Radiation Exposure from CT, PET/CT Will Be Tracked at the NIH

Current Issues & Debates

• Controversies exist whether low-dose (less than 150 mSv) medical radiation tests are related to development of cancer.
• Model used to extrapolate the cancer risk from low-dose medical radiation exposure is a "linear-no-threshold hypothesis", which implies that any amount of ionizing radiation (even small) has a finite probability of inducing cancer.
• This approach is widely accepted and used for radiation protection regulations and guidelines by the International Commission on Radiological Protection.
• Several recent studies and news reports have raised concerns regarding radiation exposure from medical devices (particularly CT and nuclear cardiology)
• A recent study published in the Archives of Internal Medicine estimated that radiation from CT might cause 29,000 new cancers and 14,500 deaths a year. Another study in the same journal pointed out that patients may have received much higher radiation from imaging tests than previous believed. Read synopsis in the older RiT post.

Addressing These Issues by NIH

• Radiology and Imaging Sciences at the National Institutes of Health (NIH) Clinical Center will incorporate radiation dose exposure reports into the electronic medical record (EMR)
• The process will be developed in corporation with major equipment vendors beginning with exposures from CT and PET/CT
• Radiation dose will be recorded, entered into DICOM header for CT and PET/CT and stored either in radiology information system or preferably hospital-based EMR. It should be trackable by patients in their own personal health records

What Will It Do?

• It is the first step toward monitoring patient dose
• It is the basis for future research on this subject
• Who knows, in the future this may be required in all institutions...

Occupational Radiation Dose Limits

Facts:

• International Commission on Radiological Protection (ICRP) issues periodic recommendations on radiation protection. The Commission was founded in 1928.
• ICRP's latest publication was Publication 103 (2007)
• ICRP effective dose limit for radiation worker (occupational dose limit) = 20 mSv per year when averaged over 5 years; any year limit to 50 mSv
• The most highly exposed workers are unlikely to receive regular annual effective doses more than 5 mSv
• Radiation workers should be monitored using personal dosimeter (film badges, TLDs)
• In emergency situations, occupational exposure can exceed these dose limits if lifesaving actions are involved. Older workers with low lifetime accumulated effective doses should volunteer for emergencies.

Nephrogenic Systemic Fibrosis Disappeared After Restrictive Use of Gadolinium?

According to a large (50 000+) retrospective cohort of patients who underwent contrast-enhanced MR examinations at a single academic institution pre- and post-adoption of strict gadolinium guidelines:-

• No new cases of nephrogenic systemic fibrosis (NSF) were diagnosed
• During the pre-guidelines adoption and transitional period, the incidence of NSF was 3 cases per 10,000 contrast-enhanced MRI
• After the adoption of guidelines, the incidence was 0 per all examinations

The Guidelines for Imaging Adult Patients

• Based on renal disease severity
• eGFR 60 or greater - GBCA can be administered as indicated
• eGFR 30-59 - weight-based dose of GBCA (0.2 mL/kg) can be administered with maximal dose of 20 mL allowed within 24 hours
• eGFR less than 30 - GBCA cannot be administered except in cases of medical necessity; informed consent required; nephrology consultation required; hemodialysis should be considered
• Very rarely that any patients with eGFR less than 30 would get contrast-enhanced MR exams (36 in 52 954 exams; 0.07%)

eGFR = estimated glomerular filtration rate; GBCA = gadolinium-based contrast agent

CT Radiation Exposure in Real Clinical Practice and Cancer Risk Estimation

Two recent studies published in the Archives of Internal Medicine in December 2009 could serve as an eye opener for every physicians ordering CT scans as well as radiologists.

Smith-Bindman et al collected CT dose data of 11 most common CT study types performed in 4 hospitals in San Francisco Bay Area. They found that there were wide variations in dose within each study type and between different types. For example, routine chest CT dose ranged from 2 to 24 mSv, routine abdomen-pelvis CT with IV contrast dose ranged from 4-45 mSv. Median effective doses for each exam were higher than they were commonly quoted in the literature, for example, 8-10 mSv is common quote for a chest CT examination. They also estimated the risk of developing cancer related to CT in several patient groups according to patient's age at the time of CT. Based on their calculation, 1 in every 80 women who undergo a chest CT for suspected pulmonary embolism at age 20 will develop cancer. Similarly, 1 in every 270 women who undergo coronary CT angiography at age 40 will develop cancer.

