Radiology

Question 1

List 5 types of non-ionising radiation.

Answer 1

1. UV
2. Visible
3. Infrared
4. RF
5. Microwaves

Question 2

List 4 types of ionising radiation.

Answer 2

1. Alpha
2. Beta
3. Gamma
4. X-ray

Question 3

The following statement best describes which type of radiation?

‘Causes atoms to lose elections and become ions or charged atoms’.

Answer 3

Ionising Radiation.

Question 4

True / False

‘X-ray ionising radiation dose is inversely proportional to distance from energy source’.

Answer 4

True.

Described by the inverse square law.

Question 5

True / False

‘As one moves away from the ionising source - exposure dosage is reduced by an equal amount’.

Answer 5

False.

Dose is decreased by square of the distance as described by the inverse square law.

Question 6

The following statement best describes what form of mutation respondent to ionising radiation?

‘Mutation occurring exclusively in cells that undergo division’.

Answer 6

Somatic mutation.

Question 7

What is the formula used to calculate exposure time?

Answer 7

Exposure rate x Time.

Question 8

What does the abbreviation ‘ALARA’ stand for?

Answer 8

As Low As Reasonably Achievable.

Question 9

The following statement best describes what?

‘Energy packets with no mass or charge’.

Answer 9

A Photon.

Question 10

What does the abbreviation ‘RAD’ stand for?

Answer 10

Radiation Absorbed Dose.

Question 11

List 3 radiation emitting devices that do not significantly interact with CRM devices.

Answer 11

1. Microwave
2. CT Scan
3. X-RAYs

Question 12

List 6 radiation emitting devices that can significantly interact with CRM devices.

Answer 12

1. Cell phone (see iphone warning)
2. Arc welder
3. Airport metal detector
4. Tens unit
5. Power tools - poor grounding
6. Ham radio

Question 13

List 5 forms of energy emitting devices that may critically damage CRM devices.

Answer 13

1. MRI
2. External defibrillation
3. Cardioversion
4. RF ablation
5. Radiation therapy

Question 14

The following statement best describes which type of radiation?

‘Possess insufficient energy to cause atoms to lose elections and become ions or charged atoms’.

Answer 14

Non-Ionising radiation.

Question 15

Yes / No

Can somatic mutation occur in germ cells?

Answer 15

No.

Somatic mutation occurs only in cells that divide. Germ cells do not divide.

Question 16

List two common germ cells.

Answer 16

1. Egg cells
2. Sperm cells

Question 17

True / False

‘Somatic Mutation respondent to ionising radiation can occur in Liver, Blood or Skin cells’.

Answer 17

True.

Somatic mutation occurs only in cells that divide.

Question 18

True / False

‘Somatic Mutation respondent to ionising radiation can occur in sperm cells’.

Answer 18

False.

Somatic mutation occurs only in cells that divide. Sperm cells do not divide.

Question 19

Convert 1 Rad into GRAY.

Answer 19

1 RAD = 0.01 GRAY.

Question 20

Convert 1 Rad into Joules per Kilo

Answer 20

1 RAD = 0.01J per Kilo.

Question 21

Appendage / Septum / Free wall

If the atrial lead displays a ‘window wiper’ style of movement in the AP view. Where is it most likely to be deployed?

Answer 21

Right Atrial Appendage.

Question 22

1. What is the likely pacing mode?
2. What type of leads?
3. What type of implant?

Answer 22

1. AAI or AOO (Biatrial stimulation)
2. Unipolar epicardial
3. Abdominal

Question 23

Does this patient likely have high or low DFT?

Answer 23

High.

Note dual coil lead - typically these are reserved for high DFT patients in current practice. Not routinely implanted due to higher complication and difficulty to explant.

Question 24

Day 1 post implant the ward nurse notes a ‘funny looking ECG’ - what could be the explanation?

Answer 24

Atrial lead pin not fully inserted.

Compare the top atrial port to the bottom ventricular port. Note how the pin of the ventricular lead extends beyond the bridge and the atrial doesnt. This requires reintervention.

Question 25

Day 1 post op X-ray reveals the following - what is wrong?

Answer 25

Atrial lead dislodgement into the ventricle.

Question 26

Patient ECG shows RBBB morphology - what could be the cause?

Answer 26

RV lead not inserted fully into the header. ## Footnote *Note how RV pin doesnt extend beyond the bridge like it does for the two other leads. This means there will be depolarisation from the LV only, giving the RBBB morphology.*

Question 27

What is this an example of?

Answer 27

Twiddlers syndrome. ## Footnote *Note how all leads have retracted out of the heart and significant coiling is observed around the generator site.*

Question 28

This patient has 3 leads but a DDD device, why?

Answer 28

RV lead fracture - thus fractured lead capped and burried and replacement implanted.

Question 29

Patient presents to ED with multiple shocks, why?

Answer 29

RV ICD lead fracture. ## Footnote *This will manifest as significant lead noise, which will be oversensed and subsequent therapies delivered. Magnet application is first step, then program therapies off, then extract/replace lead.*

Question 30

Patient presents to ED with syncope. Whats the likely cause?

Answer 30

RV lead dislodgement. ## Footnote *Note how RV lead has retracted from the septum / apex position and is angled downwards.*

Question 31

Patient presents to ED with chest pain/tightness. Whats the issue?

Answer 31

RV Perforation. ## Footnote *Note how RV lead tip has extended beyond the heart border. This will require immediate intervention.*

Question 32

Patient presents to ED with intermittent palpitations. Whats the issue?

Answer 32

Atrial lead has dislodged into the RV - requires immediate revision.

Question 33

Why position the image intensifier close to the patient?

Answer 33

To reduce x-ray scatter.

Question 34

The following shows what? 1. BiV pacing system 2. Situs invesus 3. Twiddlers 4. High defib threshold ICD system

Answer 34

High defib threshold system. ## Footnote *Lead to the right is axillary ICD lead (see thickness) which is implanted in \<5% ICD cases due to high DFT.*

Question 35

Day 1 post-op x-ray is displayed below. What is the appropriate course of action. 1. Increase outputs 2. Turn rate response on 3. Replace atrial lead with that of longer length 4. Reposition atrial lead 5. Reprogram to unipolar configuration

Answer 35

4 - Reposition atrial lead. ## Footnote *Atrial lead has retracted into the SVC. The RV lead also looks taut, slack could be increased on this lead too.*

Question 36

Patient presents with worsening SOB. Whats the issue?

Answer 36

Twiddlers syndrome - both leads have become dislodged and retracted into IVC.

Question 37

Patient presents with worsening SOB. Whats the issue?

Answer 37

Lead insulation failure observed. Likely rubbing against device leading to loss of output.

Question 38

Patient presents with worsening SOB. Whats the issue?

Answer 38

RV lead dislodgement, leading to ineffective BiVp