SCAI KERN CHAP 7 XRAY IV CONTRAST Flashcards by Fady Geha

Q1: The electromagnetic spectrum is divided into ______ regions, in order of decreasing ______ and increasing energy and frequency.

Q2: Ionizing electromagnetic waves, such as X-ray and gamma ray, have sufficient energy to ionize ______ by detaching ______ from them.

Q3: X-rays have a wavelength about 1000 times ______ than visible light and an energy that is about 10,000 to 100,000 times ______.

Q4: Radiologic density is determined by the ______ number of the material ( number of protons) , affecting how X-rays are ______. Abosrption is differential and depends of tissue density.

Q5: In fluoroscopy, images appear in ______ time and with an inverted ______ compared with standard radiographs.

Q6: Bones contain calcium that has a higher ______ number than most other tissues, allowing them to readily absorb ______.

Q7: Fat and other soft tissues absorb less X-ray and appear ______, while air absorbs the least and appears ______.

A1: seven, wavelength

A2: atoms, electrons

A3: shorter, greater

A4: atomic, absorbed

A5: real, grayscale

A6: atomic, X-rays

A7: gray, black

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Q1: Ionizing electromagnetic waves can be classified as ______ or ______ ionizing.

Q2: Direct ionization radiation produces ______ particles that have enough energy to disrupt the ______ structure of materials, producing chemical and biological changes.

Q3: X-rays and gamma rays are indirectly ionizing ( uncharged particles ), meaning they produce fast-moving particles that can ionize other ______ and break ______ bonds.

Q4: The biologic effects due to free radicals result from either a ______-stranded break or a ______-stranded DNA break.

Q5: Single-stranded breaks are readily ______, with no cell death, but incorrect repair can lead to a ______.

Q6: Double-stranded breaks are less common but more ______, potentially leading to cell ______.

Q7: If DNA damage occurs without necrosis, ______ may occur, becoming evident many years after exposure.

Q8: Each of the body’s organs has a variable ______ to radiation injury, with more biologically active organs being more ______.

Q9: The international commission on radiation units and measurements has suggested a tissue ______ factor for various organs.

Q10: This tissue weighting factor corresponds to an organ’s susceptibility to the effects of ______ radiation.

A1: directly, indirectly

A2: charged, atomic

A3: atoms, chemical

A4: single, double

A5: healed, mutation

A6: serious, necrosis

A7: carcinogenesis

A8: susceptibility, susceptible

A9: weighting

A10: ionizing

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Q1: What is the tissue weighting factor for bone marrow, colon, lung, stomach, breast, and remaining tissues?

Q2: Which tissues have a combined tissue weighting factor of 0.72?

Q3: What is the tissue weighting factor for gonads?

Q4: How does the tissue weighting factor for gonads compare to that of the bladder, esophagus, liver, and thyroid?

Q5: What is the combined tissue weighting factor for bladder, esophagus, liver, and thyroid?

Q6: Which tissues have the lowest individual tissue weighting factor listed in the table?

Q7: What is the tissue weighting factor for bone surface, brain, salivary glands, and skin?

Q8: How does the total of all tissue weighting factors in the table sum up?

Q9: Why might bone marrow, colon, lung, stomach, and breast have higher tissue weighting factors compared to other tissues?

Q10: How do tissue weighting factors contribute to understanding radiation exposure risks?

A1: 0.12

A2: Bone marrow, colon, lung, stomach, breast, and remaining tissues

A3: 0.08

A4: The tissue weighting factor for gonads (0.08) is higher than that for bladder, esophagus, liver, and thyroid (0.04).

A5: 0.16

A6: Bone surface, brain, salivary glands, and skin

A7: 0.01

A8: 1.00

A9: These tissues are more susceptible to radiation damage due to their higher biological activity and importance in overall health.

A10: They help assess the relative risk of radiation exposure to different tissues, guiding safety measures and risk management.

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A1: Dose-dependent effects with a threshold, causing direct health impacts like cell necrosis.

A2: Effects that occur by chance, without a clear threshold, not detailed in this paragraph.

A3: The point at which deterministic effects begin to occur, related to dose.

A4: Result of extensive radiation damage, preventing normal function and repair.

A5: Common tissue reaction in cardiovascular imaging, leading to necrosis and requiring careful management.

A6: Measurement used to approximate entrance skin dose, crucial for assessing potential skin damage.

A7: Injury that occurs with a time delay, making early recognition challenging.

A8: Factors such as light-colored skin, smoking, poor nutrition, obesity, hyperthyroidism, diabetes, connective tissue disorders, chemotherapy, and recent radiation exposure or previous high-dose radiation tissue injury, that increase susceptibility to radiation-induced skin damage.

A9: Recommended management for X-ray-induced skin injuries to prevent further damage.

A10: Necessary action for patients with Ka,r greater than 5 Gy to address potential skin injury.

Q1: Deterministic Effects

Q2: Stochastic Effects

Q3: Threshold

Q4: Cell Necrosis

Q5: Skin Injury

Q6: Air Kerma (Ka,r) at interventional reference point ( IRP )

Q7: Dose-Dependent skin Injury

Q8: Patient Factors for Skin Injury

Q9: Dermatologic Care ( better no biopsy )

Q10: Follow-Up for High Ka,r

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*** did not include all information in the table

Q1: What is the expected effect of a radiation dose between 0-2 Gy on the skin within the first 2 weeks?

Q2: At what dose range does transient erythema occur within the first 2 weeks?

Q3: What early effects are expected at a dose range of 2-5 Gy?

Q4: What mid-term ( after 6 weeks) effects might occur at a dose range of 5-10 Gy?

Q5: What long-term ( after 52 weeks) effects are expected at doses greater than 10 Gy?

Q6: What are the long-term effects associated with a dose range of 5-10 Gy?

Q7: At what dose range does dry/moist desquamation become a concern?

Q8: What severe long-term effects can occur at doses greater than 15 Gy?

Q9: What early and mid-term effects are expected at doses between 10-15 Gy?

Q10: What is the potential need for surgical intervention at doses greater than 15 Gy?

