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Medical Physics. Dr.Aida Radwan Tolba Assistant Professor National Cancer Institute Cairo University. التقييم. Topics of Medical Physics course. Chapter (1) Electricity within the body Chapter (2) physics of diagnostic x-ray Chapter (3) Vision

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medical physics

Medical Physics

Dr.Aida Radwan Tolba

Assistant Professor

National Cancer Institute

Cairo University

slide2

التقييم

Dr.Aida Radwan Tolba

topics of medical physics course
Topics of Medical Physics course
  • Chapter (1) Electricity within the body
  • Chapter (2) physics of diagnostic x-ray
  • Chapter (3) Vision
  • Chapter (4) Radiation protection in Medicine
  • Chapter (5) Heat and Cold in Medicine

Dr.Aida Radwan Tolba

slide4

Chapter (1)

ELECTRICITY WITHIN THE BODY

  • The electricity generated inside the body serves
  • for the control and operation of nerves, muscles,
  • and organs
  • Essentially all functions and activities of the body
  • involve electricity in some way.
  • The forces of muscles are caused by the
  • attraction and repulsion of electrical charges.
slide5

The action of the brain is basically electrical ,all

  • nerve signals to and from the brain involve the
  • flow of electrical current
  • The nervous system plays a fundamental role in
  • nearly every body function.
  • Basically, a central computer (the brain)
  • receives internal and external signals and
  • (usually) makes the proper response.
slide6

The information is transmitted as electrical

  • signals along various nerves.
  • This efficient communication system can handle
  • many millions of pieces of information at one
  • time with great speed.
slide7

The Nervous System and (The Neuron)

The nervous system can be divided into two parts:

1- the central nervous system

2- autonomic nervous System. (peripheral nervous system)

The central nervous system consists of the brain, the spinal cord, and the autonomic nervous (peripheral )system: Cranial nerves and Spinal nerves

slide8

The autonomic nervous (peripheral )system :

controls various internal organs such as the heart, intestines الأمعاء , and glands الغدد.

slide10

The basic structural unit of the nervous system is the

  • neuron. It is a nerve cell specialized for the
  • receptionاستقبال , interpretationتفسيرand transmission
  • ارسال of electrical messagesالرسائل الكهربائية .
  • Basically, a neuron consists of a cell body that
  • receives electrical messages from other neurons through
  • contacts called synapses located on the dendrites or
  • on the cell body.
slide11

The dendrites are the parts of the neuron

  • specialized for receiving information from stimuli
  • or from other cells.
  • If the stimulus is strong enough, the neuron
  • transmits an electrical signal outward along a fiber
  • called an axon.
  • The axon, or nerve fiber, which may be as long as
  • 1 meter, carries the electrical signal to muscles,
  • glands, or other neurons.
slide13

When the neuron is stimulated, a large

  • momentaryمؤقت change in the resting potential
  • occurs at the point of stimulation.
  • This potential change, is called the Action
  • potential, propagates alongthe axon.
  • The action potential is the major method of
  • transmission of signals within the body.
slide14

The stimulation may be caused by various

  • physical and chemical stimuli such as heat,
  • cold,light, sound, and odors رائحة او نكهة .
  • If the stimulation is electrical, only about 20 mV
  • across the membrane is needed to initiate the
  • action potential
slide15

Electrical Potential of Nerves

  • Across the surface or membrane of every neuron is an
  • electrical potential (voltage) difference due to the presence
  • of more negative ions on the inside of the membrane
  • than on the outside.
  • The neuron is said to be polarized. The inside of the cell is
  • (typically 60 to 90 mV) more negative than the outside.
  • This potential difference is called the resting potential of
  • the neuron.
slide16

[A] A Model of the Resting Potential

The resting potential can be explained by using a model in which a membrane separates

a concentrated neutral solution of KCL from one that is less concentrated as shown in Figure(1.3).

Dr.Aida Radwan Tolba

slide17

The KCL in solution forms K+ ions and Cl−

  • ions.
  • The membrane is assumed to permit K+
  • ions to pass through it but does not permit
  • the passage of the Cl− ions.

