Up: This again was very unprofessional and irrelevant. I would check the resume to see if the candidate is bilingual. If so I would then ask him what languages and leave that subject at that. 8. Pregnancy Problem: If the candidate is fit for the position and will do well with the company I would offer the job and then discuss maternity leave with the candidate. 9. Racial Rudeness: Asking anything that is related to the candidate’s race is irrelevant and unprofessional. I would never ask anything like this. 10. Religious Ruckus: Again this is an inappropriate question that does not need to be asked or brought up. I loud give her the information regarding paid holidays if it got to that point in the interview and let her know if she needs a different holiday that is not listed then she can feel free to use her vacation time for this holiday. I think that if I was ever in an interview with Lance and he asked me the questions like he did in the video I would definitely cut the interview short and ask to speak to his supervisor. Most questions asked in this video were done very condescending and rude. Most likely Lances superiors have no idea that this is how interviews candidates. How to cite Legal Issues in Interviewing, Papers

Comparison Between Business and Public Sector Reporting

Question: Discuss about theComparison Between Business and Public Sector Reporting. Answer: Introduction The present report is based on the differences available in reporting format of Business and public sectors. The information regarding key financial resources and key performances indicators have been discussed in the report. Analytical Summary: Key Performance Indicators The above table represents the key performance indicators of all the three organisations. As a department of social service and department of treasury finance are related to the government sector, hence their performance will not be measured on financial parameters as in the case of the private sector and the same has been presented above. The performance of the two organisation is on the basis of the work done by the for the benefit of society. In the case of Australia post, details regarding the reason for loss have been provided in the annual report, and the same is not present in the report of other two organisations. The annual report of government organisation mainly provides details regarding the programmes organised by them for the welfare of society and the annual report of private organisations emphasis on the achievements attained by the company in the industry to which it belongs. It consists a statement of activities it has performed for the benefit of environment and so ciety. In all three performance of, Department of treasury and finance is better it is because they are generating surplus by making effective utilisation of available resources. Key Financing Sources The financing sources of the government sectors are the funds which are provided to them as per the regulations and law. On the other hand, sources of private sectors are equity and borrowing which are made available to them according to their profitability status by external resources. The funds are appropriated to government organisations according to the need or nature of the liability which has to be completed and not on the basis of profit or solvency status of the organisation. The main focus is given on the work done by the organisations in the annual report of government organisation and in the case of private sectors the emphasis is on the profit, turnover and sources of finance and parameters regarding the solvency of organisation. Table showing comparison of key performance indicators and sources of financing of government and private sector Name of the entity Income statement Position statement Cash flow statement Statement of changes in equity Statement of commitment Key Performance Indicators Key sources of financing Department of social service Yes Yes Yes Yes No Social Security Families and Communities Ageing and Aged Care (Department of Social Services Annual Report 201415) Finance is provided through the appropriation of act payment is received for two kinds of funding departmental and administering. Australia Post Yes Yes Yes Yes No Loss after tax of $221.7 million which included loss of incorporation year i.e. $190million. Cash Investment amounting $ 349.9 million has been made across projects and asset replacement and acquisition. Parcel service business is the key driver of growth as it delivered growth uplift of 3.6% or $112.8 million. (Australian Post Annual Report 201415.) 1. Issue of equity 2. Bonds. 3. Borrowings. Department of treasury and finance Yes Yes Yes Yes Yes Operating cash flows surplus to revenue. Gross debt to revenue Interest expense to revenue. (VIC Government Financial report 2014-2015.) 1. Advances. 2. Borrowing. 3. Deposits. References Australian Post Annual Report 201415. [Online]. (2015). Available throughhttps://auspost.com.au/about-us/publications. [Accessed on 25th September 2016.] Department of Social Services Annual Report 201415. [Online]. (2015). Available through https://www.dss.gov.au/sites/default/files/documents/10_2015/dss_2014-15_annual_report_wcag.pdf. [Accessed on 25th September 2016.] VIC Government Financial report 2014-2015. [Online]. (2015). Available throughhttps://www.dtf.vic.gov.au/Publications/Government-Financial-Management-publications/Financial-Reports/2014-15-Financial-Report-incorporating-Quarterly-Financial-Report-No-4.[Accessed on 25th September 2016.]

