Transcript Document 7190806

Radiographic
Contrast
RTEC - A 2009
• SUBJECT & FILM
CONTRAST
• CONTRAST MEDIA
2 types of Radiographic
“Contrast”
Contrast defined as Range of density
variations (differences from black to
white)
• Subject contrast
– patient
• Film contrast
– Inherent in equipment
– The BLACKS & WHITES ON THE FILM /
IMAGE
What is good contrast ?
• High contrast
(black and white)
• Low contrast
(more shades of
gray)
Which do you like?
“Subject” Contrast
Subject Contrast
• Range of differences
in the intensity of the
x-ray beam, after it
has been attenuated
by the subject.
Radiographic Contrast : Influenced
by…
• Radiation
Quality (KVP)
• Film Contrast
• Radiographic
object (Patient)
RADIOGRAPHIC IMAGE
Radiation Quality = kVp
• High kVp ↑ 80
• Low contrast
• Many 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
QUALITY – KVP
• A visible change in contrast will not be
seen until kVp is changed 4-12 %,
depending on kVp range
– kVp level
•
•
•
30-50 kVp
50-90 kVp
90-130 kVp
change
4-5 %
8-9 %
10-12 %
change in kVp
1-3 kVp
4-8 kVp
9-16 kVp
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
Tissue
Subject Contrast
• Atomic # of object
• Higher atomic # =
more attenuation
• Density of object
• Denser = more
attenuation
•
Thicker
=
more
• Thickness of object
attenuation
Atomic Number
• Fat = 6.46
• Water = 7.51
• Muscle = 7.64
• Bone = 12.31
PATHOLOGY
•Pleural
Effusion
Excessive
fluid in lung
•More dense
than air
The right lung is almost completely collapsed;
vascular shadows can not be seen in this area (arrow).
•Lung collapses
•No tissue in
space
•Easy to
penetrate with
x-ray photons
pneumothorax
Contrast changes with the use of a grid
Less scatter radiation – shorter scale =
“better contrast”
With Grid
No Grid
Low Subject Contrast
• What can be done to attain medical
information?
• EX: You want to see the difference between
muscle & fat & organs?
• Define organ structure and function
• USE CONTRAST MEDIA
Purpose of Contrast Media
• To enhance subject contrast or
render high subject contrast
• in a tissue that normally has low
subject contrast.
• (bigger differences in z#)
Contrast Media changes the
density of the organs
Therefore
changing the
Subject contrast
will change the
Radiographic
contrast and film
contrast
Subject Contrast Using
CONTRAST MEDIA
• RADIOLUCENT - dark on image
–AIR, CO2
• RADIOPAQUE - white on image
–BARIUM
–IODINE
Contrast Media
• Negative contrast
• (AIR OR CO2)
• Positive contrast
• (all others)
• Radiolucent
• Radiopaque
• Low atomic # material
• High atomic #
material
• Black on film
• White on film
TYPES OF CONTRAST USED IN
RADIOLOGY NEGATIVE DENSITY


AIR / CO2
Naturally seen in the
LUNGS
 STOMACH
 (gas in intestines)

• ABNORMAL
AIR IN SMALL
BOWEL
• SIGN OF A
BLOCKAGE
• IN THE
SMALL
INTESTINE
TYPES OF CONTRAST USED IN
RADIOLOGY NEGATIVE DENSITY

AIR / CO2
 Mixing
with other contrast
media (barium or iodine)
 Can
give more information
about the area under
examiniation
“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
DOUBLE CONTRAST
WITH IODINE