A1: No observable effects expected

A2: 2-5 Gy

A3: Transient erythema

A4: Prolonged erythema and permanent partial epilation

A5: Telangiectasia and dermal atrophy/induration

A6: Recovery; higher doses cause dermal atrophy/induration

A7: 10-15 Gy

A8: Dermal atrophy with secondary ulceration and skin breakdown

A9: Erythema, epilation, dry/moist desquamation, and prolonged erythema

A10: Surgical repair likely

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Q1: What is the first notification threshold for Dskin,max?

Q2: What is the increment for subsequent notifications for Dskin,max?

Q3: What is the SRDL ( substantial radiatiomn dose level ) for Dskin,max?

Q4: What is the first notification threshold for Ka,r?

Q5: What is the increment for subsequent notifications for Ka,r?

Q6: What is the SRDL for Ka,r?

Q7: What is the first notification threshold for PKA?

Q8: What is the increment for subsequent notifications for PKA?

Q9: What is the SRDL for PKA?

Q10: What is the first notification threshold for fluoroscopy time?

Dskin,max is peak skin dose, requiring calculations by physicist.
Ka,r is total air kerma at the reference point.
PKA is air kerma area product.
Assuming a 100 cm2 field at the patient’s skin. For other field sizes, the PKA values
should be adjusted proportionally to the actual procedural field size (eg, for a field size of 50 cm2, the SRDL value for PKA would be 250 Gy cm2).

A1: 2 Gy

A2: 0.5 Gy

A3: 3 Gy

A4: 3 Gy

A5: 1 Gy

A6: 5 Gy

A7: 300 Gy cm²

A8: 100 Gy cm²

A9: 500 Gy cm²

A10: 30 min ( SRDL 60 minutes )

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STOCHASTIC !

Q1: Stochastic Effects

Q2: Radiation Dose Impact

Q3: DNA Backbone Injury

Q4: Latent Period Significance

Q5: Risk Assessment Factors

Q6: Age and Gender Influence

Q7: Nonfatal DNA Damage

Q8: Dose-Volume Relationship

Q9: Probability and Severity Characteristics

Q10: Implications of Patient Survival

A1: Effects that occur randomly without a clear threshold, potentially leading to cancer or genetic abnormalities.

A2: Influences the probability of stochastic effects ( higher probability with higher dose) , however severity is independent of dose.

A3: Damage that may not heal properly, resulting in mutations.

A4: Average time of 20 years for a cell to transform into malignancy, crucial for understanding long-term risks of stochastic effect.

A5: Includes age, sex, and organs at greatest risk, essential for evaluating individual patient risk.

A6: Greater susceptibility to stochastic risk in younger individuals and females at any given age.

A7: Injury that does not cause immediate death but may lead to long-term genetic changes.

A8: The relationship between dose delivered and tissue volume exposed, affecting stochastic risk levels.

A9: Probability linked to dose, while severity remains dose independant, linear and nonthreshold.

A10: Stochastic risk may be negligible if expected survival is shorter than the latent period for adverse effects.

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Q1: Stochastic effects of radiation occur by ______ in a population of exposed persons, with no clear ______.

Q2: The probability of stochastic effects is proportional to the ______ dose, while the severity is ______ of dose.

Q3: A stochastic injury involves nonfatal injury to the DNA ______ that does not properly heal, resulting in a ______.

Q4: The risk of stochastic effects is related to the ______ delivered and the volume of ______ exposed.

Q5: Stochastic effects require time for one transformed cell to multiply into a ______, with a latent period averaging ______ years.

Q6: The stochastic risk from radiation exposure is greater in the ______ and, at a given age, greater in ______ than males.

Q7: Knowing an individual’s ______ and ______, as well as the organs at greatest risk, helps assess patient risk.

Q8: Stochastic risk may be inconsequential if the patient’s expected ______ is less than the latent period for the adverse effect to ______.

Q9: Nonfatal DNA damage can lead to either ______ or a genetic ______.

Q10: The assessment of stochastic risk involves understanding the relationship between dose, tissue volume, and ______ factors.

A1: chance, threshold

A2: radiation, independent

A3: backbone, mutation

A4: dose, tissue

A5: malignancy, 20

A6: young, females

A7: age, sex

A8: survival, occur

A9: cancer, abnormality

A10: risk

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True or False :

Q1: Stochastic effects are dose-dependent, with higher doses increasing their likelihood.

Q2: Stochastic models have been created to estimate the excess relative/absolute risk per sievert of exposure.

Q3: The BEIR VII model includes risk estimates for all solid cancers, including thyroid and nonmelanoma skin cancers.

Q4: Risk estimates for ages greater than 60 are limited due to small sample sizes in the studied population.

Q5: The data show a clear age relationship for sensitivity to radiation-induced cancer.

Q6: The risk estimates are gender averaged, reflecting differences between males and females.

Q7: The BEIR VII model provides risk estimates specifically for one sievert of exposure.

Q8: Stochastic effects have a clear threshold, making them predictable at specific doses.

Q9: The relationship between dose and stochastic effects is linear and nonthreshold.

Q10: The data do not demonstrate any age-related sensitivity to radiation-induced cancer.

A1: False
Explanation: Stochastic effects are not dose-dependent , but the probability of occurrence increases with higher doses.

A2: True
Explanation: Models exist to calculate the risk associated with radiation exposure, specifically per sievert, to help understand potential health impacts.

A3: False
Explanation: The BEIR VII model excludes thyroid and nonmelanoma skin cancers from its risk estimates for solid cancers.

A4: True
Explanation: The data for individuals over 60 are limited because of smaller sample sizes, affecting the accuracy of risk estimates.

A5: True
Explanation: The data demonstrate that age is a significant factor in sensitivity to radiation-induced cancer, with younger individuals generally being more sensitive.

A6: False
Explanation: The risk estimates are gender averaged, which means they do not reflect specific differences between males and females.

A7: True
Explanation: The BEIR VII model includes risk estimates for exposure to one sievert, helping to quantify potential health risks.

A8: False
Explanation: Stochastic effects do not have a clear threshold, meaning they can occur at any level of exposure, with probability increasing with dose ( yet dose independent ).

A9: True
Explanation: The probability of stochastic effects increases linearly with dose, but there is no threshold below which they do not occur.

