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

2. 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

3. 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.

4. 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

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

6. 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

7. 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.

8. 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.

9. 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.

10. 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.

11. 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.

12. 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