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ماموگرافی

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مبانی ماموگرافی
مـامـوگـرافـی انـجـام رادیـوگـرافـی از نـسـج نـرم پستـان‌هـا اسـت و عمـدتـا بـه منظـور شنـاسـایـی و تشخیص سرطان پستان و نیز به منظور ارزیابی توده‌های قابل لمس و ضایعات غیر قابل لمس پستان مورد استفاده قرار می‌گیرد.
به طور تخمینی می‌توان گفت که با استفاده از مـامـوگرافی، سرطان پستان دو سال قبل از قابل لـمـس شـدن ضـایـعـه غـیـر طـبـیعی قابل شناسایی است

هر دستگاه ماموگرافی از چهار جزء اصلی تشکیل شده است :
1) تیوب اشعه ایکس
2) کمپرسور
3) سیستم گیرنده تصویر
4) صفحه کنترل عوامل تابش

1) تیوب اشعه ایکس
در حال حاضر سه نوع لامپ مولد پرتو ایکس در ماموگرافی وجود دارد که براساس جنس هدف یا آند آن ها، تقسیم بندی می‌شوند و عبارتند از:
لامپ‌های پرتو ایکس با هدفی از جنس تنگستن، مولیبدن و آلیاژ مولیبدن-تنگستن.
در مولد‌های پرتو ایکس از صافی‌ها جهت بالا بردن کیفیت دسته پرتو تولید شده و حذف پرتوهای کم انرژی موجود در آن و کاهش دوز جذبی پوست بیمار استفاده می‌شود. دسته پرتو ایکس تولید شده در دو مرحله قبل از رسیدن به بیمار فیلتر می‌شود.
مرحله اول مربوط به روغن درون لامپ و شیشه آن می‌شود که به آن صافی ذاتی می‌گویند.
مرحله دوم یا صافی اضافی در واقع صفحات فلزی با ضخامت‌ها و جنس‌های متفاوت هستند که بسته به مقدار انرژی دسته پرتو و جنس هدف بر سر راه پرتو‌های اولیه قرار می‌گیرند.
در لامپ‌های مولد پرتو ایکس ماموگرافی، نوع صافی و ضخامت آن بسیار مهم است.
صافی‌ها قادر هستند با حذف بخش عمده ای از پرتو‌های ترمزی، از کاهش کنتراست تصویر توسط این پرتوها جلوگیری کنند. شدت پرتوهای ایکس خروجی از لامپ مولد اشعه پرتو، در تمام قسمت‌های دسته پرتو ایکس تولید شده یکسان نیست، بلکه در سمت آند نسبت به سمت کاتد دارای شدت کمتری است. این کاهش شدت در قسمتی از پـرتـوهـای خـروجـی کـه تقـریبـا مـوازی بـا سطـح آند هستند، به علت جذب مقداری از فوتون‌های پرتو ایکس در هدف صورت می‌پذیرد. این تغییرات در شدت اشعه را اثر پاشنه آند می‌نامند که مقدار آن به زاویه خروجی دسته پرتو تابشی از هدف وابسته است.
در ماموگرافی با توجه به شکل مخروطی پستان ها، جهت تابش یکنواخت لازم است که شدت پرتو در قسمت ضخیم تر بافت (سمت قفسه سینه) بیشتر از قسمت نازکتر (قسمت نوک پستان) باشد.

2) کمپرسور
کمپرسور وسیله ای شفاف، محکم و از جنس پلاستیک (Lexan) با ضخامت mm 1 است که برای فشرده کردن عضو به کار می‌رود. سطح کمپرسور باید صاف و موازی سطح سینی نگه دارنده کاست بوده و از لحاظ دانسیته اتمی و ضخامت باید همسان و یکنواخت بـاشـد. در غیـر ایـن صـورت بـه علـت عـدم جـذب یکنـواخـت دسته پرتو در کمپرسور، مکـان‌های مختلف عضو به طور یکنواخت تابش ندیده و باعث تفسیر اشتباه پزشک می‌شود.
لبه جلویی کمپرسور که به سطح قفسه سینه بیمار تکیه می‌کند، دارای زاویه 85 درجه و 3 الی 4 سانتی متر جهت عقب راندن چربی‌های زیر بغل بالا می‌آید. این زاویه نباید شیب‌دار و منحنی باشد، چون در هنگام استفاده از کمپرسور، بافت احشایی پستان تا حد لازم فشرده نشده و ضخیم‌تر از مکان‌های دیگر بافت باقی می‌ماند.
در این صورت این قسمت از بافت،کمتر ازحد لازم تابش می‌بیند و یا این‌که اصلا در میدان تابش قرار نگرفته و از حیطه تصویربرداری حذف می‌شود.
در هر دو صورت، اطلاعات نهفته موجود در این بخش از تصویر حذف شده و باعث اشتباه پزشک می‌شود.

3) گیرنده‌های تصویر
در ماموگرافی سه نوع گیرنده تصویر وجود دارد:
الف) فیلم با تابش مستقیم اشعه ایکس
ب) کاغذ‌های زیرو رادیوگرافی
ج) فیلم‌های همراه با صفحات تشدید کننده
به علت برتری استفاده از صفحات تشدید کننده از لحاظ پرتوگیری بیماران و کیفیت تصاویر، دو روش اول از رده خارج شده اند.

4) صفحه کنترل عوامل تابش
‌کیلو ولتاژ پیک
در ماموگرافی گستره کیلو ولتاژ کاربردی در تمامی انواع تیوب‌ها با استفاده از سیستم فیلم اسکرین بینkvp 25 تاkvp40 متغیر است. بهترین کنتراست در kvp 28 تا 30 و با استفاده از تیوب با آند مولیبدن به دست می‌آید.
‌میلی آمپر
در تیوب‌های مولد پرتو ایکس ماموگرافی، تغییرات میلی آمپر از چند میلی آمپر تا 400 میلی آمپر تغییر می‌کند. مقدار میلی آمپر تنظیم شده تابعی از نوع ژنراتور (تک فاز یا سه فاز)، اندازه کانونی، فاصله عضو تا نقطه کانونی و مدت زمان تابش است.
‌مدت زمان تابش
مدت زمان تابش بسته به نوع گیرنده تصویر، قابلیت‌های هندسی دستگاه ماموگرافی و کیلو‌ولتاژ تنظیمی، تغییر می‌کند. در ماموگرافی با تابش مستقیم فیلم، مدت زمان تابش بین 1/0 تا 3 ثانیه است که با استفاده از سیستم فیلم – اسکرین سریع تر، می‌توان مدت زمان تابش را کوتاه تر کرد و از احـتمـال ایجـاد آرتیفکـت حـرکتـی (Motion Artifact) و تــکـــرار رادیـــو گــرافــی و در نـتـیـجــه از پرتوگیری بیش از حد بیمار کاست.

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