Safety and riskSafety and risk

الرحمن الله الرحمن بسم الله بسمالرحيمالرحيم

ObjectiveObjective

11--Radiation safetyRadiation safety 22--Contrast agentContrast agent

Shielding :

Operators view the target through a leaded glass screen, or if they must remain in the same room as the target, wear lead aprons. Almost any material can act as a shield from gamma or x-rays if used in sufficient amounts .

Lead apronLead apron

how much protection how much protection raterate

Thyroid collarThyroid collar

Standard 0.5mm lead apronStandard 0.5mm lead apron Protect you from 95%Protect you from 95% FROM RADIATION EXPOSUREFROM RADIATION EXPOSURE

There are three factors that control There are three factors that control the amount, or dose sourcethe amount, or dose source . .

-Time-Time: Reducing the time : Reducing the time of an exposure reduces the of an exposure reduces the effective dose . effective dose .

An example of reducing An example of reducing radiation doses by radiation doses by reducing the time of reducing the time of exposures might be exposures might be improving operator improving operator training to reduce the time training to reduce the time they take to handle a they take to handle a

source.source.

Surgeon –cardiologist Surgeon –cardiologist

-- Distance Distance: : Increasing distance Increasing distance reduces dose due reduces dose due to the inverse to the inverse square law. square law. Distance can be as Distance can be as simple as handling simple as handling a source with a source with forceps rather than forceps rather than fingers. fingers.

Radiation riskRadiation risk

Stochastic effect Stochastic effect Deterministic effect Deterministic effect

Stochastic effect Stochastic effect

Carcingenic effect .Carcingenic effect .

Related to Related to accumulative accumulative Amount of Amount of exposure exposure

Gentic effect Gentic effect

Related to Related to accumulative accumulative Amount of Amount of exposureexposure

Deterministic effectDeterministic effectRelted to thresholds levelRelted to thresholds level

FINDINGFINDING

CATARCTCATARCT

BONE MARROW FAILUREBONE MARROW FAILURE

ERYTHEMAERYTHEMA

LUNG FIBROSISLUNG FIBROSIS

Deterministic effectDeterministic effect

LEVEL >2-3 GRAY RANGELEVEL >2-3 GRAY RANGE Gray is unit of exposure of radiationGray is unit of exposure of radiation

ONE CHEST X RAY 0.15 mGRAYONE CHEST X RAY 0.15 mGRAY You need 10000 chest x ray You need 10000 chest x ray Or 100 CT abdomenOr 100 CT abdomen 30 mins to 1 hr fluoroscopy exposure 30 mins to 1 hr fluoroscopy exposure

ALARA ruleALARA rule

As low as reasonably achievable As low as reasonably achievable

Reduce number of exam Reduce number of exam Reduce time of examReduce time of exam Use alternaive Use alternaive

US vs MRI US vs MRI

BACKGROUN RADIATIONBACKGROUN RADIATION

NATURAL RADIATIONNATURAL RADIATION FROM OUTER SPACE FROM OUTER SPACE FROM RADON GAS FROM RADON GAS

(average annual dose)(average annual dose) 3.2 milli-sievert 3.2 milli-sievert Sievert is effective radiation dose Sievert is effective radiation dose

(absorbed dose) (absorbed dose)

Average annual doseAverage annual dose

Radiolgsit :Radiolgsit :

0.70.7 milliSievertmilliSievert

Technolgist :Technolgist : 0.950.95 milliSievertmilliSievert

EQUAVALANCY TO NATURAL EQUAVALANCY TO NATURAL BACKGROUND RADIATIONBACKGROUND RADIATION

33 YEARYEAR33 YEARYEAR

66 MONTHMONTH

1616 MONTHMONTH88 MONTHMONTH

33 YEARYEAR33 YEARYEAR

66 MONTHMONTH

1616 MONTHMONTH88 MONTHMONTH

Radiation doseRadiation dose

INVESTIGATIONINVESTIGATIONRISK/ PA CHESTRISK/ PA CHEST

X RAY ( 0.03 m SV)X RAY ( 0.03 m SV)

LUMBAR SPINELUMBAR SPINE100100

ABDOMINEABDOMINE5050

IVUIVU150150

CT HEADCT HEAD100100

CT CHESTCT CHEST300300

CT ABDOMENCT ABDOMEN400400

BONE SCANBONE SCAN200200

ORAL CONTRASTORAL CONTRAST

GASTROGRAPHINE GASTROGRAPHINE BARUIM BARUIM

Oral contrast mediaOral contrast media

1- barium meal, swallow ,enema, ect1- barium meal, swallow ,enema, ect (used barium as contrast ). (used barium as contrast ).