English Proficiency in the Philippines Essay Example

English Proficiency in the Philippines Essay Introduction Because English is so widely spoken, it has often been referred to as a world language, the lingua franca of the modern era, and while it is not an official language in most countries, it is currently the language most often taught as a foreign language. The history of the English language really started with the arrival of three Germanic tribes who invaded Britain during the 5th century AD. These tribes, the Angles, the Saxons and the Jutes, crossed the North Sea from what today is Denmark and northern Germany. At that time the inhabitants of Britain spoke a Celtic language. But most of the Celtic speakers were pushed west and north by the invaders mainly into what is now Wales, Scotland and Ireland. The Angles came from England and their language was called Englisc from which the words England and English are derived. Approximately 375 million people speak English as their first language. English today is probably the third largest language by number of native speakers, after Mandarin Chinese and Spanish. However, when combining native and non-native speakers it is probably the most commonly spoken language in the world, though possibly second to a combination of the Chinese languages (depending on whether or not distinctions in the latter are classified as languages or dialects). Countries such as the Philippines, Jamaica and Nigeria also have millions of native speakers of dialect continua ranging from an English-based creole to a more standard version of English. The Philippine-American connection has undergone considerable changes since then. We will write a custom essay sample on English Proficiency in the Philippines specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on English Proficiency in the Philippines specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on English Proficiency in the Philippines specifically for you FOR ONLY $16.38 $13.9/page Hire Writer Today, English the means the Americans used to teach us via the mass media, the arts, social, business and political interaction continues to be a strong thread that binds the two nations. The Spanish language, meanwhile, has been relegated to a college elective and to private gatherings of wealthy clans of Spanish descent. Why has English become so easy to learn and so easy to use in the Philippines? A major reason is that the Americans were once our colonizers and continue to influence our everyday lives in many ways. Another reason is that for most Filipinos, English is not seen as a foreign language. In a country of 60 million people who speak no less than 8 languages, English is a second language. In some areas, English is more popular than our official national language. For a select few, it is even a first language. It is not unusual to see Filipino children responding to and speaking English words long before they learn these in school According to Philippine statistics data released on March 18, 2005-six out of ten persons aged 5 years and over can speak English. Among household population 5 years old and over, 63. 71 percent of them can speak English. NCR (81. 75 percent) was the highest across regions followed by Ilocos Region (73. 75 percent), CAR (70. 99 percent), and Central Luzon (70. 12 percent). The lowest was ARMM (29. 44 percent). On the other hand, there was a relatively higher proportion among females (7. 39 percent) than males (5. 61 percent) with academic degree holder who can speak English. Body Usually, by the time the child enters elementary school, he or she has built a vocabulary of English that includes body parts, names of animals and objects, action verbs, simple adjectives (dirty, good, bad), polite expressions (please, thank you, Im sorry), nursery rhymes, and simple questions (Whats your name? How old are you? ) For most middle and upper class Filipino children, English begins at home with adults who use English or through snatches of English words and phrases heard over the radio and on TV. To the Filipino child or, at least, one who has grown up in a home where English is often heard and spoken, English is not an alien tongue. Filipino children may not understand the nuances of the English language, but its there and its theirs to manipulate. English is familiar and, better yet, user-friendly. Anybody can use it and once you get the hang of it, theres really nothing to it. The fact that the Philippine education system has been using English as a medium of instruction from elementary to university level for decades has also reinforced the notion that English is easy even a child can do it and available. It is a tool for learning and a medium of communication. More than this, English is the language of power and progress. In the Philippines, it is highly valued not only because it is functional and practical and washes over us constantly, but more importantly, because it is an affordable item, a skill that can be used to increase ones position, respectability and marketability. In most cases, the better ones ability to understand and use English, the better ones chances of career advancement. This is true for both extremes of the socio-economic ladder. English is as important to the Harvard-educated Filipino working in Manilas cosmopolitan business district as it is to the overseas contract worker working as a domestic helper in Saudi Arabia. In fact, now, more than ever, English is important to the Filipino masses seeking employment abroad. The Filipinos skill and cheap labor are in demand, yes, but so is their command and comprehension of English which makes it easy for foreign employers to tell them what to do. English, after all, is a global language and, luckily some say unluckily Filipinos managed to unravel this code quite early and easily. In recent years, serious questions have been asked about the appropriateness of English as a medium of communication for a people searching for a clear-cut identity. Filipinos are not Americans, our nationalists cried. Why then do we continue to dream their dreams and speak their language? Much as our purists and nationalists wanted to erase all traces of American colonial influence, they knew that the language, rather than the dreams, was less difficult to delete. Or so, they thought. Like the US military bases in the Philippines, English had become a symbol of the subtle but strong dominance of America. It took a