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Principles of Anesthesia II - Fall 2024 > Radiation/Laser Safety - Exam 1 > Flashcards

Radiation/Laser Safety - Exam 1 Flashcards

1
Q

Types of Radiation

Electromagnetic:

A
  • from motion of atoms
  • combines electricity & magnetim
  • electrons changing orbits
  • ex: x-rays, light rays
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2
Q

Types of Radiation

Mechanical

A
  • only travels through substances - not air
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3
Q

Types of Radiation

Nuclear (neutron)

A
  • comes from unstable atom nuclei
  • ex: nuclear plants
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4
Q

Types of Radiation

Cosmic (beta)

A
  • involves electrons only
  • ex: sun rays - travels @ speed of light almost
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5
Q

Non-ionizing radiation:

A
  • stable form
  • does not knock electrons off atoms
  • does not break molecular bonds
  • only harmful d/t heat energy (microwaves/radiowaves)
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6
Q

Ionizing Radiation:

A
  • more harmful
  • electrons are knocked off atoms
  • they create ions
  • the electrical charges cause intracellular chemical reactions
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7
Q

What are the 3 cellular risks w/ ionizing radiation?

A
  1. break DNA chains (cell death - apoptosis)
  2. mutate DNA chains - cancer
  3. Mutated sperm or egg cell - birth defects
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8
Q

Are x-rays or light rays stronger?

which one has more energy?

which one has longer wavelength?

A
  • x-rays stronger
  • x-rays more energy/shorter wavelength
  • light rays have longer wavelength
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9
Q

X-rays are carried by particles called ________.

A
  • photons (light particles)
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10
Q

How is light emitted w/ x-rays?

A
  • electrons orbit the atom in a resting state
  • they are heated and excited
  • jump to higher energy orbit
  • when they fall back down to the lower orbit - release photons (what we see as light)
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11
Q

Are small or large atoms more likely to absorb photons from x-ray?

A

large atoms
* greater energy differences b/w orbits
* lighter/brighter image on x-ray
* ex: bones, dense tissue

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12
Q

What are examples of tissue consisting of small atoms?

A
  • soft tissue
  • they don’t absorb as many photons on x-ray b/c smaller movement of electrons
  • gray on x-ray
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13
Q

x-ray machine

What does the cathode do?

A
  • heated filament in the middle
  • heat causes electrons to fly off filament
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14
Q

x-ray machine

what does the anode do?

A
  • made of tungsten (positively charged)
  • attracts electrons across tube
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15
Q

x-ray machine

how do photons escape the machine through the window?

A
  • as anode attracts the electrons - photons are released as energy
  • makes the x-ray beam
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16
Q

x-ray machine

how is an image created?

A

chemical reaction on film
* tissue absorbs photons in a way that reflects the image
* small atoms vs. large atoms

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17
Q

x-ray machine

what 2 things can affect the image quality?

A
  1. ambient light can darken/lighten image
  2. intensity changes to beam
    - over exposure: dark, obliterates structures
    - under exposure: white, exaggerates structures
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18
Q

What are 4 Diagnostic uses for x-rays?

A
  1. radiography (bone fx, tube placement, foreign objects)
  2. mammography
  3. computed tomography (x-ray w/ computer processing)
  4. fluoroscopy - real time images, high radiation amounts
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19
Q

Diagnostics x-ray

Examples of Fluoroscopy uses:

A
  • stent placement
  • CBD stent
  • aneurysm coils
  • ortho/neurosurgery
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20
Q

What is a therapeutic use for radiation?

A
  • radiation therapy
  • damages cancer cell DNA
  • creates ions w/ electrical charge - intracellular chemical reactions - breaks cancer cell DNA chains
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21
Q

Radiation Therapy SE

Hair loss:

A

anything above the waist

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22
Q

Radiation therapy SE

diarrhea/urinary changes:

A

anything below the chest (pelvis, rectum, abdomen)

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23
Q

Radiation SE:

n/v:

A

brain: chemoreceptor trigger zone
* pelvis, abdomen

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24
Q

radiation SE:

Sexual problems/infertility:

A
  • pelvis/rectum
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25
Q

Radiation SE

Fatigue:

A

Brain, Breast, Chest, Head/neck, pelvis, rectum, abdomen

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26
Q

Radiation SE

dysphagia:

A
  • chest
  • Head/neck
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27
Q

radiation doses

what is a REM?

