contrast media (presentation)

8/10/2019 Contrast Media (Presentation)

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Prepared by: Marina Chong (DMI14042309)

Norhaima(DMI14042313)

Visnie(DMI14042316)


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What is Contrast Media?Contrast media is a substance used to enhance the contrast of structures or fluidswithin the body in medical imaging.

What is the purpose of Contrast Media?It is commonly used to enhance the visibility of blood vessels and the gastrointestinal tract.


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Contrast Media can be divided into positive and negative contrast media.

Positive contrast media :- Barium or Iodine based, contains elements of high atomicnumber.

They attenuate x rays more than do the body soft tissues.These compounds can be used to fill or outline a hollow organ (Eg: alimentary tract, urinarybladder), or can be injected into a blood vessel for immediate visualisation of the vascularsupply or for subsequent excretion evaluation.

Negative contrast media ;- Gases with low specific gravity; air, oxygen and carbondioxide are most frequently used.

They are not commercially available.They appear black on a radiograph.


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Barium based contrastmedia

Iodine based c


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Certain materials or gases can be injected into veins, arteries, lymphatics, or hollowcavities to obtain contrast with the surrounding tissues.

A contrast medium is a radiopaque substance which obstructs the passage of x-raysso that the structures containing it appear white on the x-ray film, thus delineatingabnormal pouches or growths and defining the contour of body structures on x-ray.

Examples of radiopaque material are Hypaque and Renografin, dyes used in

intravenous pyelogram (IVP) and barium (the substance used in gastrointestinalseries)


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Some of the more common radiographic examinations which use contrast media are:

A.Angiography The radiographic study of the vascular system

A. Cerebral angiogram X-ray of the vessels of the brain

B. Cardiac angiogram X-ray showing the functions of the heart and largeblood vessels

C. Lymphangiogram X-ray study of the vessels of the lymphatic system

D. Arteriography X-ray examination of the arteries

E. Venography: X-ray examination of the veins


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B.Urography Radiologic study of the urinary tractC.Urogram (Pyelogram)

X-ray of the kidney and ureter with emphasis on the pelvisof the kidney by intravenous injection of a contrastmediumD.Cystogram X-ray of the urinary bladder by intravenous injection of acontrast mediumE.IVP (Intravenous Pyelography)

A succession of x-ray films of the urinary tract followingthe injection into a vein of an iodine-containing substancewhich is collected by the kidneys, passing into the uretersand subsequently the bladder, allowing the study ofurinary tract function (also known as IntravenousUrography, IVU)


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Heart and Brain Angiography


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Types of barium based contrast media:1. Barium enema2. Barium swallow3. Barium meal4. Barium follow through


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Iodine based contrast media is a form of intravenous radio contrast (radiographic dye) containing iodine,which enhances the visibility of vascular structures and organs during radiographic procedures.

Iodinated contrast media may either be oil-based or water-soluble.

Oil-based contrast medium is slowly absorbed by body tissue and is usually only used in sialographic andhysterosalpingographic examinations.

Water-soluble iodinated medium, which is more quickly absorbed, may be used in place of bariumsulphate for gastrointestinal studies that are contraindicated by the use of barium for that reason.

Iodinated medium may also be either ionic or non-ionic.

The ionic type tends to create a high osmolality in blood and may cause a contrast media reaction in someindividuals, which may be life-threatening for those with certain medical conditions.

The non-ionic form decreases this risk, but is much more expensive. The non-ionic contrast media is muchmore widely used today


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Compound Name Type Iodine content Osmolality

Ionic Diatrizoate (Hypaque 50) Monomer 300 mgI/ml 1550 Hi

IonicMetrizoate (Isopaque 370) Monomer 370 mgI/ml 2100 Hi

Ionic Ioxaglate (Hexabrix) Dimer 320 mgI/ml 580 L


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Compound Name Type Iodine content Osmolality

Non-ionic Iopamidol (Isovue 370) Monomer 370 mgI/ml 796 Lo

Non-ionic Iohexol (Omnipaque 350) Monomer 350 mgI/ml 884 Lo

Non-ionicIoxilan (Oxilan350) Monomer 350 mgI/ml 695 Lo

Non-ionic Iopromide (Ultravist 370) Monomer 370 mgI/ml 774 Lo

Non-ionic Iodixanol (Visipaque 320) Dimer 320 mgI/ml 290 L


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Carbon DioxideCarbon dioxide also has a role in angiography. It is low-risk as it is a natural product with norisk of allergic potential. However, it can be used only below the diaphragm as there is a riskof embolism in neurovascular procedures. It must be used carefully to avoid contaminationwith room air when injected. It is a negative contrast agent in that it displaces blood wheninjected intravascularly.

Air

Air can be used as a contrast material because it is less radio-opaque than the tissuedefining. An example of a technique using purely air for the contrast medium is an airarthrogram where the injection of air into a joint cavity allows the cartilage covering the endsof the bones to be visualised.