strong-willed Philippine Senate and the eruption of Mount Pinatubo to figuratively and literally bury the US bases in ashes. Obliterating English is another matter. Despite presidential orders to require government offices to communicate in our national language, and requiring all schools to use it as a medium of instruction, the campaign to Filipinize our information and communication highways and networks has not met with much enthusiasm or success. Although most Filipinos understand and are literate in the national anguage, it is not their mother tongue. Many of us have little use for it except when travelling to other areas in the country, watching local movies made in Manila, reading comics and tabloids published in Manila, watching local TV programs produced in Manila, and listening to the pronouncements of national officials, most of whom come from the capital region. Filipino, our national language, is 95% Tagalog, a dialect (or language, some scholars insist) spoke n by those who live in Manila and its outlying areas. The rest of the country speak their own dialects or languages and many see the use-Filipino campaign as nothing more than another form of domination by those who reside in the seat of economic and political power. Meanwhile, the education system, long used to English textbooks and instruction, had to scramble for Filipino books and qualified teachers who could speak Filipino. Unfortunately, the government failed to consider the difficulties and the huge amount of money needed in transforming centers of learning from English to Filipino. In a setting where education is one of the lowest budget priorities, where teachers are among the lowest paid professionals, and where the systematic translation of English to Filipino has never been given serious thought or considered important, the shift from English to Filipino ended in confusion and frustration. Perhaps, the best lesson we can learn from that experience is that language grows slowly. It cannot be transplanted and expected to blossom quickly by a mere presidential decree. The English language should be used correctly and proficiently. This does not only include pronouncing the words right but also using the grammar correctly either in speaking or writing. It is true that millions of us Filipinos use the English language, but the question is that are we all using it right? Here in Cagayan de Oro, it could not be denied that the level of education varies from every school. Thus, the degree of learning also differs. The phrase â€Å"nose bleed† has been a subject of ridicule in the city for those who are hesitant to respond in English when conversing. Call center companies have provided jobs for the local Kagayanons and this requires being well versed in the English language. Universities have also produced proficient graduates. But although these factors may seem relevant, it doesn’t conceal the fact that the level of English proficiency in the city is declining. And this is also true to other areas in the country. According to the Philippine Star the findings of a group, which was accredited to administer English proficiency tests that the skill of Filipinos on the language is deteriorating. Deputy presidential spokesperson Lorelei Fajardo was commenting on the report from the IDP Education Pty. Ltd. Philippines that showed the average score of Filipinos who took the International English Language Testing System (IELTS) last year was a poor 6. 69 where 7. 0 is the passing score. A made on how English is taught in schools, explained the poor scores in the IELTS. The level in English proficiency was also â€Å"obviously affected by the standards of resources available, especially the textbooks. † Filipinos are exposed to less and less English as programs in the local language now dominate television. The apparent deteriorating quality of teachers teaching English, error-riddled English textbooks and the decreasing English content in public primetime television were seen as the cause of the declining level of English proficiency in the Philippines. The government should address these causes if the country seeks to retain its image as foremost supplier of workers skilled in speaking the English language. A continuous decline in Filipinos’ English proficiency could affect the growth of the call center industry which is providing employment to hundreds of thousands of workers and the chances of Filipinos getting work in other countries. As many countries are demanding higher English scores (in the IELTS), Filipinos may not be able to meet the English requirement and this will have human and economic consequences for the country,† Conclusion There is still hope that the Kagayanons’ proficiency in English will still improve and that if not all at least the majority will come to realize its importance in all fields especially as they advanced in their careers. While other Asian countries are riding the Third Wave, the Filipinos are paddling in opposite directions because many of them are afraid the wave will engulf them and drown their sense of nationhood. While others keep trying to find ways to increase their English proficiency in the light of international relations, global cooperation and rapid developments in computers and telecommunications, we have been engaged in finding a voice we can truly call our own. One day, we may find that voice and speak in unison, but until then, I believe that English can do it for us, too. That is, if we stop thinking of it as a colonial instrument that broke our spirit, but as the code that helped us break through other worlds. Language, they say, is the key to understanding others. What many Filipinos miss is that English can also be used as a key to understanding ourselves. English, after all, does not belong to America. If we accept it with grace and use it with wisdom, it can belong to the rest of the world. Bibliography Avila, Darcas M. et al. Effective Writing. Malabon City: Mutya Publishing House, 2009. Barrameda, Rosalina O. et al. (Eds) Freshman College Composition. Ateneo De Manila University, 1992. Pacasio, Emy M. et al. Basic English for College. Quezon City, Philippines: Ateneo de Manila University Press, 1999. Robles, Felicidad C. Developing English Proficiency in College, Book 2. Quezon City, Philippines: JMC Press, Inc. Vinuya, Remedios V. Santa C. Buri. College English Composition. Makati, Philippines: Grandwater Publications, 2001. The Philippine Star. May 2009

