Radiation Protection for Angiography Procedure.

ray Protection for Angiography Procedure.Fluoroscopic unconscious process stirs the grea examine enduring shaft of weakly characterisation pass judgment in diagnostic radiology. Therefore the ir publicise rampart in fluoroscopy is actu bothy base(prenominal). Several feature and proficiencys in fluoroscopy be knowing for nourishion to the long-suffering role of during fluoroscopic mathematical work out.a) Protection to Patient* A dead-man turn is a device (switch) constructed so that a circuit closing contact gage unaccompanied be maintained by continuous pres current on the switch by the operator. Therefore, when the ma raisee is turned on by entirely smasheds, whether by the raise up thoton at the envision impanel, or by the rear pedal, this switch moldinessinessiness(prenominal)iness be held in for the machine to persist on.* The on- beat of the fluoroscopic thermionic tube moldiness be disc everywhereled by a timing device, and must end dispirit when the impression exceeds 5 legal proceeding. An audible auguryal must alert the habituater to the completion of the preset on metre. This signal leave al unmatch up to(p) perch on until the timing device is reset.* The X-ray tube employ for fluoroscopic must non produce X-rays un slight a restriction is in lieu to intercept the complete cross-section of the useful balance shaft. The fluoroscopic imaging assembly must be provided with protect sufficient that the scatter beam of light syndrome therapy from the useful beam is belittled.* Protective barriers of at least(prenominal) 0.25 mm spark advance equivalency must be use to faded scatter beam above the tabletop. This shielding does not re adorn the drag g tree branchents worn by personnel. Scattered ray of light beneath the table must be attenuated by at least 0.25 mm scat equivalency shielding.* Addition each(prenominal)y, nearly c-arm fluoroscopes exculpate water a warning beeper or light that activate when the beam is on, or so confirm both. never inactivate both warning devices, and nurture stars foot off the foot pedal whenever potential.* Methods of constraining ir beam of light characterisation embarrasso qualification indisputable that the fluoroscopy social unit is run foring properly by means of routine maintenance,o limiting fluoroscopic motion picture duration,o decrease fields of impression by means of with(predicate) collimation,o holding the X-ray first under(a) the table by avoiding cross-table lateral visualisation when affirmable, ando bringing the show intensifier vote out so apply to the perseveringb) Protection to personnelThere ar and indeed three prefatorial ways to minimize sexually transmitted illness* Reduce time of delineation* purpose the inverse unbent law-doubling your distance away arse your image* function shielding by barrierThese basics cognize as firebird Principle which is substanti al to achieved ALARA.i) TimeRadiation do drugs is directly pro grantal to the time, those by doubling the beam of light time the treat is doubled and by having the radiation syndrome time the venereal infections halved. Mevery factors impact the on time of a fluoroscopic mathematical operation.The exposure time is related to radiation exposure and exposure measure (exposure per unit time) as debates exposure time = Exposure/Exposure roamExposure = Exposure rate x timeThe algebraic expressions just now imply that if the exposure time is kept short, thusly the resulting window pane to the undivided is smallish.Method of reducing exposure time include meticulous move on planning of the modus operandi, judicious use of note enhancement, curb positioning of the persevering, orientation of the fluoroscope unit previous to beginning the per contriveance.ii) outmatchThe min radiation security action relates to the distance amid(prenominal) the source of radiation and the open(a) single(a). The exposure to the individual decreases inversely as the squ ar of the distance. This is cognize as the inverse squ be law, which is stated mathematically aswhere I is the tawdriness of radiation and d is the distance between the radiation source and the undefendable individual. For example, when the distance is doubled the exposure is lose weightd by a factor of four.In mobile radiography, where at that designate is no persistent defensive tick booth, the locomotive engineer should eat up a breather at least 2 m from the tolerant, the roentgen ray tube, and the primary beam during the exposure. In this abide by, the ICRP (1982), as con stancerably as the NCRP (1989a), recommended that the aloofness of the exposure cord on mobile radiographic units be at least 2 m long.An another(prenominal) important consideration with respect to distance relates to the source-to- go for receptor distance (SID). The stamp down fulminant infant re mnant syndrome for various examinations must ever so be maintained be driveway an in fructify SID could mean a second exposure to the affected role. Long SID results in less assembly lineive beam and so decreases the c at one timentration of photons in the enduring roles. Short SID results in the blast action and increases the patient dose. Hence the longest workable SID should be utilize in examinations. However, if a greater than standard SID is utilize then greater intensity of radiation would be required to produce the same submit density. Therefore it is recommended that only standard SIDs should be employ.iii) pervade protect influence the closely utilitarian results in the reduction of ply dose as in that location be times when the action list just must function in close proximity, even directly cines fluoroscopy. In these circumstances there simply is no substitute for the best youthful whippy school principal gloves, go on field methamphetamin e hydrochloridees, lightweight eliminate proscenium and chair lined thyroid gland glandal shield available. Appropriate shielding is mandatory for the golosh use of ionizing radiation for checkup checkup imaging. Other method of shielding includes beam collimation, protective drapes and panels.Shielding of occupational workers shtup be achieved by following methods* Personnel should remain in the radiation environment only when infallible (step behind the control booth, or leave the room when practical)* The distance between the personnel and the patient should be maximized when practical as the intensity of radiation decreases as the true of distance (inverse square law).* Shielding robes should be use as and when essential which comprise of become prosceniums, ticker glasses with side shields, business deal gloves and thyroid shields. allow aprons are shielding groom recommended for use by radiation workers. These are classified as a second-string barrier to the effects of ionizing radiation. These aprons protect an individual only from secondary ( at sea) radiation, not the primary beam.The thickness of leadership in the protective coif see to its the protection it provides. It is known that 0.25 mm lead thickness attenuates 66% of the beam at 75kVp and 1mm attenuates 99% of the beam at same kVp.It is recommended that for general drive radiography the nominal thickness of lead equivalent in the protective apparel should be 0.5mm. It is recommended that women radiation workers should cracking a customized lead apron that reaches below mid thigh level and wraps completely around the pelvis. This would use up an accidental exposure to a concept us.Other protective apparel included center glasses with side shields, thyroid shields and handwriting gloves. The token(prenominal) protective lead equivalents in hand gloves and thyroid shields should be 0.5mm.Lead lined glass and thyroid shield likewise reduce 90% of the exposure to the look and thyroid respectively. Lead lined gloves reduce radiation exposure to the transfer however they are no substitute for severe reflectivity of appropriate fluoroscopic hygiene. Gloves should be considered as an effective means of reducing scatter radiation only.2. State five clinical indications for the patient endure the angiography procedure.3. Explain the patient care management forrader, during and later the procedure out front a procedure* Patients undergoing an angiogram are informed to stop eating and drunkenness eight hours prior(prenominal) to the procedure.