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Safety and Risk of Radiation Contrast media, risk, precaution and management

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Title: Safety and Risk of Radiation Contrast media, risk, precaution and management


1
Safety and Risk of Radiation Contrast media,
risk, precaution and management
DR Riaz Mohammad
2
Radiation risk and safety.
  • Types of radiation
  • 1 Alpha.
  • 2 Beta.
  • 3 Gamma and ( X-rays)
  • We are all exposed to radiation from sun, rock
    and other natural sources.
  • The average background dose is 3mSv/year

3
What ionizing radiation do ?
  • Cancer
  • Genetic effects
  • Skin injuries
  • Cataracts
  • Infertility

4
  • It is important to weigh the benefit of every
    examination against the potential risk of
    performing test

5
Safety and risks of x-rays
  • Risk
  • Ionizing radiation has enough energy to
    potentially cause damage to cell and DNA. Risks
    from exposure to ionizing radiation include
    cancer.
  • Radiation dose is high in fluoroscopy due to
    continuous x-rays use
  • Benefits
  • Noninvasive and painless, help to diagnosis
    disease and monitor therapy
  • support medical and surgical treatment planning.
  • guide medical personnel as they insert
    catheters, stents, or other devices inside the
    body, treat tumors, or remove blood clots or
    other blockages

6
Risk and safety in nuclear medicine
  • Nuclear medicine is not safe for the use of human
    beings, so therefore should not be used on
    healthy people.
  • Also the procedure is not recommended for
    pregnant women because unborn babies have a
    greater sensitivity to radiation than children or
    adults.
  1. Radioactive substances emit gamma rays in to the
    body so the safest way is to use a radio nuclide
    which has a short half life, so it can decay to a
    safe level as soon as possible
  2. But the half life should not be too short because
    it will decay before the test is completed

7
  • Safety precautions . when a patient has been
    injected with radioactive substance. Wear a gown
    and disposable gloves maximize the distance from
    the patient.
  • Most of the administered radioactive isotopes is
    excreted as urine via the kidney and bladder but
    some is excreted as perspiration and saliva. This
    means that the patient has radio active
    substances on their skin and should take extra
    care when around other people. If accidents like
    urination and vomiting happen, it must be assumed
    that the material is radioactive unless proved
    other wise.

8
Radiation safety and risks
  • Accidental and avoidable exposure to ionizing
    radiation is a risk.
  • Effects of ionizing radiation on life depend on
    types of radiation, rates of receiving, and
    dosages received.
  • Natural ionizing radiation include cosmic rays
    and gamma rays from space, and natural
    radioactivity.
  • Risk of radiation from fluoroscopy and CT scan
    are not entirely negligible, so these examination
    should be done when necessary.

9
Radiation Effects
Somatic effects damages to cells passed on to
succeeding cell generations.
Genetic effects damages to genes that affect
future generations. Genes are units of
hereditary information that occupy fixed
positions (locus) on a chromosome. Genes achieve
their effects by directing the synthesis of
proteins.
Somatic effects and genetic effects show no
immediate symptoms But it may manifest in future
generations
10
Important points to remember
  • Every effort should be made to keep radiation low
    and when ever possible to use ultrasound and MRI.
  • The radiation doses mentioned are small, but some
    procedure like fluoroscopy and CT are not
    entirely negligible.
  • We must keep records of radiological
    investigations
  • The risk is lower for older people and higher in
    children and pregnant women.

11
How to minimize the risk
  • Time
  • 2. Distance
  • 3. Shielding

12
Radiation Protection.
  • General Rule
  • (ALARA Principle)
  • As
  • Low
  • As
  • Reasonably
  • Achievable

13
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16
Radiation Protection in Fluoroscopy
more exposure
Longer usage
17
Radiation Protection in Fluoroscopy
  • DISTANCE
  • - One step back from tableside
  • cuts exposure by factor of 4
  • - Move Image Int. close to patient
  • less patient skin exposure less
  • scatter

18
Shielding
Radiation Protection in Fluoroscopy
Increasing the amount of shielding around a
source of radiation will decrease the amount of
radiation exposure.
To avoid scatter Be sure to shield all directions.
Shielding
19
Radiation Protection in Fluoroscopy
  • SHIELDING
  • - Lead aprons cut exposure by factor of 20
  • distant scatter 0.25 mm Pb eq
  • direct involvement 0.5 mm Pb eq
  • Proper storage (hanging vs. folding)

20
Protection tools
Radiation Protection in Fluoroscopy
CURTAIN
THYROID
GOGGLES
THYROID
21
Radiation Injuries
Whole-body radiation victims mostly suffer from
injuries to the hemopoietic, gastrointestinal
(GI), and central nervous (CN) systems. Injuries
to the hemopoietic system lead to bone morrow
syndromes with low red and white cells and
platelet counts. The GI syndromes are anorexia,
fatigue, nausea, vomiting, and diarrhea. GI
system failures weakens body defence. Damages to
the isolated and non-renewable CN system show
ataxia (loss of motion control), disorientation,
apathy, depression, prostration (exhaustion),
convulsions, and shock. Organs such as skin,
gonads, and eyes are sensitive to radiation.
22
A Summary
Early experiences led to the discoveries of
radiation effects. Radiation causes delayed
somatic and genetic effects due to damages to
cells and the DNA molecules. Quantities of
radiation, absorbed doses, and biological
effective doses must be expressed in
units. Exposure limits for workers are
guidelines, and limits for the general public are
100th of those for workers.
23
Contrast media. Types, benefits and risk
  • Contrast media are chemical substances that due
    to its high attenuation of x-rays or differential
    absorption of x-rays from the surrounding tissues
    permit clear demonstration of organs or tubular
    structures.
  • Type of contrast
  • Oral contrast. Barium sulphate.
  • Intravascular contrast. Iodine containing-
  • 1. Low osmolar
  • 2. High osmolar
  • Contrast agent used in KSA are low osmolar, it
    is expensive but safe
  • Intravascular contrast used in MRI Gadolinium
    DTPA

