Contrast media 1

Radiographic Contrast Media RAD TECH 255 SPECIAL PROCEDURES MERRILLS VOL2 RTA BOOK CH 19

Subject Contrast Range of differences in the intensity of the x-ray beam, after it has been attenuated by the subject (patient).

Low Subject Contrast What can be done to attain medical information- see the difference between muscle, organs or vessels Define and outline – organ structure and function

Contrast media Defines subtle differences in subject contrast Increases atomic number of area injected Results in a SHORTER scale of subject contrast

Purpose of Contrast Media To enhance subject contrast or render high subject contrast in a tissue that normally has low subject contrast.

Atomic Number Fat = 6.46 Water = 7.51 Muscle = 7.64 Bone = 12.31

Radiographic Contrast : Influenced by… Radiation Quality (KVP) Film Contrast Radiographic object (Patient)

KVP TYPE OF CONTRAST USED DETERMINES KVP RANGE BARIUM 90 – 120 kVp IODINES 70 – 80 kVp (Ionic / Nonionic Water or Oil)

INJECTABLE CONTRAST MEDIA for RT 255 procedures INVASIVE PROCEDURES The “o-grams”

BEFORE CONTRAST INJECTION ALWAYS TAKE A “SCOUT” BEFORE CONTRAST INJECTION √ PATHOLOGY √ TECHNIQUE √ PREP & PRIOR CONTRAST √ POSITIONING

SPECIAL “o-grams” Venogram Arthrogram Sialogram Myelogram Arteriogram Angiogram Galactogram Hystersalpingogram…….. etc

CONTRAST INJECTION

DOUBLE CONTRAST WITH IODINE - HIP Arthorgram

To check fertility

LYMPHANGIOGRAM

Galactography - Breast Duct

Cerebral Angiogram

SPECIAL PROCEDURES ARE INVASIVE ALWAYS GET PATIENT’S HISTORY AND CONSENT BEFORE BEGINNING OR GIVING ANY CONTRAST MEDIA

CONSENTS SIGNED AND WITNESSED AFTER PROCEDURE HAS BEEN EXPLAINED CHECK DEPARTMENT PROTOCOL WHO’S RESPONSIBLE ??????

CONSENTS ASSAULT verbal threat of harm BATTERY FALSE IMPRISONMENT Unlawful touching - unauthorized treatment “X-RAY” TAKEN ON WRONG PATIENT FALSE IMPRISONMENT Restraints require permission from patient or authorized person

BLOOD WORK LAB TESTS to check function of kidneys prior to injection of contrast WATCH THE UPPER LIMITS BUN = BLOOD UREA NITROGEN Merrills pg 214 range is 8 to 25 pg 242 range is 10 - 20 always check with RAD when level above 20 CREATININE levels range: pg 214 (0.6 - 1.5) pg 242 (0.05 - 1.2) always check with RAD when level above 1.2 Indicates function of kidneys Diseases / dehydration / kidney failure

EGFR (new test) Estimated Glomerular Filtration Rate More advanced test for CREATININE levels

Review of Contrast Agents Types of Contrast Routes of Adminstration Chemical Components

Contrast Media changes the density of the organs Therefore changing the Subject contrast will change the Radiographic contrast and film contrast May need to INCREASE TECHNIQUE FROM SCOUT IMAGE

Contrast Media (review) Negative contrast (AIR OR CO2) Radiolucent Low atomic # material Black on film Positive contrast (all others) Radiopaque High atomic # material White on film

Types of Contrast Media Radiolucent- negative contrast agent x-rays easily penetrate areas- appear dark on films Negative Contrast Media Air and gas complications emboli-air pockets in vessels lack of oxygen Radiopaque- positive contrast agent- absorbs x-rays appears light Positive Contrast Agents BARIUM IODINES Both + & - can be used in same study

