Patient Care Radiation Exposure and Contrast Media Considerations Fluoroscopy Patient Care Radiation Exposure and Contrast Media Considerations

Measuring and Reporting Dose During fluoroscopy procedures, patients will receive a radiation dose contingent on type of exam and length of exposure. Patient dose can be measured and reported according to the following: Entrance Skin Exposure Most common way to report dose Easy to measure directly Bone Marrow Dose Target area for leukemia Calculated from ESE Gonadal dose Target for genetic effects Easy to measure or estimate

Average Fluoroscopy Patient Dose The patient dose for an average fluoroscopy exam is: On the next slide, compare patient dose according to radiography exam to the amount of radiation received during a fluoroscopic exam. Comparatively speaking, fluoroscopic exams can render higher patient doses. Fluoro exam ESE of 4 R/min Elsevier items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc.

X-Ray Exams and Patient Dose Technique (kVp/mAs) ESE (mR) Mean Marrow Dose (mrad) Gonad Dose (mrad) Skull 76/50 200 10 <1 Chest 110/3 2 C-Spine 70/40 150 L-Spine 72/60 300 60 225 KUB 74/60 400 30 125 Pelvis 70/50 20 Extremity 60/5 50 CT Head 125/300 3000 CT Pelvis 124/400 4000 100

Radiation Exposure Levels Natural versus man-made levels of radiation exposure.

Practices to Reduce Patient Dose Use high kVp/low mA techniques. Use fast screens. Position patient to avoid gonadal exposure. Use lead shielding. Contact, Gonadal, and Shadow Shielding

Contrast Media Exams Prior to the exam, the radiographer: Evaluates lab values prior to administering medication and beginning interventional procedures. Determines type and dose of contrast agent to be administered, based on the patient’s age, weight and medical/physical status. Provides related patient education. Explains precautions regarding administration of medications.

Reactions to Iodinated Contrast Media Ranges from mild to severe reactions No predictors Begin injection with a small amount and wait to check for signs or symptoms Protocol determines how long to wait before proceeding with administration Patients at risk for reaction are premedicated Antihistamine and/or corticosteroids Copyright © 2013, 2009, 2004, 1999, 1993, 1989, 1985, 1981 by Mosby, Inc., an affiliate of Elsevier Inc.

Contrast Reactions Symptoms Treatment Symptoms Treatment Mild Moderate Warmth None. Symptoms will resolve. Flushing Metallic taste Coughing Nausea Moderate Symptoms Treatment Erythema Antihistamine (orally, IV, or IM) Urticaria Bronchospasm Bronchodilator drug by inhalation Copyright © 2013, 2009, 2004, 1999, 1993, 1989, 1985, 1981 by Mosby, Inc., an affiliate of Elsevier Inc.

Vasovagal Reactions Symptoms Treatment Diaphoresis Place patient supine, feet elevated 20 degrees and head elevated, if breathing is a problem. Hypotension Bradycardia IV fluids and atropine administered for bradycardia Copyright © 2013, 2009, 2004, 1999, 1993, 1989, 1985, 1981 by Mosby, Inc., an affiliate of Elsevier Inc.

Severe (Anaphylaxis) Reactions Symptoms Treatment Warmth Maintain airway Call a code Epinephrine usually given IV Other drugs administered as needed by code team Tingling Itching palms and soles Dysphagia Laryngeal/bronchial edema Respiratory arrest Cardiac arrest Seizures Copyright © 2013, 2009, 2004, 1999, 1993, 1989, 1985, 1981 by Mosby, Inc., an affiliate of Elsevier Inc.

Please close this PowerPoint presentation, and continue the lesson. What’s Next? Please close this PowerPoint presentation, and continue the lesson. Presented by Based on: Syllabus on Fluoroscopy Radiation Protection, 6th Rev. By: Radiologic Health Branch – Certification Unit