Berrington de Gonzalez et al utilized Medicare claim data and IMV Medical Information Division survey to project estimated age-specific cancer risk from CT studies performed in the U.S. in 2007. Excluding CT studies done for cancer diagnosis and within the last 5 years of life, 2% (29,000) excess cancers caused by CT scans in 2007 were predicted.

What is needed?
Optimization and standardization of CT protocols and techniques to limit radiation
Reduction of number of CT scans
Collection of dose information at patient level to educate patients and health care providers about radiation exposure

Effects of radiation in our body

• 0 - 5 rem received in a short period or over a long period is safe—we don’t expect observable health effects.
• 5 - 10 rem received in a short period or over a long period is safe—we don’t expect observable health effects. At this level, an effect is either nonexistent or too small to observe.
• 10 - 50 rem received in a short period or over a long period—we don’t expect observable health effects although above 10 rem your chances of getting cancer are slightly increased. We may also see short-term blood cell decreases for doses of about 50 rem received in a matter of minutes.
• 50 - 100 rem received in a short period will likely cause some observable health effects and received over a long period will increase your chances of getting cancer. Above 50 rem we may see some changes in blood cells, but the blood system quickly recovers.
• 100 - 200 rem received in a short period will cause nausea and fatigue. 100 - 200 rem received over a long period will increase your chances of getting cancer.
• 200 - 300 rem received in a short period will cause nausea and vomiting within 24-48 hours. Medical attention should be sought.
• 300 - 500 rem received in a short period will cause nausea, vomiting, and diarrhea within hours. Loss of hair and appetite occurs within a week. Medical attention must be sought for survival; half of the people exposed to radiation at this level will die if they receive no medical attention.
• 500 - 1,200 rem in a short period will likely lead to death within a few days.
• >10,000 rem in a short period will lead to death within a few hours.

The health effects listed above are for a radiation dose to the entire body. If the radiation is given to a smaller area of the body, there are other effects that may occur, but illness or death is not expected unless noted:

• 40 rem or more locally to the eyes can cause cataracts.
• 100 rem - 500 rem or more can cause hair loss for a section of the body that has hair.
• 200 rem or more locally to the skin can cause skin reddening (similar to a sunburn).
• 1,000 rem or more can cause a breakdown of the intestinal lining, leading to internal bleeding, which can lead to illness and death when the dose is to the abdomen.
• >1,500 rem or more locally to the skin can cause skin reddening and blistering.

Fundamental dose reduction concepts in CT

• optimize scan parameters by reducing tube current, either as a user-selectable option in the scan prescription or by selecting scanners that feature angular and z-axis modulation of mA according to tissue thickness along a given projection;
• develop tabulated guidelines for height- and weight-adjusted current settings;
• increase table increment or pitch (axial and helical scans, respectively) whenever possible without reducing image quality;
• reduce the number of multiphase scans; and
• reduce inappropriate referrals and recommend less dose-intensive modalities—such as MRI, ultrasound, and radiography—whenever possible.

Factors contribute to the dose intensity of CT

1) Mode of irradiation. In contrast to planar radiography, which is planar by nature, CT involves multi-angular irradiation of the patient. As a result, dose is distributed with essentially uniform intensity throughout the scan plane rather than with the decreasing intensity with depth characteristic of radiography. In general, a CT examination of a given section of anatomy delivers a dose that is substantially higher than its radiographic equivalent. For example, the effective doses delivered by radiography and CT of the (PA) chest are approximately 2 and 800 mrem, respectively. Order-of-magnitude dose disparities between CT and radiography exist for other examination types.

2) Dose to extraneous tissues. Relatively high doses are delivered to tissues included in the scan plane but not of clinical interest, such as the breast in thoracic CT. Breast dose during such procedures lies in the range of 2 to 10 rad—in comparison with an average mean glandular dose of approximately 200 millirad per view in mammography. Dose to all tissues in the field of view at CT as well as those irradiated by secondary radiation (internal and external scatter and tube leakage) contribute to the patient's effective dose.

3) Irradiated tissue volume. With the advent of helical MDCT and subsecond gantry rotation times, and the option of contiguous or overlapping scans, greater scan lengths are achievable in increasingly less time—resulting in a concomitant increase in the average total volume of irradiated tissue. Further, the requirement for interpolation of transmission profiles from neighboring scans in helical scanning in turn necessitates additional rotations of the gantry at the extremes of the scan range, such that the exposed tissue volume is greater than the reconstructed volume. This type of dose augmentation is exacerbated as the aperture width increases.