Dr.Aida Radwan Tolba

slide18

The K+ ions diffuse back and forth across

  • the membrane; however, a net transfer
  • takes place from the high concentration
  • region H to the low concentration region L
  • producing a charge difference طبقة مستقطبة
  • (dipole layer)across the membrane and
  • hence a potential.جهد كهربائي

Dr.Aida Radwan Tolba

slide19

Eventuallyأخيرا this movement results in an

  • excess of positive charge in L and an excess
  • of negative charge in H.
  • These charges form layers on the membrane
  • to produce an electrical force that retards تعوق theflow of K+ ions from H to L.

Dr.Aida Radwan Tolba

slide20

Ultimately أخيراa condition of equilibrium is

  • produced when the K+ ion movement due to
  • diffusion is balanced by the ion movement
  • due to the electrical force from the dipole
  • layer.
  • The dipole layeris equivalent to a resting
  • potential across the membrane.

Dr.Aida Radwan Tolba

slide21

Qualitativelyنوعيا , the resting potential ofa

  • nerve exists because the membrane is
  • impermeable to the large A- (protein) ions
  • shown in next figure while it is permeable to
  • the K+, Na+, and Cl- ions.

Dr.Aida Radwan Tolba

slide23

[B] Propagation of Action Potential

Fig.(1.4) shows schematically how the axon propagates an action potential. Graphs of the

potential measured between point P and the outside of the axon are also shown. This axon has

a resting potential of about -80mV (Fig.1.4a).

  • If the left end of the axon is stimulated, the
  • membrane walls become porousمسامي او نافذ
  • to Na+ ionsandthese ions pass through the
  • membrane causing it to depolarize.
slide25

The inside momentarily كل لحظة goes positive to about 50 mV. The reversed potential in the stimulated region causes ion movement, as shown by the arrows in Figure (1.4b).

The positive current flow on the leading edge, indicatedby arrows, stimulates the regions to the right so that depolarization takes place and the potential change propagates.

Meanwhile the point of original stimulation has recovered (repolarized) because K+ ions have moved out to restore the resting potential.

The voltage pulse is the action potential.

Dr.Aida Radwan Tolba

slide26

For most neurons and muscle cells, the action potential lasts يستمر a few milliseconds; however,the action potential for cardiac muscle may last from 150 to 300 msec, as shown in Figure (1.5).

slide27

[C] Types of Nerve Fibers

Examination of the axons of various neurons with an electron microscope indicates there aretwo different types of nerve fibers which are:

Myelinated nerve fiber: They are nerves in which the membranes of axons are covered witha fatty insulating layer called myelin .that has small uninsulated gaps called nodes of Ranvierevery few millimeters (Figure 1.1).

slide28

The myelin sleeve is a very good insulator, and

themyelinated segment of an axon has very low electrical capacitance and the action potentialseems to jump from one node to the next.

Unmyelinated nerve fiber: They are nerves in which the axons have no myelin sleeve (sheath).

slide29

Myelinated axon conducts differently than the unmyelinated axon

They are the most common type in humans that conduct action potentials much faster than unmyelinated nerves.

Two primary factors affect the speed of propagation of the action potential:

1- The resistance within the core of the membrane

2- The capacitance (or the charge stored) across

the membrane.

Dr.Aida Radwan Tolba

slide30

A decrease in either will increase the

  • propagation velocity.
  • The greater the stored charge on a membrane,
  • the longer it takes to depolarize it, and thus the
  • slower the propagation speed.
  • Because of the low capacitance, the charge
  • stored in a myelinated section of a nerve fiber
  • is very small compared to that on an
  • unmyelinated fiber of the same diameter
  • and length.
  • Hence the conduction speed in the myelinated
  • fiber is faster.

