Safety and risk

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 apronhow 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 10000 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 : 0.95 milliSievert

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

17. Radiation dose

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: 130/min BP: 70/40 mm Hg RR: 28/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 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)

38. Bronchospasm Oxygen (6-10L/min) Give beta agonist inhalers (Albuterol, bronchodilators) 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

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