1. Radiographic Contrast
RTEC - A 2012
SUBJECT & FILM CONTRAST
CONTRAST MEDIA

2. 2 types of Radiographic “Contrast”
Subject contrast
patient
Film contrast
Inherent in equipment
The BLACKS & WHITES ON THE FILM / IMAGE
Two types of contrast
Contrast defined as Range of density variations (differences from black to white)
Subject
And
Film contrast

3. “Subject” Contrast

4. Subject Contrast
Range of differences in the intensity of the x-ray beam
After it has been attenuated by the subject.

5. SUBJECT CONTRAST Radiographic object - influenced by
Atomic Number of object
Density of object
Thickness of object
5 materials seen on a radiograph,
Gas/air, fat, soft tissue (muscle/organs),
bone and metals
Muscles is more dense that fat.

6. Atomic Number Fat = 6.46 Water = 7.51 Muscle = 7.64 Bone = 12.31
Basic estimate for atomic number of fat, water, muscle, and bone.

7. Tissue Subject Contrast
Atomic # of object
Density of object
Thickness of object
Higher atomic # = more attenuation
Denser = more attenuation
Thicker = more attenuation

8. PATHOLOGY
Pleural Effusion
Excessive fluid in lung
More dense than air

9. Pneumothorax Lung collapses No tissue in space
Easy to penetrate with x-ray photons
The right lung is almost completely collapsed;
vascular shadows can not be seen in this area (arrow).

10. Blunted angles on the chest xray indicating fluid.

11. Film Contrast AKA Radiographic Contrast

12. Radiographic Contrast influenced by:
Radiation Quality (KVP)
Film attributes
Radiographic object (Patient)
Radiation Quality (KVP)-lower range – more black to whites. Higher range there is a long scale of contrast
Film Contrast
Radiographic object (Patient)

13. What is good contrast ? High contrast (black and white)
Low contrast (more shades of gray)
Good contrast can not be defined because everyone’s eyes work differently.
On left it is a narrow latititude
Right has a wide latitude

15. RADIOGRAPHIC IMAGE Radiation Quality = kVp
High kVp ↑ 80
Low contrast
Lots shades of gray
Long Scale
Little differences in adjacent structures
Low kVp ↓ 70
High contrast
Black and White
Short Scale
Great differences in adjacent structures

16. Contrast changes with the use of a grid
Less scatter radiation – shorter scale = “better contrast”
With Grid No Grid

17. QUALITY – KVP
A visible change in contrast will not be seen until kVp is changed 4-12 %
kVp level change change in kVp
30-50 kVp 4-5 % 1-3 kVp
50-90 kVp 8-9 % 4-8 kVp
kVp % kVp

18. Scenario _____________________________________
Low subject contrast in the area of interest.
You want to see the difference between muscle & fat & organs?
What can be done to attain medical information and define organ structure and function?
_____________________________________

19. Scenario USE CONTRAST MEDIA
Low subject contrast in the area of interest.
You want to see the difference between muscle & fat & organs?
What can be done to attain medical information and define organ structure and function?
USE CONTRAST MEDIA

20. Changing Subject Contrast with CONTRAST MEDIA

21. Barium has a higher z# more asorbtion of photons

22. INJECTING CONTRAST MEDIA INTO THE ARM SO THAT THE BODY PICKS UP THE CONTRAST WHEN IT IS FILTERED IN THE KIDNEYS.

23. Contrast Media changes the density of the organs
1) Use contrast media
2) Changes subject contrast
3) Changes radiographic (film contrast)
Therefore changing the
Subject contrast
will change the
Radiographic contrast and film contrast

24. Purpose of Contrast Media
To enhance subject contrast or
render high subject contrast
In a tissue that normally has low subject contrast.
Creates bigger differences in atomic number (z #’s)
To enhance subject contrast or
render high subject contrast
in a tissue that normally has low subject contrast.
(bigger differences in z#)