Dr.Aida Radwan Tolba

slide31

The internal resistance of an axon decreases as

  • the diameter increases, so an axon with a large
  • diameter will have a higher velocity of
  • propagation than an axon with a small diameter.
  • The unmyelinated squidالحبار axons (~1 mm in
  • diameter) have propagation velocities of 20 to 50
  • m/sec, whereas the myelinated fibers in man (~10
  • mrn in diameter) have propagation velocities
  • of ~100 m/sec.
  • This difference in conduction speed explains why
  • the signal appears to jump from node to node in
  • myelinated nerves.
slide32

Electrical Signals From Muscles

The ElectroMyoGram (EMG)

  • One means of obtaining diagnostic information
  • about muscles is to measure their electrical
  • activityالنشاط الكهربائى .
  • The transmission of the action potential from
  • the axon into the muscle causes muscle
  • contraction انقباض .
  • The record of the potentials from muscles
  • during movement is called theelectromyogram,
  • or EMG.
slide33

A muscle is made up of many motor units. A

  • motor unit consists of a single فرع واحد neuron
  • from the brain stem or spinal cord and the 25 to
  • 2000 muscle fibers (cells) it connects via motor
  • end plates
  • The resulting potential across the membrane of
  • a muscle fiber is similar to the resting potential
  • across a nerve fiber.
slide34

Figure 2

Schematic of a neuron originating at the spinal cord and terminating on several muscle cells. the neuron and connecting muscle cells make up a motor unit (dashed line).

slide35

Muscle action is initiated by an action potential

  • that travels along an axon and is transmitted
  • across the motor end plates into the muscle
  • fibers, causing them to contract.
  • Such a measurement is made with a very
  • tiny electrode (microelectrode) thrust يدفع
  • through the muscle membrane and the
  • reference electrode isimmersed in the fluid
  • surrounding the cell.
slide36

Figure 2

(b) Instrument arrangement for measuring the action potential in a single

muscle cell.

slide37

[A] Types of Recording Electrode

  • Single muscle cells are usually not monitored in
  • an EMG examination because it is difficult to
  • isolate a single fiber.
  • Instead, EMG electrodes usually record the
  • electrical activity from several fibers.
  • The two types of electrodes.
  • - Asurface electrode attached to the skin
  • measures the electrical signals from many
  • motor units.
  • - Aconcentric needle electrode inserted under the
  • skin measures single motor unit activity by
  • means of insulated wires connected to its point.
slide38

[B] Response of Sensory and Motor Nerves to

Different Stimulus length

  • EMG obtained during electrical stimulation of a
  • motor unit.
  • The action potential appears in the EMG after a
  • latency period (the time between stimulation
  • and the beginning of the response)
slide39

In addition to electrically stimulating the

  • motor units, it is possible to excite the
  • sensory nervesالعصب الحسى that carry
  • information to the central nervous system.
  • The reflex system رد الفعل can be studied by
  • observing the reflex response at the muscle
  • with different stimulating levels.

Dr.Aida Radwan Tolba

slide40

At low stimulating levels some of the sensitive

  • sensory nerves are activated but the motor
  • nerves are not.
  • The action potential of the sensory nerves
  • moves to the spinal cord and generate the reflex
  • responseالاستجابة المنعكسة that travels along the
  • motor nerves and initiates a delayed H
  • response at the muscle.
slide41

As the stimulus is increased, both the motor

  • nerves and the sensory nerves are stimulated
  • and both the M and the H response are seen
  • At large stimulating levels only the M response
  • is seen
slide42

[C] Measurement of the Velocity of Action

  • Potential in Motor Nerves
  • The velocity of the action potential in motor
  • nerves can be determine as follows:
  • Stimuli are applied at two locations, and the latency period for each response is measured
  • The difference between the two latency periods (Dt) is the time required for an action potential to travel the distance between them (Dx).
  • The velocity of the action potential is this distance divided by this time.
slide43

As shown in Figure, for example, the latency period for the response to stimulus 1 is 4 msec longer than that for the response to stimulus 2 (Dt = 4x10-3sec).

The difference in distance

(Dx) is 0.25 m; therefore the nerve conduction velocity

v = Dx/Dt = 0.25/.004 =

62.5 m/sec.

slide44

[D] Measurement of the Conduction Velocity for

  • Sensory Nerves
  • The conduction velocity for sensory nerves can
  • be measured as follows:
  • Stimulus is applied at one site and recording
  • electrodes are placed at several locations
  • are known distances from the point of
  • stimulation
slide45

As the response traveled (Dx) between two

  • successive electrodes in Dt; therefore, the
  • velocity of the action potential is this distance
  • divided by this time.

