![Page 1: NIS - Cothron Hartman Daffner McDonald Contrast Media](https://reader033.vdocuments.net/reader033/viewer/2022052411/628ad321b3f47d4f5f552ec3/html5/thumbnails/1.jpg)
Non-InterpretiveSkillsContrastMediaUses,Reactions,&Treatments
![Page 2: NIS - Cothron Hartman Daffner McDonald Contrast Media](https://reader033.vdocuments.net/reader033/viewer/2022052411/628ad321b3f47d4f5f552ec3/html5/thumbnails/2.jpg)
BeforeYouBeginThismoduleisintendedprimarilyforclinicalmedicalstudentsorinternsintendingtolearnorreviewnon-interpretiveradiologyskills.
Pleasenotethatwhilenotintegral,thismoduleseriesassumessomefamiliaritywithbasicimagingtechniquesandinterpretiveskills.Ifyouwishtolearnorreviewtheseconcepts,pleaseseeour“InterpretiveSkills”moduleseries.
Ifmaterialisrepeatedfromanothermodule,itwillbeoutlinedasthistextissothatyouareaware
![Page 3: NIS - Cothron Hartman Daffner McDonald Contrast Media](https://reader033.vdocuments.net/reader033/viewer/2022052411/628ad321b3f47d4f5f552ec3/html5/thumbnails/3.jpg)
Objectives
Bytheendofthismodule,studentswillhaveapracticalknowledgeofradiologiccontrastagentsastheyapplytoindications,contraindicationsandcomplications.Interactivecasesandquestionswillhelpthestudentself-evaluate.
![Page 4: NIS - Cothron Hartman Daffner McDonald Contrast Media](https://reader033.vdocuments.net/reader033/viewer/2022052411/628ad321b3f47d4f5f552ec3/html5/thumbnails/4.jpg)
1.ContrastBasics2.OralContrast3.IntravenousContrastforCT4.IntravenouscontrastforMRI5.ConclusionandPearls6.Posttest
OverviewPleaseusehyperlinkstoskiptodesiredsectionsasneeded
Last slide viewed
![Page 5: NIS - Cothron Hartman Daffner McDonald Contrast Media](https://reader033.vdocuments.net/reader033/viewer/2022052411/628ad321b3f47d4f5f552ec3/html5/thumbnails/5.jpg)
WhatIsContrast?
§ Definition: amaterialusedtoenhanceinternalstructures,ie.outlinewalls,defineanatomy,andhelpdemonstrateanypathologiccondition(s)withinthebodyinmedicalimaging.
Last slide viewed
OVERVIEW
![Page 6: NIS - Cothron Hartman Daffner McDonald Contrast Media](https://reader033.vdocuments.net/reader033/viewer/2022052411/628ad321b3f47d4f5f552ec3/html5/thumbnails/6.jpg)
HowDoTheyWorkforCTorX-rays?
§ Materialswithahighatomicnumber,suchasGadolinium,Iodineinwater-solublecontrastagents,andBariumwillabsorbx-raysandwillberadiopaqueontheradiograph.
Last slide viewedOVERVIEW
![Page 7: NIS - Cothron Hartman Daffner McDonald Contrast Media](https://reader033.vdocuments.net/reader033/viewer/2022052411/628ad321b3f47d4f5f552ec3/html5/thumbnails/7.jpg)
PhotoandRadiographofContrastMedia
(a) Gadolinium based contrast(b) Water-soluble iodine based oral/IV contrast(c) Barium
Last slide viewedOVERVIEW
![Page 8: NIS - Cothron Hartman Daffner McDonald Contrast Media](https://reader033.vdocuments.net/reader033/viewer/2022052411/628ad321b3f47d4f5f552ec3/html5/thumbnails/8.jpg)
ContrastUsesThroughouttheBody
§ Arthrography:throughthejoints§ Myelography:throughthespine§ Angiography:throughthebloodvessels§ Fluoroscopy:throughtheGItract(ie.enemas,fistulogram,post-operativeleak,etc.)