24
Ideal contrast agent
  • An ideal contrast agent should be
  • Non toxic.
  • Painless to patient.
  • Low osmolar.
  • It should not be expensive

25
Patient who need special care when using contrast
  • Extreme age ( infants and elderly)
  • DM
  • Hypertension
  • Asthma
  • Sickle cell anemia and multiple myeloma
  • Liver failure
  • Renal failure

26
Contrast continue
  • Radiographic contrast agents are used to
    visualize structures or disease processes that
    would otherwise be invisible or difficult to see
  • Barium is widely used to outline
    gastrointestinal tract.All the other radio-opaque
    media rely on iodine in solution to absorb
    x-rays. Iodine containing solutions are used for
    urography, angiography and intravenous contrast
    enhancement at CT.

27
Barium
  • Barium contrast (not water soluble) usually we
    use it for upper GI study (orally) or lower GI
    study ( as enema ) because it is available, easy
    to use, gives good images, rarely cause allergy
    and cheap but it is contraindicated if there is
    perforation ( in case of perforation e.g.
    duodenal ulcer or post op leakage we use
    gastrografin (water soluble) - If there is
    perforation barium contrast used , the end
    result will be chemical peritonitis.
  • How do I know if there is perforation? - We know
    it if we see air under the diaphragm in x-ray
  • Contrast agents could be used orally , enema , IV

28
Enema double contrast which is barium air
29
Ba meal
30
CT myelogram. Inject iodine contrast in to the
subarachnoid space to see thecal sac of spinal
cord
31
Axial and coronal CT chest with contrast.
Thrombus in the pulmonary artery
32
More investigations are
  • Sailogram. Contrast examination of salivary
    gland.
  • Sino gram. Contrast examination of sinus tract
  • Ductogram. Imaging of the breast duct

33
Intravenous pyelography
34
Take precautions before giving contrast media
  • 1-Previous reaction
  • 2-Asthmatic patient
  • 3-Renal impairment gtgt contrast might cause
    acute renal failure
  • 4-dm-atopic dermatitis
  • 5-Pregnant (contrast is contraindicated)
  • 6-Sickle cell anemia and multiple myeloma
    (contrast is
  • contraindicated).
  • Probably the patient will get anaphylactic
    shock from your contrast (skin erythema, etching,
    tachycardia, tachypnea, BP drop, bronchospasm) gtgt
    so we give antihistamine and epinephrine
    immediately ?

35
Type of reaction
  • Mild
  • Signs and symptoms appear self-limited without
    evidence of progression
  • Nausea, vomiting Altered taste Sweats
  • Cough Itching Rash, hives
  • Warmth (heat) Pallor Nasal stuffiness
  • Headache Flushing Swelling eyes, face
  • Dizziness Chills Anxiety
  • Moderate.
  • Reactions which require treatment but are not
    immediately life-threatening
  • Tachycardia/bradycardia Hypotension Bronchospasm,
    wheezing
  • Pronounced cutaneous edema
  • Treatment Prompt treatment with close
    observation

36
Severe
  • Life-threatening with more severe signs or
    symptoms including
  • Laryngeal edema Profound hypotension
    Unresponsiveness
  • (severe or progressive) Convulsions
    Cardiopulmonary arrest
  • Clinically manifest
  • arrhythmias
  • Treatment Immediate treatment. Usually requires
    hospitalization.

37
Adverse reactions continue-------
  • Fortunately, most reactions are classified as
    mild. Within this category, itching, flushing,
    hives, nasal congestion, and swelling about the
    eyes and face are common. Nausea and vomiting
    have become less common with the use of low
    osmolar and iso-osmolar agents.
  • Among the moderate reactions, bronchospasm and
    laryngeal edema are encountered most frequently
    patients must also be monitored carefully for
    changes in cardiac rate and blood pressure.
  • Severe
  • These are nfrequent, can rapidly escalate to a
    life-threatening situation.
  • Need prompt treatment and even hospitalization.

38
How to treat?
  • Give atropine, anti-histamine and if needed
    adrenaline
  • To protect the patient give him steroid prior
    to the study,
  • cancel and change the modality if he has a
    special
  • condition.
  • When you write radiographic request form, make
    sure the
  • patient has no contraindications.
  • Write a detail clinical history for the
    radiologist.

39
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40
Summary
  1. Barium contrast is contraindicated if there is
    perforation and we use gastrografin instead.
  2. If there is perforation barium contrast used ,
    the end result will be chemical peritonitis
  3. Sialogram A sialogram is an x-ray of the
    salivary ducts and glands. Myelogram is an x-ray
    examination of the spinal canal.
  4. A contrast agent is injected through a needle
    into the space around the spinal cord to display
    the spinal cord, spinal canal, and nerve roots on
    an x ray.
  5. Contrast is contraindicated with pregnant women,
    sickle cell anemia and multiple myeloma.

41
Thank you
Thank you
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