Dr.Aida Radwan Tolba

slide46

Many times nerve damage results in a decreased

  • conduction velocity,

Dr.Aida Radwan Tolba

slide47

Typical velocities are 40 to 60 m/sec; a velocity

  • below 10 m/sec would indicate a problem.
  • As shown in Figure (1.11), for example, the
  • response traveled the 0.25 m from electrode1 to
  • electrode 2 in 4.3 msec; the conduction velocity is
  • 0.25 m/4.3 x 10-3 sec = 58 m/sec.
  • The conduction velocity from electrode 2 to
  • electrode 3 is 0.20 m/4 x 10-3 sec = 50 m/sec.
slide48

Electrical Signals from The Heart The Electrocardiogram (ECG)

  • [A] General Blood Circulation of the Heart
  • The heart is considered as a double pump. It has
  • four chambers ;the two upper chambers, the left
  • and right atria الأذين, are synchronized يتزامنto
  • contract simultaneously, as are the two lower
  • chambers, the left and right ventricles البطين.
  • The right atrium receives blood from the body and
  • pumps it to the right ventricle. This ventricle pumps
  • the blood through the lungs, where it is
  • oxygenated.
slide49

The blood then flows into the left atrium. The

  • contraction of the left atrium moves the blood to
  • the left ventricle, which contracts and pumps it into
  • the general circulation;
  • The blood passes through the capillaries الأوعية الدمويهinto the venous system الجهاز الدوريand returns to the right atrium.

Dr.Aida Radwan Tolba

slide50

The human heart.

Note the Sinoatrial node, or the pacemaker,

And the Atrioventricular node, which

initiates the contraction of the ventricles.

Dr.Aida Radwan Tolba

slide51

[B]Types of Nodes:

  • Sinoatrial (SA) node, or the pacemaker:
  • It is special muscle cells located in the right atrium
  • It controls the rhythmical action التأثير المتزن of the heart by an electrical signal initiated by its spontaneous stimulation التحفيز التلقائى.
  • The SA node fires at regular intervals about 72
  • times per minute; however, the rate of firing can
  • be increased or decreased by nerves external to
  • the heart that respond to the blood demands طلبof
  • the body as well as to other stimuli.
slide52

The electrical signal from the SA node initiates the

  • depolarization of the nerves and muscles of atria,
  • causing the atria to contract andpump blood into
  • the ventricles.

Dr.Aida Radwan Tolba

slide53

Atrioventricular (AV) node: It initiates the depolarization ازالة الأستقطابof the right and left ventricles, as the electrical signal passes from the atria,causing them to contract and force blood into the pulmonary الرئهand general circulations.

  • The ventricle nerves and muscles then re-polarize
  • and the sequence begins again
slide54

The nerves and muscles of the heart can be regarded as

  • sources of electricity enclosed in an electrical conductor,
  • Obviously it is not practical to make direct electrical
  • measurements on the heart; diagnostic information is obtained
  • by measuring at various places on the surface ofthe body
  • theelectric potentials generated by the heart
  • The record of the heart‘s potentials on the skin is called the
  • electrocardiogram(ECG).
slide55

Electrocardiography.

Dr.Aida Radwan Tolba

slide56

Note that the potentials measured on the surface of the body dependupon thelocation of the electrodes

  • The surface electrodes for obtaining the ECG are
  • attached to the four limbs and over the heart.
  • A typical normal signal recorded between two electrodes is shown in Fig.
  • The main features of this wave form are identified by the letters P, Q, R, S, and T.
  • The shape of these features varies with the location of the electrodes.
  • A trained observer can diagnose abnormalities by recognizing deviations from normal
slide57

An electrocardiogram.

