captrorur

t0

IMACISTICE
I

0,1 Parti

IsF.rcl-

ciplrcd

pARl-rcIP REA asIsTENt.uLut Mu)tcAL

asisrcn tu

tui

edtcdt

l.

efectu

LA

EXAM|N^RT

re, a xloc n elor mdiologice

\ur rnc,,gdr rrasNice tahz{

Ju siL,orut !D,i .or X. !ihi.,n

(an.
. 5in. d. .'qJ!
i. I ... {c Jr rxirnrJ oc I n.nflf resu,.. i
ac 1 I iodtr, i rnJc'tu.,' Tb1 r. ir-c.,( d.am. J ci.c por fi rnFr.
rh. i_e tm tnja2",

i.o ulogicc

ohincrta unor infolmalji dcspre oisanc. apmre carc

s1lbilirca diagnoiicului ti supravegtuca

moniroriarua rmrucntutui:

sunr

rizjbile

sau Gr:t slb$anle dc

MONITORUL OFICIAL AL ROM,"\IE

.valuarca durcil slu dhconfo!tului:

idcnlilicrrcdtrnordnomrlii.

ronrEri lir conD0t$i{a.

suhiLetre indicaliiLe Ji conh'indic.riilel

cxpLici p!.icntuhl dcrulorca proccliuiii

obtirc corsirnlnmanhrlr
pdnioipli la Molc cxrncnc (cxi HSC):

Asi\lcnrut medicd din ctinici

p.nicipa la prcgatuc. spccllica a

'

p..lcnnrlur ntru

cxarnen nr

trmtic dc orsdntrl srr

pregik$e nraterialclc ca,r !o. jnsoii Dacicntul Lr scryiciL,l dc rallolalic:

ini,lene pacicntul la scriciul dc radioloSic. srabilcstc modtrl d0 r.rnspon:
$pr"!cgh caza p.clcntr I lr pii .x.mcn i
sc Drtocura dc otrlircr.d rczuldlclorpcnh I li ptuzd.tarc medicului.
c\anrneLe Ddiotogicc sc

cxoul l.scftciiL.

detudtuogic dccilrc pcsonalspdcia

i/!r

-.lnciliincdicrlidinsec!le)ioeidinscriciilcdcr.dlolosicrbbliesiidcnrili.creicrtile
dc scnslbilltare

faii

Iterii din

de subsrantcle

dc.orlmn:

Dancn anor.lu ui .ddlovxsculari DrLo e. diafo(r. iahicadic s.u

brndi.!rdic- l)'lplhtli, arirrnic, cddn pulmdnlr aout. to., in:uncicnri c.rida.,

ft.crii din panm rprraruluirespirator: srinnr. ruse. ircrcc. wftczing, cri, Je ]{Dl
bDnrir, lariqospNn. cdcm lanngiin. cirnozi. atnc. si slop rspinror:
mrili$in cuhndc crilcm, senzalii dc caldurii, dlcaic. D'uir. dufii tn Locut
injccrJrii. edem angineuroric:

nanittstirisanroinrcsriirlc

stor1ri,

loni, gui

merali!. cnmpe rbdomjnalc, drrcc.

mdnitciiri n.umlogicc: anxieraie. ocf.lcc. arncl.tt. verii. aSiratic. Jczoi.nljrc.

nupdaft . co'ni. coDVulsiil

ranilisariunnmc dnr$i in nincuri. henEruic,

oLisuric,

dbhnrurie. insuticicnii

dsistenlii Drcdicali trcb{ic sn lqionc^ prubpl h r(omndlrea si sub sup y*hcrc.

m.dicului etr .ontunn untri polo.!l scton.r dc mcdic

MON

TOR L OFICIALAL ROMAN]E

Jj Prpqrrir.! nrci0nrutui nrnrn' e\rm,n!rea ra,ln o!h, i\nrcnrutuio{co,IicuLr

Stop: $trdicrer Db lolosici oas.lor sr

l:o

.- r

'

Dcoxrecc.rsulc !'nrndioprcc. ntr \unr

tunclioirtriilij unor jnio,t.Lji ncnm {xhitrci

r.c.src mxre ltc slecirt..

rccn'ncacu nrurd i.. J&i zona e$c tc7rli:

!e irdcpincrzi bijuL$iilc sal aLrobicde mdi.p..c sru clrc nmr jrr rii,nptrl dc ex.mi.re
lrirgele- Linllsodr..c,\, rcleloaDc dutri.a7):
re ind.Fa.azii prnsrmfltr.lc. nngrcni.tc !ato arplle! i toeni3 tnr!i,rca,.diokJctci:
sc deTbraci

,,,1 ,...1'l ., fl Jq'n cr

,, *.,,.;
c\.minxlrl c{e mobilizLi (}ia.h.t_ 'lL'kLii. i'jUanntii anicuLrru icure)i
.
. n,d d1. t..-t.,Lt
.l '.'l', 1.,fi.'1' n ,.t.,
b.. 1. I a1 , ,,t., .e,r ,t.
.... n. rr
paocitr't eft

ni:riirilc s'nr

'ju

sirdoprc i,i riDnut e\rDli,rri 0oririr iDdjcxridc u.Jic

in functlc d. rfeci

urc.

dc

br/r

$i.cuzcLe

t]ciur{ulLi

b) Preg:itir$ prcicn(utui si p'rriciprftr tr c{rnin,rc, .rdiotogicl

Ptucrdora elc dcs.rri h cxnirohl 12 (t1.3 Torxco..Dr.7a)
c)

orCr rlor roracicr

ftcgntiro p,.icntrlui:i psrririFrca rrc\snrinrrcs rudi0toqicj a luhutuidiscsi!

' n$ Liilr Llirgnoniruh

in gr{rir. crcni.c.

trk.r

srnmdrcdcnat. ruDlo'i rlo ltrbulri

.\ d. trrRr \atrcclorcsnhgi.n!, hcmichiahti !i r .cuurulL'i ganm csohlirn

\lcdicol ndioloo c\o.uri cxam.trtrl

ptug egc t)rcientul.o0lonn rNcoDrndiritor ncdrcL tL,idi ictar

pEgircsk D sialclc si insolc$rc nacicftuItr s.niciul d. Ddiotogrc:

itreie{e Fcicdul d$e extunci

Scgilenicl. lLrbtrtui dtgesl! fu suDt!rjbit.rad otogic

I'rrticiparo,h clpto.rr..

rnd

irlogic!

ga

tiri

nrbeanLtr dc

srro inicstndti

conrin

liranttut harilaO

pr.ienhrl c(c dmLrr cu dou liLe n{inrc dc Dtuccdtrrti.

prcicf rutui in ce cor*r c{dncnut:
cnu dlcnrionarc. ifuinic o'
pulin 8 orc s in di,njicrra c\an.nujutsa n! nuuencc. si
tu lnmezc (ctu$e sccrclr. gajricii):
se cxDlicn

!.

