Question 1

Shielding is the third method of protection.Lead aprons with a minimum of 0.5 mm of lead and a thyroid shield are used to reduce radiation exposure and should be worn by staff for protection.The patient should be shielded as well,if appropriate,when the lead shield will not interfere with the area being imaged.Select the statement regarding patient shielding that is true.

Accepted Answer

Patient shielding should be considered.All patient body parts not being imaged (e.g.,hands)should be out of the field of view during fluoroscopy.

Question 2

An interventional radiology procedure for the correction of a blocked or narrowed blood vessel is a(n):

Accepted Answer

Balloon angioplasty:Opens blocked or narrowed blood vessels by inserting a very small balloon into the vessel and inflating it.Used by IRs to unblock arteries in the legs or arms,kidneys,brain,or elsewhere in the body.Angiography:An x-ray exam of the arteries and veins to diagnose blockages and other blood vessel problems.Biliary drainage and stenting:Uses a stent (small mesh tube)to open blocked ducts and allow bile to drain from the liver.

Question 3

A diagnostic or therapeutic radiology procedure may necessitate the administration of heparin or other anticoagulant or antiplatelet medications (e.g.,aspirin,dipyridamole,ticlopidine)because vascular injury can lead to thrombus development.Heparin is often used to prevent acute thrombosis and ischemic episodes.What condition is a contraindication for the use of heparin?

Accepted Answer

Heparin is contraindicated in the patient with heparin hypersensitivity or the patient with bleeding.Thrombocytopenia and heparin-induced thrombocytopenia (HIT)can develop.Aspirin or other antiplatelet drugs can be given to prevent embolic or ischemic events caused by coagulation problems.

Question 4

Select the diagnostic and interventional radiology procedure that is not classified as a vascular procedure.

Accepted Answer

Percutaneous nephrolithotomy is classified as a nonvascular diagnostic or interventional procedure along with the following procedures:abscess drainage,chest tube placement,percutaneous gastrostomy tube placement,percutaneous jejunostomy feeding tube (J-tube)placement,cecostomy tube placement,gastrointestinal stent placement,varicocele interventions,lacrimal procedures,and percutaneous biopsies of solid organs.

Question 5

Contrast media-induced nephrotoxicity (CIN)can occur as a result of a physiologic change when a transient increase in blood flow is then followed by a longer period of decreased blood flow to the kidneys,after the administration of contrast media.Which statement best describes a true risk factor for CIN?

Accepted Answer

The most notable predictor of CIN is believed to be underlying renal insufficiency.The patient's state of hydration and the existence of any preexisting renal insufficiency affect the likelihood of CIN.Biphasic renal flow has been described following contrast administration.This involves a transient increase in blood flow and then a longer period of decreased blood flow to the kidneys.Contrast media-induced nephrotoxicity (CIN)can occur as a result of this physiologic change.Patients with normal renal function tolerate contrast administration well given certain guidelines are observed.Tumlin and colleagues (2006)cite three contributing factors:vasoconstriction,oxidative stress,and direct tubular toxicity.

Question 6

What type(s)of devices,supplies,or agents are needed for procedures that are designed to occlude a vessel or aneurysm?

Accepted Answer

Coils,embolic agents,or sclerosants may be needed for procedures designed to occlude a vessel.

Question 7

Distance is key to providing protection during fluoroscopy because radiation exposure follows the inverse square law.(For example,the exposure at 2 meters from the source will be only one fourth as much as the exposure at 1 meter's distance.)When positioning the patient relative to the fluoroscopy image intensifier/C-arm,the patient should be placed as far away from the ___ and as close to the __as possible for optimal image quality and minimum radiation dose to the patient's body.

Accepted Answer

Another important concept to follow is that "The patient should be positioned as far from the x-ray tube and as close to the image intensifier as possible for optimal image quality and minimal radiation dose." Hands should be kept away from the beam.

Question 8

A variety of specialty items are used for IR procedures.A Seldinger needle (18 gauge,2 3/4 inches)is commonly used for groin access.A sheath is commonly inserted at the arterial or venous puncture site.What is the function of the sheath?

Accepted Answer

A sheath is commonly inserted at the arterial or venous puncture site.The sheath has several functions.Most importantly,it is used to protect the puncture site and vessel from damage.This is especially true in interventional procedures that involve multiple guidewire and catheter exchanges.

Question 9

Reactions to contrast media can occur and the risk varies according to several patient and contrast-related factors.What is the single best predictor of a contrast-related reaction?

Accepted Answer

Reactions to contrast media can occur and the risk varies according to several patient- and contrast-related factors.A prior reaction to contrast media is the single best predictor of a subsequent reaction but this may not always be the case.

Question 10

Catheters are available in a variety of lengths and shapes,each with a specific advantage.Select the true statement about a pigtail catheter that describes its indications for use.

Accepted Answer

A pigtail catheter can deliver a larger amount of contrast medium because of additional side holes,as compared to the standard catheter with one end hole.Multihole straight catheters are available.Microcatheters (co-axial catheters)are used for access to very small vessels.Catheters may also have balloons that can be inflated for angioplasty purposes.Meticulous catheter technique is needed to prevent inadvertent air in the line and coagulation of blood in the catheter.