A10: False
Explanation: The data clearly demonstrate that age is a factor in sensitivity to radiation-induced cancer, with younger individuals generally more susceptible.

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1- The basic unit of radiation ionization, representing the amount of ionization that a defined mass of air undergoes when bombarded by X-rays or gamma rays.

2- The amount of energy absorbed by a material from radiation, varying according to the type of radiation ( radiation type dependent) and the atomic number of the material.

3- A unit of radiation protection that accounts for the biological effect of radiation, calculated as the rad dose multiplied by a quality factor (QF) and other modifying factors.

4- A factor used in calculating rems that accounts for the type of radiation and its biological effects; in cardiology, it is 1.0 for both X-rays and gamma rays.

5- The unit used to express rads ( RADIATION ABSORBED DOSE) , representing the amount of radiation energy delivered.

6- The unit used to express rems ( REM = RAD x QF ) , representing the amount of radiation energy absorbed, with 1 Sv equaling 100 rem.

7- 1 Sv equals 100 rem, and 1 rem equals 10 mSv, providing a basis for converting between units.

8- Gy units are used when discussing radiation being delivered, while Sv units are used when discussing radiation absorbed.

1-Roentgen (R)

2-Radiation Absorbed Dose (rad): the word “absorbed” here means given

3-Rem (Roentgen Equivalent Man): REMINDS EVERY MAN.

4- Quality Factor (QF):

5- Gray (Gy): GIVE

6- Sievert (Sv): STORE

7- Conversion Factors:

8- Radiation Delivery vs. Absorption:

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MNEMONICS

1- Roentgen (R)

2- Radiation Absorbed Dose (rad):

3- Rem (Roentgen Equivalent Man):

4- Quality Factor (QF)

5- Gray (Gy):

6- Sievert.

7- Conversion Factors.

8- Radiation Delivery vs. Absorption.

1- Picture “roaming rays” of X-rays ionizing the air.

2- “Rad Absorbs Dose”. Imagine “rad” as a sponge “absorbing” a dose of energy.

3- “Reminds Every Man”. Think of “rem” as a reminder of radiation’s effect on “every man.”

4- Envision “quality” as the first consideration in radiation effects.

5- “Gray Gives” Visualize “gray” clouds “giving” rain, akin to Gy delivering energy.

6- “Sievert Safeguards”. Associate “Sievert” with “safeguarding” absorbed energy information.

7- “Switch Values”. Remember “Switch Values” for converting between Sv, rem, and mSv.

8- “Give and Store”. “Give” (Gy) for delivery, and “Store” (Sv) for absorption.

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MNEMONICS

1- Equivalent Dose (mSv):
Mnemonic: “Equivalent Equals Estimate”

2- Effective Dose (ED) (mSv):
Mnemonic: “Effective Equals Entire”

3- Air Kerma Area Product (Gy cm²):
Mnemonic: “Air Area Assesses”

4- Cumulative Air Kerma (mGy):
Mnemonic: “Cumulative Checks”

5-Personal Dose Equivalent (mSv)
Mnemonic: “Personal Protects”

1- “E” for Equivalent and Estimate, focusing on risk estimation in tissues or organs.

2- “E” for Effective and Entire, highlighting the estimation of global risk.

3- “A” for Air, Area, and Assesses, indicating measurement by the X-ray system for overall risk.

4- “C” for Cumulative and Checks, referring to skin dose estimation by the X-ray system.

5-“P” for Personal and Protects, emphasizing measurement by personal dosimeters for occupational safety.

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Q1: The equivalent dose is measured in ______ and allows to estimate risk in a ______ or organ.

Q2: The effective dose, abbreviated as ED, is measured in ______ and allows to estimate ______ risk.

Q3: The air kerma area product or dose-area product is measured in ______ and is calculated by the ______ system to assess overall risk ( conversion to ED )

Q4: Cumulative air kerma is measured in ______ and is used to estimate the ______ dose.

Q5: The personal dose equivalent is measured in ______ and is monitored by personal occupational ______.

A1: mSv, tissue

A2: mSv, global

A3: Gy cm², X-ray

A4: mGy, skin

A5: mSv, dosimeters

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Q1: How has the preference for measuring exposure shifted from older units to more current standards, and why is air kerma now preferred over the roentgen?

Q2: Explain the concept of “kerma” and how it is used to quantify radiation energy. How does it differ from other measures of radiation?

Q3: Discuss the significance of air kerma in the context of radiation exposure. How does it relate to the overall measurement of radiation dose?

Q4: What is the relationship between radiologic dose and absorbed dose, and how do these concepts help in understanding the effects of radiation on matter?

Q5: How does the absorbed dose relate to the severity of skin effects, and why is this important in medical imaging?

Q6: Describe the concept of effective dose and its importance in assessing cancer risk from radiation exposure. How does it differ from absorbed dose?

Q7: In what ways can the equivalent dose be confusing in cardiology, particularly in fluoroscopic imaging, and why is caution advised when using this term?

Q8: How do the different units and measurements of radiation exposure contribute to a comprehensive understanding of radiation safety in medical settings?

Q9: Why is it important to adjust equivalent doses for the radiation absorption capacity of different tissues, and how does this impact patient safety?

A1: The preference has shifted to air kerma because it provides a more accurate measurement of the amount of radiation energy present at a specific location, whereas the roentgen is an older unit that is less precise and less commonly used today.

A2: Kerma, which stands for Kinetic Energy Released in Material, quantifies the energy transferred from radiation to matter per unit mass. It differs from other measures by focusing on the initial energy transfer before absorption and interaction with matter.
( measures unit of energy per mass in mGy).

A3: Air kerma is significant as it measures the energy delivered to air, serving as a proxy for potential exposure to tissues. It helps in assessing the radiation dose and is a key factor in calculating other dose measurements.

A4: Radiologic dose refers to the local concentration of energy in a radiation field when it interacts with matter, while absorbed dose ( directly related to the severity of reaction ), measures the energy absorbed per mass of material ( mGy). Understanding both helps determine the potential effects of radiation on tissues.