MONITORUL OFICI^L

ROMANE

^L

cic i'iln,nir ci nm . e\rnr.trnlLr. l-l ril.

trrbtric sa ernnnn. !n

turin n.nrirtci \

, ..p t,.
'. l.Ji'
{.
scam. ii
n,l .rflN nr tri. srtirc.lrrcierirlu o. isniclrcurLoxrr
indi mdr c\rtrr.nullirn! ntrntrN la s.nrcn'ld. md oLolic xrjrd N,r.a LIi{n\L lr
.{r dcrL nrr.rin r Dp(l.x.n.ntrlu sirnn./. rdirrriie ncdjcrhr
:,iLL

.irinao,n icasNn.n\ixbrrihda'elrift .rdii

lngrijircn pxcicnturni dupit errrnrnul rediotogh

or..ntul.*. i|tunndcirc 'lrec orr.,bi I I Titcdup:.\rmeni

0r.i.i!'rci. nnomd.tr c{e posibiLsii rnrri conn ]rrric. cr7 in c.r. se xdDr trnr,ririj o
lir:trn ut.r.irp afini \xu u lnrhli

dNi' mcdictrlr.conDndi. F.i.nrrLrc\

p&icnrLrpo.rc si rnlinince d ni t.!

I'rrticiparcr lr r\rmin3rc. radioluBidi

i. !\rni.n'td!r

rotosrc dr

ri

?. 8 srL

ttore:

r0t0nutui

nc crlc hu.1li (lcs.cnJcnd) duni

c\.ninrrer scgnrdr.lor rperiomc lj.Mr. iri.!irjr

d. r'LrnrDri rt. .oftrj .tr N I o rre imttrl. dr r\ror$l
nriD$rxrer \ubnrtrL.r dc contrr! Dni .trnn. b trdlilxirtrr.ri

\rr drfi rl'nlinhm ue

f..1risr.rd.nririi

dozc

lrr rt. llunnL chsnr. r.Ddi (tutr$:

\ubn01i de roDran dir crc sc or.g'tclrc susP.D!r l]lj0 io0

'.,

..l i {

. Bs.

.t,.

qr

a.sor LlrrlLLjrr0rtJrr

.*c nk cLII/llenm !..rrli.:ti(r-iirnlonmkr*peciini,.snntrtui.tinofla.dc

cnrrcilc\dnxt.nctimenhscihit. icltrul.fr)toDjr( din: h,rj,r/iidc \ri. snr:nfitri .tri
ll.'lc.drntsl.ba fiani.orcz llrt. prr. trscJrai
u, o l i',r ftc s. xd i'nn.c.7i rclnn s.njitichnl ..fnrni trtr pnhxr d. tidjid
N o lili
:r

J r

Lir.-.i'

'

'

L, r!

.r.. t....
'

I'fi iiciDtrrcr rsisrcntului mcdic,t

0. t..1,

ti,

ta p.occduri
rurcspccrrr.r ronneld i'nD sc r' 5orlriu dc ndr.sL..!ljm sc i.i!.pernrr. d..\rnref.
\u\Denra lnfd r.dtrsii l.r( pcnrtu r rcdu.c serTarh tlc dcttcdici
\e ntrhidr r.ch,l .r $idr SraNs:
s. rlechrva crd.rn
inrgosc.|irj sru ftJio!nticijrigog,atic) NDlirdu \c in
crid.trLiimodifirri Jtr 'xdloscoti.
oni..trolipi.tl.tcocotrjn.ruNonl

pn.ienrului!i p,rticiprrc. t{

lr

examin*cr [diologicn

c\ riurea cotccisrutuj ri critor bitiare

I colcri*utui $ c|itor bitilrd prin opacincrc

siciiic hiliorc srnr u2ibilc DdioloSrc nunar

cu

mlxt. lJ.

cofrm$care coniinc

P.Dttr Fcrerirc. .ccidcileh pfudurc dc scdsbitildcr ta iod. sc jru nilinn dd Drevenric

nr.Srind. i rnhmi'ricc. Ittl(. shr.oz, prnru Deriric. rtrsi nctuu Dcrhre. scrin( jce

r'ri.Dhrl

i0

cccsirinngiiiE alimcnkri.

l.n.ruscnsihilihrlilaiodscticclrnnoiirl'norcdcricsrtrfininiccrator!rtnt$rbdrnlide

.,,r.e

c ir.,L..,-..., .Jrn.,t :.,

nr. r. ,.i g

" .i-.n, -,.G,.

lrrclcntoI cnr ordus la scnciLL de radiologie:

drcr ru {rr rcrturc Jc scnsibilnltc. s. nri'risrrcrTii lbaric teft. in decun dc t0 hinure.
snbnditi Jc conbasri

$lrmi J gDlii.cillcinhheprticc{cir.rhcparicescon.citirTrinrIj:10minnrci
- d{ii ru se cvid$rii/t ciilc hiLi c. tr .l(J Drinur. dupi lcnnharer iri.crici. {
..J, r!.,-,,nr,,j,
t.' ."
c ole.istogmfi x cu op3.iiiere

.l..nogrrfir .N!r1i.repccaLc.ralaprc!'pue
pr.liMm ilornr{li ctr 2t /ile iminre (rc8i'n u$r digerabit. {iri.ctutozi ri trtor
conc.nrarc) irr in trciua ex.mcnului se rdjni,rijrcazi rLiDc e qrasc (oni \nra afi. mt
' ;o trc1 c. r ir.' ..
'
i"riDrc dc rdmini$'arc sc tac. rsrarcr s.Nrbitidrii:
.dniniirarea subsmrei dc c.nt'nn s! t'cc continn indicaii|.r lisiDd ift.rt ncccsxr cr
acca$

sa trc

rbsnbiii

si

.of.citdi

in

coters

Ex.nenulsc hcc iirnc rarfiild into.nn cu c.hoe'.lic

r)Pre,liln.$nlcicniuluisiprrricipare.tnc$ninarearadnoeicnnxp,r,nduirond

,1, ",n \..