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

26. AIR, CO2 BARIUM IODINE RADIOLUCENT - dark on image
RADIOPAQUE - white on image
BARIUM
IODINE
RADIOLUCENT IS ALWAYS AIR OR SOME TYPE OF AIR. It helps create air in the image
Radiopaque- barium and iodine.
Positive makes white on the image.
Negative- makes black on the image

27. Negative Contrast AIR / CO2 LUNGS STOMACH (gas in intestines)
Naturally seen in the
LUNGS
STOMACH
(gas in intestines)
Air trapped between the liver and the diaphragm on the right side of the body. This is not normal

28. ABNORMAL AIR IN SMALL BOWEL
SIGN OF A BLOCKAGE
IN THE SMALL INTESTINE

29. Solid barium without air

30. POSTIVE CONTRAST MEDIA
IODINE OR
BARIUM
X-RAY “DYE”
INCORRECT TERM
COLORLESS OR WHITE

31. 2 BASIC TYPES OF ‘”Positive” CONTRAST MEDIA
BARIUM Z# 56
KVP 90 – 120*
NON WATER SOLUABLE
GI TRACT ONLY INGESTED OR RECTALLY
IODINE Z# 53
KVP BELOW 90*
USUALLY 70 – 80 KvP
WATER SOLUABLE
POWDER
LIQUID
INTRAVENOUS OR
GI TRACT
OIL BASED
DUCTS /ORGANS

32. Positive Contrast Material
INGESTED /INSTILLED
(ORALLY OR RECTALLY)
BARUIM
IODINES
GASTROGRAFIN
HYPAQUE POWDER
INJECTED
IV – INTO BLOOD VESSELLS
Organs and ducts
IODINES
IONIC OR NON-IONIC
VESSELLS & ORGANS
OIL BASED
DUCTS /ORGANS ONLY

33. Methods of Administration of Contrast Material
INGESTED / INSTILLED
(ORALLY OR RECTALLY)
INJECTED
IV – INTO BLOOD VESSELLS
RETROGRADE
AGAINST NORMAL FLOW (Vessels & Organs)
INTRATHECAL
Spinal canal
PARENTERAL
(IV, Intrathecal)
Injecting into bloodstream
(anything other than oral)
Retrograde- in bladder or rectum.
Parenteral- anything injected or intrathecal

34. BARIUM
BARIUM SULFATE

35. HISTORY OF BARIUM BaSo 4 LEAD SUBSTRATE – TOXIC
BISMUTH SUBNITRATE – TOXIC
THORIUM – RADIOACTIVE
BARIUM SULFATE - INERT
(goes in and comes out the same – not absorbed)
NOTE SOME PATIENT MAY SHOW ALLERGY TO SUSPENSION SOL.
Lead substrate-was first used and they found it was toxic
Bismuth subnitrate- also found it was toxic
Barium in inert it comes out the same way it goes out.

36. Barium Sulfate BaSO+ Esophogram, UGI, Small Bowel,Lower GI or BE
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

37. Barium Sulfate BaSO+
Because it is not water soluble – it must be mixed in a SUSPENSION with water
FLOCCULATION – when barium clumps (separates from the water)
Barium residue in the colon can dry and cause an obstruction
Drink plenty of fluids after exam
Flocculation is when the BA is in the system too long and the BA separates from the suspension it begins to get very hard and can cause a bowel obstruction.

38. BARIUM MIXED IN A SUSPENSION MUST BE SHAKEN
CHECK THE CAP (LID) FIRST !!!!!!!
SUSPENSION – sodium citrate, vegetal gums, flavoring and sweeteners to improve palatability

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

40. BARIUM CONCENTRATION DIFFERENT FOR EXAMS W/W RATIO (weight/weight)
Mixture of barium to water – 100 g suspension
“THICK” VS “THIN” BARIUM

41. BARIUM “THICK & THIN”
THICK –
DOUBLE CONTRAST
THIN –
SINGLE CONTRAST

44. BARIUM ORAL OR RECTAL LABELS ARE DIFFERENT
CHECK CAREFULLY BEFORE GIVING TO THE PATIENT
BA for rectum has no flavoring so don’t use orally.