§ Fluoroscopy:throughtheGUtract(ie.cystogram,urethrogram,hysterosalpingogram)
Last slide viewedOVERVIEW
![Page 9: NIS - Cothron Hartman Daffner McDonald Contrast Media](https://reader033.vdocuments.net/reader033/viewer/2022052411/628ad321b3f47d4f5f552ec3/html5/thumbnails/9.jpg)
WhenWouldContrastNotBeHelpful?
§ KidneyStones§ RetroperitonealBleed§ IntracranialHemorrhage§ OtherContraindicationsDiscussedLater
Teaching Point: There is enough inherent contrast within each of these processes to make the diagnosis without contrast.
Last slide viewedOVERVIEW
![Page 10: NIS - Cothron Hartman Daffner McDonald Contrast Media](https://reader033.vdocuments.net/reader033/viewer/2022052411/628ad321b3f47d4f5f552ec3/html5/thumbnails/10.jpg)
Pre(A),Post(B),andDelayed/Pyelographic(C)CTimagesdemonstratedifferentstagesofcontrastexcretionthroughthekidneys.Notehowtherenalcalculusisbestseenonpre-contrastimages,andbecomesprogressivelyobscuredascontrastaccumulatesinthekidneyandcollectingsystem.
Last slide viewedOVERVIEW
![Page 11: NIS - Cothron Hartman Daffner McDonald Contrast Media](https://reader033.vdocuments.net/reader033/viewer/2022052411/628ad321b3f47d4f5f552ec3/html5/thumbnails/11.jpg)
OralContrast:BariumvsWater-Soluble
§InertSubstance§BetterOpacification/distentionofGItract§BetterMucosalDetail§Resistanttodilution§Cheap
§IVorotherroute§Reabsorbed
§SeveredesmoplasticreactionifoutsideGItract§DelayedtransitmaycauseBariumtoinspissate§Mayobscurepathologyonsubsequentscans
§Irritatingtotracheobronchialtree§Lessdistention/poorercoating§Moreexpensive
Barium
Water Soluble
Pros Cons
Last slide viewedOVERVIEW
![Page 12: NIS - Cothron Hartman Daffner McDonald Contrast Media](https://reader033.vdocuments.net/reader033/viewer/2022052411/628ad321b3f47d4f5f552ec3/html5/thumbnails/12.jpg)
OralContrastExtravasation
WatersolublecontrastwasusedastheinitialcontrastagenttodiagnosethisesophagealruptureinthispatientwhohadBoerhaaveSyndrome.
Teaching Point: Use water-soluble contrast if GI leak is suspected.
Last slide viewedOVERVIEW
![Page 13: NIS - Cothron Hartman Daffner McDonald Contrast Media](https://reader033.vdocuments.net/reader033/viewer/2022052411/628ad321b3f47d4f5f552ec3/html5/thumbnails/13.jpg)
ExampleofUGIusingBarium
Last slide viewedOVERVIEW
![Page 14: NIS - Cothron Hartman Daffner McDonald Contrast Media](https://reader033.vdocuments.net/reader033/viewer/2022052411/628ad321b3f47d4f5f552ec3/html5/thumbnails/14.jpg)
*
§A malignant stricture (arrow) in the mid esophagus is nicely demonstrated in this barium esophogram.
§CT scan demonstrates a malignant mediastinal mass (*) that was causing the esophageal stricture.
Last slide viewedOVERVIEW
![Page 15: NIS - Cothron Hartman Daffner McDonald Contrast Media](https://reader033.vdocuments.net/reader033/viewer/2022052411/628ad321b3f47d4f5f552ec3/html5/thumbnails/15.jpg)
WhenDoYouUseIntravenousContrast?
IV contrast is given to make lesions more conspicuous and to increase vascular & soft tissue detail.
Last slide viewedOVERVIEW
![Page 16: NIS - Cothron Hartman Daffner McDonald Contrast Media](https://reader033.vdocuments.net/reader033/viewer/2022052411/628ad321b3f47d4f5f552ec3/html5/thumbnails/16.jpg)
CTimagesoftheliverpre,immediatepost-contrast,anddelayedphase(A,B,C)showprogressivenodularenhancementofthislesion,whichendedupbeingahemangioma.