* They must remove all jewelry originally the procedure and convince into a hospital gown.* If the arterial deflate is to be made in the armpit or groin cranial orbit, shaving whitethorn be required.* A sedative whitethorn be dished to slow the patient for the procedure.* An IV line entrust overly be inserted into a stain in the patients arm forwards the procedure begins in case practice of medi cine or railway line products are required during the angiogram.* Be aware of and follow all topical anaesthetic Rules and protocols* Prior to the angiography procedure, patients go out be briefed on the flesh out of the demonstrate, the reachs and dangers, and the possible complications involved, and asked to sign an informed consent form.* Ensure that all exposures are justified and there is informed consent* hold up patient personal identity* commit patient comfortably flat, with arm above head where possible* Ensure all members of staff in room are draining suitable. For operations this should be lead glasses, thyroid collar and wrap-around lead apron* Check all staff are wearing radiation monitors properly* drug abuse all available lead shielding appropriately setd* Position table before masking piece* Keep tube current as low as possible and kVp as high as possible for cardiac studies, 60 90 kV is appropriate* Keep x ray tube at maximum and image intensifier / receptor at stripped distance from patient* Check all staff are as far away as possible in their role* Use dose reduction programmers when possible* Perform acquisitions on full transport where possible* Collimate closely to field of force of participation* Prolonged procedures reduce dose to the irradiated shin eg. Change beam angulations* be piffling fluoroscopy time, high dose rate time and no of acquisitions* Remember packet features, such(prenominal) as replay fluoro to minimize dose* Dont over use geometric elaboration* Remove grid for small patients or when image intensifier / find oneselfor gagenot be purposed close to patient* Check and record screening time and DAP at the end of the case and retrospect against the DRL.During the procedure* The radiologic technologist lead position you on the exam table. A radiologist a mendelevium who specializes in the diagnostic interpretation of aesculapian images will administer a local anesthetic and then arrive a smal l nick in your fell so that a thin catheter lavatory be inserted into an arteria or mineral nervure. The catheter is a flexible, dig out tube nigh the size of a strand of spaghetti. It usually is inserted into an artery in your groin, although in some cases your arm or another localise will be selected for the catheter.* The radiologist will ease the catheter into the artery or vein and mildly melt it to the area under investigation. The radiologist will be able to watch the drift of the catheter on a fluoroscope, which is an roentgen ray unit combine with a television monitor.* When the catheter reaches the area under composition, the secernate agent will be injected finished the catheter. By watching the fluoroscope screen, the radiologist will be able to see the outline of your filiation vessels and identify whatsoever blockages or other randomisedities.* Angiography procedures go off range in time from less than an hour to three hours or more. It is impo rtant that you relax and remain as distillery as possible during the examination. The radiologic technologist and radiologist will stick by in the room with you end-to-end the procedure. If you suffer any difficulty, let them know.* Angiography likewise can be performed using magnetized rapport instead of roentgenograms to produce images of the consanguinity vessels this procedure is known as magnetic resonance angiography (MRA) or magnetic resonance venography (MRV).After the procedure* Because stark internal haemorrhage is a possible complication of an arterial pierce, an overnight stay in the hospital is sometimes recommended following an angiography procedure, particularly with intellectual and coronary thrombosis angiograms.* If the procedure is performed on an outpatient basis, the patient is typically kept under close observation for a period of at six to 12 hours before macrocosm released.* If the arterial puncture was performed in the femoral artery, the pat ient will be instructed to keep his leg straight and relatively unshakable during the observation period.* The patients crosscurrent press and vital signs will be monitored and the puncture place ascertain(p)ed closely. Pain medication whitethorn be order if the patient is experiencing irritation from the puncture, and a cold pack is applied to the localise to reduce increase. It is figure for the puncture site to be sore and bruised for several(prenominal) weeks.* The patient whitethorn likewise develop a hematoma, a disfranchised mass created by the communication channel vessels broken during the procedure. Hematomas should be watched prudently, as they whitethorn indicate move bleeding of the arterial puncture site.* Angiography patients are also advised to get laid two to three long time of rest and simplicity after the procedure in order to avoid placing any overweening stress on the arterial puncture. Patients who experience continued bleeding or unnatural swelling of the puncture site, sudden dizziness, or chest assiduity in the days following an angiography procedure should seek medical maintenance immediately.* Patients undergoing a resorcinolphthaleine angiography should not drive or expose their eyeball to direct temperateness for 12 hours following the procedure.4. Identify the caseful of contrast specialty, the dose and delivering technique in angiography procedure.* Reducing radiation doses to the patient also generally reduces doses to the medical personnel. Angiography procedure is using fluoroscopy imaging technique which is a real-time imaging technique.5. List down the catheters and blow over telegraphs inclusive of size, play and the hole oddball that are apply in angiography procedures.The use of lead gloves during procedures is unusual as they are cumbersome and difficult to work in. The self-activating brightness control will increase the exposure to go by means of two layers and one only protects the ha nd, so if they are going to be apply a programme that sets the radiation factors rather than allowing adjustment may be appropriate. In practice, with careful collimation and attenuation to detail it should not necessary for the operators hand to be in the primary beam and only close to it for short periods. firearm doing catheterization, radiologist should do it behind the lead glass viewer which consists of lead equivalent glass of 0.25mm thickness. Geometric consideration is one of the important things in angiography because source of exposure to personnel is mainly from scattered radiation from the patient. So, it is important to minimize the amount of scattered radiation to personnel. This can be achieved by geometric consideration involving the roentgenogram tube, patient and image intensifier. The image intensifier should be as close as possible to patient to minimize the amount of scattered radiation hitting personnel.Because in angiography room is infertile for all things , personnel such as radiologist, nurses, radiographer or student should wear shoes which are prepared only. Make sure that film badges always outside personnel trunk to measure the