comrulli rtnichitor. cxvrtilito' lict.cli.crte. a ciiitor uriMrc. pR/enle

crl.ulilortuliopacl san ndiot nsprrcDri I hrroitor:
iab,ltr r dialnosti.niui in malfo.naiil .o*cniLrtc boat. .hrni.a ,!fitii.
eridcDlicrcd

MONTORLJLOF C AL AL ROMAN]E

ridiografia relali sinplii

rcLropncuoopcnbnclj

Componcnrclc apamruluireDal nu surtviztbitd

ld prcgndrea paclentului r fr.reriaielor

lte paciotul l. scni. iu I dc rad iolog ic ri il $rpr.vcghca, dupa xccer
lu

i ncn

tr!

ra diosra liN .un

tr

sc cxplicil prcientuluimccsiralc{

ri m ot

pJrdd'ii\,

con$miiimui 'e'rlr
rcginr rliN.Drarsi

d ur or ncdjcarnc nrc

pcntu conrbarcrc! AlzDlr:

2 3 zilc sc rc..nmdi ftei'n almdrrr fira ilbro (nncie. Iqnne, zalavaluri) si
nc|a!'lcnl. Jtri alc gro!z!:
in fryiui .xamdndlul pric.tul coisunri uf rcenh hidric (supc. hnonadc, ccaj, api pLdi)i
in scira dndintca examcnuhi cmsunri numai codi $i ptine pr.lml
in dinind o examcnuh'inuminincisjnu sonsuni lictridc:
cudoui zilc inrinlea exanirarii sc dninisftaza carbuie mcdicinal si rifencd ciic 2 rb

in sMn diDlinlc{ c*nmulul sc adminisrftaTi 2 ti.guri trlci de ricin Gau att purgariv
ftcomando, i0r dnnin.ah sc face ohn, cvaclaloorcr
sc rccomndt padienrului sa-!i golcrsci vczicr.

P.rri.ipdrea rsistehtului

sc .-l,.p..c1ul'
alio

rln

mldirlcpdnttu clisna clacnabnc.

vnunLsisc!t-lr, p,. tnu

dc.omh!.

pdnj.ipi

Presi tircr bxcirntu

subshntc

recomandicxomcnul si n0bilcsrccomhindicrtiile:
o blinc cons imln mantul:

in sole

firi

oA c.

ln!I[

rcJ

mdi.'t h

duni c\d'n.n

PrcdliM

procddud

E/.r. Pre

rt .

i, .n'ir

t"

.h

Ut d"

pnctn tulu i pentr u oieloe ranc I u ro gr.fie er creio rie)

lrstc cxamjnecr rddioLoeict a rinichiuki ti pclltului rcnat, urcrcrcLor si vczicij unnre cu
.,i' Jr !r( r !ra. jnh.
hr, r r. !i.. I' m.! i

'Jn

MONIIORUL OFICIALAL ROMANIE

!izuaLizaEaririchilfrl ciilouinar.:
pdnh dialnosicnrer pielo ncliilc i rt d mdltbmali
suspiciune de

brroli

lf

corgd ih t. alc ra ctului unnar:

rcmlai
hiDefrcnsiunc anuriali dc cduzi ftnovasuhri.

Accl$si.r

pcnrru ndiognfrarn.li sinDli l!.rrc sc ddxugi:

sub$anra dc conhn Od stoD l0%.60% satr 75%:

ncdicancnrdde urgenii

i|

coruL

scnebjliririi h iod

s.lic!

ld lclcd pcnrru radigu{ii rcn.li simpLi:

pdorcnol.sc avenizat si rcdnci iigenir dc lichidc (pc.h ca subst.lade conlras
conccntcze h n ivclul nnichi ul L'i ) i
in dinrincala caafr.nului nu nrandci, nu bcd pcnru a icadea votunul dc urini:
inajnc. crcctuiriiinjccticicu subsrdnla dc conrasisef.cc ctisn]i cvacuaroic

Parriciprrm sshtenruld ncdicil h procedurn

Dr.icntoi cnc condN ld mdntogiel

cstc dcztiEc si asczal ru masa in dccubn doNall
sc rcdlizcrzi o ndiogralie pc goli
sc lircc rcsrared la iod fin injectarc .01 tv 1 tnt sub$anii de contrasl rinD in clre sc
re" 0.,
r.ocnr.,Jcrdhiprr.rg,J.,n.c1.r cd.nrt ,c..
ccaalec. dispncc. gEruri ii \nNaiuri):
Jtr!! apdasemenr nrrnitin i, {dninisFirer sc intrmpe gisc aJhrnisrreazi mcdicaria dc

'.r'.lr'

- drr

,.

oBar nntrl rolu0rzt sd rJnritrisrcr2i: 20nn Odislon 75% la aduhi kru 25,11 din

". d 4coii'
' rdiogulli
S. hc
la t . 5-. l0-. t5
''

ifichnrlui in rerca urinari.

irgrijircr dupi procedurn:

nu sunt rcccsnre

insrij

Sc

rd).l1n

olu c ro

. 20 . l0 umarind proercna subsr!trtci dc L nivetul

g('legcrczicr sisc trde inci o ndi.EmUc

snccirlci

paclcmul esb slituir si bcr dtrlrc lichidc.

?rcsitirc' Dacirnlulu'

Deniru n
cxamirdrcr rrdidlogici a sischltut cotccror rral (ca ire. pctvis_ urctcr) prin i,rtcd.rca
subnarlcr dc conta$ dncd ii urelere sub corlrol uiosc.pic.

lite

cramii[rcarodio]ogic,amrcftldpacicntit.rtacrrcurolrrtiac econrrindicoti:
suspi.iurc du obenrrici

MoNToRLJLoFcALALRo[,ANlE

rccleati c. perinr uNgrilic:

sub$anla dc

'

conlhii

Odisron 30% sru i.durd dcNa t0%.

sc ob!inc consinlananhL:

0cccrll pcnh radioerolir rcnali simp

!i

I'drti. iparor ash ten rnt ui hedicat la pro.cdlri

pcntu rcduccdn dinscoDfortutui se poolcldninisrr! ms.dariv:
se facc cisdscopie, sub conr.lulchroscoptrtuise iniroduc 5 t0ntslbshnridec.trrs{tr\6r

' r.lz

.,

pLdn r'(."rc

rr 'lut.'(" ol, e''1k

t'.r'r' rrr'i. \ /inul .a' t r. -i. ot,Jt c,r,r.,n.po,rJ L .,.t,o."c]..
- {...ruc.' J'rdngmlJ r' ni'ru'coclJn.c,L,... 1,.d. J.."itr:.. "i ",:
r in..
'n ,rD(r(r.'

pcld'n.ub.r'.dJ.t.1,:-

.fr.r

sc moniroizcaTi scnnete tjc sinednto sau intccrje. lrimcl. u ni

nor li r.z d&a .par
rcensftra san linr conliDc.lDagurisc mmti mcdiouli
sc unarctreclinlnarca, sc poilc insalarcrenijar
podd aouza d jena u5d..i in abdomcnul iDtcior, scnzaljc dc prosiune
an,pra r!/iui.
spasmealc vercii urin cl
eo !
,ollrL
iru"ti
'!!cs[i'!'lFro
s cun\rm.'tnmuth tch'Jc

rrriiciprr$

parirnrutui tr ctgrourctu!rniie lcisr0grrfi cr

n: d,lo! cr I \-,.rr Litu,.. u.uh.,, Jdcro ,c,,

'rc.\f o J..

