Term
| List the difference between fluoroscopy and cineangiography in relation to radiation exposure |
|
Definition
| Fluoroscopy generates 1/5th the x-ray exposure of the cineangiography |
|
|
Term
| Select the concepts, which the cath lab radiation safety policy should include |
|
Definition
-Routine monitoring of personnel radiation exposure.
-Continuing education programs for personnel on radiation safety.
-Program to make personnel aware of the risks associated with radiation exposure.
-Requiring protective equipment to be worn by all personnel.
-Procedures to check safety of all equipment. |
|
|
Term
| Select the correct statements in regards to radiation safety devices like lead glasses, lead aprons, and thyroid shields |
|
Definition
a. Lead Glasses
-Eyeglasses made of 0.5 to 0.75 mm lead-equivalent glass, should be worn by personnel exposed to radiation on a daily basis.
-Glasses containing 0.5 mm lead offer four times the protection of regular glasses; glasses with photochromic lenses offer two times the protection of regular glasses; plastic lenses offer no protection.
-It is important that radiation protective glasses contain a wrap-around side shield.
b.Lead Aprons
-Should contain 0.5 mm thick lead lining.
-Aprons should be fluoroscopied at least once a year to asses the integrity
-Wrap around lead aprons should be considered, and they should be long enough to cover the long bones and should extend to the knee or just below the knee.
-Aprons should be placed in an appropriate hanger or storage rack after each use. Repeatedly throwing an apron over a chair or stretcher may damage the lead lining.
-Should be examined under fluoroscopy at least once a year
c.Thyroid Shields
-Like lead aprons, thyroid shields should also be properly stored, and they should be checked periodically. |
|
|
Term
| Given a definition of a radiation unit(Roentgen, Rad, & REM), select its name |
|
Definition
-Roentgen (R) – is the measure of ionization delivered to a specific point(exposure).
-Rem – (Radiation equivalent dose in man) is used to express the biologic impact of a given exposure. 1 rad = 1 rem.
-rad – (Radiation absorbed dose) is the amount of radiation energy deposited per unit mass of tissue the amount of absorbed dose depends on the tissue type. For soft tissue 1 R = 1 Rad, for bone 1 R = 4 Rad (greater absorption). |
|
|
Term
| List or select the components involved in the generation of the x-ray image |
|
Definition
-X-Ray generator
-X-Ray tube
-Image intensifier |
|
|
Term
| Select the correct position for the operator to stand in order to receive the least amount of scatter radiation |
|
Definition
| The radiographer receives the least amount of scatter radiation, by standing at right angles to the scattering object, the patient. |
|
|
Term
| List five of the methods used to limit radiation exposure |
|
Definition
-Wear leaded aprons, preferably wraparound > 0.5 mm, provide 80% protection.
-Limit the cine/fluoroscopy time.
-Use collimators.
-Reduce the distance between the X-Ray source and patient.
-Maximize the distance between the X-Ray source and staff.
-Limit the milliamperes per kilovolts as much as possible for an adequate image.
-Use slower panning, and provide good initial angiographic setup. Angled views almost double the radiation.
-Keep the image magnification as low as possible.
-Use extra shielding(thyroid guards, lead glasses, table shields). |
|
|
Term
| Select the four principles in radiation safety |
|
Definition
-The less exposure, the less chance of absorbed-energy biologic interaction.
-No known level of ionizing radiation is a permissible dose or absolutely safe.
-Radiation exposure is cumulative. There is no washout phenomenon.
-All participants in the cardiac cath lab have accepted some degree of radiation exposure, but they are obliged to minimize risks to other personnel and themselves. |
|
|
Term
| Given a component of the x-ray system, select its proper function |
|
Definition
a.X-Ray generator
-Provides the power source necessary to accelerate the electrons through the x-ray tube. (Page 295)
b.X-Ray Tube
-It converts electrical energy, provided from the generator, to an x-ray beam. (Page 291)
-Only 0.2% - 0.6% of the electric energy provided to the tube eventually is converted to x-ray.(Page 292)
c.Image Intensifier
-Converts the invisible x-ray image into a visual image.