dose receive to the personnel.The most important thing to remember is that all individuals should be fully instruct and learned to be responsible for radiation safety. social occasion of a radiation expert is essential and is particularly useful in equipment specification, assessment and persona assurance, only when also in the formulation of topical anaesthetic Rules.Technique Reduces doc Radiation Exposure During AngiographyCurrent technique requires that physicians perform radiation procedures wear lead gowns. The new technique involves use of a body distance floor mounted lead plastic panel to protect to physicians as they monitor patients angiograms and control exam table movement. An addition bar allows the physician to remain safely behind the shield and still retain table control for pan ning.In the study, researchers recorded radiation exposure to various split of a physicians body during 25 coronary angiography procedures and compared those results with radiation exposure during angiography on 25 patients using received radiation protection. A lead apron, thyroid shield, eyeglasses and facemask were used in both techniques, unless a crown mounted shield was used in the conventional technique. The researchers placed radiation badges outside and inside(a)(a) the facemask outside and inside the thyroid shield on the right and leftfield arm outside and inside the lead apron and on the right and left leg.The new equipment resulted in a 90 percent reduction in radiation exposure to the physicians head, arms, and legs. Exposure of the thyroid and torso was minimal with both techniques.Enhanced physician radiation protection during coronary angiography is readily achievable with this new technique, utter Martin Magram, M.D., of the University of Maryland medical examination Center in Baltimore, Md. Dr. Magram presented the study results on may 3 at the American Roentgen Ray Society one-year Meeting in Vancouver, British Columbia.Dr. Magram pointed out that by freeing physicians from the choose to wear lead gowns, the new technique could preserve their ability to benefit patients.It may take by years their ability to apply the skills they have developed over long careers of serving patients, noted Dr. Magram.New methods of radiation protection must parallel the development of new radiation techniques, added Dr. Magram. The samara is to limit medical workers radiation exposure with effective and easy-to-use techniques, and the use of this backstage bar and lead plastic shield may be such a technique. commentAngiography is the x-ray study of the melody vessels. An angiogram uses a radiopaque substance, or soil, to make the blood vessels megascopic under x ray. Arteriography is a type of angiography that involves the study of the arter ies.PurposeAngiography is used to detect abnormalities or blockages in the blood vessels (called occlusions) throughout the circulatory scheme and in some electronic organs. The procedure is commonly used to identify atherosclerosis to appoint heart disease to evaluate kidney function and detect kidney cysts or tumors to detect an aneurysm (an abnormal bulge of an artery that can rupture leading to hemorrhage), tumor, blood curdle, or arteriovenous malformations (abnormals tangles of arteries and veins) in the brain and to diagnose problems with the retina of the eye. It is also used to bemuse surgeons an accurate single-valued function of the heart prior to open-heart surgery, or of the brain prior to neurosurgery.PrecautionsPatients with kidney disease or wounding may suffer further kidney malign from the contrast moderates used for angiography. Patients who have blood curdling problems, have a known allergy to contrast mediums, or are hypersensitized to iodine, a comp onent of some contrast mediums, may also not be suitable candidates for an angiography procedure. Because x rays carry risks of ionizing radiation exposure to the fetus, pregnant women are also advised to avoid this procedure.DescriptionAngiography is usually performed at a hospital by a trained radiologist and assisting technician or nurse. It takes place in an x-ray or fluoroscopy suite, and for most types of angiograms, the patients vital signs will be monitored throughout the procedure.Angiography requires the guessing of a contrast dye that makes the blood vessels visible to x ray. The dye is injected through a procedure known as arterial puncture. The puncture is usually made in the groin area, armpit, inside elbow, or neck. The site is cleaned with an antiseptic agent and injected with a local anesthetic. First, a small scratch line is made in the skin to help the chivy pass. A harry containing an inner telegram called a stylet is inserted through the skin into the artery . When the radiologist has perforate the artery with the molest, the stylet is distant and replaced with another long cable called a pass along wire. It is normal for blood to spout out of the spur before the repoint wire is inserted.The guide wire is fed through the outer needle into the artery and to the area that requires angiographic study. A fluoroscopic screen that displays a view of the patients vascular system is used to pilot the wire to the correct spatial relation. Once it is in position, the needle is removed and a catheter is slid over the distance of the guide wire until it to reaches the area of study. The guide wire is removed and the catheter is left in place in preparation for the shaft of the contrast medium, or dye.Depending on the type of angiography procedure cosmos performed, the contrast medium is each injected by hand with a syringe or is mechanically injected with an mechanical injector connected to the catheter. An self-activating injector is used ofttimes because it is able to propel a large book of dye very quickly to the angiogram site. The patient is warned that the jibe will start, and instructed to remain very still. The injection causes some mild to turn back discomfort. Possible side effects or reactions include headache, dizziness, irregular heartbeat, nausea, warmth, sunburn sensation, and chest pain, but they usually last only momentarily. To view the area of study from different angles or perspectives, the patient may be asked to miscellanea positions several times, and ensuant dye injections may be administered. During any injection, the patient or the tv camera may move.Throughout the dye injection procedure, x-ray pictures and/or fluoroscopic pictures (or pathetic x rays) will be taken. Because of the high impel of arterial blood prey, the dye will dissipate through the patients system quickly, so pictures must be taken in speedy succession. An instinctive film changer is used because the manual changing of x-ray plates can eat up valuable time.Once the x rays are complete, the catheter is belatedly and carefully removed from the patient. Pressure is applied to the site with a bedaze or other weight for 10-20 minutes in order for clotting to take place and the arterial puncture to reseal itself. A pressure bandage is then applied.Most angiograms follow the general procedures outlined above, but convert meagerly faceing on the area of the vascular system being studied. A pattern of common angiography procedures are outlined belowintellectual angiographyCerebral angiography is used to detect aneurysms, blood clots, and other vascular irregularities in the brain. The catheter is inserted into the femoral or carotid artery and the injected contrast medium travels through the blood vessels on the brain. Patients frequently experience headache, warmth, or a fervent sensation in the head or neck during the injection portion of the procedure. A intellectual angiogram takes two to four hours to complete.Coronary angiographyCoronary angiography is administered by a heart surgeon with training in radiology or, occasionally, by a radiologist. The arterial puncture