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Title: RADIOGRAPHIC CONTRAST EXAMINATION INTRODUCTION
Description: Radiographic contrast examinations are specialized imaging techniques that use contrast agents to enhance the visibility of internal structures on radiographs. These agents, introduced into the body via various methods such as oral, intravenous, or rectal administration, help differentiate tissues and organs that may not be clearly visible on standard X-rays. By altering the way X-rays interact with the body, contrast agents improve the visualization of soft tissues, blood vessels, and hollow organs, aiding in the diagnosis of various conditions. This introduction serves as a foundation for understanding the role and application of contrast in radiographic imaging.
Description: Radiographic contrast examinations are specialized imaging techniques that use contrast agents to enhance the visibility of internal structures on radiographs. These agents, introduced into the body via various methods such as oral, intravenous, or rectal administration, help differentiate tissues and organs that may not be clearly visible on standard X-rays. By altering the way X-rays interact with the body, contrast agents improve the visualization of soft tissues, blood vessels, and hollow organs, aiding in the diagnosis of various conditions. This introduction serves as a foundation for understanding the role and application of contrast in radiographic imaging.
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RCE INTRODUCTION
AKA:
- RADIOCONTRAST AGENTS
- CONTRAST MATERIALS
- DYES
CONTRAST MEDIA
CONTRAST MEDIA PURPOSE
DEFINITION: has high/ low Z
- improve visbility of internal structures
- highlight specific area of organs
- Pharmaceutical that increases the
information for dx
- enhance/ visualized different organ/ body
structure
- Soft tissue low absorption/ inteaction
- ABSORPTION dependent on:
Atomic Number, Atomic Density, electron
density, partthickness, K edge
PHOTOELECTRIC INTERACTION
CONTRAST
dIfference betweem two colors
IV INJECTION- bloodvessels
- BRAIN, SPINE, LIVER, KIDNEY
Oral: UPPER GIT
CM ROUTES
RECTAL: LOWER GIT
INHALATION: xenon gas
- LUNG/ BRAIN
INTRATHECAL : SPINAL CORD
KINDS OF CM
NEGATIVE CM
- LOWER Z than the surrounding tissue
Apperance: BLACK / RADIOLUCENT
INCREASING DENSITY
RCE INTRODUCTION
1
EXAMPLES: AIR, CO2, O2
APPLICATION: HYDROCEPHALUS (walter
dandy) 1918
POSITIVE CM
higher Z than the surrounding tissues
- increased absorption
APPEARANCE: WHITE/ GRAY/ RADIOPAQUE
DECREASE DENSITY
EXAMPLES: BARIUM SULFATE(powder
mixed with water) , IODINATED
COMPOUNDS
BARIUM SULFATE
BARIUM SULFATE
BARIUM SULFATE PROPERTIES
DISCOMFORTS, SIDE EFFECTS AND
REACTION CAUSES
RCE INTRODUCTION
WHAT: white powder
- does not dissolved
- Usage: digestive tract
1
...
Oral
ABSORBS WATERS
HIGH Z
INSOLUBLE IN WATER
CANNOT ABSORB BY THE GIT
NON TOXIC
Viscosity
-aka: thick, sticky
if CM is thicker:
- harder to eject
- heat and vessel irratation
2
WARMING CM
- HELPS: toxicity, miscibility, osmolality
THIN BARIUM
- 1 part barium + 1 part Water
AKA: CREAM : thin milkshake
Usage: entire GI TRACT
TYPES
THICK BARIUM
-3-4 parts barium + 1 part water
AKA: COOKED CEREAL
usage: ESOPHAGUS/ MUCOSAL LINING
CONCENTRATION
- Wt/Vol
- 100 ml suspension
PARTCLE SIZE
- large for DCS
VISCOSITY
- low viscosity for DCS
BARIUM SULFATE VARIABLES
THIXOTROPY
- stretchanility of Barium sulfate
ADDITIVES
- stabilizing, anti- caking, anti flocculation