Last slide viewedOVERVIEW
![Page 17: NIS - Cothron Hartman Daffner McDonald Contrast Media](https://reader033.vdocuments.net/reader033/viewer/2022052411/628ad321b3f47d4f5f552ec3/html5/thumbnails/17.jpg)
WhatCanGowrong?
§ Extravasation§ Allergy§ ContrastInducedNephropathy§ MetabolicAcidosis
Last slide viewedOVERVIEW
![Page 18: NIS - Cothron Hartman Daffner McDonald Contrast Media](https://reader033.vdocuments.net/reader033/viewer/2022052411/628ad321b3f47d4f5f552ec3/html5/thumbnails/18.jpg)
Extravasation
Contrast extravasating into the subcutaneous tissues.
Last slide viewedOVERVIEW
![Page 19: NIS - Cothron Hartman Daffner McDonald Contrast Media](https://reader033.vdocuments.net/reader033/viewer/2022052411/628ad321b3f47d4f5f552ec3/html5/thumbnails/19.jpg)
• As a clinician you may inherit this patient and will need to know the signs of... • Ulceration and possible necrosis• Compartment Syndrome • Reflex Sympathetic Dystrophy Syndrome:
Chronic pain syndrome due to trauma to nerve complexes/soft tissue
ComplicationsofExtravasation
Last slide viewedOVERVIEW
![Page 20: NIS - Cothron Hartman Daffner McDonald Contrast Media](https://reader033.vdocuments.net/reader033/viewer/2022052411/628ad321b3f47d4f5f552ec3/html5/thumbnails/20.jpg)
ComplicationsofExtravasation
Skin necrosis after large volume extravasation.
Last slide viewedOVERVIEW
![Page 21: NIS - Cothron Hartman Daffner McDonald Contrast Media](https://reader033.vdocuments.net/reader033/viewer/2022052411/628ad321b3f47d4f5f552ec3/html5/thumbnails/21.jpg)
Howdowetreatthis?§ Always assessthepatientfirst!
§ Aradiologistisafirstlineresponderandwillevaluateforvolumeextravasatedandneurovascularcompromise.
§ Reducepain/Decreaseswellingwithcoldorwarmcompressesandelevation.
§ Hyaluronidasecanbeadministered.§ Surgicalconsult:Volumes>100ml,Progressive
swelling/pain,Decreasedtissueperfusion,Changeinsensation,Skinulceration/blistering
Last slide viewedOVERVIEW
Always document in patient’s chart!
![Page 22: NIS - Cothron Hartman Daffner McDonald Contrast Media](https://reader033.vdocuments.net/reader033/viewer/2022052411/628ad321b3f47d4f5f552ec3/html5/thumbnails/22.jpg)
AllergicReactions
§ IVcontrastisadrugandthereforecanhaveadversereactions.
§ Typeofreactions:• Mild:nausea,vomiting,urticaria,pain,sweats,
shaking,chills,pallor,dizziness• Moderate:symptomaticurticaria,vasovagal
reactions,mildbronchospasm,andtachycardia,hypertension
• Severe:laryngeal/pulmonaryedema,severebronchospasm,seizure,diffuseerythema,severehypotension/cardiacarrest
Last slide viewedOVERVIEW
![Page 23: NIS - Cothron Hartman Daffner McDonald Contrast Media](https://reader033.vdocuments.net/reader033/viewer/2022052411/628ad321b3f47d4f5f552ec3/html5/thumbnails/23.jpg)
ACRPre-TreatmentGuidelinesForContrastAllergy
§ ElectivePremedication:§ Prednisone50mgPO@13,7,&1hourprior+Diphenhydramine50mgPO/IM/IV1hourprior,or...
§ Methylprednisolone32mgPO@12&2hours+antihistamine(asabove).
§ EmergencyPremedication:§ Methylprednisolone40mgorHydrocortisone200mgIVq4prior+antihistamine(asabove).