4) Nature of CT image formation. Modalities that use image-recording media with limited dynamic range—such as screen-film radiography—have associated with them limits to the dose that can be recorded without loss of information. CT, however, is an inherently digital-imaging modality for which there is no such dose penalty. Image quality in CT will increase with increasing dose as the level of Poisson-distributed noise decreases.

5) Nonoptimized scanning protocols. The NRBP UK CT dose survey1 demonstrated that patient-efficient doses for the same examination could vary by up to a factor of 10 among institutions. However, this magnitude of variability represents a significant improvement in the findings of the 1991 survey by the same group in which dosewise variation on the order of a factor of 40 was found. This change is, in part, the result of emergent awareness of the radiation burden imposed by CT and the application of dose-mitigating strategies based on patient age, body habitus, and the tissue type to be imaged.

ACR accreditation for Pediatric CT Scans

ACR accreditation ensures that: 

1. The physician interpreting scans has met stringent education and training standards 
2. The technologists operating the equipment are certified by the appropriate body 
3. The imaging equipment is surveyed regularly by a medical physicist to make sure that it is functioning properly and is taking optimal images without excess radiation. 

The ACR advises that no imaging exam should be performed unless there is a clear medical benefit. The ACR supports the use of the optimal level of radiation needed in imaging exams to achieve necessary results. 

The government can help ensure appropriate imaging and lower the radiation dose that Americans receive from scans each year by: 

1. Requiring accreditation of all imaging facilities (including hospitals) — ACR accreditation signifies that the equipment is surveyed regularly by a medical physicist, the technologists are appropriately certified and the interpreting physicians have met stringent education and training standards. This avoids repeat imaging due to poor quality scans and the associated radiation exposure. Patients can find accredited facilities at ACR.org. 

2. Encouraging/Incentivizing use of ACR Appropriateness Criteria®-based decision support/exam order entry systems — These systems educate providers on which exam is best for a patient’s condition (or when no scan is warranted). This process ensures that patients get the right scan for the right reason at the right time, reduces inappropriate imaging, helps avoid unnecessary exposure to radiation, and is proven to improve quality and lower cost by ensuring appropriate imaging and that providers obtain needed information from the correct scan. 

3. Encouraging/Incentivizing participation in the ACR Dose Index Registry® — Facilities contribute anonymized, HIPPA-compliant dose information on every scan and periodically compare their dose indices to national benchmarks. This ongoing and regular feedback allows facilities opportunities to adjust dose accordingly and gauge how their radiation reduction efforts are working over-time. 

Risk factors for IV Contrast Reactions

How do radiologists ensure the risk to their patients is minimised and that the number of reactions they observe are the fewest possible? According to Cohan, the first step is to identify patients who are at increased risk of having an acute allergic-like reaction. The three commonly acknowledged risk factors for acute allergic-like reactions include patients who have had a prior adverse contrast reaction of the allergic-like type, patients with allergies to other substances, and patients with a history of asthma.
"Not surprisingly, the patients who are at the highest risk of having an allergic-like reaction are those who have had previous reactions to the same kind of contrast material," he says. "It's not a complete guarantee that someone will have the same reaction, but a subsequent allergic reaction is much more likely, compared with patients who haven't had reactions before. It has been estimated that the increased risk in these prior reactors is about five-fold. Not quite at the same level are patients who have allergies to other substances, including foods and other medications and asthmatics. Prior studies have found that the risk of an acute allergic-like reaction in these two groups is increased by a factor of about two to three."
There is also a problem with the large amount of patients who have allergies to other medications or foods. Such allergies are very common and may be present in up to 50% of people.

Cohan believes that it is important to have a number of overlapping mechanisms in place to detect patients who are at increased risk of having an allergic-like contrast reaction, so that if one component fails the others may succeed in identifying patients as having an increased risk of having a contrast reaction."Obviously, we wouldn't be doing anything very selective in such a large group by identifying them as being at increased risk," says Cohan. "So, many experts have recommended that we consider those patients who have severe allergies or have many allergies as being particularly at risk, although the data to support this behaviour is not very compelling.This is merely an assumption that many of us make."
"The clerk who schedules an imaging test usually asks the patients the relevant questions," he explains. "The patient is then interviewed by a technologist on arrival in the radiology department. In addition the medical records are reviewed."