2-IN CT study (diluted 2-IN CT study (diluted gastrographine) gastrographine)

Gastrographine is used in upper Gastrographine is used in upper GI study (in case of bowel perforation GI study (in case of bowel perforation

))

GASTROGRAPHINEGASTROGRAPHINE

MAIN INDICATION :MAIN INDICATION : IF THERE IS BOWEL PERFORATIONIF THERE IS BOWEL PERFORATION Why ?????? .Why ?????? .

CONTRA INDICATION CONTRA INDICATION .. IF THERE IS RISK OF ASPIRATION IF THERE IS RISK OF ASPIRATION The The risk is a chemical pneumonitis risk is a chemical pneumonitis

BARIUM (contrast media )BARIUM (contrast media )

Barium used for GI Barium used for GI studystudy::

Contra- indicated ifContra- indicated if

there perforationthere perforation

Or toxic mega colonOr toxic mega colon..

The risk is The risk is chemical peritonitis chemical peritonitis

MR CONTRASTMR CONTRAST

11--EXPENSIVEEXPENSIVE

22--we are giving 0.1 m mol /kgwe are giving 0.1 m mol /kg

Reaction was described on MR contrastReaction was described on MR contrast

But much less than CT CONTRASTBut much less than CT CONTRAST -33--NEPHEROGENIC SYSTEMIC NEPHEROGENIC SYSTEMIC

FIBROSISFIBROSIS::-If contrast given in CRFIf contrast given in CRF

NEPHEROGENIC SYSTEMIC NEPHEROGENIC SYSTEMIC FIBROSISFIBROSIS

is a rare and serious syndrome thatis a rare and serious syndrome that involves fibrosis of skin, joints, eyesinvolves fibrosis of skin, joints, eyes,,

Most patients with NSF have undergone Most patients with NSF have undergone hemodialysis for renalhemodialysis for renal

failurefailure,,

NSF may also cause joint contractures NSF may also cause joint contractures resulting in joint pain and limitation in resulting in joint pain and limitation in range of motionrange of motion

NEPHEROGENIC SYSTEMIC NEPHEROGENIC SYSTEMIC FIBROSISFIBROSIS

Currently, Currently, there is no effective there is no effective treatment for nephrogenic systemic treatment for nephrogenic systemic fibrosis.fibrosis.

CT SCANCT SCAN

IV contrast in pulmonary IV contrast in pulmonary embolismembolism

Contrast media reactionContrast media reaction??? ???

Status: Lethargic. Pulse: 130/min BP: 70/40 mm Hg RR: 28/min Chest: Some expiratory wheezes

Contrast mediaContrast media

TAKE PRECAUTION BEFOR GEVING TAKE PRECAUTION BEFOR GEVING CONTRAST AGENT:CONTRAST AGENT:

1-PREVIOUS REACTION1-PREVIOUS REACTION 2-ASTHMATIC PATIENT2-ASTHMATIC PATIENT 3-RENAL IMPAIRMENT3-RENAL IMPAIRMENT 4-DM-ATOPIC DERMATITIS4-DM-ATOPIC DERMATITIS 5-PREGNANT5-PREGNANT 6-SCA-MULTIPLE MYELOMA6-SCA-MULTIPLE MYELOMA

TYPE OF REACTIONTYPE OF REACTION 1-MILD : nuasia & vomting 1-MILD : nuasia & vomting 2-MODERATE : skin reaction and 2-MODERATE : skin reaction and

brochospasm brochospasm 3-SEVER hypotenstion .3-SEVER hypotenstion . HOW TO TREAT?HOW TO TREAT?