is typically given in the femoral artery, and the heart surgeon uses a guide wire and catheter to perform a contrast injection and x-ray serial publication on the coronary arteries. The catheter may also be placed in the left ventricle to examine the mitral and aortal valves of the heart. If the cardiologist requires a view of the right ventricle of the heart or of the tricuspid or pulmonic valves, the catheter will be inserted through a large vein and guided into the right ventricle. The catheter also serves the purpose of monitor blood pressures in these different locations inside the heart. The angiogram procedure takes several hours, depending on the complexity of the procedure. pulmonic angiographyPulmonary, or lung, angiography is performed to evaluate blood circulation to the lungs. It i s also considered the most accurate diagnostic testify for detecting a pulmonic embolism. The procedure differs from cerebral and coronary angiograms in that the guide wire and catheter are inserted into a vein instead of an artery, and are guided up through the put up of the heart and into the pulmonary artery. Throughout the procedure, the patients vital signs are monitored to ensure that the catheter doesnt cause arrhythmias, or irregular heartbeats. The contrast medium is then injected into the pulmonary artery where it circulates through the lung capillaries. The test typically takes up to 90 minutes.Kidney angiographyPatients with chronic renal disease or injury can suffer further alter to their kidneys from the contrast medium used in a kidney angiogram, yet they oftentimes require the test to evaluate kidney function. These patients should be well-hydrated with a intravenous saline drip before the procedure, and may benefit from available medications (e.g., dopamine) t hat help to protect the kidney from further injury due to contrast agents. During a kidney angiogram, the guide wire and catheter are inserted into the femoral artery in the groin area and advanced through the group AB aorta, the main artery in the abdomen, and into the renal arteries. The procedure will take approximately one hour.resorcinolphthalein angiography fluorescein angiography is used to diagnose retinal problems and circulatory disorders. It is typically conducted as an outpatient procedure. The patients pupils are dilated with eye drops and he rests his chin and forehead against a bracing apparatus to keep it still. Sodium resorcinolphthalein dye is then injected with a syringe into a vein in the patients arm. The dye will travel through the patients body and into the blood vessels of the eye. The procedure does not require x rays. Instead, a rapid series of close-up photographs of the patients eyeball are taken, one set immediately after the dye is injected, and a s econd set approximately 20 minutes later once the dye has moved through the patients vascular system. The correct procedure takes up to one hour.Celiac and mesenteric angiographyCeliac and mesenteric angiography involves x-ray geographic expedition of the celiac and mesenteric arteries, arterial branches of the abdominal aorta that tack blood to the abdomen and digestive system. The test is commonly used to detect aneurysm, thrombosis, and signs of ischemia in the celiac and mesenteric arteries, and to locate the source of gastrointestinal bleeding. It is also used in the diagnosis of a turn of events of pre tick offs, including hepatic adit vein site high blood pressure, and cirrhosis. The procedure can take up to three hours, depending on the number of blood vessels studied.SplenoportographyA splenoportograph is a variation of an angiogram that involves the injection of contrast medium directly into the quick temper to view the splenetic and opening veins. It is used to diagnose blockages in the splenic vein and portal vein thrombosis and to assess the specialism and location of the vascular system prior to liver transplantation.Most angiography procedures are typically paying for by major medical insurance. Patients should check with their individual insurance plans to determine their coverage.Aftercare RisksBecause angiography involves puncturing an artery, internal bleeding or hemorrhage are possible complications of the test. As with any invasive procedure, infection of the puncture site or bloodstream is also a risk, but this is rare.A bezzant or heart attack may be triggered by an angiogram if blood clots or face on the inside of the arterial wall are dislodged by the catheter and form a blockage in the blood vessels or artery. The heart may also become irritated by the movement of the catheter through its chamber during pulmonary and coronary angiography procedures, and arrhythmias may develop.Patients who develop an allergic reaction to the contrast medium used in angiography may experience a chassis of symptoms, including swelling, difficulty breathing, heart failure, or a sudden drop in blood pressure. If the patient is aware of the allergy before the test is administered, certain medications can be administered at that time to counteract the reaction.Angiography involves minor exposure to radiation through the x rays and fluoroscopic guidance used in the procedure. Unless the patient is pregnant, or multiple radiological or fluoroscopic studies are required, the small dose of radiation incurred during a single procedure poses little risk. However, multiple studies requiring fluoroscopic exposure that are conducted in a short time period have been known to cause skin necrosis in some individuals. This risk can be minimized by careful monitoring and support of cumulative radiation doses administered to these patients.Normal resultsThe results of an angiogram or arteriogram depend on the artery or organ system being examined. Generally, test results should display a normal and unimpeded range of blood through the vascular system. Fluorescein angiography should result in no leakage of fluorescein dye through the retinal blood vessels.Abnormal resultsAbnormal results of an angiography may display a restricted blood vessel or arterial blood flow (ischemia) or an irregular placement or location of blood vessels. The results of an angiography vary widely by the type of procedure performed, and should be interpreted and explained to the patient by a trained radiologist. hardening of the arteriesA chronic condition characterized by thickening and hardening of the arteries and the build-up of plaque on the arterial walls. Arteriosclerosis can slow or impair blood circulation.Carotid arteryAn artery located in the neck.CatheterA long, thin, flexible tube used in angiography to inject contrast material into the arteries. cirrhosis of the liverA condition characterized by the destruction of healthy liver tissue. A cirrhotic liver is marred and cannot break down the proteins in the bloodstream. Cirrhosis is associated with portal hypertension.EmbolismA blood clot, air bubble, or clot of extraneous material that travels and blocks the flow of blood in an artery. When blood hang on to a tissue or organ is blocked by an embolism, infarction, or death of the tissue the artery feeds, occurs. Without immediate and appropriate treatment, an embolism can be fatal.Femoral arteryAn artery located in the groin area that is the most frequently accessed site for arterial puncture in angiography.Fluorescein dyeAn chromatic dye used to illuminate the blood vessels of the retina in fluorescein angiography.Fluoroscopic screenA fluorescent screen which displays moving x-rays of the body. Fluoroscopy allows the radiologist to visualize the guide wire and catheter he is moving through the patients artery. black market wireA wire that is inserted into an artery to guides a catheter to a certain location in the body.IscehmiaA lack of normal blood supply to a organ or body part because of blockages or bottleneck of the blood vessels. chagrinCellular or tissue death skin necrosis may be caused by multiple, consecutive doses of radiation from fluoroscopic or x-ray procedures. boldnessFatty material that is deposited on the inside of the arterial wall.Portal hypertensionA condition caused by cirrhosis of the liver. It is characterized by impaired or reversed blood flow from the portal vein to the liver, an enlarged spleen, and dilated veins in the esophagus and stomach.Portal vein thrombosisThe development of a blood clot in the vein that brings blood into the liver. Untreated portal vein thrombosis causes portal hypertension.For Your InformationBooks* Baum, Stanley, and Michael J. Pentecost, eds. Abrams Angiography. 