WHO IS AT RISK?

- Pt. with RF are at 10X increased risk to develope RF.

- If pt. had a previous reaction, but it is not sure that the pateint will have another one.

- Pt. with asthma, drug or food allergy.

- Sea food allergy

- On nephrotoxic deugs (NSAIDS, aminoglycosides)

- Advanced age is risk for RF.

- Metformin (Glucophage), has been associated with the development of severe lactic acidosis following administration of intravenous contrast media.

- Experts recommend stopping metformin therapy at the time of the procedure, or before, and for at least 48 hours following the administration of contrast material.

Risk of pacemakers in MRI

 MRI systems expose patients to very strong magnetic fields that can disrupt electronic pulses generated by a pacemaker.  A study performed in 2009 found that the magnetic field can also increase the temperature at the tip of the pacemaker lead within the heart and can cause heart tissue to burn.  FDA researchers also found that when the pacemaker is exposed to strong magnetic fields it could drastically alter the pulse and may not stimulate the heart properly. According to the National Council of Aging, a person’s chance of needing an MRI doubles after the age of 65 and 50% to 75% of patients with pacemakers will need an MRI over their lifetime

Magnetic resonance imaging (MRI) is generally contraindicated in patients with pacemakers,and American Heart Association (AHA) guidelines recommend consideration of MRI only in exceptional circumstances,excluding the vast majority of pacemaker patients who might benefit from MRI examination. However, in February 2011, the US Food and Drug Administration (FDA) approved the Revo MRI SureScan Pacing System, the first cardiac pacemaker designed to be used safely during MRI examinations.

For patients without an MRI-safe pacemaker, the electromagnetic fields and radiofrequency (RF) energy generated by MRI may pose risks (eg, interference with pacemaker operation, damage to system components, inappropriate therapy, lead or pacemaker dislodgement, or change in capture threshold). A scientific statement from the AHA on the safety of MRI in patients with cardiovascular devices includes the following limited recommendations on the performance of MRI in patients without an MRI-safe pacemaker or ICD

• Performing the examination at centers with expertise in MRI and electrophysiology
• Having a physician with pacemaker/ICD expertise decide whether it is necessary to reprogram the device before the MRI examination
• Having a person with expertise in MRI physics and safety involved in planning the scan, with consideration for the use of scanning parameters that minimize risk (eg, the lowest RF power levels and the weakest/slowest necessary gradient magnetic fields)
• Testing pacemaker functions before and after the examination
• Observing the patient closely throughout the examination, including monitoring of heart rhythm and vital signs

USE OF CONTRAST MEDIA DURING LACTATION

The traditional and standard recommendation is that lactating women who receive intravascular iodinated contrast or gadolinium should discontinue breast-feeding for 24 hours, and the expressed milk during this period should be discarded [1]. The rationale for this recommendation appears weak, for several reasons:

• Only tiny amounts of iodinated or gadolinium-based contrast medium given to a lactating mother reach the milk. For example, a recent study of 20 lactating women found that less than 0.04% of the maternal dose of intravenous gadolinium passes into the breast milk [2].
• Only a tiny fraction of iodinated contrast or gadolinium entering the infant gut is absorbed. For example, only 1-2% of oral iodinated contrast is absorbed into the bloodstream [3].

Given these considerations, and in accordance with the results of a comprehensive review by the European Society of Urogenital Radiology, the very small potential risk associated with absorption of contrast medium may be insufficient to warrant stopping breast-feeding for 24 hours following either iodinated or gadolinium contrast agents [4]. A recent review in the New England Journal of Medicine also concluded that iodinated contrast administered to breast-feeding women posed no risk to the infant [5].

Key point: Lactating women who receive iodinated contrast or gadolinium can continue breast feeding without interruption.

Credit cards in Oman

 Visa and Mastercard are the most widely accepted  "credit cards in Oman"  .
Charge cards issued by American Express and Diners Club are also available in the the list of  "credit cards in Oman"  and are accepted, although to a lesser extent than the major  "credit cards in Oman"  , mainly because of the higher commission charged to the supplier of the goods or services you are purchasing. Cash withdrawal from ATM option available in all the banks issued "credit cards in Oman" the region but there will be a charge for a cash transaction. For standard "credit cards in Oman" annual charges are OR15 per year and gold cards its bit high.