Contrast mediaContrast media

Reactions can range from minor to Reactions can range from minor to severe, sometimes resulting in death severe, sometimes resulting in death with death being about 0.9 per with death being about 0.9 per 100,000 cases100,000 cases

I V contrast mediaI V contrast media

A common misconception that even A common misconception that even exists among healthcare exists among healthcare professionals is that an allergy to professionals is that an allergy to contrast media is related to an contrast media is related to an allergy to seafood (usually shellfish) allergy to seafood (usually shellfish) because both share iodine in because both share iodine in common, implicating iodine as a common, implicating iodine as a sourcesource

Contrast Reactions GuideContrast Reactions Guide

For all casesFor all cases Always follow BLS and ACLS Guidelines asAlways follow BLS and ACLS Guidelines as Remember your ABCs (Airway, Breathing, Remember your ABCs (Airway, Breathing,

Circulation) Circulation) Call for help (EMT/code team)Call for help (EMT/code team) Whenever epinephrine is administered, consider Whenever epinephrine is administered, consider

cardiac contraindications cardiac contraindications For pediatric patients, remember appropriate For pediatric patients, remember appropriate

medication dosing (typically weight based)medication dosing (typically weight based)

Contrast Reactions GuideContrast Reactions Guide

UrticariaUrticaria Discontinue contrast administration Discontinue contrast administration Usually, no treatment needed Usually, no treatment needed Mild to Moderate Reaction: Benadryl 25-50 Mild to Moderate Reaction: Benadryl 25-50

mg PO/IM/IV (adult dosing); advise patient mg PO/IM/IV (adult dosing); advise patient not to drive home alone after treatment; not to drive home alone after treatment; Pediatric Dose is 1 mg/kg up to 50 mgPediatric Dose is 1 mg/kg up to 50 mg

Severe Reaction: Epinephrine SC (1:1000) Severe Reaction: Epinephrine SC (1:1000) 0.1-0.3 mL (equivalent to a dose of 0.1-0.3 0.1-0.3 mL (equivalent to a dose of 0.1-0.3 mg) mg)

BronchospasmBronchospasm

Oxygen (6-10L/min) Oxygen (6-10L/min) Give beta agonist inhalers (Albuterol, Give beta agonist inhalers (Albuterol,

bronchodilators) bronchodilators) Epinephrine SC (1:1000) 0.1-0.3mL Epinephrine SC (1:1000) 0.1-0.3mL

(equivalent to 0.1-0.3mg) (equivalent to 0.1-0.3mg) If hypotension, give Epinephrine If hypotension, give Epinephrine

(1:10,000) 1mL slowly IV (equivalent to (1:10,000) 1mL slowly IV (equivalent to 0.1mg) and up to 1 mg as needed0.1mg) and up to 1 mg as needed

Hypotension with Hypotension with TachycardiaTachycardia

Trendelenberg position or elevate Trendelenberg position or elevate legs legs

Oxygen (6-10L/min) Oxygen (6-10L/min) Rapid bolus of large volumes of Rapid bolus of large volumes of

normal saline (NS) normal saline (NS) If poorly responsive, give Epinephrine If poorly responsive, give Epinephrine

(1:10,000) 1mL slowly IV (equivalent (1:10,000) 1mL slowly IV (equivalent to 0.1mg) and up to 1 mg as needed to 0.1mg) and up to 1 mg as needed

Hypotension with Bradycardia Hypotension with Bradycardia (Vasovagal Reaction)(Vasovagal Reaction)

Trendelenberg position or elevate Trendelenberg position or elevate legs legs

IV placement, Monitor (Rhythm, IV placement, Monitor (Rhythm, Blood Pressure, Pulse Oximetry), and Blood Pressure, Pulse Oximetry), and EKG EKG

Oxygen (6-10L/min) Oxygen (6-10L/min) Rapid bolus of large volumes of Rapid bolus of large volumes of

normal saline (NS) normal saline (NS)

CASE No. 12