A
  • radiation dose times a weighted factor
  • nearly ~ to a Rad
  • measured as millirem (mrem) 1/1000 of a Rem
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28
Q

Allowable yearly mrem doses

whole body:

A
  • 5,000 mrem
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29
Q

Allowable yearly mrem doses

extremities:

A

50,000

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30
Q

Allowable yearly mrem doses

lens of eye:

A

15,000

31
Q

allowable yearly mrem doses

pregnancy

A
  • 500mrem after 2nd trimester
32
Q

CXR mrem:

A

5-10mrem
* could be more w/ scatter and old machines

33
Q

coronary angiogram mrem:

A
  • 1,500 mrem
  • done under fluoro
34
Q

angioplasty mrem

A
  • 5,700 mrem
35
Q

CT mrem:

A
  • 5,000 mrem
36
Q

Indirect sources of Radiation

What is scatter?

A
  • incidental radiation that projects across the room
  • reflected off tables, patients, other surfaces
37
Q

Scatter -

What is collimation?
how does it affect scatter?

A
  • has to do w/ how wide the window is that photons are escaping through
  • wider beam = more collimation/scatter
38
Q

What things can increase scatter?

A
  • wider beam window (increased collimation)
  • obese pts
  • bigger areas being x-rayed
  • increased distance b/w pt and machine
39
Q

What was the only symptom noticed in studies w/ 200,000 mrem exposure?

A
  • transient erythema
  • fetal doses < 10,000 mrem unlikely to cause effects after 20 weeks
40
Q

Where are dosimeters worn?

A
  • outside apron on collar
  • inside apron on waist
40
Q

Radiation Protection as low as Reasonably Achievable (ALARA)

What 4 things can providers do to decrease exposure to radiation?

A
  1. reduce time spent near beam entry
  2. distance: double distance from beam = cut exposure by 3/4
  3. scatter: be > 6ft from pt
  4. Shielding: lead aprons, portable shields, thyroid shield, lead glasses
41
Q

What 3 things should we not do w/ our dosimeters?

A
  1. mix up inside vs. outside
  2. share w/ others
  3. don’t leave in car on dash/seat - absorbs heat from cosmic rays = higher reading
42
Q

What form of radiation does MRI use?

A

non-ionizing

43
Q

Principles of MRI:

________ ________ used to orient nuclei of ________ to north-south poles.

A
  • magnetic field
  • hydrogen molecules
  • radiowave pulses change orientation of specific atoms which radiates energy
44
Q

What generates the contrast in MRI?

A
  • the time until tissue relaxation occurs when RF waves turn off
  • affected by: densities of hydrogen nuclei in tissues, chemical & phys properties
45
Q

T1 view:

A

Magnetic Vector relaxes
* fat bright, water dark
* gray-white matter contrast & normal anatomy

46
Q

T2 View:

A

Axial spin relaxes
* Fat dark, water bright
* identifies tissue edema & pathology

47
Q

MRI contrast

How does Gadolinium work?

A
  • alters the magnetic properties of nearby water molecules = enhanced image
48
Q

SE of Gadolinium

Clearance:

A
  • itching, rash, warm skin sensation (benadryl)
  • normal GFR - 24 hrs
49
Q

Magnetic Field

What 2 things do ferromagnetic objects experience?

A
  • attractive force
  • high degree of Torque (line up w/ magnetic field)
  • field always on
50
Q

What are 4 risks of MRI?

A
  • projectile risk
  • RF energy causes tissue/device heating
  • electromagnetic interference w/ EKG (artifact)
  • Acoustic noise: 125dB (chainsaw) = hearing protection
51
Q

What are 2 typical options for providing anesthesia in MRI?

What is our goal?