4th ed.Radiation Protection for Angiography Procedure.Radiation Protection for Angiography Procedure.Fluoroscopic procedure produces the greatest patient radiatio n exposure rate in diagnostic radiology. Therefore the radiation protection in fluoroscopy is very important. Several feature and techniques in fluoroscopy are designed for protection to the patient during fluoroscopic procedure.a) Protection to Patient* A dead-man switch is a device (switch) constructed so that a circuit closing contact can only be maintained by continuous pressure on the switch by the operator. Therefore, when the machine is turned on by any means, whether by the push button at the control panel, or by the foot pedal, this switch must be held in for the machine to remain on.* The on-time of the fluoroscopic tube must be controlled by a timing device, and must end alarm when the exposure exceeds 5 minutes. An audible signal must alert the substance abuser to the completion of the preset on time. This signal will remain on until the timing device is reset.* The X-ray tube used for fluoroscopic must not produce X-rays unless a barrier is in position to intercept the entire cross-section of the useful beam. The fluoroscopic imaging assembly must be provided with shielding sufficient that the scatter radiation from the useful beam is minimized.* Protective barriers of at least 0.25 mm lead equivalency must be used to attenuate scatter radiation above the tabletop. This shielding does not replace the lead garments worn by personnel. Scattered radiation under the table must be attenuated by at least 0.25 mm lead equivalency shielding.* Additionally, most c-arm fluoroscopes have a warning beeper or light that activate when the beam is on, some have both. Never inactivate any warning devices, and keep ones foot off the foot pedal whenever possible.* Methods of limiting radiation exposure includeo making certain that the fluoroscopy unit is functioning properly through routine maintenance,o limiting fluoroscopic exposure time,o reducing fields of exposure through collimation,o keeping the X-ray source under the table by avoiding cross-table lateral v isualization when possible, ando bringing the image intensifier down close to the patientb) Protection to personnelThere are therefore three basic ways to minimize dose* Reduce time of exposure* Use the inverse square law-doubling your distance away quarter your exposure* Use shielding by barrierThese basics known as Cardinal Principle which is important to achieved ALARA.i) TimeRadiation dose is directly proportionate to the time, those by doubling the radiation time the dose is doubled and by having the radiation time the doses halved. Many factors impact the on time of a fluoroscopic procedure.The exposure time is related to radiation exposure and exposure rate (exposure per unit time) as followsExposure time = Exposure/Exposure rateExposure = Exposure rate x timeThe algebraic expressions simply imply that if the exposure time is kept short, then the resulting dose to the individual is small.Method of reducing exposure time include meticulous advanced planning of the procedure, judicious use of contrast enhancement, appropriate positioning of the patient, orientation of the fluoroscope unit prior to beginning the procedure.ii) DistanceThe second radiation protection action relates to the distance between the source of radiation and the exposed individual. The exposure to the individual decreases inversely as the square of the distance. This is known as the inverse square law, which is stated mathematically aswhere I is the intensity of radiation and d is the distance between the radiation source and the exposed individual. For example, when the distance is doubled the exposure is reduced by a factor of four.In mobile radiography, where there is no fixed protective control booth, the technologist should remain at least 2 m from the patient, the x-ray tube, and the primary beam during the exposure. In this respect, the ICRP (1982), as well as the NCRP (1989a), recommended that the length of the exposure cord on mobile radiographic units be at least 2 m long. Another important consideration with respect to distance relates to the source-to-image receptor distance (SID). The appropriate SIDs for various examinations must always be maintained because an incorrect SID could mean a second exposure to the patient. Long SID results in less divergent beam and thus decreases the concentration of photons in the patients. Short SID results in the reverse action and increases the patient dose. Hence the longest possible SID should be employed in examinations. However, if a greater than standard SID is used then greater intensity of radiation would be required to produce the same film density. Therefore it is recommended that only standard SIDs should be used.iii) ShieldingShielding procedure the most utilitarian results in the reduction of staff dose as there are times when the procedure list simply must function in close proximity, even directly cines fluoroscopy. In these circumstances there simply is no substitute for the best modern flexible le ad gloves, lead glasses, lightweight lead apron and lead lined thyroid shield available. Appropriate shielding is mandatory for the safe use of ionizing radiation for medical imaging. Other method of shielding includes beam collimation, protective drapes and panels.Shielding of occupational workers can be achieved by following methods* Personnel should remain in the radiation environment only when necessary (step behind the control booth, or leave the room when practical)* The distance between the personnel and the patient should be maximized when practical as the intensity of radiation decreases as the square of distance (inverse square law).* Shielding apparel should be used as and when necessary which comprise of lead aprons, eye glasses with side shields, hand gloves and thyroid shields.Lead aprons are shielding apparel recommended for use by radiation workers. These are classified as a secondary barrier to the effects of ionizing radiation. These aprons protect an individual on ly from secondary (scattered) radiation, not the primary beam.The thickness of lead in the protective apparel determines the protection it provides. It is known that 0.25 mm lead thickness attenuates 66% of the beam at 75kVp and 1mm attenuates 99% of the beam at same kVp.It is recommended that for general purpose radiography the minimum thickness of lead equivalent in the protective apparel should be 0.5mm. It is recommended that women radiation workers should wear a customized lead apron that reaches below mid thigh level and wraps completely around the pelvis. This would eliminate an accidental exposure to a concept us.Other protective apparel included eye glasses with side shields, thyroid shields and hand gloves. The minimum protective lead equivalents in hand gloves and thyroid shields should be 0.5mm.Lead lined glass and thyroid shield likewise reduce 90% of the exposure to the eyes and thyroid respectively. Lead lined gloves reduce radiation exposure to the hands however they are no substitute for strict observation of appropriate fluoroscopic hygiene. Gloves should be considered as an effective means of reducing scatter radiation only.2. State five clinical indications for the patient undergo the angiography procedure.3. Explain the patient care management before, during and after the procedureBefore a procedure* Patients undergoing an angiogram are advised to stop eating and drinking eight hours prior to the procedure.