§ Steroidsnoteffectiveifgiven<4-6hoursprior
Last slide viewedOVERVIEW
![Page 24: NIS - Cothron Hartman Daffner McDonald Contrast Media](https://reader033.vdocuments.net/reader033/viewer/2022052411/628ad321b3f47d4f5f552ec3/html5/thumbnails/24.jpg)
TreatmentofReactions
• A:Airway,O2,Assessment,Assistance,Access• B:Breathing(CPR),Bag-valve-mask• C:Circulatoryassistance->IVfluids• D:Drugs
Last slide viewedOVERVIEW
![Page 25: NIS - Cothron Hartman Daffner McDonald Contrast Media](https://reader033.vdocuments.net/reader033/viewer/2022052411/628ad321b3f47d4f5f552ec3/html5/thumbnails/25.jpg)
TreatmentofReactions• Urticaria:
• Diphenhydramine50mgPO/IM/IV
• ifsevere,alphaagonistorEpi0.1-0.3mgSC(ifnocontraindications)
• Facial/LaryngealEdema:
• GiveO2
• Alphaagonist
• Ifhypotensive,Epi0.1-0.3mlSC/IMupto1mg(Alternatively1-3mlIV)
• Bronchospasm:
• GiveO2,monitorEKG,BP,andpulseox
• Betaagonistinhalers2-3puffsPRN
• Ifnoresponse,Epi0.1-0.3mlSC/IMupto1mg(Alternatively1-3mlIV)
Last slide viewedHavealowthresholdtocallacodeasthesecandevelopintolifethreateningemergencies!
OVERVIEW
![Page 26: NIS - Cothron Hartman Daffner McDonald Contrast Media](https://reader033.vdocuments.net/reader033/viewer/2022052411/628ad321b3f47d4f5f552ec3/html5/thumbnails/26.jpg)
TreatmentofReactions• HypotensionwithTachycardia(Anaphylaxis):
• Trendelenburgposition
• GiveO2,monitorvitals
• RapidIVfluidadministration
• Epi1-3mlIVupto1mg,ifpoorresponsetoabove
• HypotensionwithBradycardia(VasovagalReaction):
• Trendelenburgposition
• Give02,monitorvitals
• RapidIVfluidadministration
• Atropine0.6-1mgIVslowly,ifpoorresponsetoabove(repeatupto2-3mg
Last slide viewedOVERVIEW
![Page 27: NIS - Cothron Hartman Daffner McDonald Contrast Media](https://reader033.vdocuments.net/reader033/viewer/2022052411/628ad321b3f47d4f5f552ec3/html5/thumbnails/27.jpg)
ContrastInducedNephropathy(CIN)
• Contrastisexcretedbyglomerularfiltration.
• Patientswithborderlinerenalfunctionmayexperienceglomerular/tubulardamageresultingintransientimpairmentinrenalfunction/oliguria.
• ThereisnouniversallyaccepteddefinitionforCIN,butanincreaseof0.5mg/dlwithin48hoursofcontrastadministrationiswidelyaccepted.(Solomonetal)
• Serumcreatininehaslimitationsasanaccuratemeasureofrenalfunction.E-GFR(estimatedglomerularfiltrationrate)ismorecommonlyused.
Last slide viewedOVERVIEW
![Page 28: NIS - Cothron Hartman Daffner McDonald Contrast Media](https://reader033.vdocuments.net/reader033/viewer/2022052411/628ad321b3f47d4f5f552ec3/html5/thumbnails/28.jpg)
StagesofChronicKidneyDisease(CKD)
Stage of CKD Description GFR ml/min/1.73 m2
1 Kidney damage with normal GFR
90 or more
2 Mildly decreased GFR 60-89
3 Moderately decreased GFR
30-59
4 Severely decreased GFR 15-29
5 Renal failure-markedly decreased GFR
<15 (or dialysis)
Last slide viewedOVERVIEW
![Page 29: NIS - Cothron Hartman Daffner McDonald Contrast Media](https://reader033.vdocuments.net/reader033/viewer/2022052411/628ad321b3f47d4f5f552ec3/html5/thumbnails/29.jpg)
WhyisCKDImportant?§ ContrastadministrationhasariskofconvertingCKDintoESRDandtherebynecessitatingdialysis.
