1. Safety and risk

2. بسم الله الرحمن الرحيم

3. Objective Objective 1-Radiation safety 1-Radiation safety 2-Contrast agent 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.leaded glasslead aprons gamma

5. Lead apron how much protection rate

6. Thyroid collar Standard 0.5mm lead apron Standard 0.5mm lead apron Protect you from 95% Protect you from 95% FROM RADIATION EXPOSURE 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. -Time: Reducing the time of an exposure reduces the effective dose. effective dose 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 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. source. Surgeon –cardiologist 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. - 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.inverse square law forcepsinverse square law forceps

8. Radiation risk Stochastic effect Stochastic effect Deterministic effect Deterministic effect

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

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

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

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

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

14. Average annual dose Radiolgsit : Radiolgsit : 0.7 milliSievert 0.7 milliSievert Technolgist : Technolgist : 0.95 milliSievert 0.95 milliSievert

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

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

18. ORAL CONTRAST GASTROGRAPHINE GASTROGRAPHINE BARUIM BARUIM

19. Oral contrast media 1- barium meal, swallow,enema, ect 1- barium meal, swallow,enema, ect (used barium as contrast ). (used barium as contrast ). 2-IN CT study (gastrographine) 2-IN CT study (gastrographine)

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

21. BARIUM (contrast media ) Barium used for GI study: Contra- indicated if there perforation Please use gastrographine (water soluble) The risk is chemical peritonitis The risk is chemical peritonitis

22. Which contrast we will use ???

23. Baruim enama

25. CT SCAN

27. Pumonary embolism

28. Contrast media reaction ???

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

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

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

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

33. 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 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

34. CASE No. 12