Scor,/i.{lirNtii:

iDdcmifi oarca crioloeici undr atccriunii

inlcclii nnmE ficcvcmc:

mdiogtufia sinpti.

prog irei

tiri

sub$rnr, dc contEsr cvidcnriaza cdhtiiidrlvczicrLi

. .:roeni nbrl'J"ron
.cn,1..udq r .(,., nrt...
'
n rcz(i dun3 utuFJle tooxc'ficrcd($rndcnrrr
- pnounrociidghlia vcztca sc !mpt. h inccpur cu rcr si 1nli sc ilrcclcz, subsdnh dc
-

sonda!c/icrlAsblldlotc!sauNclatonsroili:

MON TORILOF

C^LAL ROMAN

strb$lntx dc conrr(: iodrri dc N. t0r, sar odiion 30l,,i

m.rc'ja lclc \d I leg in ii trctic dc

n.rodi

s.xiurrrpricntuLsiscc\niuapbccdln.\iDcccsirdcnE\rrnctruhjti
\egoLc$c trlcniNrt!tus.sc licccli$ni(rcctut n.\igrzctc nrpicdictj vizibiltr ca):
nari.ftul .!c condN h Rdnnogle
Paniriparca ,{stentului mcdical l. pror{durn

cin gulia

cu n'bmnb de cotrta*
r.ddsii prin $ndr DONC:
sc fa.e $ndrj rc, .rl. sc !o csrc vczicr ti se lacc snttaihri cu xciJ bonc:
cu rc'itrei O,yor s! nroJuc nr ve7lca l00 200ntdin subjanra dc conra{i

ircIidc pcie:
pr!icntul Did ruglr
sc

!i

ru uri'iezcdc.il dupi sfirsirutcxrmcnuLuii

ft$rtDge consnul dc llchide t0 llorcinri

\c gole$c vczicx si sc sprLi:
!u sdngr (n'}on sc i'irr..tuc 100 lj0mtae{
sc

. t|f

inicor..x s.id.i sc iniccrcra in vczi.i ruh$fi, dc contre:

onaofic'.xdc\cc rlcrlli:
drni uro!rtu. n'bmD{x de contrn se coiccn!.azi in vezici dwa 1,2 orc.inJ
liod. lit!. ndnrsriir

se

lnerijnc{ dupn tro.cdurN

s! rccomanda conslntrt unei caDriraii

'mi

dclichide.

artcriogrltia rcndn
Enc explonren i',lchiuhrl prin adminilrrc. suh$Drci Jc conhe
Pnrticip,re. rsistenrrl!i modical lr pro.rduri
prcea1itol prci.n rului sc h.c.a penra cct.Lnlrc Namniari rcmh:
r.drogDfiile se f.c l. 2 :l secundc.6 si S rccunde de l. inceDc..r

I t. r'o.

Pree.

tirci

pacicn

tu

idnini\trini nrh{ ncl

jtonfl

Esc examcnul radiollgic crr! evident.zr contuoitc riii.hilor duDi intmduDrcr rcrtrLl,i

.cnl

sc

lntotlrcc cu lDxmlul dc pncurnororax:

ii

MON TORULOF

CALAL ROMANIE

pacieutul N maranci in dimincala cxamcnululi

inscrm prcccdcnrll su lacc
cv{uaroMi

clii

-'ncdi.ulbhduccinlojrfndr1000

1200nl grdlpioareseexccurindiogranai

la locul purcliei se apll0i un pnDsamenrneril.

Progfti.d pariutului

s,i

pr.ticiparc. ll e\rnin,ro, rdiolngicn

sistemuhi ncrvos

.rploidd radlolrdnci

a .ominrnrlui rahidian ptu injccr.rca in spaliut

o' dq iodrr.l- a olubi.
'l
'
'
Aoesr exancn pcmitc
sa sc vizualiTeTe ou prccizic sllcturilc vc ebrale :i panvcrtcbnlc

Micloeldli, cdnst in

.dbdr'tu di'n

uri

un|

.Lh

lonbarc (vcrcbrc. dis.uri irtqacncbnlc, lig.mcnrc nns.ulnre, midulo spinirii). D p,

intoduceRr scrnneFului ti apoi i tu^ninrei rnagneiice. rLasti ichnici cso dir cc in cc niai
I

nd

icnrii !i coni hi ndic,

\indturneneurologicederemi'ra(e de o

'

0o

mprsiune .rcdr lad sdu rdiculari:

runori cecbnlc san .curorcningidc (arun.i ctnd scaDncF0l si IlcM

rlergie
h

tii

la substanla

l).kfsir$c

$Lnr

ioilri:

mcmniaii

sc cxPIcA pacidn tu lLd ttuccJ ua:

sc ohrire conslnFnentul iniiflnar:
sc tuce lngmeza pcntru a cichdcnn cvenrurl isroric dcllcreic h iod;
sc ticc tundulde ochlpentur ercludc scmnclcdc hipcncNiunc inrracrani.nii

scplanificilaradiologie:

\ rei t '.r'rrulu oan i" c'ax J\'ir r n'Frd, . \ 'iinar

'r
sc m.nrcaza ur calclcrbrdtr0la pc o !c., pcnfenct:
sc injccrcaTj subidnra id&r, nr canaLul Dhidian (onniFque) plir ptrnctic rahrdiant
clccruali krnrbar diresr pe Das!ftdiologi.ii
dupi locrlizarca Edioscopicd . sqmcmutLri considcrur suslJccr. sc ctctueaz, rdiognlil
din2 pl.nun: mrcnponcndr ii prufili
pcnh clcduaEa in bune condilii a miclognfic sc rc.onandi utilt.rcx unui apaEi dc
radnJdiagnostic prclaar cu rnrsd basctrlMri (clcgidali, ou nmgind aDrpLiticrra prin
anrpliticatorul dc lumirozilltc cuplal
un m.niror TV si rDnenhi h crbjnd dc

c.mdndrbincFotcjari contr radirliilorX.