Mimesis Definition and Use

Mimesis Definition and Use Mimesis is a  rhetorical term for the imitation, reenactment, or re-creation of someone elses words, ​the manner of speaking, and/or delivery.   As Matthew Potolsky notes in his book Mimesis (Routledge, 2006), the definition of mimesis is remarkably flexible and changes greatly over time and across cultural contexts (50). Here are some examples below.   Peachams Definition of Mimesis Mimesis is an imitation of speech whereby the Orator counterfeits not only what one said, but also his utterance, pronunciation, and gesture, imitating everything as it was, which is always well performed, and naturally represented in an apt and skillful actor.This form of imitation is commonly abused by flattering jesters and common parasites, who for the pleasure of those whom they flatter, do both deprave and deride other mens sayings and doings. Also this figure may be much blemished, either by excess or defect, which maketh the imitation unlike unto that it ought to be. (Henry Peacham, The Garden of Eloquence, 1593) Platos View of Mimesis In Platos Republic (392d), . . . Socrates criticizes the mimetic forms as tending to corrupt performers whose roles may involve expression of passions or wicked deeds, and he bars such poetry from his ideal state. In Book 10 (595a-608b), he returns to the subject and extends his criticism beyond dramatic imitation to include all poetry and all visual art, on the ground that the arts are only poor, third-hand imitations of true reality existing in the realm of ideas. . . .Aristotle did not accept Platos theory of the visible world as an imitation of the realm of abstract ideas or forms, and his use of mimesis is closer to the original dramatic meaning. (George A. Kennedy, Imitation. Encyclopedia of Rhetoric, ed. by Thomas O. Sloane. Oxford University Press, 2001) Aristotles View of Mimesis Two basic but indispensable requirements for a better appreciation of Aristotles perspective on mimesis . . . deserve immediate foregrounding. The first is to grasp the inadequacy of the still prevalent translation of mimesis as imitation, a translation inherited from a period of neoclassicism is which its force had different connotations from those now available. . . . [T]he semantic field of imitation in modern English (and of its equivalents in other languages) has become too narrow and predominately pejorativetypically implying a limited aim of copying, superficial replication, or counterfeitingto do justice to the sophisticated thinking of Aristotle . . .. The second requirement is to recognize that we are not dealing here with a wholly unified concept, still less with a term that possesses a single, literal meaning, but rather with a rich locus of aesthetic issues relating to the status, significance, and effects of several types of artistic representation. (Stephen Halliwell, The Aesthetics of Mimesis: Ancient Texts and Modern Problems. Princeton University Press, 2002) Mimesis and Creativity [R]hetoric in the service of mimesis, rhetoric as imaging power, is far from being imitative in the sense of reflecting a preexistent reality. Mimesis becomes poesis, imitation becomes making, by giving form and pressure to a presumed reality . . ..(Geoffrey H. Hartman, Understanding Criticism, in A Critics Journey: Literary Reflections, 1958-1998. Yale University Press, 1999)[T]he tradition of imitatio anticipates what literary theorists have called intertextuality, the notion that all cultural products are a tissue of narratives and images borrowed from a familiar storehouse. Art absorbs and manipulates these narratives and images rather than creating anything wholly new. From ancient Greece to the beginnings of Romanticism, familiar stories and images circulated throughout Western culture, often anonymously. (Matthew Potolsky, Mimesis. Routledge, 2006)