A5: The absorbed dose is directly related to the severity of skin effects because it quantifies how much energy is absorbed by the skin, influencing the extent of potential damage during medical imaging.

A6: The effective dose estimates the risk of cancer from radiation exposure by considering the sum of equivalent doses adjusted for tissue absorption. It differs from absorbed dose by providing a risk-based assessment.

A7: In cardiology, particularly in fluoroscopic imaging, the equivalent dose can be confusing due to different units and quantities. Caution is advised because it may not accurately reflect absorbed doses for specific organs. It is rather a term needed for dosimetry of neutrons.

A8: Different units and measurements provide a comprehensive view of radiation exposure, ensuring accurate assessment and safety in medical settings. They guide the implementation of protective measures and optimize patient care.

A9: Adjusting equivalent doses for tissue absorption is crucial for patient safety as it accounts for the varying sensitivity of tissues to radiation, helping to minimize potential harm and optimize treatment.

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Q1: Total Air Kerma (Ka,r)

Q2: Procedural Cumulative Air Kerma (CAK)

Q3: Intersection with IRP

Q4: Air Kerma Area Product (KAP)

Q5: Dose-Area Product (DAP)

Q6: Peak Skin Dose (PSD)

Q7: Qualified Physicist

Q8: Fluoroscopic Time (FT)

Q9: Threshold-Dependent Effects

Q10: Linear Nonthreshold Effects

A1: Used to monitor patient dose burden, associated with deterministic skin effects.

A2: X-ray energy delivered to air, measured at the IRP.

A3: Primary X-ray beam intersection with the rotational axis of the C-arm gantry.

A4: Product of instantaneous air kerma and X-ray field area, impacted by collimation.

A5: Another term for KAP, used to monitor stochastic effects.

A6: Maximum dose received by any area of a patient’s skin.

A7: Provides the most accurate assessments of PSD with known air kerma and X-ray geometry.

A8: Time-dependent parameter, not a true measure of procedural radiation dose.

A9: Effects associated with Ka,r, related to dose burden.

A10: Associated with PKA, relates to potential stochastic/cancer effects.

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Q1: What does total air kerma (Ka,r) represent in the context of radiation exposure? What is IRP?

Q2: How is procedural cumulative air kerma (CAK) measured, and what does it signify?

Q3: What is the significance of the intersection with the isocenter in X-ray imaging?

Q4: How does the air kerma area product (KAP) differ from Ka,r in terms of measurement?

Q5: Why is the dose-area product (DAP) important for monitoring radiation exposure?

Q6: What role does peak skin dose (PSD) play in assessing radiation effects on patients?

Q7: Why is a qualified physicist important in the assessment of PSD?

Q8: How is fluoroscopic time (FT) used in the context of radiation procedures, and what are its limitations?

Q9: What are threshold-dependent effects, and how are they related to Ka,r?

Q10: How do linear nonthreshold effects relate to the air kerma area product (KAP)?

A1: Total air kerma (Ka,r) represents the procedural cumulative air kerma at the IRP, used to monitor patient dose burden associated with threshold dependent deterministic skin effects ( X ray energy delivered to air at the IRP). IRP is 15 cm on the X-ray tube side of isocenter which is the primary X-ray beam intersection with the rotational axis of the “C” arm gantry

A2: CAK is measured as the X-ray energy delivered to air at the interventional reference point (IRP) and signifies the cumulative radiation dose a patient receives during a procedure. ( CAK = (Ka,r))

A3: The intersection with the isocenter is significant because it is where the primary X-ray beam aligns with the rotational axis of the C-arm gantry, affecting the accuracy of dose measurements.

A4: KAP differs from Ka,r as it is the product of instantaneous air kerma and X-ray field area, impacted by collimation ( it includes the field exposed), and is used to monitor dose burden associated with stochastic effects or cancer effects. ( DAP = KAP).

A5: DAP is important because it provides a measure of the overall radiation dose a patient receives, helping to assess the risk of linear nonthreshold stochastic effects like cancer.

A6: PSD measures the maximum dose received by any area of a patient’s skin, crucial for evaluating potential skin damage from radiation exposure.

A7: A qualified physicist is important because they provide the most accurate assessments of PSD, using detailed knowledge of air kerma and X-ray geometry.

A8: FT is used as a time-dependent parameter to track the duration of radiation exposure, but it does not measure the actual dose and is not influenced by angulation, cine pictures or frame rate changes.

A9: Threshold-dependent effects are deterministic effects that occur when radiation exposure surpasses a certain threshold, and Ka,r is used to monitor these effects.

A10: Linear nonthreshold effects are associated with stochastic risks, where any dose can potentially cause effects, and KAP is used to monitor these risks.

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Q1: Most of the radiation an individual receives annually comes from ______ radiation.

Q2: Natural radiation accounts for about ______% of the radiation we receive, with radon contributing ______% of the total background radiation dose.

Q3: Man-made radiation accounts for ______% of the total radiation exposure.

Q4: The average background radiation per year received in the United States is about ______ mSv.

Q5: A routine chest X-ray exposes a patient to about ______ to ______ mSv.

Q6: The current exposure limit for the public recommended by the ICRP is an effective dose of ______ mSv per year.

Q7: The annual equivalent dose limits for the eye is ______ mSv, and for skin/hands/feet is ______ mSv.

A1: background

A2: 82, 55

A3: 18

A4: 3.6

A5: 0.02, 0.04

A6: 1

A7: 15, 50

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Q1: Staff must provide periodic dose updates to assist the operator with ______ awareness.

Q2: Postprocedure, all cardiac catheterization reports should include available radiation parameters: FT (min), Ka,r (Gy), and ______ (Gy cm²).

Q3: Patient notification, chart documentation, and communication with the primary care provider should be routine for ______ procedures.

Q4: Patients should be educated regarding potential skin changes with a ______ to ______ week phone call follow-up or office visit as required.

Q5: For Ka,r > 10 Gy (PKA > 1000 Gy cm²), a qualified physicist should promptly calculate ______.

Q6: The Joint Commission identifies PSD > ______ Gy as a sentinel event; hospital risk management and regulatory agencies should be contacted within 24 hours.

