Safety Flashcards
(83 cards)
1
Q
What are the concentrations for epinephrine IV and IM?
A
1:10,000 (IV- 0.1 mg); 1:1,000 (IM - 0.3 mg)
2
Q
Treatment of Laryngeal Edema
A
Oxygen and Epinephrine
3
Q
Treatment of Hypotension with low HR (and type of reaction)
A
Vagal
Atropine (0.6-1.0mg)
4
Q
Treatment of Hypotension with high HR (and type of reaction)
A
Anaphylaxis
Epinephrine (IV preferred in hypotension)
5
Q
Treatment of Severe hypertension over 200 mmHg
A
Labetalol 20 mg IV
6
Q
Treatment difference between mild and moderate-severe hives
A
Benadryl 25-50mg for both; PO for mild, IV or IM for moderate-severe
7
Q
Treatment for mild/moderate cough/bronchospasm
A
Oxygen then albuterol (2 puffs), 90 mcg/puff
8
Q
Treatment for severe cough/bronchospasm
A
Oxygen then epinephrine
9
Q
Examples of severe complications of contrast extravasation
A
Skin ulcers, compartment syndrome, tissue necrosis
10
Q
Heparin halflife
A
30 min to 4 hours (dose dependent); LMWH is 2-4 hours (dose dependent)
11
Q
Reversal agent of Warfarin
A
FFP, Vitamin K, or Prothrombin Complex Concentrate
12
Q
Reversal agent of Heparin
A
Protamine Sulfate
13
Q
Reversal agent of Pradaxa
A
Praxbind
14
Q
Reversal agent of Plavix
A
DDAVP, Platelets
15
Q
Reversal agent of Eliquis
A
Adexanet alfa/PCC
16
Q
Lower limit platelet counts for procedures? INR?
A
Platelets should be >50,000. INR should be under 1.5
17
Q
Cynthia’s home/desk: what MR Zone?
A
Zone 1
18
Q
Joanne putting in an IV and asking a dude why he has sharpel from Nam in his groin. MRI Zone?
A
Zone 2
19
Q
True or False 5Gauss line must be within zone 4?
A
False. Can extend into Zone 3.
20
Q
True or false, in the event of a patient event in the MR scanner you should bring the patient to zone 3 first before beginning CPR?
A
False. Start in the damn scanner
21
Q
Half-life of Xenon-133? Average energy? Decay type? where is it made?
A
Half life: 5.3 days, 81 keV, beta minus, reactor
22
Q
Half-life of I-131? Average energy? Decay type? where is it made? Critical organ?
A
Half life: 8 days, 365 keV, beta minus, reactor, thyroid or liver if bound to MIBG
23
Q
Half-life of Tc-99m? Average energy? Decay type? where is it made?
A
Half life: 6 hours, 140 keV, generator
24
Q
Half-life of Rubidium-82? Decay type? where is it made?
A
Half life: 75 seconds, beta plus. Generator
25
Half-life of Gallium-67? Average energy? Decay type? where is it made? Critical organ?
Half life: 78 hours, 100, 200, 300, 400, electron capture, cyclotron
Critical organ: distal colon
26
Half-life of Iodine-123? Average energy? Decay type? where is it made? Critical organ?
Half life: 13 hours, 159 keV, electron capture, cyclotron
| Critical organ: thyroid, unless I-123 MIBG (bladder)
27
Half-life of Thallium-201? Average energy? Decay type? where is it made? Critical organ?
Half life: 73 hours, 167 keV (81 keV Hg daughter)
| Critical organ: Kidney
28
Half-life of Indium-111? Average energy? Decay type? where is it made? Critical organ In-111 prostascint? In-111 WBC? In-111 Octreoscan?
Half life: 67 hours, 173 and 247 keV, electron capture, cyclotron
Critical organ of prostascint: liver, WBC spleen, octreoscan spleen
29
How does a Geiger Mueller counter work?
Detects a small amount of radioactive contamination. It’s a gas filled detector and has a high applied voltage from the anode to cathode. This causes one ionization to result in an “avalanche” of other electrons, thus allowing for high efficiency of detection of even a single gamma ray. It takes time to dissipate, and results in “dead time” before the next ionization.