and anti foaming
(Sodium carbonate/ sodium citrate - prevent
flocculation)
SIDE EFFECTS
ASPIRATIONS
- laryngeal penetration: CM flows to airways
MEDIASTINAL LEAKAGE
RCE INTRODUCTION
3
- perforation: fibrosing mediastinitis
PERITONEAL LEAKAGE
- unsuspected perforation: post op cases
IMPACTION AND OBSTRUCTION
- hardening of barium sulfate
HYPERSENSITIVITY
- rare
MIXTURE
Cold Tap Water
40- 45 degrees Farenheit
- less colon irratation
- increase CM retention
- less spasm and cramping
- anesthetic effect in COLON
TEMPERATURE
ROOM
85- 90 degrees Farenheit
- recommendation
NO TO HOT WATER
- may cause brun of colon mucosal lining
2 TYPES OF CM: IONIC AND NON IONIC
IODINATED CM
NON IODINATED CM
AGENT: IODINE
APPEARANCE: colorless water solutions
Concentration: mg/ ml
Usage: anywhere in the body
(*more iodine= more dense x-ray effect)
HIGH OSMOLAR
- Diatrizoate
- Metrizoate
LOW OSMOLAR
RCE INTRODUCTION
LOW OSMOLAR
iopamidol
iohexol
iopromide
4
IODINATED CM
NON IODINATED CM
- loxaglate
ISO OSMOLAR
- Iodixanol (visipaque)
SODIUM
MEGLUMINE
3 TYPES
OIL BASED IODINATED CM
WATER SOLUBLE CM
2 types
1
...
1 Ionic: oral cholegraphy/ urography/
Angiography (HOCM)
1
...
Reduced tonicity
- decreased human side effects +
discomforts
- reduced vasodilation and heat+ flashing
sensations
2
...
CHEMICAL TOXICITY
- less tendency toc ross cell membrance
2
...
1 Ionic: IV cholegraphy
2
...
DECREASED HYPERSENSITIVITY
REACTIOONS
- decreased fatal reaction (1/ 80k)
WATER INSOLUBLE CM
ADVERSE EFFECT
Mild and self limited
2 TYPES
1
...
MILD
2
...
SEVERE
2
...
5 mg%
- concentration: > 50% for 1-3 days
- peak: 3-7 days
- returns to baseline: 10- 14 days
Incidence: 2-7% general population
EXTRAVASATION
- leads to tissue damage
- direct toxicity
- COMPARTMENT SYNDROME - pressure
effect
DELAYED REACTIONS
- 30 minutes - 7 days
incidence: 14- 30% - ionic monomer
8- 10% - non ionic monomer
DRUG INTERACTIONS
- Biguanides : lactic acidosis
( stopped 48 hrs pre CM exam)
- beta blocker: hypersensitivity
- Oral Cholecystographic Agent- renal
toxicity
(IV CM to be postponed)
PREGNANCY
- Avoided
- if the IV ICM crosses placenta: produced
RCE INTRODUCTION
6
IODINATED CM
NON IODINATED CM
transient fetal hypothyroidism
angiography
measured in cP (centripose)
VISCOSITY
DEPENDENT:
- SIZE AND SHAPE OF SOLUTE PARTICLES
- TEMPERATURE
HIGH OSMOLALITY
- 600 to 2100 mOsm/ kg
LOW OSMOLALITY
3 types:
1
...
Ionic Dimers
- concentration: 59% (high concentration)
- Osomolality: 600 mOSm/kg
- peripheral arteriography
3
...
PSYCHOSOMATIC REACTIONS
2
...
TECHNIQUE REACTIONS
4
...
ANAPHYLACTIC REACTIONS
Obtain pertinent hx
- diseases hx
- medicines hx
- possibility of pregnancy
- prior CM
- serum creatinine levels
EVALUATING THE PATIENT
S- SIGNS AND SYMPTOMS
A- ALLERGIES
M- MEDICATIONS
P- PAST ILLNESS
L- LAST ORAL INTAKE
E- EVENTS LEADING UP TO THE PRESENT
INJURY
METHODS OF CM ADMINISTRATION
DIRECT METHOD (NON FUNCTIONAL
STUDY) ANATOMY BASED
- BE
- RGP
- CYSTOGRAPHY
INDIRECT METHOD (FUNCTIONAL STUDY)
PHYSIOLOGY BASED
- ORAL METHOD
RCE INTRODUCTION
8
- IM
- IV
SCLERAL METHOD
METHODS IN ADMINISTERING SENSITIVITY
TESTS
SUBLINGUAL METHOD
INTRADERMAL METHOD
INTREVENAL METHOD
OIL
TABLETS (BaS)
POWDER
LIQUID (all iodinated CM)
SUSPENSION (BaS)
WATER BASED
- INJECTED
-vessels/ ducts
CM PHYSICAL PROPERTIES
- ingested/ instilled
- open wound
OIL BASED
- INJECTED
- not into vessel
- duct
- not ingested
SCREENING: MEDICAL HX
PRE TESTING
PRECAUTION
SPECIAL CONSIDERATION
- General Considerations
1
...