A1: radiation

A2: PKA

A3: high-dose

A4: 2, 4

A5: PSD

A6: 15

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Q1. What devices are used to measure radiation exposure for health care workers?

Q2. What crystal does the TLD badge use?

Q3. How does the TLD badge measure X-ray exposure?

Q4. What is the substrate in the OSL badge?

Q5. How does the OSL badge measure X-ray exposure?

Q6. What do the badge filters mimic?

Q7. What dose exposures are usually reported?

Q8. Who is responsible for wearing a dosimeter?

Q9. How many dosimeters provide a better reflection of effective dose?

Q10. Where should a pregnant worker wear dosimeters?

Q11. What is the monthly radiation exposure limit for a pregnant worker?

Q12. What is the total radiation exposure limit for a pregnant worker?

Q13. Is a pregnant worker legally allowed to remain in the lab?

Q14. What is recommended for pregnant workers regarding radiation safety?

Q15. What technology helps reduce procedural radiation dose in real time?

A1. TLD (thermoluminescent dosimeter) badge and OSL (optically simulated luminescent) badge.

A2. Lithium fluoride crystal ( absorbs x ray ).

A3. It absorbs X-rays and releases light photons when heated, proportional to X-ray absorbed.

A4. Aluminum oxide doped with carbon.

A5. Releases light when struck with a laser, proportional to X-ray absorbed.

A6. Badges have different filters to mimick attenuation for different parts of the body.

A7. Shallow, lens ( eye) , or deep dose exposure.

A8. The individual health care worker.

A9. Two dosimeters (one under garment, one outside collar). One single dosimeter is also acceptable.

A10. Under the lead collar and on the thyroid collar.

A11. No more than 0.5 mSv (0.05 rem) per month.

A12. Not to exceed 5 mSv (0.5 rem) total during pregnancy.

A13. Yes, legal precedent supports this.

A14. Counseling from the radiation safety officer.

A15. Real-time operator dose monitoring.

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Q1. When is radiation exposure to the fetus particularly concerning?

Q2. Why might radiation exposure within 2 weeks of uterine implantation be less critical?

Q3. What organization suggests the risk of fetal congenital malformation per mSv exposure?

Q4. What is the approximate risk percentage of fetal congenital malformation or malignancy per mSv?

Q5. What radiation dose is often regarded as the cutoff for considering therapeutic abortion?

Q6. During what period is the 100 mSv dose considered most sensitive?

Q7. Is pregnancy in the cardiac catheterization laboratory safe with appropriate safeguards?

Study These Flashcards

A1. During the first trimester.

A2. Because all the cells are pluripotent at that point.

A3. United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR).

A4. About 0.0002% per mSv (0.002% per rem).

A5. 100 mSv (10 rem).

A6. Between 10 days to 26 weeks.

A7. Yes, it is safe and feasible.

Pregnancy ( i did not include tables 7.8 and 7.9. U may refer to the book )

Study These Flashcards

NCRP DOSE LIMITS GUIDELINES ( lower dose limits for ICRP )

Study These Flashcards

Q1. How does an operator’s single procedure radiation exposure compare to a patient’s? Q2. How is operator exposure expressed for organ-specific exposure? Q3. How is operator exposure expressed for whole-body exposure? Q4. What does the effective dose represent? Q5. What is the total recommended maximal dose for an invasive cardiologist per year? Q6. How is the total accumulative dose for an invasive cardiologist calculated? Q7. What organization lists recommendations for occupational radiation dose limits? Q8. To what level has the ICRP lowered the occupational total body annual radiation dose limit? Q9. What other organ’s dose limit has the ICRP lowered to 20 mSv? Q10. Why did the ICRP lower the dose limits for the eye?

A1. It is significantly less than a patient’s exposure. A2. As equivalent dose. A3. As effective dose. A4. The sum of equivalent doses from different tissues adjusted for radiation absorption capacity of each tissue. A5. 50 mSv (rem) per year. A6. Age multiplied by 10 mSv (age × total rems). A7. National Council on Radiation Protection (NCRP). A8. 20 mSv. A9. The eye. A10. Because eye injury occurs at doses lower than previously reported.

Questions: Q1. An interventional cardiologist receives about ______ to ______ mSv per year, depending on volume and case selection. Q2. The US occupational dose limit is ______ mSv per year. Q3. A busy interventionalist doing complex cases may receive in excess of ______ mSv per year. Q4. Personnel dosimeters and best practices for radiation safety are important because of potential exposure exceeding ______ mSv per year. Q5. Nurses and technologists receive approximately ______ mSv per year, depending on their role and location during the procedure. Q6. The cumulative additional risk for cancer in those exposed to occupational radiation is about ______% x mSv. Q7. This risk can also be expressed as ______% x rem. Q8. If a busy interventionist receives 25 mSv per year and practices for 20 years, the total dose would be about ______ mSv. Q9. The added cancer risk in this scenario would be ______%. Q10. The additional radiation exposure would increase cancer risk from baseline by ______% to ______%.

A1. 1, 10 ( way below 50 mSv per year ). A2. 50 A3. 50 A4. 50 A5. 2 A6. 0.004 A7. 0.04 A8. 500 ( 50 rem ) A9. 2 ( 500 x 0.004 %) A10. 20, 22

Q1. What type of tube is the X-ray tube? Q2. What faces the spinning anode in the X-ray tube? Q3. Where are electrons sent from in the X-ray tube? Q4. What temperature does the cathode reach to emit electrons? Q5. What is the process called when electrons boil off the cathode? Q6. What sets up the voltage potential across the X-ray tube? Q7. What causes electrons to move from the cathode to the anode? Q8. What does kVp represent? Q9. What does mA stand for? Q10. What determines radiation dose?

A1. Vacuum tube. A2. Cathode coil(s). A3. Generator. A4. About 3,000 °F. A5. Thermionic emission. A6. The generator. A7. Voltage potential across the tube. A8. Energy of the photons (peak voltage). A9. Milliamperes (number of photons). A10. Variations in mA and kVp.

