1. Contrast media 1

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

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

4. 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

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

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

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

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

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

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

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

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

15. CONTRAST INJECTION

16. DOUBLE CONTRAST WITH IODINE - HIP Arthorgram

17. To check fertility

19. LYMPHANGIOGRAM

20. Galactography - Breast Duct

21. Cerebral Angiogram

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

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

25. 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

26. 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
always check with RAD when level above 20
CREATININE levels range:
pg 214 ( ) pg 242 ( )
always check with RAD when level above 1.2
Indicates function of kidneys
Diseases / dehydration / kidney failure

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

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

29. 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

30. 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

31. 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

32. 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*

33. 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)

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

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

36. 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

37. 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

38. Extravasation of BA in abd

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

40. 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

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

42. IODINE IONIC OR NON IONIC
WATER OR OIL BASE

43. 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

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

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

46. 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

47. 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)

48. More money
Less reactions
Less money
More reactions

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

50. 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

51. Newer Contrast Agents Balance Safety and Visualization