Nursing Mother
3
...
4 mg/dl :
increase renal failure
- MULTIPLE MYELOMA
SICKLE CEL ANEMIA: increased blood clot
IF NOT AVAILABLE
risk factors:
- age over 60 yo
- kidney disease
- family hx of kidney failure
- diabetes treated w/ insulin / other
prescribed drugs
3 months
LAB SERUM/ CREATININE
ELEVATED CREATININE
- hydration
- decrease total CM administered
- increase amount of time between CE
studies
- infuse Sodium bicarbonate solution
- discontinue other nephrotoxic drugs
- acethylcysteine
NEPHROTOXICITY PREVENTION
- Creatinine Requirements
- > 50 y/o: 30 days creatinine
- <50 y/o ( no creatinine needed)
unless:
- renal medical condition
RCE INTRODUCTION
10
- cancer
- 30 days chemotherapy
- hx of renal disease
- received tx for nephrotoxic drugs
FOR GD BASED MRI
- SIGNED inform consent (risk addressed)
- no CM used
- dose: 0
...
Know the patient
2
...
CHEMOTOXIC
2
...
Cardiac arrest
2
...
Severe hypertension
4
...
Pain
2
...
Itching
RCE INTRODUCTION
12
4
...
Rashes
6
...
Choking
MOST COMMONLY AFFECTED SYSTEM
1
...
RESPIRATORY SYSTEM
3
...
GI
WEIGHT
0- 11 KG = 3 ML/ KG
11- 23 KG = 2 ML/ KG
DOSE
23- 45 KG = 5 ML/ KG
> 45 KG = 1 ML/ KG
CM HISTORY
1896
HASHK + LINDERTHAL
injection of chalk containing solution in
arterial system
1906
RETROGRADE UROGRAPHY+
CYSTOGRAPHY
Opaque CM
1904
1st performed RETROGRADE UROGRAPHY
- Air introduction in UB
1911
SILVER IODIDE
(non toxic, inorganic compounds)
Colloidal Silver
1923
ROWENTREE ET AL
1923
SICARD AND FORESTER
EXCRETORY UROGRAPHY
IODIZED POPPY SEED OIL
10% SODIUM IODIDE
RCE INTRODUCTION
13
1928
BINZ AND ROTH
MOSES SWICK - IV ICM
1929
ROSENAO + JEPKINS
SODIUM IODIDE AND UREA
1943
1959
TINNEP + STOPANNY
FISHER
THORIUM OXIDE
TIN OXIDE
1970
NON IONIC CM
RCE INTRODUCTION
14
Title: RADIOGRAPHIC CONTRAST EXAMINATION INTRODUCTION
Description: Radiographic contrast examinations are specialized imaging techniques that use contrast agents to enhance the visibility of internal structures on radiographs. These agents, introduced into the body via various methods such as oral, intravenous, or rectal administration, help differentiate tissues and organs that may not be clearly visible on standard X-rays. By altering the way X-rays interact with the body, contrast agents improve the visualization of soft tissues, blood vessels, and hollow organs, aiding in the diagnosis of various conditions. This introduction serves as a foundation for understanding the role and application of contrast in radiographic imaging.
Description: Radiographic contrast examinations are specialized imaging techniques that use contrast agents to enhance the visibility of internal structures on radiographs. These agents, introduced into the body via various methods such as oral, intravenous, or rectal administration, help differentiate tissues and organs that may not be clearly visible on standard X-rays. By altering the way X-rays interact with the body, contrast agents improve the visualization of soft tissues, blood vessels, and hollow organs, aiding in the diagnosis of various conditions. This introduction serves as a foundation for understanding the role and application of contrast in radiographic imaging.