Q11. What impacts image quality in X-ray formation? Q12. What happens to most electrons crossing from cathode to anode? Q13. What was a limitation of early generation X-ray tubes? Q14. How is heat controlled in current X-ray systems? Q15. What is the speed range of the rotating anode? Q16. What helps cool the X-ray tube? Q17. What material do photons strike to produce X-rays? Q18. What is the point source from which X-rays emerge called? Q19. What filters absorb low-frequency X-rays ( not useful and may produce noise ) ? Q20. What does collimation help with?

A11. Radiation dose. A12. Produce heat. A13. Heat production challenges. A14. Rotating anode and oil circulation. A15. 3500-10,000 rpm. A16. Oil circulating around the tube. A17. Tungsten anode. A18. X-ray beam focal spot. A19. Copper and aluminum filters. A20. Shape the X-ray beam, reduce scatter and decrease exposure.Scatter radiation from Compton interactions within the patient is directly related to dose, degrades image quality, and serves as the primary source of radiation exposure to the operator and staﬀ!!

Q1. The X-ray tube is a ______ tube with a cathode coil facing a spinning anode. Q2. Electrons are sent to the cathode from the ______. Q3. The cathode becomes white hot at about ______ °F. Q4. The process by which electrons boil off the cathode is called ______ emission. Q5. The generator sets up a ______ potential across the X-ray tube. Q6. The maximal voltage across the X-ray tube is referred to as ______, representing photon energy. Q7. The number of photons crossing from cathode to anode is measured in ______ . Q8. Radiation dose is determined by variations in ______ and ______. Q9. Most electrons crossing from cathode to anode produce ______, with only a small percentage producing X-rays. Q10. Early generation X-ray tubes were limited due to challenges in ______ production. Q11. Current systems control heat with a rapidly rotating anode spinning at ______ to ______ rpm. Q12. Oil circulating around the X-ray tube helps with ______. Q13. Photons striking the ______ anode produce X-rays. Q14. X-rays emerge from a point source called the X-ray beam ______ spot. Q15. Low-frequency X-rays are absorbed by ______ and aluminum filters. Q16. Collimation helps shape the X-ray beam and reduce ______. Q17. Scatter radiation from Compton interactions within the patient is directly related to ______. Q18. Scatter radiation degrades ______ quality. Q19. Scatter radiation is the primary source of radiation exposure to the ______ and staff.

A1. vacuum A2. generator A3. 3,000 A4. thermionic A5. voltage A6. kVp A7. mA A8. mA, kVp A9. heat A10. heat A11. 3,500, 10,000 A12. cooling A13. tungsten A14. focal A15. copper A16. scatter A17. dose A18. image A19. operator

X-ray fluoroscopy system

Q1. Where are electrons produced in an X-ray system? Q2. What are electrons converted to in the X-ray tube? Q3. What happens to X-rays immediately after they are produced? Q4. Through what do X-rays travel after leaving the tube? Q5. What happens to most X-rays as they pass through the patient? Q6. What do a few ( only a few ) X-rays reach after passing through the patient? Q7. What types of image detectors are mentioned? Q8. What do X-rays strike on the detector? Q9. What is emitted when X-rays strike the cesium-iodide phosphor? Q10. What technology has replaced image intensifiers in imaging systems?

A1. In the generator. A2. X-rays. A3. They diverge immediately. A4. Through the table and the patient. A5. Most are absorbed or scattered. A6. An image detector. A7. Image intensifier and flat panel. A8. A face layer of cesium-iodide phosphor. A9. A clump of light photons. A10. Flat-panel detectors.

Q11. In flat-panel systems, what converts photons to electrons? Q12. What device is in direct contact with the input phosphor in flat-panel systems? Q13. What happens to the signal after photodiode conversion in flat-panel detectors? Q14. How is the video signal sent to the monitor in flat-panel systems? Q15. Why does fewer steps in image transfer improve image quality? Q16. What image qualities are enhanced by flat-panel detectors? Q17. What does the avoidance of multiple energy conversions improve? Q18. How does improved image quality affect radiation dose? Q19. What is fundamentally changed in digital X-ray systems compared to analog? Q20. Do analog and digital systems share similar X-ray tube technologies?

A11. Photodiodes. A12. Charge-coupled visible-light device. A13. It is digitized. A14. Sent directly to the monitor. A15. Less image degradation occurs. A16. Uniformity, brightness, and dynamic range ( unlike with intensifier ) A17. Overall system performance. A18. Allows dose reduction. A19. The detector. A20. Yes ( similar x ray tube technology and different detector )

Q21. What is the main source of image degradation in traditional analog systems? Q22. What is the role of the cesium-iodide phosphor layer? Q23. What is the benefit of direct digital video signal generation? Q24. How does the flat-panel system improve dynamic range? Q25. What does the flat-panel system avoid that traditional systems ( image intensifier ) require? Q26. What type of device is a charge-coupled visible-light device? Q27. What is the purpose of filters on the image detector? Q28. What is the effect of scatter radiation on image quality? Q29. What is the relationship between image transfer steps and image uniformity? Q30. What is the main advantage of flat-panel detectors over image intensifiers?

A21. Multiple image transfer steps. A22. Converts X-rays to light photons. A23. Reduces image degradation. A24. By reducing image transfer steps. A25. Conversion of energy to light and then electricity. A26. Detector component. A27. To filter out unwanted X-rays. A28. Degrades image quality. A29. Fewer steps improve uniformity. A30. Improved image quality and "" dose reduction""" !!!

Q1. What technology has improved challenges with dynamic range in X-ray imaging? Q2. What issue did prior technology have over denser bones? Q3. Compared to bones, which tissue required less exposure? Q4. What patient characteristic can require increased X-ray dose? Q5. What procedural requirement can increase X-ray dose? Q6. Does magnification increase or decrease X-ray dose? Q7. How has flat-panel technology affected the dose increase from magnification? Q8. Who initially sets the imaging parameters? Q9. Can parameters be modified after manufacturer settings? Q10. What does resolution depend on?

A1. Flat-panel technology. A2. Blooming ( structures appear larger ) over denser bones. A3. The lungs. A4. Obesity. A5. Steep angulated views. A6. Increase. A7. It has reduced the degree of dose increase. A8. The manufacturer. A9. Yes, based on laboratory needs. A10. Field size.