Gonadal Shielding and Beam Collimation Policy

Gonadal shielding is an important radiation protection technique that can reduce the genetically significant dose (GSD) from diagnostic x•rays. The radiographic field shall be restricted to the area of clinical interest. Gonadal shielding of not less than 0.5 mm lead equivalent shall be used for patients the direct beam, except for cases in which this would interfere with the diagnostic procedure.

Purpose

The purpose is to minimize the radiation exposure to the gonads.

Scope

This policy applies to all radiographic or fluoroscopic exams and procedures using ionizing radiation, including portable units.

Implementation

Implementation of this policy is the responsibility of the technical staff.

Is there a maximum number of CT scans that is considered safe?

No, there is no cutoff value for the number of CT scans that can be performed. The decision to perform each scan is based on the expert medical judgment of the requesting physician, who includes radiation dose and cumulative radiation dose in the risk/benefit consideration.

MRI-safe pacemaker-Revo MRI SureScan Limitations

 Medtronic first-generation Revo MRI SureScan Pacing System has some significant limitations.

1. The MRI-pacemaker is for new heart patients. Patients who already have a pacemaker can not get this new model unless they undergo the risky procedure of having their old pacemaker completely removed. Usually, when it comes time to replace the battery in a pacemaker (about 5-7 years), the metal case containing battery and circuitry is detached from the leads, and a new model device is hooked up to the leads. But doctors generally consider it too risky to remove the old leads from the heart for fear of tearing the heart or the veins through which the leads are inserted into the heart. Part of the design of the Revo pacemaker is its new leads and so they must be the leads that connect the pacemaker to the patient’s heart.

2. Patients must have the Revo pacemaker implanted for 6 weeks before receiving an MRI.

3. The Revo pacemaker requires a certain position of the patient inside the MRI tube so as to avoid most chest scans. This is to prevent overheating the metal tips of the leads that are attached to the heart. So heart scans are forbidden with this first generation model.

4. And Owen Faris, senior scientific reviewer for the FDA, explains that the new pacemaker won’t work for all types of MRI scans and won’t work in all MRI scanners. In his words:

In addition to the chest scan exclusion, there is a restriction on how much radio-frequency energy can be deposited into the body by the scanner. MRI scanners have two operating modes for most clinical applications. ‘Normal operating mode’ is how the scanner is normally programmed and that mode restricts the scanner to lower-energy scans (less than 2 Watts per kilogram). This is sufficient energy for most clinical MRI scans. However, for some patients and for certain scans, more power is needed. In those cases, the MRI scanner is placed in ‘First level control’ mode, which allows for greater energy deposition (up to 4 Watts per kilogram). For patients implanted with the REVO MRI pacemaker, those patients are not allowed to have these higher energy scans.

MRIs for these patients are also restricted to only allow use of 1.5 tesla MRI systems. "Tesla" is a measure of the strength of the magnetic field.

5.  Medicare does not now pay for MRI scans on a patient who has a pacemaker. Medtronic spokesperson Wendy Dougherty says that the company will not speculate on whether Medicare will cover MRIs done on patients wearing the new Revo pacemaker. The federal agency is considering a petition from a physician to cover MRIs done during an investigational study to determine the risk of MRIs involving pacemakers already in use. During the comment period for this request, Medtronic asked Medicare to restrict MRI payment to patients wearing pacemakers approved by the FDA for use with MRIs. Medicare’s decision is due by March 1. Patients on Medicare would be wise to check on whether their plan will pay for an MRI before getting the test, which costs between $1,600 and $3,500 at different medical centers and offices.

Radiation doses from common CT scan and other imaging studies

The typical radiation doses associated with some common imaging tests are shown below. Remember, the annual dose we all receive from background radiation is from 3 to 5 mSv.