Micldgnfia pue iD cvidcnta:

- loma ii difr.nsiunile.rnalului q'inrli
- n nrerb ilitllca accsru ia, Ncrtua lclc obsh.o lc:
toma, dimcfsiunilc si0noori. chidturu.r ob rcoluluii
- pa.icnnn vd rnni.c h pat ptni.c iddul va t{e in rirculrti, sineDrici (5-6 orc)

MON TORUL OFICIAL AL ROMANIE

t0,2 Roltrl r.istntului ncdicrlln efcctuaru cx.m$clor cu izoropi radilmrivi (scintigrrfic)

En.cnmlnarc. cu radnJnucliTicrrc cmir mdldhj gxhmr, carc sc por punc nr cv idcnri ca;rnaiiv
si crlll! vcu aj uutu I derectoarc Lo r.
R.dnJn ucl izl i prczinla afinndrc pcnh rnunrtre oqanc. pcnru iesurlri pacientc in r{e sc fixca/i.

'
-

dercrara rnodilicirilor structurrlc alc utur orlan brari pc cxisrenb ufor ditcrumc dc
conccntrliea matc.ialului mdioocliv i. rcsulurile nonatc si rnonnatc nr arjilc jldide:
rizualiz ca unor orlmc si rcgnri cart nu pot ti vantc.rdiologic:
dcthtarca luLb0r,rjlorp.fuzici risu!a'e ladlcht oigrnelor ti icsdlurilori

dilcrcnri.tud rudonLorn,aligne de cclc b.nigne:

Jno.iroizarcr evolutiei tumrilor$i a nspunsuiLo! ltr rrdlahcntiiradicrc. chiniotcEpjc)
Era tnel.. i.obriseJa.n Dtar n' depdnu ehtrtt rutirnfi rctd d.

Ltu".tttc :( lir ri d'nhrl.ht.

Pu.itntttl oz
ihhirldrii pt?ptoralnztu ti.lc cdrcali. poa ltoccttntd
"wie,le i:otopi klnnnili s. adDri
subndntele ttdtrl
itra:d de cah? plr:onat

seNknr/./e 1e.lii

.(

tn .Iutn

sub$.nlclcmaratc cu lToiopi rooDanddc peltru un otr0mil tip de exdncni

sub$anrc care liinircaz.nxarca izobpitornr rtborsan.(draestc cutrt):
bardirle neccsaE .dninnrini h$ril.r(r ion0clrilo4l
mderialc dctnrNrie rDecificc sc^iclilord0 hdlicini nuclcnrr.

sc

expli.i Dicicnlultri riscurilc

si

htlit,

ta

bdeioiitc:

- dnnrxo \ub{anleindioadive scfmc rct. ! rpc.te pni unni si icca ci

rcchneriu. cct mai itizar rasor_ sc rcdrcc dlpa 6 orc ,i diqrarc dtrpa 24 orc;
n.'.. /cL ." rT.!r..h-t.tun' a4rc.
, ir.didca c$e mal mici dc.iir in cazuL cxaminini radiot.oiN
-

ui

pericol .ldiolcriv

cri$i

dar e$c

finifr

deoarccc

fotosesc do/e fornc

uncori localizaro rumorilor c{e foanc dilicili. arar contunri nccLrrc Jhrr...
lcsnul n.mrll din ju .bR,rrbc odionNt rl:
sc cvalrcazi rhre! pacicDruhi tcftu a sc stnbilj drui:
sc poate dcplasn singur sau arc ncvoic dc toroLiunl.n.i
przinut clnsrrnecri tizicc sdndaj Fnei dc cotecb.c a uritui, linie vcnorsir. sonda
nxzogrstricA s i Dcccsiri prc0ruri i:
estcdiabcri. si rcbuic si ia
ei
'nedicamc
ncocsni alrc cxamene scidie.ntce
pc ru I stabjli.rdinea cxccuririi (s.inrigdlb sc
tircc inainrea alrorcxarndcradioLogicc cu $rbsramc pe baza de iod):
sc ve ucadacipaci.nru aresnccrarrucomd inle:
sc nrdcprndrui obicctclc mcolicc, bijlrnile din cafrput dc
inrc:

,
,

rercihd,

!nEf(r;..r,cc"\"ncnr s

c.uool

*n

MONITORIJL OFICIAL AL ROMAN E

dacl pacicnla .laprcaza sc anrccidt riscu.iLe

innunc.l)aclenta nu

varlipt2 l

P$.i.ul3riti(i penlrtr dtferite tiDnri

de

!i

bcDclicljlc. C6nd exancnnl

sc

zilc

eranrn:

Scinliqr{fir ordidcn

'

cvrll'arer fnncriei vcoticuiarci

evrLuurer pcnnzici nrioca'dicc
Sc ibloscsc lc.hncriu 99. rdli! 201 odru sc xdniinisrrca, i v. cu 15 rinurc sru 4 orc nminLcr

iniectarea sc hcc in ftnnul

clbrtuhi. unuiRdiohsor(tcchncliu

- lrcgrtxr., se fioe dilevaminute mri tirziui

- sudirTirirnciiadcnomricrdiacasi Dodilic.drpc

99

dt, hliu20l);

rclli Driolrdic

Scintigrun, irfracrului miocardic

sc.crli7r.7,.L rcchidi,l 99 m:
l.cili7.$zr lcznnca. didcnsiunM si cxti' erea la 24-96 orcde h dcb(l:
- lcnL d i.ilira cxc ria biLiari a radiorasontui $ admtnisrclz.i tdpic duni

N minindt El

sc

nnor boli iinamrro.ii (ptrc0monic, pietorcfrnii. TBC,

hce clismrcvr.u

,!p0 4-6 oto

pulin 4 orci

iu fnmcuicclDulin 4,6.ru:
se inrrcotc mMic{lia (or.cdrdul Dcdicllui) ccl puin c! 24 orc inainrci
cstc inlonnar ci ronrl dfcazd in tocdie 30 minurci
hbtric si con$mc nu lt. lichidc pcnto . Iirlori/r eliminarci rrasonlL'i

Scintic.alia c! s,liu
SruJiMi cxisrenia

i'reclja.!

sc

.ri.:

s.ancri inreg corput fird 4ezrr akcnrariv in

sc Lcd reexaminarc dupa

Tciul d!'ezn

rumori

dccubtt

do6.t, venrat ri

24,43si 7zdcorr.