Q11. How does a small field of view affect resolution? Q12. What happens to resolution with a larger field of view? Q13. How is magnification achieved with a larger field of view? Q14. What is required to maintain signal-to-noise ratio when resolution decreases? Q15. What determines complete system operation? Q16. What elements stabilize system performance and imaging? Q17. Who is central to the control loops in system operation? Q18. Does image processing bundle pixels in small or large field of view? Q19. What is the trade-off when increasing field of view? Q20. What is the role of the operator in imaging system control?

A11. Resolution may increase. A12. Resolution may decrease. A13. By bundling pixels ( which decrease resolution and is compensated by increasing x ray dose ). A14. Increase in X-ray dose. A15. Combination of operator-selectable parameters and feedback elements. A16. Feedback elements. A17. The operator. A18. Large field of view. A19. Loss of resolution. A20. Center of many control loops.

Q1. Electrons generated are converted to ______. Q2. X-rays pass through the ______. Q3. X-rays are sensed on the input ______. Q4. In both systems, X-rays are converted to ______. Q5. The limitation with the image intensifier is the multiple ______ involved. Q6. Light photons are converted back to ______ in the image intensifier. Q7. Electrons are accelerated and strike the output ______. Q8. The image is picked up by the ______ chips. Q9. The image is converted to a video signal and digitized in the ______ converter. Q10. In the flat-panel system, light is converted to electrons and sensed by a ______ array. Q11. The signal in the flat-panel system is digitized and sent directly to the ______.

A1. X-rays A2. patient A3. phosphor A4. light A5. steps A6. electrons A7. phosphor A8. CCD A9. A/D (analog-to-digital) A10. transistor A11. monitor

Q1. X-ray image detector dose per pulse is typically measured in ______. Q2. The detector dose is considerably smaller than the ______ dose. Q3. Generally, what percentage or less of incident radiation penetrates the subject and reaches the detector? Q4. X-ray unit framing rate is the number of ______ the system generates per unit time. Q5. The framing rate is an operator-selectable parameter ranging between ______ and ______ pulses per second. Q6. The framing rate determines the image ______ resolution. Q7. Imaging field size is the area of the X-ray beam that impinges on the ______. Q8. Lower-energy photons are defined as those with photon energies less than ______ keV. Q9. Lower-energy photons have insufficient ______ power to reach the detector. Q10. These lower-energy photons expose the subject without contributing to ______ formation. Q11. Undesirable photons are filtered out by layers of ______ and ______. Q12. The filtration layers are placed in the X-ray tube ______ port. Q13. The X-ray beam filtration removes photons that are considered ______. Q14. The X-ray unit framing rate is also called the pulsing ______. Q15. The imaging field size is discussed in greater depth under “______” in the “Quantifying Dose in Fluoroscopic Procedures” section.

A1. nanogray ( X-ray image detector dose per pulse: This is the dose for each X-ray pulse (typically measured in nanogray) that reaches the detector). A2. subject A3. 5% A4. pulses A5. 4, 30 A6. temporal A7. subject ( KAP ) A8. 30 A9. penetrating A10. image A11. aluminum, copper A12. exit A13. undesirable A14. rate A15. KAP

Q1. What is the X-ray image detector dose per pulse typically measured in? Q2. Is the detector dose larger or smaller than the subject dose? Q3. What percentage or less of the incident radiation penetrates the subject and reaches the detector? Q4. What does the X-ray unit framing rate represent? Q5. What is the range of the X-ray unit framing rate in pulses per second? Q6. What does the framing rate determine in image quality? Q7. What is the imaging field size? Q8. What photon energy level is considered lower-energy photons? Q9. Why are lower-energy photons undesirable? Q10. What materials are used to filter out undesirable photons?

A1. Nanogray. A2. Smaller. A3. 5%. A4. The number of pulses generated per unit time. A5. Between 4 and 30 pulses per second. A6. Image temporal resolution. A7. The area of the X-ray beam that impinges on the subject. A8. Less than 30 keV. A9. They expose the subject but do not contribute to image formation. A10. Aluminum and copper.

Q1. What type of imaging is required for procedure performance? Q2. What type of acquisition is necessary for postprocedure review and long-term access? Q3. Digital imaging allows for ______ image data to be made immediately available. Q4. The increase in information content with digital imaging requires a significant increase in system ______. Q5. System bandwidth facilitates ______ and postacquisition review and archiving of studies. Q6. Newer systems have the bandwidth for storage and transfer of ______ amounts of data. Q7. Once in digital format, data are written to disk using the ______ standard. Q8. When was the DICOM standard established? Q9. The DICOM format provides for seamless image access across internal and external ______ connections. Q10. The DICOM format provides a medium for short- and long-term image storage on various ______ devices. Q11. What technology is included to prevent data loss? Q12. Initially, digital image storage was limited by large expensive ______ capabilities. Q13. The duration of digital image storage was previously defined as ______ years in the film era. Q14. The cost of digital storage has ______ over time. Q15. The ready availability of terabytes for large media storage has made long-term cine image availability less of a ______.

A1. High-quality real-time fluoroscopic imaging. A2. Cineangiographic acquisition. A3. High-resolution. A4. Bandwidth ( spectrum of frequencies to emit signals ) A5. Online. A6. Large. A7. DICOM (Digital Communication in Medicine). A8. 1990s. A9. Network. A10. Archival media. A11. Disaster recovery technology. A12. Storage. A13. 7. A14. Dropped. A15. Concern.

RADIATION DOSE MANAGEMENT IN THE CATHETERIZATION LABORATORY

Q1. The interventional cardiology board certification examination includes ______ and radiation safety. Q2. Only certain ______ mandate fluoroscopy training. Q3. Everyone should receive radiation safety training commensurate to their ______. Q4. The radiation safety education program should be coordinated with the hospital radiation safety ______. Q5. Initial didactic training should include physics of ______ production. Q6. Equipment technology should cover modes of ______. Q7. Training should include image quality in ______. Q8. Biology effects of radiation and principles of radiation ______ are part of the training. Q9. Updates on radiation safety should be ______. Q10. Hands-on training is required for newly hired and current operators on new ______.