-Are equipped with different-sized image fields that alter the image resolution. (Page 294-295)
-Smaller input screen diameter = smaller image field size = sharper resolution. |
|
|
Term
| Given one of the following factors involved in the generation of x-rays; mA, kVp, select the correct definition and factors involved with each |
|
Definition
a.Electrical current (mA)
-The number of photons generated per unit of time.
-The greater the electrical current, the greater number of photons, resulting in improved image resolution.
-Increasing mA reduces “mottling” or the spotty appearance. Level of mA limited by tube heat capacity.
-Increasing mA increases radiation exposure and scatter to patient and cath lab personnel.
b.Kilovoltage (kVp)
-The energy spectrum of the x-ray beam.
-To obtain better images through more tissue, a higher kV level is required (shorter wavelength), especially in obese patients. High KVp produces lower resolution because of wide scatter, and greater radiation exposure to patients and laboratory personnel occurs. |
|
|
Term
| Given a list, select the result of high kilovolt exposure |
|
Definition
| Higher kV = high energy = shorter wavelength = uniform penetration = lower resolution because of wide scatter = higher contrast = greater radiation to patients and cath lab personnel. |
|
|
Term
| Given a patient that is going to receive contrast media for a catheterization, select the correct method for setting up the contrast for administration and preparing the patient |
|
Definition
-Should be warmed to body temperature.
-Prior to administration, the nurse or technician should ask the patient if he is aware of any known contrast allergies. Iodine gives contrast it’s radiopaque qualities and is a known allergen.
-Inform the patient about common sensations associated with administration of contrast agents.
-If there is a history of iodine/seafood allergy, the physician may wish to administer corticosteroids or antihistamines prior to angiography. |
|
|
Term
| Select some of the side effects associated with contrast media administration during an angiography procedure |
|
Definition
-Hypotension, bradycardia, arrhythmia, hives, flushed skin, bronchospasm, laryngeal edema, nausea and vomiting are associated with iodinated contrast administration.
-Epinephrine should be readily available for the treatment of anaphylaxis.
-Non ionic agents, reduce the incidence of bradycardia, arrhythmia, hypotension, and the need for coughing during the arteriography. |
|
|
Term
| List the indications for low osmolar/non-ionic contrast |
|
Definition
Indications for low osmolar/non-ionic agents include:
-Unstable ischemic syndromes
-Congestive heart failure
-Diabetes
-Renal Insufficiency
-Hypotension
-Severe bradycardia
-History of contrast allergy
-Severe valvular disease
-Injection of the internal mammary artery. |
|
|
Term
| Choose the correct reasons for coughing post contrast media injections |
|
Definition
-Coughing maintains arterial pressure and cerebral blood flow and influences vagal tone as well.
-Coughing does not increase coronary blood flow. |
|
|
Term
| Given a list, select the best catheter position for left ventriculography |
|
Definition
-The optimal catheter position is one that avoids contact with the papillary muscles or positioning too close to the mitral valve allowing contrast injection to artifactually produce mitral regurgitation.
-A midcavity position appears to be the best.
-Ventricular ectopy during the injections is common.
-Before performing the cineangiography a test injection of 5 to 8 ml of contrast will confirm proper catheter position and identify problems with the power injector settings. |
|
|
Term
| List the indications for LV grams |
|
Definition
-Identify LV function for patients with coronary artery disease, myopathy or valvular heart disease.
-Quantitate degree of mitral regurgitation.
-Identify ventricular septal defect.
-Quantitate mass of myocardium for regression of hypertrophy or other similar research studies. |
|
|
Term
| List two adverse events that occur during a ventriculogram |
|
Definition
-Cardiac arrhythmias
-Intramyocardial staining, generally transient.
-Embolism from thrombi or air.
-Contrast-related complications
-Transient Hypotension |
|
|
Term
| Given a list or a diagram, choose the correct wall segments seen on a 30 RAO and 60 LAO with 20 cranial angulation left ventriculogram |
|
Definition
a.30 RAO Visualizes:
-High lateral wall
-Anterior wall
-Apical wall
-Inferior wall
b.60 LAO 20 CRA Visualizes:
-Postero-Lateral wall
-Septal wall
-Ventricular Septal Defects |
|
|
Term
| Given a wall motion term define the various types of normal and abnormal LV wall motions |
|
Definition
-Synergy – uniform, almost concentric, inward motion of all points along the ventricular inner surface during systole, producing maximal effective work at minimal energy (coordinated contractions).
