1. Safety and risk

2. بسم الله الرحمن الرحيم

3. Objective
1-Radiation safety
2-Contrast agent

4. 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.

5. Lead apron how much protection rate

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

7. 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.

8. Radiation risk
Stochastic effect
Deterministic effect

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

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

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

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

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

14. Average annual dose Radiolgsit : 0.7 milliSievert Technolgist :

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

17. 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

18. ORAL CONTRAST
GASTROGRAPHINE
BARUIM

19. 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 )

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

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

23. 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

24. 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

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

27. CT SCAN

29. IV contrast in pulmonary embolism

30. Contrast media reaction ???

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

32. 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

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

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

35. 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

36. 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)

37. Contrast Reactions Guide
Urticaria
Discontinue contrast administration
Usually, no treatment needed
Mild to Moderate Reaction: Benadryl 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) mL (equivalent to a dose of mg)

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

39. 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

40. 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)

41. CASE No. 12