IBHRE® > Radiology > Flashcards

Radiology Flashcards

Discusses radiographic views, safety and management within the EP lab environment. Currently weighted 3% in the CCDS exam. (38 cards)

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1
Q

List 5 types of non-ionising radiation.

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

List 4 types of ionising radiation.

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

The following statement best describes which type of radiation?

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

A

Ionising Radiation.

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4
Q

True / False

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

A

True.

Described by the inverse square law.

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5
Q

True / False

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

A

False.

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

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6
Q

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

‘Mutation occurring exclusively in cells that undergo division’.

A

Somatic mutation.

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7
Q

What is the formula used to calculate exposure time?

A

Exposure rate x Time.

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8
Q

What does the abbreviation ‘ALARA’ stand for?

A

As Low As Reasonably Achievable.

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9
Q

The following statement best describes what?

‘Energy packets with no mass or charge’.

A

A photon

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10
Q

What does the abbreviation ‘RAD’ stand for?

A

Radiation Absorbed Dose

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11
Q

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

A
  1. Microwave
  2. CT Scan
  3. X-RAYs
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12
Q

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

A
  1. Cell phone (see iPhone warning)
  2. Arc welder
  3. Airport metal detector
  4. Tens unit
  5. Power tools - poor grounding
  6. Ham radio
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13
Q

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

A
  1. MRI
  2. External defibrillation
  3. Cardioversion
  4. RF ablation
  5. Radiation therapy
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14
Q

The following statement best describes which type of radiation?

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

A

Non-Ionising radiation.

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15
Q

Yes / No

Can somatic mutation occur in germ cells?

A

No.

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

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16
Q

List two common germ cells.

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A
  1. Egg cells
  2. Sperm cells
17
Q

True / False

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

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A

True.

Somatic mutation occurs only in cells that divide.

18
Q

True / False

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

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A

False.

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

19
Q

Convert 1 Rad into GRAY.

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A

1 RAD = 0.01 GRAY.

20
Q

Convert 1 Rad into Joules per Kilo

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A

1 RAD = 0.01J per Kilo.

21
Q

Appendage / Septum / Free wall

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

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A

Right Atrial Appendage.

22
Q
  1. What is the likely pacing mode?
  2. What type of leads?
  3. What type of implant?
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A
  1. AAI or AOO (Biatrial stimulation)
  2. Unipolar epicardial
  3. Abdominal
23
Q

Does this patient likely have high or low DFT?

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A

High.

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

24
Q

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

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A

Atrial lead pin not fully inserted.

Compare the top atrial port to the bottom ventricular port. Note how the pin of the ventricular lead extends beyond the bridge and the atrial doesn’t. This requires re-intervention.

25
Day 1 post op X-ray reveals the following - what is wrong?
Atrial lead dislodgement into the ventricle.
26
Patient ECG shows RBBB morphology - what could be the cause?
RV lead not inserted fully into the header. ## Footnote *Note how RV pin doesn't extend beyond the bridge like it does for the two other leads. This means there will be depolarization from the LV only, giving the RBBB morphology.*
27
What is this an example of?
Twiddler's syndrome. ## Footnote *Note how all leads have retracted out of the heart and significant coiling is observed around the generator site.*
28
This patient has 3 leads but a DDD device, why?
RV lead fracture - thus fractured lead capped and buried and replacement implanted.
29
Patient presents to ED with multiple shocks, why?
RV ICD lead fracture. ## Footnote *This will manifest as significant lead noise, which will be oversensed and subsequent therapies delivered. Magnet application is first step, then program therapies off, then extract/replace lead.*
30
Patient presents to ED with syncope. What's the likely cause?
RV lead dislodgement. ## Footnote *Note how RV lead has retracted from the septum / apex position and is angled downwards.*
31
Patient presents to ED with chest pain/tightness. What's the issue?
RV Perforation ## Footnote *Note how RV lead tip has extended beyond the heart border. This will require immediate intervention.*
32
Patient presents to ED with intermittent palpitations. What's the issue?
Atrial lead has dislodged into the RV - requires immediate revision.
33
Why position the image intensifier close to the patient?
To reduce x-ray scatter.
34
The following shows what? 1. BiV pacing system 2. Situs inversus 3. Twiddlers 4. High defib threshold ICD system
High defib threshold system. ## Footnote *Lead to the right is axillary ICD lead (see thickness) which is implanted in \<5% ICD cases due to high DFT.*
35
Day 1 post-op x-ray is displayed below. What is the appropriate course of action. 1. Increase outputs 2. Turn rate response on 3. Replace atrial lead with that of longer length 4. Reposition atrial lead 5. Reprogram to unipolar configuration
4 - Reposition atrial lead. ## Footnote *Atrial lead has retracted into the SVC. The RV lead also looks taut, slack could be increased on this lead too.*
36
Patient presents with worsening SOB. What's the issue?
Twiddler's syndrome - both leads have become dislodged and retracted into IVC.
37
Patient presents with worsening SOB. What's the issue?
Lead insulation failure observed. Likely rubbing against device leading to loss of output.
38
Patient presents with worsening SOB. What's the issue?
RV lead dislodgement, leading to ineffective BiVp
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