-Asynergy – Uncoordinated contractions caused by local disturbances from ischemia, infarction or myopathy in the pattern of wall motion contraction.
-Hypokinesia – a diminished, but not absent, motion of one part of the LV wall.
-Akinesia – total lack of motion of a portion of the LV wall.
-Dyskinesia - paradoxical systolic motion or expansion of one part of the LV wall. |
|
|
Term
| List four of the problems in the interpretation of coronary angiograms |
|
Definition
-Poor opacification
-Vessel overlap
-Total occlusion
-Spasm |
|
|
Term
| Choose the principles of which cath lab staff should be aware of, in order to obtain optimum cineangiograms and items to be recorded during the cineangiogram |
|
Definition
a.Principles:
-The image intensifier should be as close to the patient’s chest as possible to optimize image and reduce scatter.
-The patient should be instructed to take a deep breath before the start of cine. This pulls the diaphragm downward, out of the field of view.
-All EKG electrodes, wires, metal snaps, should be out of the field of view.
-Use of collimator should be mandatory.
b.Items to be recorded:
-Time of each contrast injection.
-Projection angulation of the “C” arm.
-Type and French size of the catheter used.
-Record the name and dosage of any drug during procedure. If drugs that affect the coronary dilatation or constriction are given during the angiogram, it should be recorded on the film with a lead letter marker.
-If LV angiographic volume is to be calculated, a grid is filmed, to calculate a correction factor. |
|
|
Term
| Given a vessel segment identify which angiographic view of a coronary artery will best define that segment |
|
Definition
LCA-
-Straight AP or 5 degrees to 10 degrees RAO: Left Main
-30 degrees to 45 degrees LAO and 20 degrees to 30 degrees Cranial: LAD-circumflex bifurcation
-30 degrees to 40 degrees RAO and 20 to 30 degrees caudal: circumflex and marginal branches
-5 degrees to 30 degrees RAO and 20 degrees to 45 degrees cranial: LAD and diagonals
-50 degrees to 60 degrees LAO and 10 degrees to 20 degrees caudal: LAD-circumflex bifurcation, circumflex, marginal branches
-Lateral: Bypass conduits to LAD
RCA-
-30 degrees to 45 degrees LAO and 15 degrees to 20 degrees cranial: Proximal, mid PDA
-30 degrees to 45 degrees RAO: Proximal, mid, PDA |
|
|
Term
| State the definition of TIMI and of each TIMI grade |
|
Definition
Myocardial blood flow has been assessed angiographically by use of the Thrombolysis in Myocardial Infarction (TIMI) score for qualitative grading of coronary flow. TIMI flow grades 0 to 3 have become a standard description of coronary blood flow in clinical trials. TIMI 3 flows have been associated with improved clinical outcomes.
TIMI 3- Normal distal runoff
TIMI 2- Good distal runoff
TIMI 1- Poor distal runoff
TIMI 0- Absence of distal runoff |
|
|
Term
| State what is important for an operator to note when viewing collateral circulation |
|
Definition
| The operator notes whether the opacification is forward (anterograde) or backward (retrograde). This evaluation is important for making decisions about which vessels might be protected or lost during coronary angioplasty. |
|
|
Term
| State the definition of a grid and what it is used for in cineangiography |
|
Definition
| A grid is a series of 1-cm squares embedded in plastic, which is used to calibrate an area on an angiogram. Also used to calculate a correction factor for ventricular volume analysis. |
|
|
Term
| Given a factor that may adversely affect the processing of a film, match the cause to the result of the problem |
|
Definition
-Inadequate chemical replenishment, causes light underdeveloped films.
-Overreplenishment of chemicals causes dark overdeveloped films.
-Low temperature of developing solution causes light underdeveloped films.
-High temperature of developing solution, causes dark overdeveloped films.
-Film transport speed out of calibration.
-Dirty solution tanks/dirty transport rollers cause fogged or scratched film. |
|
|
Term
| List the parameters that should be used to process film under an established quality control program |
|
Definition
-Film transport speed
-Developer/fixer temperature
-Replenishment rates |
|
|