Dr.Aida Radwan Tolba

slide58

[C] The major electrical events of the normal heart cycle

(1)The atrial depolarization and

contraction, which produces the

P wave ;

(2) the ventricular depolarization,

which produces the QRS

complex,

(3) the ventricular contraction

occurs between S and T, and

(4) the ventricular repolarization,

which produces the T wave.

slide59

إسكيمية: قصور في تدفق الدم يؤدي الي الذبحة الصدرية

Dr.Aida Radwan Tolba

slide60

In intensive care areas and during surgery the

  • ECG is usuallycontinuouslymonitored and
  • displayed on the CRT of an oscilloscope.
  • An ECG shows disturbances in the normal
  • electrical activity of the heart.
  • For example, an ECG may signal the presence
  • or an abnormal condition known as heart block.

Dr.Aida Radwan Tolba

slide61

If the normal SA node signal is notconducted into

  • the ventricle, then a pulse from the AV node will
  • control the heartbeat at a frequency of 30 to 50
  • beats/min, which is muchlower than normal (70 to
  • 80 beats/min). While a heart block like this
  • could make a patient a semi- invalid, an implanted
  • pacemaker could enable him to live a
  • reasonably normal life.
slide62

Electrical Signals From The Brain Electroencephalogram (EEG)

  • If you place electrodes on the scalp فروة الرأسand
  • measure the electrical activity, you will obtain some
  • very weak complex electrical signals.
  • These signals are due primarily to the electrical
  • activity of the neurons in the cortex القشرة of the
  • brain.
  • The recording of the signals from the brain is
  • called the electroencephalogram (EEG)
slide63

Electrodes for recording the signals are often

  • small discs of chlorinated silver.
  • They arc attached to the head at locations that
  • depends upon the part of the brain to be studied.
  • The reference electrode is usually attached to the
  • ear.
  • In routine exams, 8 to 16 channels are recorded
  • simultaneously.
slide64

Since asymmetrical activity is often an indication of

  • brain disease,( the right side signals are often
  • compared to the left side signals).

International standard 10–20 system of electrode location forEEGs.

slide65

Normal EEGs.

Dr.Aida Radwan Tolba

slide66

Importance of EEG

  • EEG is used as an aids مساعدin the diagnosis of
  • diseases involving the brain. It is most useful in the
  • diagnosis of epilepsy الصرعallows يسمح لنا
  • classification of epileptic seizures نوبات الصرع
  • The EEG aids in confirming brain tumors since
  • electrical activity is reduced in the region of a
  • tumor.
slide67

The EEG is also used as a monitor in surgery

  • when the ECG cannot be used, and is useful for
  • indicating the anesthesia level مستوى التخدير of the
  • patient.
slide68

Electrical Signals From The Eye

The ElectroRetinoGram (ERG)

and the ElectroOculoGram (EOG)

  • The recording of potential changes تسجيل التغير فى الجهد الكهربى produced by the eye when the retina
  • الشبكيةisexposed to a flash of light is called the
  • electroretinogram (ERG).
  • One electrode is located in a contact lens that fits
  • over the cornea القرنية and the other electrode is
  • attached to the ear or forehead الجبهة to
  • approximate the potential at the back of the eye
slide69

Schematic of an ERG. The letters identify portions ofa normal ERG

The placement of theelectrodes for obtaining ERG.

Dr.Aida Radwan Tolba

slide70

The B wave is the most interesting clinically since

  • it arises in the retina.
  • The B wave is absent in the ERG of a patient
  • with inflammationالتهاب of the retina that
  • results in pigment changesor retinitis
  • pigmenlosa تغير صبغة العين
slide71

The Electrooculogram (EOG) is the recording of potential

  • changesdue to eye movement.
  • تسجيل التغير في الجهد الكهربائي للعين نتيجة حركة العين
  • Electrooculogram provide information on the orientation of
  • the eye, its angular velocity, and its angular acceleration.
  • Some studies have been done to determine the effects of
  • drugs onthe eye movement and the eye movement involved
  • in sleep and in visual search.
slide72

(a) For obtaining the EOG an electrode is mounted on each side of

the eye. The visual angle is indicated.

(b) The change of potential is plotted as a function of visual angle.

Dr.Aida Radwan Tolba