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Patient are screened for the following:-Previous reactions to iodinated contrast media

All severe allergies and reactions (both medications and food)History of diabetes, kidney disease, pheochromocytoma, solitary kidney, kidney or othertransplant, or myelomaCurrent use of any metformin-containing medicationsFor women of child-bearing age, currently or possibly pregnant or currently breast-feeding.

Diet restriction avoid solid foods for 36 hours before diagnostic proceduresDiet such clear liquids as vegetable or apple are permitted.it is important reasons to empty, clean and less likely vomit during procedure.


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Creatinine Testing Prior to Contrast Administration Routine creatinine testing prior to contrast administration is not necessary in all patients. Themajor indications are age over 60, history of renal insufficiency, diabetes mellitus, orhypertension.


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Prednisone 50mg po at 13 hours, 7 hours and 1 hour prior to planned administrationof intravenous contrast plus diphenhydramine 50mg po, iv or im at 1 hour prior toplanned administration of intravenous contrast

Or

Methylprednisolone 32mg po at 12 hours and 2 hours prior to planned administrationof contrast plus diphenhydramine 50 mg po, iv or im at 1 hour prior to the plannedadministration of contrast

Or

Hydrocortisone 200mg iv at 13 hours, 7 hours and 1 hour prior to plannedadministration of intravenous contrast if patient is unable to take po medications


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There are a few reaction that patient may encountered during contrast media.The patient may feel that he or she has urinated on himself or herself.It also puts a metallic taste in the mouth of the patient.NauseaVomitingDiarrheaHypertensionIntestinal crampingPainEdemaDizziness


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Oral and rectal administration of barium sulphate is usually safe but constipation andabdominal pain may occur after barium meals or enemas.

Barium fecoliths are rare complications of barium contrast examinations and usuallyseen in diverticula of the colon.

It may associated with abdominal pain, appendicitis, bowel obstruction or perforation.They may even have to be removed surgically.

Leakage of barium into peritoneal cavity - Bowel obstruction. Allergic reactions to barium preparation Bronchospasm, urticarial.


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Symptoms Allergies

Contrast media reaction

Hay fever

Eczema

Treatments


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Treatments

Make sure patients has done their check ups in making sure they are not allergiodine.

If patient has a reaction from the previous procedure, giving them a non ionic agentcan reduce the risk of a repeat reaction.

Choose the appropriate choice of contrast media and premedication to make surepatient is not in a risk of a reaction.

In high risk subjects, monitoring for the first hour is recommended.


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Nasal congestionLimited nausea/vomiting

Mild hypertension

Sneezing

Headache

Dizziness Altered taste


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Diffuse erythemaFacial edema

Isolated chest pain

Wheezing


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Diffuse edema, or facial edema with dyspenaDiffuse erythema with hypotension

Laryngeal edema

Anaphylactic shock (hypotension + tachycardia)

Convulsion, seizures

Hypertensive emergency


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http://www.ncbi.nlm.nih.gov/pubmed/11471623 http://www.aafp.org/afp/2002/1001/p1229.html

http://emedicine.medscape.com/article/422855-overview#aw2aab6b3

http://en.wikipedia.org/wiki/Iodinated_contrast

http://en.wikipedia.org/wiki/Contrast_medium

http://en.wikipedia.org/wiki/Radiocontrast_agent

http://training.seer.cancer.gov/abstracting/procedures/clinical/radiologic/contrast.html

Contrast Media Safety Issues and ESUR Guideline H.S. Thomsen (Ed.) ACR Manual on Contrast Media Version 9, 2013
http://www.ncbi.nlm.nih.gov/pubmed/11471623http://www.aafp.org/afp/2002/1001/p1229.htmlhttp://emedicine.medscape.com/article/422855-overviewhttp://en.wikipedia.org/wiki/Iodinated_contrasthttp://en.wikipedia.org/wiki/Contrast_mediumhttp://en.wikipedia.org/wiki/Radiocontrast_agenthttp://training.seer.cancer.gov/abstracting/procedures/clinical/radiologic/contrast.htmlhttp://training.seer.cancer.gov/abstracting/procedures/clinical/radiologic/contrast.htmlhttp://training.seer.cancer.gov/abstracting/procedures/clinical/radiologic/contrast.htmlhttp://en.wikipedia.org/wiki/Radiocontrast_agenthttp://en.wikipedia.org/wiki/Radiocontrast_agenthttp://en.wikipedia.org/wiki/Contrast_mediumhttp://en.wikipedia.org/wiki/Contrast_mediumhttp://en.wikipedia.org/wiki/Iodinated_contrasthttp://en.wikipedia.org/wiki/Iodinated_contrasthttp://emedicine.medscape.com/article/422855-overviewhttp://emedicine.medscape.com/article/422855-overviewhttp://emedicine.medscape.com/article/422855-overviewhttp://emedicine.medscape.com/article/422855-overviewhttp://www.aafp.org/afp/2002/1001/p1229.htmlhttp://www.aafp.org/afp/2002/1001/p1229.htmlhttp://www.ncbi.nlm.nih.gov/pubmed/11471623http://www.ncbi.nlm.nih.gov/pubmed/11471623


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contrast media (presentation)

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