A
  • Sevoflurane - MRI safe volatile
  • TIVA - opioids not needed
  • minimize movement
52
Q

AANA Standards & MRI

A
  1. normal monitors: EKG, BP, pulse-ox, capnography
  2. have airway equip. available
  3. suction available
  4. MRI pumps or long tubing!
  5. laryngoscope handles, blades = induce in different room
53
Q

MRI patient position concerns

  • head/neck:
  • abdominal scans:
A
  • head/neck: airway inaccessible, stop scan if needed
  • abdomen: brachial plexus injuries b/c arms over head (padding)
54
Q

Provider Safety

What medical devices are not MRI safe?

A
  • Pacemakers
  • AICDs
  • Implanted insulin pumps
55
Q

Provider safety:

What medical devices are MRI safe?

A
  • heart valves
  • endovascular, biliary stents (8 weeks)
  • coronary stents
  • vascular ports, IVC filters
  • ortho implants
56
Q

Provider Safety

What can rapid movement toward the magnetic field cause?

(>1m/sec)

A
  • dizziness
  • HA
  • light flashes
  • nausea
57
Q

What does LASER stand for?

How is the beam?

A
  • Light Amplification by Stimulated Emission of Radiation
  • focused narrow beam, high-intensity
58
Q

What 5 types of surgery commonly use LASER?

A
  1. Cosmetic: minimal scarring
  2. LASIK
  3. dental
  4. general (condyloma, TURP)
  5. ENT: precise areas (sinuses, tracheal tumor)
59
Q

How does the LASER work?

A
  • electrons excited from energy source
  • move to higher orbit
  • return to ground state
  • release photons of energy
    electromagnetic radiation

more concentrated than x-ray

60
Q

Properties of Laser Radiation

monochromatic:

A
  • all photons in laser beam are same wavelength
61
Q

Properties of Laser Radiation

Coherence:

A
  • the travel of photons is synchronized in time and space
  • no random movement
62
Q

Properties of Laser Radiation

Collimation:

A
  • laser beam photons are nearly parallel
  • beam is focused on small area w/ no scatter
63
Q

Properties of Laser Radiation

What are 6 advantages of using LASER?

A
  • excellent precision
  • good hemostasis
  • rapid healing
  • less scar formation
  • less post-op edema/pain
  • lower infection rates
64
Q

Lasing Medium

What is argon LASER used for?

A
  • modest tissue penetration (superficial)
  • 0.05-2mm deep
  • dermatology
65
Q

Lasing Medium

What is Carbon Dioxide LASER used for?

A
  • scatter minimal
  • surrounding tissue damage negligible
  • great for vocal cords/oropharynx
66
Q

Lasing Medium

What is the Nd:YAG LASER used for?

A
  • most powerful
  • more heat
  • deeper tissue penetration (2-6mm)
  • tumor debulking
67
Q

What are 5 Hazards of LASER?

A
  1. atmospheric contamination: lesion lasered - particles vaporized and breathed in/colonized (condyloma)
  2. perforation of vessel/structure
  3. embolism (entrain air if vessel perf)
  4. inappropriate energy transfer
  5. airway fire
68
Q

What are the symptoms of inhaling particulate?

A
  • HA, nausea (immediately)
  • can cause: interstitial pneumonia, bronchiolitis, emphysema
  • carcinogenic!
69
Q

Generic Laser Safety:

A
  • laser glasses for provider & pt w/ eyes taped
  • windows covered
  • laser plume masks
  • suction
  • water/saline irrigation - fire risk
  • don’t tent drapes
70
Q

What is the “fire triad”?

A
  1. ignition source: laser, ESU
  2. fuel: drapes, gauze dressings, ETT, gel mattress pads, facial/body hair
  3. oxidizer - keep O2 levels lower w/ laser (O2, nitrous, air)
71
Q

What Airway Fire Safety things can we do?

A
  • laser-resistant ETTs
  • low FiO2 (21% if possible)
  • wet pledgets around ETT
  • methylene blue in ETT cuff - rupture sign (no fire prevention)
  • use scissors to cut into trachea instead of bovie
  • remove ETT during laser procedure and reinsert PRN sats
72
Q
A

Principles of Anesthesia II - Fall 2024 (10 decks)

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