safety and risk. بسم الله الرحمن الرحيم objective objective 1-radiation safety...
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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