Iodine mixed with air
of a bladder (canine)
DOUBLE CONTRAST WITH IODINE HIP Arthorgram
Changing Subject Contrast
with CONTRAST MEDIA
POSTIVE CONTRAST MEDIA
• IODINE OR
• BARIUM
• X-RAY “DYE”
•
INCORRECT TERM
• COLORLESS OR
WHITE
2 BASIC TYPES OF
‘”Positive” CONTRAST MEDIA
IODINE Z# 53
BARIUM Z# 56
KVP 90 – 120*
KVP BELOW 90*
USUALLY 70 – 80 KvP
• NON WATER
SOLUABLE
• WATER SOLUABLE
• GI TRACT ONLY
INGESTED OR
RECTALLY
• or OIL BASED
•
•
•
•
POWDER
LIQUID
INTRAVENOUS OR
GI TRACT
• DUCTS /ORGANS
Contrast Material
INGESTED /INSTILLED
– (ORALLY OR RECTALLY)
• BARUIM
• IODINES
– GASTROGRAFIN
– HYPAQUE POWDER
INJECTED
– IV – INTO BLOOD VESSELLS
– Organs and ducts
• IODINES
– IONIC OR NONIONIC
• VESSELLS & ORGANS
• OIL BASED
– DUCTS /ORGANS ONLY
Methods of Administration
of Contrast Material
• INGESTED /
INSTILLED
– (ORALLY OR RECTALLY)
• RETROGRADE
– AGAINST NORMAL FLOW
(Vessels & Organs)
• INTRATHECAL
– Spinal canal
• INJECTED
– IV – INTO BLOOD VESSELLS
• PARENTERAL
(IV, Intrathecal)
– Injecting into
bloodstream
– (anything other than
oral)
BARIUM
BARIUM SULFATE
HISTORY OF BARIUM BaSo
• 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.
4
Barium Sulfate
BaSO+
• 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
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
BARIUM CONCENTRATION
• DIFFERENT FOR EXAMS
• W/W RATIO (weight/weight)
• Mixture of barium to water – 100 g suspension
• “THICK” VS “THIN” BARIUM
BARIUM “THICK & THIN”
• THICK – USED FOR
• DOUBLE
CONTRAST
• THIN – SINGLE
CONTRAST
BARIUM
ORAL OR RECTAL
• LABELS ARE
DIFFERENT
• CHECK CAREFULLY
BEFORE GIVING TO
THE PATIENT
BARIUM SULFATE
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),
• Which retains fluid and prevents precipitation
of the barium suspension in the normal small
bowel
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
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)
“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
BARIUM
• MIXED IN A SUSPENSION
• MUST BE SHAKEN
• CHECK THE CAP (LID) FIRST !!!!!!!
• SUSPENSION – sodium citrate, vegetal
gums, flavoring and sweeteners to
improve palatability
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
EXTRAVASATION
• LEAKAGE THROUGH A DUCT OR
VESSEL OR ORGAN INTO THE
SURROUNDING TISSUE
• Barium should not be given in cases of
suspected perforation
GASTROINTENSTIAL
CONTRAST
MEDIA
PROCEDURES
ESOPHOGRAM / OPMS
UPPER GI (UGI)
SMALL BOWEL (SMBFT)
BARIUM ENEMA (BE)
GASTRO ENEMA
Drinking Ba for Esophogram
Hiatal Hernia
Reflux
“heartburn”
UGI
double contrast single contrast
Be Kind to your patientsoffer them a wet towel for the Ba mustache !
Enteroclysis
SMB
BARIUM
BARIUM ENEMA
Supplies for BE
SINGLE
BE
DOUBLE (AC)
SINGLE VS DOUBLE CONTRAST
BARIUM ENEMA
• Extravasation
– Following a
Colonoscopy with
biopsy
IODINE CONTRAST
INJESTED FOR
INTESTINAL STUDIES
Alternative to BA contrast:
Gastrograffin or Hypaque (Iodine)
• High atomic #
– Close to iodine
• Water soluble
• Similar usage as
Barium
Gastrografin
• Water soluble iodinecontaining contrast
media are of value
when there is a
suspected perforation
or leakage of an
anastomosis after
operation
• Oral or Rectal use
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)
GASTROGRAFIN

