SCAI KERN CHAP 7 XRAY IV CONTRAST Flashcards
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
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
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.
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
*** 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
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 )
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.
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
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.
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:
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.
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.
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
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.
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.
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.
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
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
Radiation Exposure for Health Care Workers