30-60 ninurc.

Scinttehlir h.prtohilirri
linos.stc c! r.dlotasor (0.hncriu 99'n rdministd i.v
Aprccir7.i ltrncrjilc licalului si velcii biliarc. nchire

vialtjz.r$

dislibcrix slinderului Oddi.

lnrru srinnriarc. conhctlci ampllei laicr sc adminiyrcazi
siopromarolosln liDici colicii biliarc.

vczicii bili.rc. tdentifi.i

i.v norlini $Llf c

c rcpruducc

MONITORUL OFICIAL AL ROMANIE

rnr

ob.ncni i'nagnrilor d.rrinde d. t..7.Dk sau ab$f! vjzuxLiTirit!c2i.ii hiLiaE. dncrutur

bilnrconitrtr $r o(le ,lrl
R

ScinrierNri! hcn,tosptr

DtrehiiiQfnvn
I'o
l'

c dclccrx

L' .!

inii

ici

h porric. lorma

5i dm.nstur it. r.' ftnr

non n,efu$rzc lFlarcc \i stlcDr.c. hlLmrlisnre hclalicc sxu splcmcc. cnoza

.'

n.1.,,.

.oro dti

r1, ero,c,'r

\u 'n.ccsnii p,?giti,. pqro..du.illi i ingrliiE dnpi.r.ndi "

'mrddi

nrlnLri

id.fiitrcrr.a s tocxLiTau r hon td, mcr.sh/elor n!trrocndo.rinc_

Nnnlonar.r ru o orncRi.nJoc.nc
foloscsc.ctrotM(unanxkrgdesotrrronri'k.marcrrcutIisrulridtu I ).
vlJicul iabilcnc drci c .an l. sc idrcn'il ratumcntut cc tulir 2 srprirlini ina cl
?arliriparca ssist lului mrdicsl lr proccdrrn
ii p dc I rilc s. rlDmierlaza pacicntutui cli1c

pjcxrtri Lugot nenin r fru\cni

\c ad'nm'nr$/a ftdroruclidu iv:

dtrpii o o'a s. s..ic./i i r.e corptrlctr dcLNcloNl dc

dcoubilJorsal.lftcnl.venrnlsisc.hliI lilDc:

n/e

P.! c

r't \c r$azi

cltrrjd

nLccesn.ir

I or. s. dil nr flitr/ !fus. plrntu r f!!ilitu.rcrerir

drF Iort { i,nnnnhvi uplr.sxri\:
i.qr.rr;cxMrcr lr 1.1 l.l .* de oE duJrii injcchrc.
dtrp!

scinrigr!fi. osor!il

.ril!rrx.\r.'siei ti.!tunloLneopLr cor\i m.ra$zcloros!\c:

. $ rnlisesrc r.rhneirm 9r. .rrc scadninijrc.zir.v

, .,l . Dr rJt,....i
I c '1.'
sr sittuienc |x.iDirul ca

\crnru durcrzi:ll)

inr.

cu I :t

injecturc st cxxnrim,c si

o,!imi,rcdcinrclistrri!.:

ber..l

pLLli,j

2 tftr dc aDi pcftu

60 ornrur..

S(i i!'rli!.,rrririxrnni
lliJcntirz, adciornre. crnccr!,

h pcrphstu de

Ioloftrc I nreri. r.ifrlr.tlicc rdDlinilr.rc

panhrtjidi
cu tcc]jDcriudr 9qn

)i jod

t:i n .$

jnrtgi*mrc.rmaliniLrretaccdupi t5mnutcrfcspccnv :]oLcdctdinjcchrc

N scldnmistr rTasubi.nrcdecoDrrsrc.rccoriniodDe[ncirnodirjcirc4trarlc

Jcr

douo

MONITORUL OFICIALAL ROMAN E

Scinliqrdir pulmo..ri d. perfuziehenlilnlie

Se obtinc consim!amlnrul scns al pa.icnrtrlui
ln s.intigmfin de pcrfozie sc ad,ninisrca/i

.$czarp. rand nr Jecuibr iorsal. latcnl si

i.v.

lcnhl

bu

nim. D.r.ari

litup

ii

cu md iorrNor

.dre dctccronl

PacicNol csc

dc 4 inrcgisrwi

De

Scintigrafir dc lcnlilitic_foloseste Xenon lll sa! Kripton * I'n cdo sc inhrld/t.

sc i.depineazi rotrlc bijuciilc sau obiccrclc nrkli.cdin rul{orrelui.

Scintilr.liN.rn.li
livallcazii

l ipuri

de

crurt si lufclia rcnrlr. dctedeazi matdmiri congdnlraLc. tulhuliili dc

cii!la!.

scintigrd i r.i alc:

de perfulc:
scintigEiastnrctumlii

scrlgtufir

Ercgnmn (sndiazi c.prar!{ $i cx0rtia unor subs[nte cu caic Oreciazi risDuNr]

rcnsirnii dndirlc la tahncn0l

R.dlordsdnLlrc injcc'crzi i
los.{c rcchnet iu'n 99'n
inri ea testutui p..idtul rcbur. s, b.a .el Duiin 2 paharc dc apii si si !nnc^
Durao !e ctorvxnia inte l4 ore.
Dup. tc! lidclcniul h.bu ic sa b$ Dnilic li.[idu pcnh clnnindra subslantci mdturciir.
Tcstol c{c s ab iradiant ncdurror
So lb

Scinticalia timidirni
E!idcntiaz{: ddonohul, cncctuI, riroidna.bo.la Crav*. hiperii IiDo lnoldia
Sc lnloscac Tcchn.rilm 99m.
Lx pacinrii cuDolcu1i or canccr dc rnoidt hcrrc s a a0lca! rahhcn| ex.mcnulse tacc aiua
pentru a idcnritica cv.n rurlc le Drcbslazc
.0 iod
CL catela siprininl inai' c Fcicntul nu hco cxplorin cu sub$r.re iodarc, ntr consunt

lll

Cu avl/tr| mcdlcului picic ul inrctutc unele rntamcile

antirinidienecarc Dor innucnl. tuncra rnoidianr.

Sci.tilr.lia h,m,ri

c!

rtrlir0jrc. potivihmnc.