45. Palatability OF BARIUM
Chalky taste with barium sulphate/water mixture
Contain a flavoring agent, sweetners
To disguise the unpleasant taste
Thicker or thinner suspensions may be used
Many commercial preparations contain carboxymethyl cellulose (Raybar, Barosperse)
1. Which retains fluid and prevents precipitation of the barium suspension in the normal small bowel
chalky taste with barium sulphate/water mixture
contain a flavoring agent, sweetners
To disguise the unpleasant taste
thicker or thinner suspensions may be used
Many commercial preparations contain carboxymethyl cellulose (Raybar, Barosperse),
which retains fluid and prevents precipitation of the barium suspension in the normal small bowel

46. GASTOINTESTINAL exams
BARIUM COATS LINING OF INTESTINE
SINGLE CONTRAST - BARIUM ONLY
DOUBLE CONTRAST – WITH AIR
CARBON DIOXIDE TABLETS –
FIZZIES / CRYSTALS
SODA
ROOM AIR (LOWER GI)

48. EXTRAVASATION
LEAKAGE THROUGH A DUCT OR VESSEL OR ORGAN INTO THE SURROUNDING TISSUE
Barium should not be given in cases of suspected perforation

49. Extravasation
Following a Colonoscopy with biopsy

50. Extravasation of BA in abd

51. GASTROINTENSTIAL CONTRAST MEDIA PROCEDURES
ESOPHOGRAM / OPMS
UPPER GI (UGI)
SMALL BOWEL (SMBFT)
BARIUM ENEMA (BE)
GASTRO ENEMA

53. Drinking Ba for Esophogram

55. On the RT side there is some narrowing because of peristalsis.

56. Hiatal Hernia Reflux “heartburn”
Hiatal hernia- part of the stomach is moving into the chest cavity.
Relux- the food and drinks come back up out of the stomach after eating or driniking.

58. Supplies for BE

59. “DOUBLE CONTRAST” studies with Barium
Air used with other contrast agents
Better to see internal structures
BE – room air mixed with Ba UGI – gas “fizzies” used

60. DOUBLE CONTRAST EXAMS
To achieve double contrast examination of the stomach, air or carbon dioxide gas must be introduced
Most radiologists use effervescent tablets (sodium bicarbonate , tartaric acid & calcium carbonate)
To react with the gastric contents to produce carbon dioxide
To achieve double contrast examination of the stomach, air or carbon dioxide gas must be introduced
Most radiologists use effervescent tablets (sodium bicarbonate , tartaric acid & calcium carbonate)
to react with the gastric contents to produce carbon dioxide

61. BE SINGLE DOUBLE (AC)

62. UGI double contrast single contrast

63. DOUBLE CONTRAST WITH IODINE
Iodine mixed with air of a bladder (canine)
This is double contrast with iodine of the bladder of a dog

64. IODINE CONTRAST

65. Iodine Water Soluble High atomic # 53 Radiopaque Used to radiograph
Vessels
Arteries
Veins
Function of internal organs
Gastrointestinal system
Ducts

66. IODINATED CONTRAST WATER BASED INJECTED VESSELLS/DUCTS
Ionic
Non-ionic
INGESTED or instilled
OPEN WOUNDS
OIL BASED
INJECTED
NEVER VESSELLS
ONLY DUCTS
NOT INGESTED
OPEN WOUNDS

67. Gastrointestinal studies: Gastrograffin or Hypaque (Iodine)
High atomic #
Close to iodine
Water soluble
Similar usage as Barium

68. Gastrograffin
Water soluble iodine-containing contrast media are of value when there is a suspected perforation or leakage of an anastomosis after operation
Oral or Rectal use

69. GASTROGRAFIN POWDERED FORM – MIXED WITH H20
LIQUID IN BOTTLE – MAY BE MIXED
USED WHEN PATIENTS ARE ILL,
SUSPECTED PERFORATIONS
PRE-OPERATIVELY
(BITTER TASTE)
CAN INCREASE PERISTALSIS (SMB STUDY)