* They must remove all jewelry before the procedure and change into a hospital gown.* If the arterial puncture is to be made in the armpit or groin area, shaving may be required.* A sedative may be administered to relax the patient for the procedure.* An IV line will also be inserted into a vein in the patients arm before the procedure begins in case medication or blood products are required during the angiogram.* Be aware of and follow all Local Rules and protocols* Prior to the angiography procedure, patients will be briefed on the det ails of the test, the benefits and risks, and the possible complications involved, and asked to sign an informed consent form.* Ensure that all exposures are justified and there is informed consent* Check patient identity* Position patient comfortably flat, with arm above head where possible* Ensure all members of staff in room are wearing suitable. For operations this should be lead glasses, thyroid collar and wrap-around lead apron* Check all staff are wearing radiation monitors correctly* Use all available lead shielding appropriately sited* Position table before screening* Keep tube current as low as possible and kVp as high as possible for cardiac studies, 60 90 kV is appropriate* Keep x ray tube at maximum and image intensifier / receptor at minimum distance from patient* Check all staff are as far away as possible in their role* Use dose reduction programmers when possible* Perform acquisitions on full inspiration where possible* Collimate closely to area of interest* Prolon ged procedures reduce dose to the irradiated skin eg. Change beam angulations* Minimize fluoroscopy time, high dose rate time and no of acquisitions* Remember software features, such as replay fluoro to minimize dose* Dont over use geometric magnification* Remove grid for small patients or when image intensifier / sensing element cannot be placed close to patient* Check and record screening time and DAP at the end of the case and review against the DRL.During the procedure* The radiologic technologist will position you on the exam table. A radiologist a physician who specializes in the diagnostic interpretation of medical images will administer a local anesthetic and then make a small nick in your skin so that a thin catheter can be inserted into an artery or vein. The catheter is a flexible, hollow tube about the size of a strand of spaghetti. It usually is inserted into an artery in your groin, although in some cases your arm or another site will be selected for the catheter.* Th e radiologist will ease the catheter into the artery or vein and gently guide it to the area under investigation. The radiologist will be able to watch the movement of the catheter on a fluoroscope, which is an x-ray unit combined with a television monitor.* When the catheter reaches the area under study, the contrast agent will be injected through the catheter. By watching the fluoroscope screen, the radiologist will be able to see the outline of your blood vessels and identify any blockages or other irregularities.* Angiography procedures can range in time from less than an hour to three hours or more. It is important that you relax and remain as still as possible during the examination. The radiologic technologist and radiologist will stay in the room with you throughout the procedure. If you experience any difficulty, let them know.* Angiography also can be performed using magnetic resonance instead of x-rays to produce images of the blood vessels this procedure is known as magn etic resonance angiography (MRA) or magnetic resonance venography (MRV).After the procedure* Because life-threatening internal bleeding is a possible complication of an arterial puncture, an overnight stay in the hospital is sometimes recommended following an angiography procedure, particularly with cerebral and coronary angiograms.* If the procedure is performed on an outpatient basis, the patient is typically kept under close observation for a period of at six to 12 hours before being released.* If the arterial puncture was performed in the femoral artery, the patient will be instructed to keep his leg straight and relatively immobile during the observation period.* The patients blood pressure and vital signs will be monitored and the puncture site observed closely. Pain medication may be prescribed if the patient is experiencing discomfort from the puncture, and a cold pack is applied to the site to reduce swelling. It is normal for the puncture site to be sore and bruised for se veral weeks.* The patient may also develop a hematoma, a hard mass created by the blood vessels broken during the procedure. Hematomas should be watched carefully, as they may indicate continued bleeding of the arterial puncture site.* Angiography patients are also advised to enjoy two to three days of rest and relaxation after the procedure in order to avoid placing any undue stress on the arterial puncture. Patients who experience continued bleeding or abnormal swelling of the puncture site, sudden dizziness, or chest pains in the days following an angiography procedure should seek medical attention immediately.* Patients undergoing a fluorescein angiography should not drive or expose their eyes to direct sunlight for 12 hours following the procedure.4. Identify the type of contrast medium, the dose and delivering technique in angiography procedure.* Reducing radiation doses to the patient also generally reduces doses to the medical personnel. Angiography procedure is using fluoro scopy imaging technique which is a real-time imaging technique.5. List down the catheters and guide wires inclusive of size, shape and the hole type that are used in angiography procedures.The use of lead gloves during procedures is unusual as they are cumbersome and difficult to work in. The automatic brightness control will increase the exposure to go through two layers and one only protects the hand, so if they are going to be used a programme that sets the radiation factors rather than allowing adjustment may be appropriate. In practice, with careful collimation and attenuation to detail it should not necessary for the operators hand to be in the primary beam and only close to it for short periods.While doing catheterization, radiologist should do it behind the lead glass viewer which consists of lead equivalent glass of 0.25mm thickness. Geometric consideration is one of the important things in angiography because source of exposure to personnel is mainly from scattered radiati on from the patient. So, it is important to minimize the amount of scattered radiation to personnel. This can be achieved by geometric consideration involving the x-ray tube, patient and image intensifier. The image intensifier should be as close as possible to patient to minimize the amount of scattered radiation hitting personnel.Because in angiography room is sterile for all things, personnel such as radiologist, nurses, radiographer or student should wear shoes which are prepared only. Make sure that film badges always outside personnel body to measure the dose receive to the personnel.The most important thing to remember is that all individuals should be fully trained and learned to be responsible for radiation safety. Involvement of a radiation expert is essential and is particularly useful in equipment specification, assessment and quality assurance, but also in the formulation of Local Rules.Technique Reduces Physician Radiation Exposure During AngiographyCurrent technique r equires that