Sc loloscsc lufci cAnd rMmogrxlir nu crc coNtudcrti

rcnru $.djxli/rea .ar.utulLt.
Rrdiotasorul (cchncriu 99m) rre arinitarc pcfh ldngtionii dilui. mch$ati.
lntcdarca n'bsrnlei sc li.c ir sdrnrL contohrdraL sinllui sustccr:
inrogisrmrca sc licc dupa I0 min(cdd ti ifteor.rcr
nu sc ctcctucaT.i pro..dud iidinrcr nensrclor dco.rcce sc tmducd o hinerplazic bdieni

1.

'

pcnh

a aacilira excrelia

uLirah c*c iccesaricrc*crci consurului de lichid.

pe,sodnclc t.t! ar cka hk !\ Dt!

Sa rt rinn itt rork!r. Iopin ).1 ot.:
Sa rnc.htrn. ouniitutu nrr tu dpit:
lrtpd[ah^nurt- hti sii tRiarad!! 3oti

t...ttanddt

rd

(tL j.ototi:

MONITORUL OFICIAIAL ROMANIE

03 P ftici prren .si(cnrului mcdic{ I ll cxa m$ d .u ultrasnn cr. (euhog 6ticc)

Ulrrdlon.emfidcadexlminarcrnein!@ivapcnruvi^alftreastNcrunbrdnresuturitc,rot)tc
|

c.D ri.p' rir' g.r.rci ler-i -o",'h'orcind,.tu..d,...utur

ir limp rcdl a oryanctor abdomiMtc (io a .bdominati. ficar, vczic, qj

canrlclcbili.ru.pxndersul rin ichi, u rdcrctc. vczica uinadl) i
evrluarcd morilirlrii uDoiorgnne. a lonnci, di,ne'siunitor, poziticti
.\ilufta unor sructori stah vtaaLizdro rdioto8ic sa! inacccsib c:
nbbitrci diagno$icuLui dc sarcnli. lmurnc. ntfiutui dc .ftgeE a sarcinii. sdrciii
huniplc, nrlformrtii fihlc
vi^aljldre!

.
-

geLpcoirurcalizmaconradului cureguncrruti
DrusoD l*rll $u dc hrnicpcnrtu indcFnarca gctului.

sc prczin

(i pNicnn' lui avanilj c lc si dczavaniaj clc.

.tr prcziDto riscJcftdirrii:

prcSilired oi. minini:

ru ncccsni subiant dc.oniE$r
hu inUtrdreaza htul. se poalc rupcra lir6 iscr
rLddt. d.p Jl J'.,.f.d,.y.n".n0
Lro.iu.

fi exaDrjnalc jnrruritc pline cu acf (pliimaD, inrc$in)i

pacicntii
n
obczi undele ulhsonorc sunr dcnuarc.
r\plica rchtricr Dbceduri. nodut dc cotaborare:
nu por

ec![.'ntumridrsptu.\(ntuJtr.:rcBi]a.tr\.
ru: d.n.r ,F gbz( o.uli \ i ,eTur i, au r \r r. _. d( ,-i
.., e/i,rnit.- t.. dp,\r oc {rq{r.gr:i

( i0uhis! iA0ituJ\ieurorco
'cl . d'!n!ntt
n r.p'. tr r

nob hr;tr r.n,

toi

inr,ruN.,'1,-rtu
scrJ. ir.1r-: r.oq.h,

Ifti.ipa

rcu r sisre nt ulu i nedicat ta procd url

veriilcd dd.t llcientut a respcct rucomndrntci
scascazi in Dozitc adecvaG cxamonului:
sc rsigur, doDractol Dennancnr intc rrdnsducb rj rcstrmcnr

Ecoqrdri! tnnsEofmiann
lxamen cndoscopic tiulhsoidrpenh !i4atizarod cdrdului din pozilir rcblc.rdiaci
ctiminind
n, lertlicn !e lc cu 0 trc stucruir
Fsm subcu tor al. oasc te toracctui. p iimrni
Ved

rol,.

d* {J rorutccog,.,t c.oftsr ,juLd

Prcl.n'Llnu trLbutr \r nrinricc

s. n

hn

or

c , o{upl .,

P*dcip.rcr N$tuntului mdicd t, pro.rdurt

sc montc'i rD .atcd nnmvciosl

so

apli.i clc.6ozi pdnh ECC, sc nonibn-Lt cordll;

rnoniro zeazd I priD dpliclrea uDeinaD$ctc.lcDsioDctnluii

se nontcaza un pnlsoxnncm:
sc aseiT.i Dncienrul in decubir lrldrl tnq:
se anestcziuilirineclc !isc iDtodnce ctuoscotul|Iin caritalca hrDili
sc

pi.i

la csolagr

sc meirorizc.zi arcnr pxcicnrul in , o orr:

Ecogmfirtin\csolagianxt.rtcvi^rliza:infarcrllnrioddrdic,cadoniopatia.dcfecreseDble

tr.n(oracicl
Pcmitcvi/ allzareasi 4recieRrfuncrlikrco ului,
Prticip!rur 6istcntului n.di.rl h proccd{rn

Echoqrafi r

'

pacicntuL csrc aFzat in dccubitdosaLi

scrpllcipcromccun gcl orrcst lircilirczclrdsmrcroirlrftsuncrclor:

$ ind.panci^

gcLtrl

Nu neresiG nBrjirc dupd proccdurn.

trchoennr abdoninrln
Pcmi(c vizualizr.ca !orrci abdorniralc fic0r!1, lcTicli si ciiitor bilia( D,ncL.asuhj. nnirhjor.
trrcGRl$ sl lczicii urinarc
Nu ncccsili subslltrla dc conhsl. prNcdua csc uriLi pcntu feDcilc gn!ide. pacicnti aLcr!i.L
Pocicnlul ntr ntninci inrinrcr rc$ulul.
Pozitia pacicmrlui c{e in fuDclie de orglnul vizar, dc obicci decubit domaL
ftczdra gaTelor ti lrairlui in abdonci dtuorsloneazA imaginco.

Echoqr. fic D oo p lc. rncrio-Ycno$n

F.lahrcaza pcnncrbilihrer laselordc sangc,,lirccli!

vrczd UuxLluisanevin. ukmsuncictc tiind

Plrticiparea aststenldui modicrl Ir pbceduri

- sc dcscopd, ncnbrcleJc i',venigard sc.pli., gclnlconduclori
llurul vcno! poore li rcprcdus ca un suner suieritor (daci von c{c ronbozari

iu

se

lcrcepe nici un zsomot):

zonclc dcocluie ti Arudul de obslruclic
onrilicarc pnn scanarc Dwtexl
Pcntu exrmenul ancrclo! sc 0ootc opri cir.trlaria lcnddsi prin rtlicarer nran$lctor dc
tensionrcrru la coapsii, sdnbi. si glczni:

nan uc{onrl$ plascdt mcdirt

sub mrnfra unnlati (prcsilneaiitrd La trn nilclsupcnor

TAristolicc inrcgistare in exnem iDlarca .omali) i
sc dliberszn b pEsiuM dinnan$cri si se noterzi yaloarcr ccd nii mrreaT l...rc

'

aparc Ntccru L c.radcrist ic de senrnal

DoDflcrtui.ralffi

pr.cedura sc rcpdn ocntru UccarcnivcL.