§ Avoidance/alternativesarerecommendedforpatientswithStage4-5CKD.
§ AKIisanabsolutecontraindicationtointravenouscontrast.
§ Incaseslikethis,cliniciansneedtocommunicatewiththeradiologistabouttherisks,benefits,andpossibleimagingalternatives,suchasnon-contrastCTorUS.
Last slide viewedOVERVIEW
![Page 30: NIS - Cothron Hartman Daffner McDonald Contrast Media](https://reader033.vdocuments.net/reader033/viewer/2022052411/628ad321b3f47d4f5f552ec3/html5/thumbnails/30.jpg)
CINSpecialConsideration:Metformin
• Metforminisclearedbyrenaltubularsecretion.
• Accumulationinthebloodstreamcanleadtolifethreateninglacticacidosis.
• Metforminshouldbeheldfor24hourspriortocontrast.
• Itmayberesumedupondocumentingreturntonormalrenalfunction
Last slide viewedOVERVIEW
![Page 31: NIS - Cothron Hartman Daffner McDonald Contrast Media](https://reader033.vdocuments.net/reader033/viewer/2022052411/628ad321b3f47d4f5f552ec3/html5/thumbnails/31.jpg)
MRIContrast
§ LikeCT,intravenouscontrasthelpsinthediagnosisofmanyimportantpathologies
§ Gadolinium(64Gd)isaspecialmetalthathasstrongparamagneticproperties,effectingtherelaxationtimeinthescanningsequence.
§ Advantagesaresimilartootherformsofenhancedradiologicstudies,ie.bettervisualizationofanatomyandpathology.
§ ThefreeGdionisinherentlytoxictohumans,andmustbechelatedwithDTPAtobesafelyexcretedbythekidney.
Last slide viewedOVERVIEW
![Page 32: NIS - Cothron Hartman Daffner McDonald Contrast Media](https://reader033.vdocuments.net/reader033/viewer/2022052411/628ad321b3f47d4f5f552ec3/html5/thumbnails/32.jpg)
• MRIImagespre(A)andpost(B)contrastofalesion(blackarrow)intherighthepaticlobe.
• Notethelesionismuchmoreconspicuousonthepost-contrastimagewherethereisalsocontrastopacificationofthevasculatureincludingtheaorta(whitearrow).
• ThislesionendedupbeinganFNH.
Last slide viewedOVERVIEW
![Page 33: NIS - Cothron Hartman Daffner McDonald Contrast Media](https://reader033.vdocuments.net/reader033/viewer/2022052411/628ad321b3f47d4f5f552ec3/html5/thumbnails/33.jpg)
ContraindicationstoGadolinium
• Gadoliniumisadrugandthereforehaspotentialforadversereactionsjustlikeiodinatedcontrast.
• Pregnancy:Gadoliniumpassesthroughtheplacentaandaccumulatesintheamnioticfluid,thereforeonlygiveninemergencies.
• RenalDiseaseprecludesnormalexcretionandleadstoincreaseddurationofexposure.
• Accumulationinasciticfluidhasthepotentialfordelayedexposure,howevertherearenoreportedcases.
Last slide viewedOVERVIEW
![Page 34: NIS - Cothron Hartman Daffner McDonald Contrast Media](https://reader033.vdocuments.net/reader033/viewer/2022052411/628ad321b3f47d4f5f552ec3/html5/thumbnails/34.jpg)
NephrogenicSystemicFibrosis
§ Definition:Arareandprogressivefibrosingsyndromeinvolvingtheskin,joints,eyes,andinternalorgans.
§ Describedonlyinpatientswithimpairedrenalfunction.§ Incaseslikethis,Gadoliniumisnotgivenwithoutdiscussingtherisks,benefits,andalternativeswiththepatientandreferringphysician.
§ Whennecessary,usethelowestpossibleeffectivedoseandagentswithlessincidenceofNSF.