Question 11

Select the statement that correctly describes the mechanism of action of contrast media.

Accepted Answer

Since the beginning of radiographic imaging,contrast media have been used to enhance visualization of anatomic structures.Contrast agents can be positive or negative in effect.A negative contrast agent attenuates (absorbs)the x-ray beam less than surrounding tissue.A positive contrast agent attenuates the beam more than surrounding tissue.Visualization caused by contrast injection is affected by several issues.Iodine concentration is directly related to the radiopacity produced by the contrast medium.

Question 12

The majority of serious reactions to contrast media occur immediately or within 20 minutes after the injection.Increased capillary permeability and constriction of bronchial smooth muscle cells are present.What statement by the patient would alert you to the possibility that the patient was having a mild reaction to the contrast agent?

Accepted Answer

Signs and symptoms of a mild reaction appear self-limited without evidence of progression,including nausea,vomiting,cough,warmth,headache,dizziness,shaking,altered taste,itching,pallor,flushing,chills,diaphoresis,rash,hives,nasal stuffiness,edema of the eyes and face,and anxiety.

Question 13

Personnel radiation monitoring is an important part of radiation exposure safety.Select the statement that best describes the proper placement of the personal radiation dosimeter.

Accepted Answer

Personal radiation dosimeters are typically used on the trunk (under the apron)and at the collar level (outside the apron).Personal radiation dosimeters should not be left on aprons as this would cause inaccurate readings when an apron or thyroid shield is worn by other than the intended user.Monitors are usually exchanged and monitored on a monthly basis.

Question 14

Some of the new complex interventional procedures may require prolonged fluoroscopic guidance in order to perform and complete the procedure.Select the procedure that requires prolonged fluoroscopic guidance.

Accepted Answer

Some procedures that require prolonged fluoroscopy (e.g.,vertebroplasty,percutaneous transluminal coronary angioplasty,endograft repair of abdominal aortic aneurysms,and uterine artery embolization)and repeated interventional procedures may make the patient more vulnerable to injury.The radiation risk to the patient involves more than skin dosage.

Question 15

Embolic materials induce mechanical obstruction within a vessel and formation of thrombus via platelet activation and activation of the patient's clotting mechanism.Select an appropriate clinical indication for an embolic procedure.

Accepted Answer

Some clinical indications for use of embolic agents include severe hemoptysis,upper and lower gastrointestinal bleeding,pelvic embolization (e.g.,after trauma,uterine fibroid embolization,postpartum hemorrhage),pseudoaneurysm,arteriovenous (AV)fistula,and preoperative solid organ embolization (e.g.,renal,splenic).

Question 16

Fluoroscopy time should be limited as much as possible.What measures aid OR staff to limit the time of live fluoroscopy?

Accepted Answer

Fluoroscopy time should be limited as much as possible.Fluoroscopy time is often noted by equipment that produces an audible sound after 5 minutes of fluoroscopy and staff should be aware of this warning.Some equipment may have a feature that shows actual fluoroscopy time on a screen.Last-image-hold is a technique that radiologists can use to limit fluoroscopy time.Loop-replay will also allow for review of an image without additional exposure time.

Question 17

All staff members are responsible for patient and staff safety.The principle of ALARA,"As Low As Reasonably Achievable," is a protective measure designed to protect both patients and staff.What are the three principles of ALARA?

Accepted Answer

The "As Low As Reasonably Achievable" (ALARA)principle should be used.Personnel should be familiar with the three principles of radiation protection:time,distance,and shielding.

Question 18

What are the indications for using a power injector during an interventional radiology vascular procedure?

Accepted Answer

In addition to x-ray equipment,other essential equipment includes power injectors for precise timing and rate of injection of contrast media,torque devices to guide catheters,and vascular closure devices to assist hemostasis.

Question 19

Diagnostic and therapeutic procedures performed in a comprehensive cancer center interventional radiology department might include the injection of targeted antimetabolic drugs into the blood supply that feeds a tumor to block further blood flow and kill cancer cells.Select the appropriate procedure.

Accepted Answer

Chemoembolization:Delivery of cancer-fighting agents directly to the site of a cancer tumor while depriving the tumor of its blood supply;currently being used mostly to treat cancers of the endocrine system and liver cancers.Oncology embolotherapy procedures:chemoembolization of the liver,transarterial placement of yttrium-90 microspheres (90Y),tumor ablation with radiofrequency (RFA)/thermal,cryotherapy energy,and brachytherapy delivery.

Question 20

Small amounts of a thrombolytic drug can be instilled into portacaths and aspirated to ensure patency of the device.An example of a true statement regarding thrombolytics is:

Accepted Answer

Intravascular thrombolytic agents are used to dissolve a thrombus so normal vascular patency can be achieved.Thrombolytic drugs activate the conversion of plasminogen to plasmin and break down fibrin.Thrombolytic drugs are most effective on a fresh clot.Thrombolytic drugs cause a systemic lytic state and hemorrhage is a possible complication.The patient should be screened for both relative and absolute contraindications for thrombolytic therapy.

Quiz 28: Interventional Radiology

An interventional radiology procedure for the correction of a blocked or narrowed blood vessel is a(n) :