Bitter taste

Better if chilled or
mixed with ice

Monitor patient
closely
Gastrografin via NG tube
Peptic ulcer
•
•
•
•
Use Gastro
Contrast may leak
Into the peritoneum
Causing peritonitis
Gastric neoplasm w/ perforation
• EXTRAVASATION OF
CONTAST INTO THE
PERITONEUM
Gastrografin
enema
SINGLE CONTRAST ENEMA
BARIUM (110 KVP)
GASTROGRAFIN (90 KVP)
“To BE or not to BE”
• Massive
retroperitoneal air
• pneumomediastinum
• subcutaneous air
• secondary to bowel
perforation
• after barium enema
Extravasation of BA in abd
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
Never force contrast
Patient might aspirate into the lungs!
KVP
RANGE
•
BARIUM
90 – 120 kVp
(Range due to: Thick vs thin vs double contrast)
IODINES
(Ionic / Nonionic
70 – 80 kVp
Water or Oil)
INJECTABLE
CONTRAST MEDIA
INVASIVE PROCEDURES
IVP / IVU
Iodine
•
•
•
•
Water Soluble
High atomic # 53
Radiopaque
Used to radiograph
–
–
–
–
Vessels
Arteries
Veins
Function of internal
organs
INJECTABLE
IODINE - NONIONIC
Newer
Contrast Agents Balance
Safety and Visualization
IODINATED CONTRAST
WATER BASED
OIL BASED
• INJECTED
• INJECTED
•
• NEVER VESSELLS
VESSELLS/DUCTS
• INGESTED
• ONLY DUCTS
• OPEN WOUNDS
• NOT INGESTED
• OPEN WOUNDS
IODINE WATER BASED
CONTRAST
• IONIC
• NON IONIC
• LESS $$$
• MORE $$$
– $25 per bottle
• MORE REACTIONS
– $200 per bottle
• LESS REACTIONS
Iodine Contrast Material
• Ionic Contrast
– Anion – Cation +
– More patient allergic
reactions
• Ionic contrast media
dissociates into two
molecular particles in
blood plasma =
• Causing pt reactions
•Non-Ionic Contrast
•Less patient allergic
reactions
CONTRAST MEDIA
• IONIC CONTRAST
benzene ring
• NON IONIC
CONTRAST
IODINATED Contrast Agents
IONIC
NON-IONIC
• High Osmolality (Higher • Low Osmolality (Lower
risk of complications)
risk of complications)
– (Hypaque)
• (Isovue)
– (Conray)
Intravenous injections are
INVASIVE
ALWAYS GET PATIENT’S
HISTORY AND CONSENT
BEFORE BEGINNING
OR GIVING ANY
CONTRAST MEDIA
Patient Assessment Check List
• Information update !!
CONTRAST REACTIONS
General
 > 10 million diagnostic procedures / year
 Conventional ionic contrast reactions 10%
 1 in 1000 severe

Allergic to Iodine
• General Rule:
• No Iodine Contrast will be
given
– Pre – medication is available
• May or may not react if
previous iodine given
INJECTED CONTRAST
• IODINE BASED
• IONIC OR
• NON IONIC
INJECTED IODINE STUDIES
GENITOURINARY
Contrast injected into the VEIN

IVP / IVU

CYSTOGRAMS
(Retrograde may use a foley catheter)

GASTROINTESTINAL
 ERCP – (CBD)
15 MIN POST CONTRAST
INJECTION - IVP
CYSTOGRAM
REACTIONS & Treatment
USUALLY** WITHIN FIRST 5 MINUTES
• Nausea & Vomiting & Urticaria
• Hypotension (bradycardia)
• Hypotension (tachycardia)
• Bronchospasm
• Anaphylactoid
• Seizures
• Extravasation
ALWAYS –know the location
of drug trays and crash carts
Cholelithiasis
GB STONES
Normal ERCP
(checks for stones/blockage in bile duct)
GB STONES
Other Injected
Contrast Studies
Cerebral Angiogram
Renal Arteriogram
MYELOGRAM (SPINAL CORD)
INTRATHECAL INJECTION
Extravasation of Contrast
into soft tissue of arm
Contrast leaking from bladder
OIL – BASED
IODINE
CONTAST
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)
To check fertility
LYMPHANGIOGRAM
Galactography - Breast Duct
Oral & IV contrast
CT Scan
CT showing Abnormal GB
ORAL & IV CONTRAST
(CT/ MRI)
CAT SCAN
REVIEW
CONTRAST
 WHAT AFFECTS CONTRAST ?
 SUBJECT CONTRAST
 WHAT DO WE USE TO ENHANCE
SUBJECT CONTRAST?
 TYPES OF CONTRAST & USES
 ADVERSE AFFECTS OF CONTRAST
USAGE