Test	Dose (mSv)	Equivalent period of background radiation	Citation
Chest x-ray (standard two views)	0.06-0.1	8-12 days	1, 2
Mammography	0.13-0.7	16-88 days	1, 2
Abdomen x-ray	0.5-0.7	62-88 days	1
Lumbar spine x-rays	1.8	7 months	1
Head CT scan	2.0	8 months	2
Chest CT scan	8.0	3 years	2
Abdomen and pelvis CT scan	10.0	3 years	2
Virtual colonoscopy	10.2	3 years	3
Whole body PET/low dose non-contrast CT scan	8.5-10.3	3 years	4
Whole body PET/full dose contrast-enhanced CT scan	23.7-26.4	8-9 years	4
Prospective ECG-gated coronary CT angiogram	4.0	1 year	6
Retrospective ECG-gated coronary CT angiogram	18.0	5 years	6
Tc-99m sestamibi 1 day cardiac rest-stress test	12	3.5 years	4
Coronary angiography (diagnostic)	4.6-15.8	2-5 years	1
Coronary angiography (with intervention)	7.5-57.0	2-19 years	1

CAR Renatal Agencies in RWANDA

Agence de Voyage et Tourism
Avenue des Mille Collines
Phone Contacts: +250 252501388
Email: oida56@ahoo.com

Cite Tours & Travel
Phone Contacts: +250 252571277
Fax: +250 252571278
Email: cite&rwand1.com

Gorilland Safaris Ltd Tours
Phone Contacts: +250 252574565
Fax: +250 252519120
Email: gorillasnd@rwanda1.com

International Tour and Travel Ltd
SORAS Building
Phone Contacts: +250 252574057
Fax: +250 252575582
Email: itt@rwanda1.com

Kiboko Tours & Travel
Avenue de la Paix, Kigali Centre
Phone Contacts: +250 252520118
Fax: +250 252501741
Email: kiboko@rwanda1.com

Kigali Safaris S.a.r.L
Email: kglsafaris@yahoo.fr

Nord Sud International Travel & Tour Agency
Ave. de la Paix
Phone Contacts: +250 252570449
Fax: +250 252575349

Rwanda Eco-Tours Agency
Ave. De La, Gakingiro
Phone Contacts: +250 252500331
Email: info@rwandaecotours.com
Web: www.rwandaecotours.com

Satguru Travel & Tours Services
Ave. du Commerce
Phone Contacts: +250 252572643
Fax: +250 252573853
Email: stt@rwanda1.com

Socor Top Travel & Tour Agency
De la Revoulution
Phone Contacts: +250 252572552
Fax: +250 573853
Email: socor@rwanda1.com

The Travel Company
Phone Contacts: +250 252505151
Fax: +250 252577472 Email: info@thetravelcompany.rw

Traser (Travel Agency Service)
Phone Contacts: +250 252574990
Fax: +250 2525745564
Email: tnserw@yahoo.com

Zebra Country Tours
Cell: +250 788468152
Email: info@zebracountry.rw
Web: www.zebracountry.rw

List of banks in Libya

Central Bank of Libya مصرف ليبيا المركزي
Headquarters	Tripoli
Established	1956
Central bank of	Libya
Currency	Libyan dinar
ISO 4217 Code	LYD
Website	cbl.gov.ly
Preceded by	Libyan Currency Committee

Tel: +218 (21) 3333591 – 99 / +218 (21) 4441481
Fax: +218 (21) 4441488 / +218 (21) 4902148

 National Commercial Bank
Orouba Street AlBaida
P.O.BOX 543 AlBaida
Tel: +218 (21) 3612429 / +218 (21) 3617977
Fax: +218 (21) 446705 / +218 (21) 3610306
Website: http://www.altejaribankly.com

African Bank of Trade and Investment
Al Fateh Tower (2nd Floor No.28)
P.O. BOX 12132 Tripoli
Tel: +218 (21) 3351405
Fax: +218 (21) 3351413

Britsh Arab Commercial Bank (BACB)
EL – Fatah Tower (Floor15 – Office No.154)
P.O .BOX 91051
Tel: +218 (21) 3351489
Fax: +218 (21) 3351730 – 32
Website: http://www.bacb.co.uk

Agricultural Bank
Area Agheiran
P.O BOX 1100 Tripoli
Tel: +218 (21) 4870586 / +218 (21) 4870745
Fax: +218 (21) 4870747 / +218 (21) 4870777
Website:www.agribank ly-org 

Al Umma Bank
Omar Almokhtar Street, Tripoli
P.O BOX 685 Tripoli
Tel: +218 (21) 3330651 / +218 (21) 3331195 – 94
Fax: +218 (21) 3330602 / +218 (21) 3330880 – 88
Website: http://www.umma-bank.com

