Drm Cek List Pemakaian Dosis Radiasi.docx

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RUMAH SAKIT MAWAR Jl. SDPS SURABAYA

DRM : NORM...............

FORMAT PEMAKAIAN DOSIS RADIASI

NAMA DIAGNOSA

NO

NB. NO 1 2 3 4 5 6 7 8 9 10

TANGGAL

: :

TGL LAHIR / UMUR

:

L/P

:

JENIS PEMERIKSAAN RADIOLOGI

JENIS PEMERIKSAAN RADIOLOGI Foto Thorax FotoTulangBelakang Mammography Lower GI Tract IVP CT Scan Head dan Contras Media CT Scan Thorax dan Contras Media CT Scan Abdomen dan Contras Media Coroner ( CTA )/ Angiografi PET/ CT

DOSIS PAPARAN RADIASI

RADIASI DOSE 0.1 mSv 1.5 mSv 4 mSv 8 mSv 3 mSv 4 mSv 7 mSv 20 mSv 12 mSv 25 mSv

JUMLAH TOTAL RADIASI

Edukasipaisen/ Keluarga ttd

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