MON[ORUL OFICIAL AL ROMANIE

Extnenul cch0errfi. duplcx

II

rterelor

.N

rotidc

_, fu
I P,
'li
'J

caturidian. anrecirzi vilcza

l'$ticiprrer rsistcntului

lisre

mcdical la profu durn

prcicnrllcire a$czar in dcctrbn doFrl( cdpul lixdrre[ru a impicdila h$.arca aeralai
$anlicagctul sisc fxce examinarcri
restul cvidc irli ocluzir su slcDoz andrelcaror dc

irdi.d m atonci

cdnd:

erisri s.innc trutrrologi.c (LLhuriri a.urc

rh.ur n.h umrco frnznon ):

f.ci!trt!l aclli cetuleei
sc pc(dp strflu'ipc.rcm.rdidi.

de vorbitc, dc

\ctlck nrn |.ft.i frrc.tr,,,

lichogrdia pclvinn
Di
.swm preTcnrci si cvohllici sadnii
'rlqii
poar.
Sc
rerlia t. doua ciii

d{ pd

nli

loq

cilndrdrllu'

g ol

.' renr'.

Eclrlrxfir in obsretric,
l)ii
rsupra cxntcnl.j s rcinij_ l.o'tui dc njdaiii (&vir.rcr utcritu sau i,r atar. acd{eir).
'lLriipL&cr.rc (placenra
itr$rrii
tncvla, srtoin. unica s.u muhinia. ptozcnrlrie.,,i$ra sarcirji.

T,d!

-I crtul cnc \.1't

' pcrrru fir
in.fensiv

i.tcr ,.tr,. r, r,r.,d.t!.?.ts,c|rr.,

ln.pnmtrl riDcsrnr, ccholrdli. sd reali4izt ne calc lmnsvdlfrLi. in hneslrut2 si :] sc prefqi

Pr..Ditr s.

\lnzli in Jlrubn dosrl

shdominrli r.sira lrcori re,ca 0tltra pcnh x se Nrer ditnrcnra dc sacut gesrionat.
Darl lcz'ca \rr goali c! o ori inri'rco lxdncnutui se ofcri pacicnrd I
Ddrrc nuri dc lpa si
!n. rugara r nu Dicrioncze Dini la lcmindm cxancnuhi.

crls

d'ir" dj.i F...ir"r..r'.,.ch4e.rt, ,,b r,,r.., blrc,: ,d,t,.,.,d ,rr' drJ!.Jn-n'i' ra.ro.." rlcrer.r
f. tr,rbto1 ,..J
Crlm rrtin,lt ru n...$r,LJrk!;trrc. \(.!r no:lc fi luJ d
sonJ" \ F r .' . .r p' r. onr1u,r. ,f
Mcroda sc prcfcra tu

c.nl

pcnornclorobczc. cL mulrjptc .catrici .bJominalc.

Echoprufia pelvinnin sinecoloaie

Sc eiectucaz de .ceula pD ralc tdnsvagin.t..
Pemne vi^alizarcd d.nlui \ia ov{ctor (fomri, sh,dr..r. polilic).

f!

Tronrpclc
sum vahiEdecir in c.^ripatotoslcc.
f:slc uLila pcnrru di4msic.red fibronuhri ddin. potjpitor. chisturitor Jd
a bdoncn d lui inlrosd. ldeniifi carca caf ccrclor

orar, cvtdcrtiqca

MON TORUL OFC ALAL ROMAN]E

proshri 5i r..r ta birbrti

Pc.nirc elalnarcx pr.siir.i. v., c0lclor\dnin.tc. toctului\tlcsur,tuiDerirccul
I'Nrticiprc. N3htcntului ncdicdt tr p.occ urn
. s. lacc o c iini cvrcLrbie cu.pr.ri'nativ o od inxinre_ prc^nrr rna!$iilor tccalc

ri.hotruri,

de

rul c{e a$zar in decrbir latcrxL riilg satr decubn dd^rt:

pcntu examin.rca endo'tctita apfnrulc{e ptasarlnr un sic dc larcx tubrnxl
l-lrplonrer po.tc !i/u1i7!:
hipcntufir b.i,ine, dc pr.$ri camctu dc prosiari satr rccr, pm$rrira. tutudrd dc

|acic

tirho.nfra scrolrli
Podc v ztraliza rumorj rcnicuLa.c hcniogc sau ,naligne. orrira. h bcetul. vxncoccluL.
.prliJnnul. heda s.ror ta..'ittorhidii. darcrLLE$iolxr. bsi!rci rcnictrtara
Sc poarc folosi pcftushidarca a{t0idcbiopsienr caztrLmeirFnilnni de c.nc.r ttc r{nart
Tc(Ll e$c icrduDutiz.rrl. u rcccsiri prcgftirc snecirti. sc podc l:tce in once moDc .l
uiLei. durcri rp,ori'ndiy 20 iimlc

Ich0qr,fir tiroidiann

Llf"'rr',

.h

J uo

I'acictrh'l cjc arezat in dNubit

No trcccsni prcliftc sDc.iali.

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in J, 1-,,d.t{,.

dnisrl. !dpul n hrpL(nrn,

L r

r !n

purrl

l trli\ r.l

c.

Erhorralia orhiului
lcnnire cxxrniDrrca Fitrlor cxrcrioarc atuncicard nutnb hnsprrcire sud
unarircx deTliIiIi dc rcrini

opace

I clc

urtL,

ir

Fcholr'ri nimrr!
p.n e ft,.,e,, nn'.rurilor sinului. d.cclcazi
LnaiiuDr {hora e cu dirnerut
Dmc dc I qn.
'nai
frcc dilctonrjcrcr inr. formrliunichrricd
\i tuDonLte (tunr.ri solide sau Li.hidcl,.lcii sitftii
se'nio osicd tnu! hxh-!niiatc sr0 bcnignirrtc. p.mr ic:hid.rrr