Contrast media are used in radiographic
imaging to
a) increase the radiographic density of the
area of interest
b) enhance the subject contrast of the area
of interest
c) decrease the radiographic density of the
area of interest
d) lower the subject contrast of the area of
interest
Contrast media are used in radiographic
imaging to
a) increase the radiographic density of the
area of interest
b) enhance the subject contrast of the area
of interest
c) decrease the radiographic density of the
area of interest
d) lower the subject contrast of the area of
interest
A negative contrast agent will
a) increase density and is radiopaque
b) decrease density and is radiopaque
c) decrease density and is radiolucent
d) increase density and is radiolucent
A negative contrast agent will
a) increase density and is radiopaque
b) decrease density and is radiopaque
c) decrease density and is radiolucent
d) increase density and is radiolucent
Perforation of the colon during a lower GI
barium study may result in complications
resulting from
a) flocculation
b) bronchospasm
c) convulsion
d) extravasation
Perforation of the colon during a lower GI
barium study may result in complications
resulting from
a) flocculation
b) bronchospasm
c) convulsion
d) extravasation
Depending on the environment of the
barium sulfate,such as acid in the
stomach, the powder may have a
tendency to clump – this is called
a) flocculation
b) bronchospasm
c) convulsion
d) extravasation
Depending on the environment of the
barium sulfate,such as acid in the
stomach, the powder may have a
tendency to clump – this is called
a) flocculation
b) bronchospasm
c) convulsion
d) extravasation
4. Perforation of the vessel while injecting a
contrast media may resulting in
a) flocculation
b) bronchospasm
c) convulsion
d) extravasation
Perforation of the vessel while injecting a
contrast media may resulting in
a) flocculation
b) bronchospasm
c) convulsion
d) extravasation
Barium sulfate:
1. is filtered by the kidneys
2. is absorbed by the stomach
3. coats the gastrointestinal lining
4. is absorbed by the jejunum
Barium sulfate:
1. is filtered by the kidneys
2. is absorbed by the stomach
3. coats the gastrointestinal lining
4. is absorbed by the jejunum
High atomic number elements absorb x-rays
at a greater rate than low atomic number
elements.
1. true
2. false
6. High atomic number elements absorb xrays at a greater rate than low atomic
number elements.
1. true
2. false
7. Barium sulfate is contraindicated if the
patient is suspected of having a
gastrointestinal tract perforation.
1. true
2. false
7. Barium sulfate is contraindicated if the
patient is suspected of having a
gastrointestinal tract perforation.
1. true
2. false
Radiolucent contrast media:
1. are positive contrast agents
2. appear dark on radiographs
3. are composed of elements with high
atomic numbers
4. none of the above
Radiolucent contrast media:
1. are positive contrast agents
2. appear dark on radiographs
3. are composed of elements with high
atomic numbers
4. none of the above
Radiopaque contrast media:
1. are positive contrast agents
2. appear light on radiographs
3. are composed of elements with high
atomic numbers
4. all the above
Radiopaque contrast media:
1. are positive contrast agents
2. appear light on radiographs
3. are composed of elements with high
atomic numbers
4. all the above
Each of the following is an example of a
negative contrast media except:
1. air
2. soda water
3. barium sulfate
4. gas-producing crystals
Each of the following is an example of a
negative contrast media except:
1. air
2. soda water
3. barium sulfate
4. gas-producing crystals
An air embolus can form as a complication
of negative contrast media administration.
1. true
2. false
An air embolus can form as a complication
of negative contrast media administration.
1. true
2. false
Barium sulfate is soluble in water.
1. true
2. false
Barium sulfate is soluble in water.
1. true
2. false
Ionic contrast media dissociates into two
molecular particles in blood plasma.
1. true
2. false
Ionic contrast media dissociates into two
molecular particles in blood plasma.
1. true
2. false
Most adverse reactions associated with
Ionic contrast media are significantly
decreased with the non-ionic contrast
media
1. true
2. false
Most adverse reactions associated with
Ionic contrast media are significantly
decreased with the non-ionic contrast
media
1. true
2. false
Which of the following acute reactions to
contrast media usually requires no medical
treatment?
a) bronchospasm
b) laryngeal edema
c) urticaria
d) convulsions
Which of the following acute reactions to
contrast media usually requires no medical
treatment?
a) bronchospasm
b) laryngeal edema
c) urticaria
d) convulsions
Which of the following acute reactions to
contrast media usually requires immediate
medical treatment?
a) Bronchospasm / laryngeal edema
b) Nausea & Vomiting
c) Urticaria
d) Warn flush /metallic taste
Which of the following acute reactions to
contrast media usually requires immediate
medical treatment?
a) Bronchospasm / laryngeal edema
b) Nausea & Vomiting
c) urticaria
d) Warn flush /metallic taste
What can be done for a patient who will receive
water- soluble iodine contrast media to reduce
allergic-like effects?
premedicate with steroids and antihistamines
b) give intravenous fluids
c) instruct the patient to drink warm salt water
before the procedure
d) give a negative contrast agent with the iodinated
medium
a)
What can be done for a patient who will receive
water- soluble iodine contrast media to reduce
allergic-like effects?
premedicate with steroids and antihistamines
b) give intravenous fluids
c) instruct the patient to drink warm salt water
before the procedure
d) give a negative contrast agent with the iodinated
medium
a)
The end of contrast &
Contrast media
RT A - 2009