A1. physics A2. states A3. responsibilities A4. officer A5. X-ray A6. operation A7. fluoroscopy A8. safety A9. annual A10. equipment

Q1. Operator dose is directly proportional to ______ dose. Q2. Reducing the dose to the patient benefits the ______ and staff. Q3. Minimizing radiation dose requires meticulous application of established ______ practices. Q4. A procedure-based review of radiation dose management is outlined in ______ 7.6. Q5. Minimizing patient exposure benefits the operator and ______ (Table 7.11). Q6. Fluoroscopy should be used only when looking at the ______. Q7. ______ imaging should be limited during procedures. Q8. Important variables during the procedure include steep angles, frame rate, collimation, protective shielding, and table and image receptor ______. Q9. Operator and staff must maximize their ______ from the X-ray tube. Q10. The inverse square law relates to the effect of ______ on exposure. Q11. Most of the operator's exposure occurs from scatter from the ______ side of the patient. Q12. When the X-ray tube is closest to the operator, radiation exposure is ______. Q13. In a cranial left anterior oblique view, with the X-ray tube on the same side as the operator, exposure is ______ times more than in a caudal right anterior oblique view !!!!! Q14. In a caudal right anterior oblique view, the X-ray tube is on the ______ side of the table from the operator. Q15. All appendages of the operator and patient should be out of the ______ field.

A1. patient A2. operator A3. best A4. Table A5. staff A6. monitor A7. Cine A8. height A9. distance A10. distance A11. ENTRY A12. greatest A13. six A14. opposite A15. imaging

Strategies to decrease radiation exposure in the cathlab: Q1. Proper collimation: Q2. Minimize beam “on-time”: Q3. Use filters: Q4. Keep kVp high: Q5. Minimize mA: Q6. Use minimal views: Q7. Keep image intensifier close: Q8. Narrow source-to-image distance: Q9. Use lowest framing rate: Q10. Use pulsed fluoroscopy: Q11. Limit “high-dose” fluoroscopy: Q12. Minimize magnified views: Q13. Use gonadal shielding: Q14. Vary views:

A1. Narrow the beam. A2. Use fluoroscopy only when necessary. A3. Aluminum and copper filters at tube exit. A4. Maintain good image contrast. A5. Use lowest milliamperes possible. A6. Limit number of imaging angles. A7. Place close to the patient to reduce dose. A8. Keep distance as short as possible. A9. Reduce pulses per second to minimum needed. A10. Prefer pulsed over continuous fluoroscopy. A11. Avoid prolonged high-dose settings. A12. Use magnification sparingly. A13. Protect sensitive organs directly. A14. Distribute radiation over a wider area.

Q1. Three basic tenets for minimizing occupational exposure are ______, distance, and shielding. Q2. Studies should be kept as ______ as possible. Q3. One minute of fluoroscopy results in about one-tenth the dose of one minute of ______. Q4. Most radiation exposure in the laboratory is due to ______. Q5. The operator typically receives about ______ times the dose from fluoroscopy than from cine. Q6. Table height and ______ can significantly affect radiation dose due to scatter. Q7. Scatter radiation is lowest when table height is ______ and the I.I. is close to the patient. Q8. Operators should stay as ______ from the X-ray source as possible. Q9. Extension tubing should be attached to catheters to allow operators to be ______ from the X-ray source. Q10. Distance may impact radial cases with increased operator dose, but this decreases with increased operator ______.

A1. time A2. short A3. cineangiography A4. fluoroscopy A5. six A6. I.I. (image intensifier) A7. higher A8. far A9. farther A10. experience

Q1. Operators and staff should routinely use all available personal protective ______ and in-room shielding. Q2. Protective garments and aprons with ______ shielding stop approximately 95% of scatter radiation. Q3. Ceiling- and table-mounted shields are effective in reducing ______ dose. Q4. Posterior subcapsular cataract formation is a proven risk from exposure to significant ______ radiation. Q5. Protective glasses must fit properly, have ______-mm lead-equivalent protection, and additional side shielding. Q6. Radiation caps are available as ______ and lead-equivalent options. Q7. Radiation caps reduce ______ radiation, but long-term benefits are less well established. Q8. Sterile protective disposable drapes decrease operator scatter but may increase ______ dose. Q9. Floor-mounted mobile lead shielding devices reduce radiation and may allow operators to forgo wearing ______. Q10. Mobile shielding devices lack extra protection for personnel at the ______ of the bed and the left side of the table. Q11. Robotic systems offer a radiation-free environment for the operator in a ______ laboratory location. Q12. Risks to the profession include cataract formation, brain tumors, skin injury, and ______ defects. Q13. Orthopedic injuries from protective attire are often categorized as ______ and underestimated. Q14. Techniques that reduce patient dose will also reduce ______ dose. Q15. Interventional cardiologists should strive for the safest environment for patients, staff, and ______.

A1. apparel A2. thyroid A3. operator A4. eye A5. 0.25 A6. lead A7. cranial A8. patient A9. lead A10. head A11. remote/non-in-procedure room A12. inheritable A13. anecdotal A14. operator A15. themselves

Check figure 7.6: Q1. What happens to X-rays when the source-to-image distance increases? Q2. How does the image size change when the source-to-image distance increases? Q3. What must increase to satisfy the exposure equation when the image appears larger?

A1. X-rays are lost due to their divergence. A2. The image appears larger. A3. The amount of X-ray dose increases.

Check figure 7.7: Q1. Where is the image intensifier positioned relative to the patient in the first scenario? Q2. How is the operator positioned relative to the X-ray tube in the first scenario? Q3. What effect does increasing the source-to-image distance have on X-ray dose? Q4. In the first scenario, who receives more exposure, the operator or the patient? Q5. In the second scenario, how is the patient positioned relative to the X-ray tube? Q6. What is the consequence of having a wide source-to-image distance in the second scenario?

A1. Close to the patient. A2. Far from the X-ray tube. A3. It requires a greater X-ray dose. A4. The operator receives more exposure. A5. At a comfortable distance from the X-ray tube. A6. Increased X-ray dose and increased dose to the patient.

SCAI KERN CHAP 7 XRAY IV CONTRAST Flashcards

(53 cards)