physicians performing radiation procedures wear lead gowns. The new technique involves use of a body length floor mounted lead plastic panel to protect to physicians as they monitor patients angiograms and control exam table movement. An extension bar allows the physician to remain safely behind the shield and still retain table control for panning.In the study, researchers recorded radiation exposure to various parts of a physicians body during 25 coronary angiography procedures and compared those results with radiation exposure during angiography on 25 patients using conventional radiation protection. A lead apron, thyroid shield, eyeglasses and facemask were used in both techniques, but a ceiling mounted shield was used in the conventional technique. The researchers placed radiation badges outside and inside the facemask outside and inside the thyroid shield on the right and left arm outside and inside the lead apron and on the right and left leg.The new equipment re sulted in a 90 percent reduction in radiation exposure to the physicians head, arms, and legs. Exposure of the thyroid and torso was minimal with both techniques.Enhanced physician radiation protection during coronary angiography is readily achievable with this new technique, said Martin Magram, M.D., of the University of Maryland Medical Center in Baltimore, Md. Dr. Magram presented the study results on May 3 at the American Roentgen Ray Society Annual Meeting in Vancouver, British Columbia.Dr. Magram pointed out that by freeing physicians from the need to wear lead gowns, the new technique could preserve their ability to benefit patients.It may extend by years their ability to apply the skills they have developed over long careers of serving patients, noted Dr. Magram.New methods of radiation protection must parallel the development of new radiation techniques, added Dr. Magram. The key is to limit medical workers radiation exposure with effective and easy-to-use techniques, and t he use of this extension bar and lead plastic shield may be such a technique.DefinitionAngiography is the x-ray study of the blood vessels. An angiogram uses a radiopaque substance, or dye, to make the blood vessels visible under x ray. Arteriography is a type of angiography that involves the study of the arteries.PurposeAngiography is used to detect abnormalities or blockages in the blood vessels (called occlusions) throughout the circulatory system and in some organs. The procedure is commonly used to identify atherosclerosis to diagnose heart disease to evaluate kidney function and detect kidney cysts or tumors to detect an aneurysm (an abnormal bulge of an artery that can rupture leading to hemorrhage), tumor, blood clot, or arteriovenous malformations (abnormals tangles of arteries and veins) in the brain and to diagnose problems with the retina of the eye. It is also used to give surgeons an accurate map of the heart prior to open-heart surgery, or of the brain prior to neuros urgery.PrecautionsPatients with kidney disease or injury may suffer further kidney damage from the contrast mediums used for angiography. Patients who have blood clotting problems, have a known allergy to contrast mediums, or are allergic to iodine, a component of some contrast mediums, may also not be suitable candidates for an angiography procedure. Because x rays carry risks of ionizing radiation exposure to the fetus, pregnant women are also advised to avoid this procedure.DescriptionAngiography is usually performed at a hospital by a trained radiologist and assisting technician or nurse. It takes place in an x-ray or fluoroscopy suite, and for most types of angiograms, the patients vital signs will be monitored throughout the procedure.Angiography requires the injection of a contrast dye that makes the blood vessels visible to x ray. The dye is injected through a procedure known as arterial puncture. The puncture is usually made in the groin area, armpit, inside elbow, or neck. The site is cleaned with an antiseptic agent and injected with a local anesthetic. First, a small incision is made in the skin to help the needle pass. A needle containing an inner wire called a stylet is inserted through the skin into the artery. When the radiologist has punctured the artery with the needle, the stylet is removed and replaced with another long wire called a guide wire. It is normal for blood to spout out of the needle before the guide wire is inserted.The guide wire is fed through the outer needle into the artery and to the area that requires angiographic study. A fluoroscopic screen that displays a view of the patients vascular system is used to pilot the wire to the correct location. Once it is in position, the needle is removed and a catheter is slid over the length of the guide wire until it to reaches the area of study. The guide wire is removed and the catheter is left in place in preparation for the injection of the contrast medium, or dye.Depending on the type of angiography procedure being performed, the contrast medium is either injected by hand with a syringe or is mechanically injected with an automatic injector connected to the catheter. An automatic injector is used frequently because it is able to propel a large volume of dye very quickly to the angiogram site. The patient is warned that the injection will start, and instructed to remain very still. The injection causes some mild to moderate discomfort. Possible side effects or reactions include headache, dizziness, irregular heartbeat, nausea, warmth, burning sensation, and chest pain, but they usually last only momentarily. To view the area of study from different angles or perspectives, the patient may be asked to change positions several times, and subsequent dye injections may be administered. During any injection, the patient or the camera may move.Throughout the dye injection procedure, x-ray pictures and/or fluoroscopic pictures (or moving x rays) will be taken. Becaus e of the high pressure of arterial blood flow, the dye will dissipate through the patients system quickly, so pictures must be taken in rapid succession. An automatic film changer is used because the manual changing of x-ray plates can eat up valuable time.Once the x rays are complete, the catheter is slowly and carefully removed from the patient. Pressure is applied to the site with a sandbag or other weight for 10-20 minutes in order for clotting to take place and the arterial puncture to reseal itself. A pressure bandage is then applied.Most angiograms follow the general procedures outlined above, but vary slightly depending on the area of the vascular system being studied. A variety of common angiography procedures are outlined belowCerebral angiographyCerebral angiography is used to detect aneurysms, blood clots, and other vascular irregularities in the brain. The catheter is inserted into the femoral or carotid artery and the injected contrast medium travels through the blood vessels on the brain. Patients frequently experience headache, warmth, or a burning sensation in the head or neck during the injection portion of the procedure. A cerebral angiogram takes two to four hours to complete.Coronary angiographyCoronary angiography is administered by a cardiologist with training in radiology or, occasionally, by a radiologist. The arterial puncture is typically given in the femoral artery, and the cardiologist uses a guide wire and catheter to perform a contrast injection and x-ray series on the coronary arteries. The catheter may also be placed in the left ventricle to examine the mitral and aortic valves of the heart. If the cardiologist requires a view of the right ventricle of the heart or of the tricuspid or pulmonic valves, the catheter will be inserted through a large vein and guided into the right ventricle. The catheter also serves the purpose of monitoring blood pressures in these different locations