2 BASIC TYPES OF CONTRAST material BARUIM Z# 56 NON WATER SOLUABLE GI TRACT ONLY INGESTED OR RECTALLY KVP 90 – 120* IODINE Z# 53 WATER SOLUABLE POWDER LIQUID INTRAVENOUS OR Intrathecal GI TRACT Also OIL based KVP BELOW 90*

Methods of Administration of Contrast Material INGESTED (ORAL) RETROGRADE AGAINST NORMAL FLOW INTRATHECAL Spinal canal PARENTERAL (IV, Intrathecal) Injecting into bloodstream (anything other than oral)

Contrast media for SPECIAL PROCEDURES Diagnostic agents that are injected into Circulatory System, Joint Spaces, Ducts Body orifices/organs: uterus, breast, salivary & lymph glands

BARUIM SULFATE Not used in Special Procedures BARIUM – a review BARUIM SULFATE Not used in Special Procedures

Barium Sulfate High atomic number Not soluble in water Used to coat the lining of organs Supplied in different thicknesses Used Esophogram, UGI, Small Bowel,Lower GI or BE

EXTRAVASATION OF CONTRAST INTO PERITONEUM Ba ADVERSE REACTIONS BARIUM INERT SUSPENSION MAY CAUSE ALLERGY OCG TABLETS (IODINE) ALLERGY AFTER EXAM – MAY SOLIDIFY DIFFICULT TO EVACUATE INCREASE FLUIDS, MILD LAXATIVE EXTRAVASATION OF CONTRAST INTO PERITONEUM

Extravasation of BA in abd

Ingested CONTRAST Gastrografin or Hypaque High atomic # Close to iodine Water soluble Similar usage as Barium

GASTROGRAFIN Adverse Reactions Water soluble, safe in the abdominal cavity Safe to use if perforation is suspected Very harmful to the lung tissue Do not use if aspiration is possible

Gastro – Pathology present Bowel Obstruction Note contrast Seen in kidneys as well

IODINE IONIC OR NON IONIC WATER OR OIL BASE

IODINATED CONTRAST iodine z # 53 WATER BASED INJECTED VESSELLS/DUCTS INGESTED Organ function/flow OPEN WOUNDS OIL BASED INJECTED NEVER VESSELLS ONLY DUCTS NOT INGESTED OPEN WOUNDS

INJECTION OF IODINE into Vessels ALWAYS A WATER BASED IODINATED COMPOUND BOLUS INJECTION INFUSION DRIP IONIC VS NON IONIC CONTRAST 50 -70 % CONCENTRATE

IODINE WATER BASED CONTRAST IONIC LESS $$$ MORE REACTIONS NON IONIC MORE $$$ LESS REACTIONS

CONTRAST MEDIA IODINE is either: IONIC or NON-IONIC Osmolarity # Of Particles (Cations + And Anions -) In Solution Per Kilogram Of Water High Osmolarity =more Cations And Anions Can Upset Homeostasis Nonionic Have No Charged Particles

Contrast Agents IONIC High Osmolality (Higher risk of complications) Diatrizoate sodium (Hypaque) Iothalamate meglumine (Conray) NON-IONIC Low Osmolality (Lower risk of complications) Gadodiamide (Omniscan) Iodixanol (Visipaque) Iopamidol (Isovue) Iopromide (Ultravist) Ioversol (Optiray)

More money Less reactions Less money More reactions

IODINE CONTAST Instilled in ORGAN OIL – BASED IODINE CONTAST Instilled in ORGAN

FAT EMBOLUS IF IT GETS INTO BLOOD VESSEL Oil Based Iodine Fatty Acids Insoluble in water White on the radiograph = Radiopaque Uses Broncography (lungs) Tear ducts Salivary glands Lymphatic system Hysterrosalpingogram Galactography (breast ducts) FAT EMBOLUS IF IT GETS INTO BLOOD VESSEL

Newer Contrast Agents Balance Safety and Visualization