Parents Sexuality Influence Essay Example | Topics and Well Written Essays - 750 words

Parents Sexuality Influence - Essay Example The discussion of the sexuality of children with their parents is least common. However, many people think that sexuality education must be taught from the parents. Neither the parents nor the children are not prepared to talk with each other on issues which are common at teenage like drinking, sex, drug usage etc. Many of the parents do care about such issues, want their children to have safe and healthy sex, but they don't get the appropriate time to discuss, thinks talking on sex is a vulgar subject, and do not feel comfortable in discussion it. This may be because of big generation gap between them. However, the daughter consults more than the sons do. Most of the teenagers prefer to consult sexuality education centers for their problems. These centers are quite useful as they keep young people aware of the consequences and risks of premature sex. Having sex at young age can be both harmful physically and psychologically. The society in which people are living also influences in parent-children relationship. Some society, which are conservative and are more under religious influence find it a bit easier to discuss than in socially affected place. However, it is the duty of the parents, at a certain age i.e. 14-18 years of their children, the parents must take their children into confidence and discuss on their sexual development. This is the age where sexuality becomes more common among teenagers. The people need to make it clear that sexuality is the part of maturity of humans. The parents need to talk with their children and discuss sexuality issues. The fathers can talk with the sons, similarly the mothers with their daughters, discuss about the consequences of sexuality and advice them on periodic basis i.e. after six months or yearly basis of the consequences of sexuality. In this way, if children face any serious problems, the parents can consult medical consultants or may require regular treatments. The parents need to show more frankness, openness, and attentiveness in their attitude when discussing sexuality with the children. The parents need to keep their tone cool and humble, and answer them seriously. The privac y of the child must be kept intact. The father can tell the sons about the usage of condoms and mothers can help daughters when they are in their sexual periods. However, children think their parents can help them in making their sexual decisions. Awareness Among Younger generation: The parents and sexuality centers need to provide awareness among the younger generation about the sexually transmitted diseases (STDs) such as HIV/AIDS etc. If not dealt properly with such diseases, improper pregnancy, inappropriate sex etc can be very deadly. In many European countries like Netherlands and Germany they have started sexuality awareness programs through electronic media, where parents come and give useful information to young masses. These sexuality communities can also help the parents in making them better sex educators. However in France, the children are send to such centers, and the parents cannot withdraw them before the age of 13. Although sexual education can be taught from other sources, but the love and care parents can give, children cannot get it from anywhere. Bibliography: Press Release TeenPregnancy.org. Teens Say Parents Most Influence Their Sexual Decisions.

Raising money and funding Assignment Example | Topics and Well Written Essays - 250 words

Raising money and funding - Assignment Example Financial steps to reduce chances of business failure include ensuring that the business maintains ploughed back profits, good relations with creditors and suppliers, as well as improving entrepreneurial skills (Feinleib, 2011). The factors outlined guard the new business from problems related to inadequate finances and expertise. In addition, a business plan may help foresee potential failure in business. A business plan is a statement that stipulates the business goals, an evaluation of internal and external business environments, and a plan on the means of attaining goals. The core elements of a complete business plan include the goals of the firm, its background information, means of achieving the goals, financial analysis, opportunities, and threats facing the firm, and the exit strategy (Feinleib, 2011). Sources of funding for business owners include personal savings, donations from family and friends, bank loans, as well as venture capital. The sources are mainly essential for new businesses as a preventive measure against failure. Because banks may not offer unsecured loans, effective strategies of securing funding include using equity funding where the firm offers to sell part of its value to investors who become shareholders to the firm. In addition, venture capital is preferred, in which case the venture capitalist firm owns part of the firm and shares in its profits upon providing startup

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.