Al Wahda Bank
Emhemed Almgarief – Algeria Square, Tripoli
Tel: +218-21-3330503 / +218-21-3330600 / +218-21-3330699
Fax: +218-21-3334024 / +218-21-3338834
Website: http://www.wahdabank.com
 
Bank AL wafa
Location: AL Fallah Area
P.O. BOX 84212 Tripoli
Tel: +218 (21) 4815123
Fax: +218 (21) 4801247
Website: http://www.alwafabank.com
 
Sahara Bank
Tel: +218 (21) 3337182
Fax: +218 (21) 3337182
Website: http://www.saharabank.com.ly

Bank Gumhouria
Omar Mukhtar Street
P.O. BOX 685T Tripoli
Tel: +218 (21) 4442541
Fax: +218 (21) 4442476 / +218 (21) 3332505
Website: www.gumhouria-bank.com.ly
 
Mediterranean Bank
Omar Al Mokhtar Street
P.O.BOX 410, Benghazi
Tel: +218-61-9098386 / +218-21-9091048
Fax: +218-21-9098106
Website: http://www.meditbank.net

 
Bank of Commerce & Development
Abu Meshmasha Area (AL nsser Street)
P.O.BOX 9054 Tripoli
Tel: +218 (21) 3340765
Fax: +218 (21) 3341359
Website: http://www.bankofcd.com
 
Al Aman Bank
Dat El Imad Complex 9Tower – Ground Floor
P.O BOX 91271 Tripoli
Tel: +218 (21) 3350219 – 16 / +218 (21) 3330898 – 99
Fax: +218 (21) 3350386 – 7
Website: http://www.abci.ly
 
Al Wafa Bank
P.O.BOX 84212, Tripoli
Tel: +218-21-3351518
Fax: +218-21-3351519
Website: http://www.alwafabank.com
 
Bank of Valleta Malta
AL Fateh Tower; Ground Floor – Office No.49
P.O BOX 93299 Tripoli
Tel: +218 (21) 3351661
Fax: +218 (21) 3351665
Website: http://www.bov.com
 
Mediterranean Bank
P.O.BOX 9830 Tripoli
Tel: +218 (21) 3408659 / +218 (21) 3408657
Fax: +218 (21) 3408656 / +218 (21) 3408653
Website: http://www.meditbank.net

 
Al Ejmaa Alarabi Bank
Al Sherif Street
P.O. BOX 17551.Benghazi
Tel: +218-61-9090128 / +218-61-9096679
Fax: +218-61-9099600 / +218-61-9099706
Website: http://www.alejmaa.com

Bank of Commerce & Development
P.O.BOX 9054 Benghazi
Tel: +218 (61) 2229630 – 38
Fax: +218 (61) 9097115
Website: http://www.bankofcd.com/


Al Ejmaa Alarabi Bank

Tripoli Branch
Dat El Imad, Tower 1
P.O. BOX 17551 Tripoli
Tel: +218 (21) 3350055 – 57
Fax: +218 (21)3350485 – 86
Website: http://www.alejmaa.com

Domestic Banking Corporation
Ben Al Waleed Street, Al Dahra Area, Tripoli
Tel: +218-21-3350226 – 28
Fax: +218-21-4448623 / +218-21-4449730
Website: http://www.arabbankingcorp.com
 
Jumhoria Bank
AL Shohadaa Square (Green Square)
P.O.BOX 65004 Tripoli
Tel: +218 (21) 3335664 / +218 (21) 3338027
Fax: +218 (21) 3338608 / +218 (21) 3339627
Website: http://www.gumhouria-bank.com


Saving and Real-Estate Investment Bank
Al Sreem Street – Abu Miliana Street – Al Masera Al Kobra Street
P.O BOX 2289, Tripoli
Tel: +218-21-3330434 / +218-21-3330561 / +218-21-3331746
Fax: +218-21-3344631 to 34
Website: http://www.eddekharbank.com
 
Security Bank for Trade and Investment
Hay Al Andalous
P.O. BOX 91271 Tripoli
Tel: +218 (21) 4775220
Fax: +218 (21) 4775288

Libyan Arab Foreign Bank
Dat El Imad Complex (Tower No.2)
P.O.BOX 2542 Tripoli
Tel: +218 (21) 3360054 / +218 (21) 3350161
Fax: +218 (21) 3350165
Website: www.lafbank.com/