Last slide viewedOVERVIEW
![Page 35: NIS - Cothron Hartman Daffner McDonald Contrast Media](https://reader033.vdocuments.net/reader033/viewer/2022052411/628ad321b3f47d4f5f552ec3/html5/thumbnails/35.jpg)
ConclusionandPearls• Commonlyusedcontrastagentsmaybecategorizedasparticulate(barium),water-soluble(ionicandnonionic),andparamagnetic.
• Bariumremainsthemainstayforradiographicevaluationofthe(holloworgansofthe)GItract.However,bariumistoxicoutsidethelumenofthebowel.
Last slide viewedOVERVIEW
![Page 36: NIS - Cothron Hartman Daffner McDonald Contrast Media](https://reader033.vdocuments.net/reader033/viewer/2022052411/628ad321b3f47d4f5f552ec3/html5/thumbnails/36.jpg)
ConclusionandPearls• Contrastagentscanresultinlifethreateningreactionswheningestedorinjectedintoapatient
• AvoidusinggadoliniuminpatientswithrenalfailurebecauseoftheriskofNSF
• Theradiologistandorderingphysicianshouldworktogethertodecidetheriskbenefitofadministeringcontrastwithrespecttorenalfunctionandallergy/needforpremedication.
Last slide viewedOVERVIEW
![Page 37: NIS - Cothron Hartman Daffner McDonald Contrast Media](https://reader033.vdocuments.net/reader033/viewer/2022052411/628ad321b3f47d4f5f552ec3/html5/thumbnails/37.jpg)
PostTest
Last slide viewedOVERVIEW
![Page 38: NIS - Cothron Hartman Daffner McDonald Contrast Media](https://reader033.vdocuments.net/reader033/viewer/2022052411/628ad321b3f47d4f5f552ec3/html5/thumbnails/38.jpg)
1.A36yearoldfemale,postRoux-en-YgastricbypasspresentstothedepartmentforamodifiedUGI.Whatcontrastagentdoyoubeginwithtoruleoutleak?
A. BariumB. Watersolublecontrast
Last slide viewedOVERVIEW
![Page 39: NIS - Cothron Hartman Daffner McDonald Contrast Media](https://reader033.vdocuments.net/reader033/viewer/2022052411/628ad321b3f47d4f5f552ec3/html5/thumbnails/39.jpg)
Biscorrect
• Whenrulingoutaleak,startwithwatersolublecontrast.BariumcanresultinaseveredesmoplasticreactionifitextendsoutsideoftheGItract.
Last slide viewedHelp !!!
![Page 40: NIS - Cothron Hartman Daffner McDonald Contrast Media](https://reader033.vdocuments.net/reader033/viewer/2022052411/628ad321b3f47d4f5f552ec3/html5/thumbnails/40.jpg)
2.Forwhichofthefollowingconditionswouldcontrastbehelpfulinmakingthediagnosis?
A. KidneyStonesB. IntracranialHemorrhageC. HepatocellularCarcinomaD. RetroperitonealBleed
Last slide viewedOVERVIEW
![Page 41: NIS - Cothron Hartman Daffner McDonald Contrast Media](https://reader033.vdocuments.net/reader033/viewer/2022052411/628ad321b3f47d4f5f552ec3/html5/thumbnails/41.jpg)
AnswerCiscorrect• Thereisenoughinherentcontrastwithinkidneystones,retroperitonealbleedandintracranialhemorrhagetomakethediagnosiswithoutcontrast.Infact,thepathologicprocessesintheseinstancesmaybeobscuredbythecontrast.
• Intravenouscontrastwouldbehelpfulforthediagnosisofhepatocellularcarcinoma,ahypervasculartumorwhichenhancestoagreaterdegreethantheliveraftertheadministrationofintravenouscontrast.
Last slide viewedHelp!!!
![Page 42: NIS - Cothron Hartman Daffner McDonald Contrast Media](https://reader033.vdocuments.net/reader033/viewer/2022052411/628ad321b3f47d4f5f552ec3/html5/thumbnails/42.jpg)
3.A47yearoldmalepresentsforfollowupenhancedCTandreportedhivesafterthelaststudy.Whatshouldyoudo?