Know 100 mR/hour
30
What is the function of a Geiger Mueller Counter?
Detect low levels of radioactive contamination on surfaces
31
What is the function of a Ionization Chamber?
Measure absolute exposure/dose rate at a point
32
What is the function of a Dose Calibrator?
Measure radioactivity to be administered to nuclear medicine patients
33
What is the function of a Liquid Scintillation or Gamma Counter?
Absolute quantification of removable activity on surfaces (swipe survey)
34
Personnel Dosimeter
Estimation of external dose to occupational worker over a period of time
35
What is the transportation Index?
Highest radiation level at 1 meter from the surface of the package.
36
Transportation index in mR/hour (1m from surface) of White 1, Yellow 2 and Yellow 3 labels
White 1: 0, yellow 2: 1, yellow 3: 10, exclusive use >10 mR/hour
37
Maximum exposure rate on contact (mR/hour) of White 1, Yellow 2 and Yellow 3 labels
White 1: <0.5 mR/hour, Yellow 2: <50 mR/hour, Yellow 3: <200 mR/hour
Exclusive use less than 1000 mrem/hr
38
What defines a "radiation area"
>0.05 mSv in a given hour at 30 cm
39
What defines a "high radiation area"
>1 mSv in a given hour at 30 cm
40
What defines a "very high radiation area"
>5 mSv in a given hour at 30 cm
41
How is a surface wipe test done?
Wipe 300 cm2 of surface of package and assay with a well counter
Usually the policy is 220 decays per minute/cm2
If over, you must notify your radiation safety officer.
42
NRC Code 10 CFR 19
Notices, instructions and reports to workers
43
NRC Code 10 CFR 20
Standards for protection against radiation
44
NRC Code 10 CFR 35
Medical use of byproduct material
45
NRC Code 10 CFR 71
Packaging and transportation of radioactive material.
46
Who is in charge of nuclear waste?
?NRC (Mettler)
47
How often do closed nuclear sources need to be spill tested? (I assume this meant leak tested)
A licensee possessing sealed sources must leak test the source every 6 months.
48
How often is gamma camera extrinsic uniformity checked?
Daily
49
How often is gamma camera intrinsic uniformity checked?
Weekly
50
How often is the Jaczak Phantom checked?
Semiannually
51
How often is the bar phantom for gamma camera QC done?
Weekly
52
How often is constancy checked in nuclear medicine?
Daily
53
How often is linearity checked in nuclear medicine?
Quarterly
54
How often is accuracy checked in nuclear medicine?
Annually
55
How often is geometry checked in nuclear medicine?
At installation or whenever moved/altered
56
What do spheres assess on a Jaszcak phantom?
Contrast
57
What do rods assess on a Jaszcak phantom?
Resolution
58
How often is nukes center of rotation checked?
Monthly
59
How often is the 4 quadrant linearity phantom for gamma cameras checked for QC?
Weekly
60
How often is the 4 quadrant linearity phantom for gamma cameras checked for QC?
Weekly
61
How often does a nuclear department need to internally review protocols? (I assume this is asking how often does the radiation safety program have to be reviewed?)
At least annually
62
In nuclear medicine, how would you increase the detail of looking at a pediatric septic hip?
?Pinhole collimator?
63
Understand receiver bandwidth
Increasing rBW increases noise and decreases chemical shift artifact of the second kind
64
What is the fatal dose of radiation? (LD50)
The dose of radiation expected to cause death to 50 percent of an exposed population within 30 days (LD 50/30). Typically, the LD 50/30 is in the range from 400 to 450 rem (4 to 5 sieverts) received over a very short period.
65
How is linearity tested with technetium?
Spatial resolution and linearity are tested with a quadrant bar phantom which is tested Weekly.
If they ask about dose calibrator linearity, this is tested quarterly. Here is how:
Let a Tc source decay from 100 mCi to 0.1 mCi and it should follow a downward slope with a half life of 6 hours. You should be +/- 10% of theoretical values
66
What is zipper artifact?
