Safety and riskSafety and risk

الرحمن الله الرحمن بسم الله بسمالرحيمالرحيم

ObjectiveObjective

11--Radiation safetyRadiation safety 22--Contrast agentContrast agent

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 .

Lead apronLead apron

how much protection how much protection raterate

Thyroid collarThyroid collar

Standard 0.5mm lead apronStandard 0.5mm lead apronProtect you from 95%Protect you from 95%

FROM RADIATION EXPOSUREFROM RADIATION EXPOSURE

There are three factors that control There are three factors that control the amount, or dose sourcethe amount, or dose source . .

--TimeTime: Reducing the time : Reducing the time of an exposure reduces the of an exposure reduces the

effective doseeffective dose . .

An example of reducing An example of reducing radiation doses by radiation doses by reducing the time of reducing the time of exposures might be exposures might be improving operator improving operator training to reduce the time training to reduce the time they take to handle athey take to handle a

sourcesource..

Surgeon –cardiologistSurgeon –cardiologist

-- DistanceDistance: : Increasing distance Increasing distance reduces dose due reduces dose due to the inverse to the inverse square law. square law. Distance can be as Distance can be as simple as handling simple as handling a source with a source with forceps rather than forceps rather than fingersfingers . .

Radiation riskRadiation risk

Stochastic effectStochastic effect Deterministic effectDeterministic effect

Stochastic effectStochastic effect

Carcingenic effectCarcingenic effect

Related to Related to accumulative accumulative Amount of Amount of exposureexposure

Gentic effectGentic effect

Related to Related to accumulative accumulative Amount of Amount of exposureexposure

Deterministic effectDeterministic effectRelted to thresholds levelRelted to thresholds level

FINDINGFINDING

CATARCTCATARCT

BONE MARROW FAILUREBONE MARROW FAILURE

ERYTHEMAERYTHEMA

LUNG FIBROSISLUNG FIBROSIS

Deterministic effectDeterministic effect

LEVEL >2-3 GRAY RANGELEVEL >2-3 GRAY RANGEGray is unit of exposure of radiationGray is unit of exposure of radiation

ONE CHEST X RAY 0.15 mGRAYONE CHEST X RAY 0.15 mGRAYYou need 10000 chest x rayYou need 10000 chest x ray

Or 100 CT abdomenOr 100 CT abdomen3030 mins to 1 hr fluoroscopy exposuremins to 1 hr fluoroscopy exposure

ALARA ruleALARA rule

As low as reasonably achievableAs low as reasonably achievable

Reduce number of examReduce number of exam Reduce time of examReduce time of exam

Use alternaiveUse alternaive

US vs MRIUS vs MRI

BACKGROUN RADIATIONBACKGROUN RADIATION

NATURAL RADIATIONNATURAL RADIATIONFROM OUTER SPACEFROM OUTER SPACE

FROM RADON GASFROM RADON GAS

((average annual doseaverage annual dose))3.23.2 milli-sievert Sievert is effective milli-sievert Sievert is effective

dose (absorbed dose)dose (absorbed dose)

Average annual doseAverage annual dose

RadiolgsitRadiolgsit: :

0.70.7 milliSievertmilliSievert

TechnolgistTechnolgist: : 0.950.95 milliSievertmilliSievert

EQUAVALANCY TO NATURAL EQUAVALANCY TO NATURAL BACKGROUND RADIATIONBACKGROUND RADIATION

33 YEARYEAR33 YEARYEAR

66 MONTHMONTH

1616 MONTHMONTH88 MONTHMONTH

33 YEARYEAR33 YEARYEAR

66 MONTHMONTH

1616 MONTHMONTH88 MONTHMONTH

Radiation doseRadiation dose

INVESTIGATIONINVESTIGATIONRISK/ PA CHESTRISK/ PA CHEST

X RAY ( 0.03 m SV)X RAY ( 0.03 m SV)

LUMBAR SPINELUMBAR SPINE100100

ABDOMINEABDOMINE5050

IVUIVU150150

CT HEADCT HEAD100100

CT CHESTCT CHEST300300

CT ABDOMENCT ABDOMEN400400

BONE SCANBONE SCAN200200

ORAL CONTRASTORAL CONTRAST

GASTROGRAPHINEGASTROGRAPHINE BARUIMBARUIM

Oral contrast mediaOral contrast media

11 - -barium meal, swallow ,enema, ectbarium meal, swallow ,enema, ect((used barium as contrastused barium as contrast .) .)

22--IN CT study (gastrographine)IN CT study (gastrographine)

GASTROGRAPHINEGASTROGRAPHINE

MAIN INDICATIONMAIN INDICATION: : IF THERE IS BOWEL PERFORATIONIF THERE IS BOWEL PERFORATION

WhyWhy. ?????? . ??????

CONTRA INDICATIONCONTRA INDICATION ..IF THERE IS RISK OF ASPIRATIONIF THERE IS RISK OF ASPIRATION The The risk is chemical pneumonitisrisk is chemical pneumonitis

BARIUM )contrast media (BARIUM )contrast media (

Barium used for GI Barium used for GI studystudy::

Contra- indicated if Contra- indicated if there perforationthere perforation

Please use Please use gastrographine gastrographine (water soluble(water soluble))

The risk is The risk is chemical peritonitischemical peritonitis

Which contrast we will useWhich contrast we will use??? ???

Baruim enama

CT SCANCT SCAN

Pumonary embolismPumonary embolism

Contrast media reactionContrast media reaction??? ???

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

TAKE PRECAUTION BEFOR GEVING TAKE PRECAUTION BEFOR GEVING CONTRAST AGENTCONTRAST AGENT::

11--PREVIOUS REACTIONPREVIOUS REACTION22--ASTHMATIC PATIENTASTHMATIC PATIENT

33--RENAL IMPAIRMENTRENAL IMPAIRMENT44--DM-ATOPIC DERMATITISDM-ATOPIC DERMATITIS

55--PREGNANTPREGNANT66--SCA-MULTIPLE MYELOMASCA-MULTIPLE MYELOMA

TYPE OF REACTIONTYPE OF REACTION11--MILD : nuasia & vomtingMILD : nuasia & vomting

22--MODERATE : skin reaction and MODERATE : skin reaction and brochospasmbrochospasm

33--SEVER hypotenstionSEVER hypotenstion. . HOW TO TREATHOW TO TREAT??

Contrast mediaContrast media

Reactions can range from minor to Reactions can range from minor to severe, sometimes resulting in death severe, sometimes resulting in death with death being about 0.9 per with death being about 0.9 per 100,000 cases100,000 cases

I V contrast mediaI V contrast media

A common misconception that even A common misconception that even exists among healthcare exists among healthcare professionals is that an allergy to professionals is that an allergy to contrast media is related to an contrast media is related to an allergy to seafood (usually shellfish) allergy to seafood (usually shellfish) because both share iodine in because both share iodine in common, implicating iodine as a common, implicating iodine as a sourcesource

CASE No. 12