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Radiographic Contrast Media

Radiographic Contrast Media. RAD TECH 255 SPECIAL PROCEDURES WEBPAGE VERSION MERRILLS VOL2 RTA BOOK REV: SPRING 2010. Subject Contrast. Range of differences in the intensity of the x-ray beam, after it has been attenuated by the subject (patient). For LOW CONTRAST stucures:

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Radiographic Contrast Media

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  1. RadiographicContrast Media RAD TECH 255 SPECIAL PROCEDURES • WEBPAGE VERSION MERRILLS VOL2 RTA BOOK REV: SPRING 2010

  2. Subject Contrast • Range of differences in the intensity of the x-ray beam, after it has been attenuated by the subject (patient). • For LOW CONTRAST stucures: • 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 used to: • enhance subject contrast or render high subject contrast in a tissue that normally has low subject contrast

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

  4. Radiographic Contrast : Influenced by… • Radiation Quality (KVP) • Film Contrast • Radiographic object (Patient) Atomic Number • Fat = 6.46 • Water = 7.51 • Muscle = 7.64 • Bone = 12.31

  5. KVPTYPE OF CONTRAST USED DETERMINES KVP RANGE BARIUM _______kVp IODINES ________kVp (Ionic / Nonionic Water or Oil)

  6. INJECTABLECONTRAST MEDIAfor RT 255 procedures INVASIVE PROCEDURES The “o-grams”

  7. ALWAYS TAKE A “SCOUT” BEFORE CONTRAST INJECTION Why? List 4 reasons

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

  9. CONTRAST INJECTION KNEE ARTHROGRAM

  10. DOUBLE CONTRAST WITH IODINE - HIP Arthrogram

  11. To check fertilitycan be oil or water based contrast

  12. Myelogram

  13. Myelogram Contrast • Pantopaque was introduced in 1944 as a oil contrast medium • The first low-osmolar contrast medium to be produced was metrizamide (Amipaque) • Oil never completely re –absorbed • (Pre-employment L.sp)

  14. SIALOGRAM

  15. Galactography - Breast Duct

  16. Cerebral Angiogram

  17. LYMPHANGIOGRAM Now largely replaced by ________ ?

  18. Dacryocystography Now largely replaced by CT

  19. SPECIAL PROCEDURESARE INVASIVE ALWAYS GET PATIENT’S HISTORY AND CONSENT BEFORE BEGINNING OR GIVING ANY CONTRAST MEDIA

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

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

  22. The ARRT has a published code of ethics. • The ARRT Code of Ethics provides the radiologic technologist with an operational blueprint of norms of professional conduct.

  23. Review of Ethics(Pt Care Book –Professional Ethics) The science of rightness and wrongness of human conduct and character is termed ethics. • __________is the ethical principle that means that “above all, do no harm.” • _________ principle that means that being truthful is right. • __________ is the ethical principle that means that actions benefit others.

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

  25. 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* f/s

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

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

  28. 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* 2 BASIC TYPESOF CONTRAST material

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

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

  31. BLOOD WORKLAB 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

  32. EGFR (new test) • Estimated • Glomerular • Filtration • Rate More advanced test for • CREATININE levels • Why is this important?

  33. various water-soluble contrast media for urography and angiography • Both ionic and non-ionic monomers* • are all extracellular contrast media • are excreted unmetabolized by glomerular filtration • Approximately 85-90% of the injected dose is found in urine within the first 6 hours • 95-100% within the first 24 hours

  34. monomers* • The ionic monomeric agents are salts that • dissociate into two molecules • one anion containing the radiopaque property due to three iodine atoms • and one cation without radiopaque properties • More on this later in the lecture…..

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

  36. Barium Sulfate • High atomic number Z #? ______ • 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. 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 CONTRASTGastrografin or Hypaque • High atomic # • Close to iodine • Water soluble • Similar usage as Barium

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

  42. IODINEIONIC OR NON IONIC WATER OR OIL BASE

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

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

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

  46. CONTRAST MEDIAIODINE 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. 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) Contrast Agents

  48. Less money More reactions More money Less reactions

  49. OIL – BASED IODINE CONTAST Instilled in ORGAN – Not vessells Oil-based iodine contrast media are made from fatty acids of poppy seed oil containing 48% and 37% iodine

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