This type of zipper artifact results from varying transmitter leakage ("feed-through") picked up by the receiver system. Perhaps the most common origin of this RF noise is an extraneous source that reaches the receiver coil because the door of the RF shielded scanner room has not been fully closed or its seal is defective. A second common cause is RF emission from anesthesia monitoring equipment (e.g., pulse oximeters) used within the scanner room.
67
What is pulsation artifact in MRI?
Know what it looks like, goes in phase encode direction
68
What is phase contrast aliasing? I’m assuming this is asking about velocity encoding?
Venc: Velocity encoding, a prescribed parameter for PC-MRI/MRA to reflect maximum flow velocity expected
Venc set too low: aliasing
Venc set too high: noise, inability to detect small flow differences
69
Other MRI artifacts to know?
Aliasing, Susceptibility, Zipper, Gibbs/truncation, dielectric, moire to name a few
70
What is ultrasound aliasing? How do you fix aliasing?
Increase the PRF, decrease frequency of the probe, increase the angle of the probe, change the scale
71
How does increasing source to object distance affect dose?
The further you get from the source, the less the dose.
| Inverse square law.
72
How do you increase contrast in a bar phantom?
Not sure what this is asking. A bar phantom normally checks spatial resolution, and sometime linearity in the setting of a gamma camera.
73
What does circle artifact look like on CT?
Figure 20. CT image of a water-filled phantom shows ring artifacts.
The presence of circular artifacts in an image is an indication that the detector gain needs recalibration or may need repair services. Selecting the correct scan field of view may reduce the artifact by using calibration data that fit more closely to the patient anatomy.
It can also happen in obese patients
74
What is center of rotation artifact? What causes it?
Any problem that is picked up by the detector via the source or the mechanics of the of the camera can carry through to all 2D images generating a ring artifact
Cause: non-uniform flood
Tested: Monthly
75
What can you do for respiratory motion artifact in MRI?
Instruction and education.
Make sure the patient is stable and comfortable.
Sedation for uncooperative patients
To suppress signal form moving tissues
Use a surface coil.
Use a spatial saturation pulse to null signal from unwanted moving anatomical objects.
Fat suppression can help.
76
What are advantages of Dual Energy CT?
```
Lower dose
Virtual unenhanced Images
Delineation of different materials
80 and 140 kVp
Metal artifact reduction
```
77
Which gado agents have the highest risk of NSF?
NSF has been encountered almost exclusively after patient exposure to several specific linear GBCM, with the high-risk agents being gadodiamide (Omniscan®) - non-ionic and linear, gadoversetamide (OptiMark®, no longer manufactured), and gadopentetate dimeglumine (Magnevist®).
78
True or false: Ionic contrast cannot be used for myelography
True. If you do you could kill the patient. MUST use non-ionic
79
Any risk with breast feeding and contrast? This applies for both gado and iodinated contrast.
There is no evidence that the tiny amount of absorbed GBCM has any adverse effect on a breastfed infant. Therefore, there is NO need for a mother to stop breastfeeding after a GBCM-enhanced study. However, as with the administration of iodinated contrast media, if the mother is concerned, she can stop breastfeeding for 12 to 24 hours after the study, and pump and discard any milk produced during this time
80
True or false, CT iodinated contrast requires stop breastfeed?
False
81
How long must one stop breastfeeding if given I-131 thyroid therapy?
Rest of this baby
82
How long must one stop breastfeeding if given I-123?
One week
83
Is gado safe in pregnancy?
No
GBCM have been classified by the Food and Drug Administration as pregnancy class C drugs (no adequate and well-controlled studies in humans have been performed, although animal reproduction studies have shown an adverse effect on the fetus) and are therefore relatively contraindicated in pregnant patients. These agents pass through the placental barrier and enter the fetal circulation. They are then filtered by the fetal kidneys and excreted into the amniotic fluid, where they may remain for a prolonged period. Prolonged presence of the chelate in the amniotic fluid could theoretically increase the risk of dissociation of the potentially toxic gadolinium ion (see separate section on nephrogenic systemic fibrosis, to follow). For this reason, GBCM should only be administered to pregnant patients in carefully selected situations in which the benefit is thought to outweigh the potential risk.