70. GASTROGRAFIN Bitter taste Better if chilled or mixed with ice
Monitor patient closely

71. Gastrograffin via NG tube

72. Peptic ulcer Use Gastro Contrast may leak Into the peritoneum
Causing peritonitis

73. Gastric neoplasm w/ perforation
EXTRAVASATION OF CONTAST INTO THE PERITONEUM

74. Gastrografin enema

75. SINGLE CONTRAST ENEMA BARIUM (110 KVP) GASTROGRAFIN (90 KVP)

76. 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

77. Never force contrast Patient might aspirate into the lungs!
They can aspirate into the lungs if they have had strokes.
This is BA into the lungs

78. INJECTABLE CONTRAST MEDIA
INVASIVE PROCEDURES
IVP / IVU

79. Intravenous injections are INVASIVE
ALWAYS GET PATIENT’S HISTORY AND CONSENT BEFORE BEGINNING OR GIVING ANY CONTRAST MEDIA

80. Patient Assessment Check List
Information update !!

81. INJECTED CONTRAST
IODINE BASED
IONIC
NON IONIC

82. IODINATED Contrast Agents
IONIC
High Osmolality (Higher risk of complications)
(Hypaque)
(Conray)
NON-IONIC
Low Osmolality (Lower risk of complications)
(Isovue)

83. Iodine Contrast Material
Non-Ionic Contrast
Less patient allergic reactions
Ionic Contrast
Anion -
Cation +
More patient allergic reactions
Ionic contrast media dissociates into two molecular particles in blood plasma =
Causing pt reactions

84. Newer Contrast Agents Balance Safety and Visualization

85. IODINE WATER BASED CONTRAST
IONIC
LESS $$$
$25 per bottle
MORE REACTIONS
NON IONIC
MORE $$$
$200 per bottle
LESS REACTIONS

86. CONTRAST REACTIONS > 10 million diagnostic procedures / year
Conventional ionic contrast reactions - 10%
1 in 1000 severe

87. Allergic to Iodine May or may not react if previous iodine given
General Rule:
No Iodine Contrast will be given
Pre – medication is available
May or may not react if previous iodine given

88. REACTIONS & Treatment USUALLY** WITHIN FIRST 5 MINUTES
Nausea & Vomiting & Urticaria
Hypotension (bradycardia)
Hypertension (tachycardia)
Bronchospasm
Anaphylactoid
Seizures
Extravasation

90. ALWAYS –know the location of drug trays and crash carts

91. INJECTED IODINE STUDIES
GENITOURINARY
Contrast injected into the VEIN
IVP / IVU
CYSTOGRAMS
(Retrograde may use a foley catheter)
3. GASTROINTESTINAL
4. ERCP – (CBD)

92. 15 MIN POST CONTRAST INJECTION - IVP
CYSTOGRAM

94. Cholelithiasis GB STONES

95. Normal ERCP (checks for stones/blockage in bile duct)

96. GB STONES

97. Other Injected Contrast Studies

98. Cerebral Angiogram

100. Renal Arteriogram

102. MYELOGRAM (SPINAL CORD) INTRATHECAL INJECTION

103. Extravasation

104. “To BE or not to BE” Massive retroperitoneal air pneumomediastinum
subcutaneous air
secondary to bowel perforation
after barium enema
Diverticulitis- fecal matter gets stuck in these out pouchings and causes infection.

105. Extravasation of Contrast into soft tissue of arm

107. Contrast leaking from bladder

108. OIL – BASED
IODINE CONTRAST

109. Oil Based Iodine Fatty Acids Insoluble in water Uses
White on the radiograph = Radiopaque
Uses
Bronchography (lungs)
Tear ducts
Salivary glands
Lymphatic system
Hysterrosalpingogram
Galactography (breast ducts)

110. To check fertility

111. LYMPHANGIOGRAM

112. Galactography - Breast Duct

113. Oral & IV contrast
CT Scan

114. CT showing Abnormal GB

115. ORAL & IV CONTRAST (CT/ MRI)