Safety and risk

بسم الله الرحمن الرحيم

Objective 1-Radiation safety 2-Contrast 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 apron how much protection rate

Thyroid collar Standard 0.5mm lead apron Protect you from 95% FROM RADIATION EXPOSURE

There are three factors that control the amount, or dose source. -Time: Reducing the time of an exposure reduces the effective dose . An example of reducing radiation doses by reducing the time of exposures might be improving operator training to reduce the time they take to handle a source. Surgeon –cardiologist - Distance: Increasing distance reduces dose due to the inverse square law. Distance can be as simple as handling a source with forceps rather than fingers.

Radiation risk Stochastic effect Deterministic effect

Stochastic effect Carcingenic effect . Related to accumulative Amount of exposure Gentic effect Related to accumulative Amount of exposure

Deterministic effect Relted to thresholds level FINDING CATARCT BONE MARROW FAILURE ERYTHEMA LUNG FIBROSIS

Deterministic effect LEVEL >2-3 GRAY RANGE Gray is unit of exposure of radiation ONE CHEST X RAY 0.15 mGRAY You need 10000 chest x ray Or 100 CT abdomen 30 mins to 1 hr fluoroscopy exposure

ALARA rule As low as reasonably achievable Reduce number of exam Reduce time of exam Use alternaive US vs MRI

BACKGROUN RADIATION NATURAL RADIATION FROM OUTER SPACE FROM RADON GAS (average annual dose) 3.2 milli-sievert Sievert is effective radiation dose (absorbed dose)

Average annual dose Radiolgsit : 0.7 milliSievert Technolgist :

EQUAVALANCY TO NATURAL BACKGROUND RADIATION 3 YEAR 6 MONTH 16 MONTH 8 MONTH

Radiation dose RISK/ PA CHEST X RAY ( 0.03 m SV) INVESTIGATION 100 LUMBAR SPINE 50 ABDOMINE 150 IVU CT HEAD 300 CT CHEST 400 CT ABDOMEN 200 BONE SCAN

ORAL CONTRAST GASTROGRAPHINE BARUIM

Oral contrast media 1- barium meal, swallow ,enema, ect (used barium as contrast ). 2-IN CT study (diluted gastrographine) Gastrographine is used in upper GI study (in case of bowel perforation )

GASTROGRAPHINE MAIN INDICATION : IF THERE IS BOWEL PERFORATION Why ?????? . CONTRA INDICATION . IF THERE IS RISK OF ASPIRATION The risk is a chemical pneumonitis

BARIUM (contrast media ) Barium used for GI study: Contra- indicated if there perforation Or toxic mega colon. The risk is chemical peritonitis

MR CONTRAST 1-EXPENSIVE 2-we are giving 0.1 m mol /kg Reaction was described on MR contrast But much less than CT CONTRAST 3-NEPHEROGENIC SYSTEMIC FIBROSIS: If contrast given in CRF

NEPHEROGENIC SYSTEMIC FIBROSIS is a rare and serious syndrome that involves fibrosis of skin, joints, eyes, Most patients with NSF have undergone hemodialysis for renal failure, NSF may also cause joint contractures resulting in joint pain and limitation in range of motion

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

CT SCAN

IV contrast in pulmonary embolism

Contrast media reaction ???

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

Contrast media TAKE PRECAUTION BEFOR GEVING CONTRAST AGENT: 1-PREVIOUS REACTION 2-ASTHMATIC PATIENT 3-RENAL IMPAIRMENT 4-DM-ATOPIC DERMATITIS 5-PREGNANT 6-SCA-MULTIPLE MYELOMA

TYPE OF REACTION 1-MILD : nuasia & vomting 2-MODERATE : skin reaction and brochospasm 3-SEVER hypotenstion . HOW TO TREAT?

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

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

Contrast Reactions Guide For all cases Always follow BLS and ACLS Guidelines as Remember your ABCs (Airway, Breathing, Circulation) Call for help (EMT/code team) Whenever epinephrine is administered, consider cardiac contraindications For pediatric patients, remember appropriate medication dosing (typically weight based)

Contrast Reactions Guide Urticaria Discontinue contrast administration Usually, no treatment needed Mild to Moderate Reaction: Benadryl 25-50 mg PO/IM/IV (adult dosing); advise patient not to drive home alone after treatment; Pediatric Dose is 1 mg/kg up to 50 mg Severe Reaction: Epinephrine SC (1:1000) 0.1-0.3 mL (equivalent to a dose of 0.1-0.3 mg)

Bronchospasm Oxygen (6-10L/min) Give beta agonist inhalers (Albuterol, bronchodilators) Epinephrine SC (1:1000) 0.1-0.3mL (equivalent to 0.1-0.3mg) If hypotension, give Epinephrine (1:10,000) 1mL slowly IV (equivalent to 0.1mg) and up to 1 mg as needed

Hypotension with Tachycardia Trendelenberg position or elevate legs Oxygen (6-10L/min) Rapid bolus of large volumes of normal saline (NS) If poorly responsive, give Epinephrine (1:10,000) 1mL slowly IV (equivalent to 0.1mg) and up to 1 mg as needed

Hypotension with Bradycardia (Vasovagal Reaction) Trendelenberg position or elevate legs IV placement, Monitor (Rhythm, Blood Pressure, Pulse Oximetry), and EKG Oxygen (6-10L/min) Rapid bolus of large volumes of normal saline (NS)

CASE No. 12