1. Safety and risk 1

2. بسم الله الرحمن الرحيم 2

3. Objective Objective 1-Radiation safety 1-Radiation safety 2-Contrast agent 2-Contrast agent 3

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 4

5. Lead apron how much protection rate 5

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 6

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 7

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

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 9

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

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 11

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 12

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 3.2 milli-sievert Sievert is effective radiation dose (absorbed dose) Sievert is effective radiation dose (absorbed dose) 13

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

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

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 17

18. ORAL CONTRAST GASTROGRAPHINE GASTROGRAPHINE BARUIM BARUIM 18

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 (diluted gastrographine) 2-IN CT study (diluted gastrographine) Gastrographine is used in upper Gastrographine is used in upper GI study (in case of bowel perforation ) GI study (in case of bowel perforation ) 19

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 a chemical pneumonitis The risk is a chemical pneumonitis 20

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

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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 23

24. NEPHEROGENIC SYSTEMIC FIBROSIS is a rare and serious syndrome that is a rare and serious syndrome thatsyndrome involves fibrosis of skin, joints, eyes, involves fibrosis of skin, joints, eyes,fibrosis Most patients with NSF have undergone hemodialysis for renal Most patients with NSF have undergone hemodialysis for renalhemodialysis failure, NSF may also cause joint contractures resulting in joint pain and limitation in range of motion 24

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

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27. CT SCAN 27

28. IV contrast in pulmonary embolism 28

29. Contrast media reaction ??? 29

30. Status: Lethargic. Pulse: 130/min BP: 70/40 mm Hg RR: 28/min Chest: Some expiratory wheezes 30

31. Contrast media 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

32. 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

33. 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

34. 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

35. Contrast Reactions Guide For all cases For all cases Always follow BLS and ACLS Guidelines as Always follow BLS and ACLS Guidelines as Remember your ABCs (Airway, Breathing, Circulation) Remember your ABCs (Airway, Breathing, Circulation) Call for help (EMT/code team) Call for help (EMT/code team) Whenever epinephrine is administered, consider cardiac contraindications Whenever epinephrine is administered, consider cardiac contraindications For pediatric patients, remember appropriate medication dosing (typically weight based) For pediatric patients, remember appropriate medication dosing (typically weight based) 35

36. Contrast Reactions Guide Urticaria Urticaria Discontinue contrast administration Discontinue contrast administration Usually, no treatment needed 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 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) Severe Reaction: Epinephrine SC (1:1000) 0.1-0.3 mL (equivalent to a dose of 0.1- 0.3 mg) 36

37. Bronchospasm Oxygen (6-10L/min) Oxygen (6-10L/min) Give beta agonist inhalers (Albuterol, bronchodilators) Give beta agonist inhalers (Albuterol, bronchodilators) Epinephrine SC (1:1000) 0.1-0.3mL (equivalent to 0.1-0.3mg) 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 If hypotension, give Epinephrine (1:10,000) 1mL slowly IV (equivalent to 0.1mg) and up to 1 mg as needed 37

38. Hypotension with Tachycardia Trendelenberg position or elevate legs Trendelenberg position or elevate legs Oxygen (6-10L/min) Oxygen (6-10L/min) Rapid bolus of large volumes of normal saline (NS) 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 If poorly responsive, give Epinephrine (1:10,000) 1mL slowly IV (equivalent to 0.1mg) and up to 1 mg as needed 38

39. Hypotension with Bradycardia (Vasovagal Reaction) Trendelenberg position or elevate legs Trendelenberg position or elevate legs IV placement, Monitor (Rhythm, Blood Pressure, Pulse Oximetry), and EKG IV placement, Monitor (Rhythm, Blood Pressure, Pulse Oximetry), and EKG Oxygen (6-10L/min) Oxygen (6-10L/min) Rapid bolus of large volumes of normal saline (NS) Rapid bolus of large volumes of normal saline (NS) 39

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