inside the heart. The angiogram procedure take s several hours, depending on the complexity of the procedure.Pulmonary angiographyPulmonary, or lung, angiography is performed to evaluate blood circulation to the lungs. It is also considered the most accurate diagnostic test for detecting a pulmonary embolism. The procedure differs from cerebral and coronary angiograms in that the guide wire and catheter are inserted into a vein instead of an artery, and are guided up through the chambers of the heart and into the pulmonary artery. Throughout the procedure, the patients vital signs are monitored to ensure that the catheter doesnt cause arrhythmias, or irregular heartbeats. The contrast medium is then injected into the pulmonary artery where it circulates through the lung capillaries. The test typically takes up to 90 minutes.Kidney angiographyPatients with chronic renal disease or injury can suffer further damage to their kidneys from the contrast medium used in a kidney angiogram, yet they often require the test to evaluate kidn ey function. These patients should be well-hydrated with a intravenous saline drip before the procedure, and may benefit from available medications (e.g., dopamine) that help to protect the kidney from further injury due to contrast agents. During a kidney angiogram, the guide wire and catheter are inserted into the femoral artery in the groin area and advanced through the abdominal aorta, the main artery in the abdomen, and into the renal arteries. The procedure will take approximately one hour.Fluorescein angiographyFluorescein angiography is used to diagnose retinal problems and circulatory disorders. It is typically conducted as an outpatient procedure. The patients pupils are dilated with eye drops and he rests his chin and forehead against a bracing apparatus to keep it still. Sodium fluorescein dye is then injected with a syringe into a vein in the patients arm. The dye will travel through the patients body and into the blood vessels of the eye. The procedure does not require x rays. Instead, a rapid series of close-up photographs of the patients eyes are taken, one set immediately after the dye is injected, and a second set approximately 20 minutes later once the dye has moved through the patients vascular system. The entire procedure takes up to one hour.Celiac and mesenteric angiographyCeliac and mesenteric angiography involves x-ray exploration of the celiac and mesenteric arteries, arterial branches of the abdominal aorta that supply blood to the abdomen and digestive system. The test is commonly used to detect aneurysm, thrombosis, and signs of ischemia in the celiac and mesenteric arteries, and to locate the source of gastrointestinal bleeding. It is also used in the diagnosis of a number of conditions, including portal hypertension, and cirrhosis. The procedure can take up to three hours, depending on the number of blood vessels studied.SplenoportographyA splenoportograph is a variation of an angiogram that involves the injection of contrast med ium directly into the spleen to view the splenic and portal veins. It is used to diagnose blockages in the splenic vein and portal vein thrombosis and to assess the strength and location of the vascular system prior to liver transplantation.Most angiography procedures are typically paid for by major medical insurance. Patients should check with their individual insurance plans to determine their coverage.Aftercare RisksBecause angiography involves puncturing an artery, internal bleeding or hemorrhage are possible complications of the test. As with any invasive procedure, infection of the puncture site or bloodstream is also a risk, but this is rare.A stroke or heart attack may be triggered by an angiogram if blood clots or plaque on the inside of the arterial wall are dislodged by the catheter and form a blockage in the blood vessels or artery. The heart may also become irritated by the movement of the catheter through its chambers during pulmonary and coronary angiography procedure s, and arrhythmias may develop.Patients who develop an allergic reaction to the contrast medium used in angiography may experience a variety of symptoms, including swelling, difficulty breathing, heart failure, or a sudden drop in blood pressure. If the patient is aware of the allergy before the test is administered, certain medications can be administered at that time to counteract the reaction.Angiography involves minor exposure to radiation through the x rays and fluoroscopic guidance used in the procedure. Unless the patient is pregnant, or multiple radiological or fluoroscopic studies are required, the small dose of radiation incurred during a single procedure poses little risk. However, multiple studies requiring fluoroscopic exposure that are conducted in a short time period have been known to cause skin necrosis in some individuals. This risk can be minimized by careful monitoring and documentation of cumulative radiation doses administered to these patients.Normal resultsTh e results of an angiogram or arteriogram depend on the artery or organ system being examined. Generally, test results should display a normal and unimpeded flow of blood through the vascular system. Fluorescein angiography should result in no leakage of fluorescein dye through the retinal blood vessels.Abnormal resultsAbnormal results of an angiography may display a restricted blood vessel or arterial blood flow (ischemia) or an irregular placement or location of blood vessels. The results of an angiography vary widely by the type of procedure performed, and should be interpreted and explained to the patient by a trained radiologist.ArteriosclerosisA chronic condition characterized by thickening and hardening of the arteries and the build-up of plaque on the arterial walls. Arteriosclerosis can slow or impair blood circulation.Carotid arteryAn artery located in the neck.CatheterA long, thin, flexible tube used in angiography to inject contrast material into the arteries.CirrhosisA c ondition characterized by the destruction of healthy liver tissue. A cirrhotic liver is scarred and cannot break down the proteins in the bloodstream. Cirrhosis is associated with portal hypertension.EmbolismA blood clot, air bubble, or clot of foreign material that travels and blocks the flow of blood in an artery. When blood supply to a tissue or organ is blocked by an embolism, infarction, or death of the tissue the artery feeds, occurs. Without immediate and appropriate treatment, an embolism can be fatal.Femoral arteryAn artery located in the groin area that is the most frequently accessed site for arterial puncture in angiography.Fluorescein dyeAn orange dye used to illuminate the blood vessels of the retina in fluorescein angiography.Fluoroscopic screenA fluorescent screen which displays moving x-rays of the body. Fluoroscopy allows the radiologist to visualize the guide wire and catheter he is moving through the patients artery.Guide wireA wire that is inserted into an arter y to guides a catheter to a certain location in the body.IscehmiaA lack of normal blood supply to a organ or body part because of blockages or constriction of the blood vessels.NecrosisCellular or tissue death skin necrosis may be caused by multiple, consecutive doses of radiation from fluoroscopic or x-ray procedures.PlaqueFatty material that is deposited on the inside of the arterial wall.Portal hypertensionA condition caused by cirrhosis of the liver. It is characterized by impaired or reversed blood flow from the portal vein to the liver, an enlarged spleen, and dilated veins in the esophagus and stomach.Portal vein thrombosisThe development of a blood clot in the vein that brings blood into the liver. Untreated portal vein thrombosis causes portal hypertension.For Your InformationBooks* Baum, Stanley, and Michael J. Pentecost, eds. Abrams Angiography. 4th ed.