A. Prednisone50mgPO@13,7,&1hourprior+Diphenhydramine50mgPO/IM/IV1hourprior
B. Methylprednisolone40mgIV3hourspriortocontrastadministration.
C. Acetylcysteine140mg/kgPO/NGx1D. Donothing.
Last slide viewedOVERVIEW
![Page 43: NIS - Cothron Hartman Daffner McDonald Contrast Media](https://reader033.vdocuments.net/reader033/viewer/2022052411/628ad321b3f47d4f5f552ec3/html5/thumbnails/43.jpg)
AnswerAiscorrect
• Intravenouscontrastcanbethoughtofasamedication.Likeanymedication,patientscandevelopallergies—someofwhichcanbelifethreatening.Specificprotocolshavebeenestablishedtodecreasetheprobabilityofacontrastreactionusingacombinationofsteroidsanddiphenhydramine.
Last slide viewedHelp!!!
![Page 44: NIS - Cothron Hartman Daffner McDonald Contrast Media](https://reader033.vdocuments.net/reader033/viewer/2022052411/628ad321b3f47d4f5f552ec3/html5/thumbnails/44.jpg)
4.A63yearoldfemalejustreceivedIVcontrastandreportedfeeling“lightheaded.”BP80/45HR150.Whichofthefollowingarenotindicated?
A. SupplementalO2B. Atropine0.6mgIVC. TrendelenburgpositionD. Epinephrine1mlIV
Last slide viewedOVERVIEW
![Page 45: NIS - Cothron Hartman Daffner McDonald Contrast Media](https://reader033.vdocuments.net/reader033/viewer/2022052411/628ad321b3f47d4f5f552ec3/html5/thumbnails/45.jpg)
AnswerBiscorrect• Thisisanexampleofananaphylacticreactionwhichdevelopedaftercontrastadministration.Pleasenotethatthepatientishypotensivewithtachycardia.Rememberthatintravenouscontrastisamedicationandcanresultinlifethreateningallergicreactions.Asalways,assessthepatientsfirstanddecideontheseverityofthesituationbytakingvitalsignsandexaminingthepatient.Establishedprotocolsforthetreatmentofthesereactionsincludeoxygen,ivfluid,TrendelenbergpositionandEpinephrine(IVorIM).
•• Vasovagalreactionsontheotherhandresultinahypotensivepatientwithbradycardia.Atropineisthemedicationofchoicetotreatthesepatients.
Last slide viewedHelp!!!
![Page 46: NIS - Cothron Hartman Daffner McDonald Contrast Media](https://reader033.vdocuments.net/reader033/viewer/2022052411/628ad321b3f47d4f5f552ec3/html5/thumbnails/46.jpg)
5.A67yearoldfemaleondialysishasasuspectedbraintumor.CananMRIbedoneusingGadolinium?Why?
A. YesB. NoC. Depends
Last slide viewedOVERVIEW
![Page 47: NIS - Cothron Hartman Daffner McDonald Contrast Media](https://reader033.vdocuments.net/reader033/viewer/2022052411/628ad321b3f47d4f5f552ec3/html5/thumbnails/47.jpg)
AnswerCiscorrect• Nephrogenicsystemicfibrosis(NSF)isarareandprogressivefibrosingsyndromeinvolvingtheskin,joints,eyes,andinternalorgans.NSFhasbeendescribedonlyinpatientswithimpairedrenalfunctionandthoseondialysis.Inthesepatients,Gadoliniumisnotgivenwithoutdiscussingtherisks,benefits,andalternatives(contrastenhancedCTorMRIwithoutcontrast)withthepatientandreferringphysician.WhenacontrastenhancedMRIisdeemednecessary,theradiologistwillusethelowestpossibleeffectivedoseandagentswithlessincidenceofNSF.
Last slide viewedHelp!!!
![Page 48: NIS - Cothron Hartman Daffner McDonald Contrast Media](https://reader033.vdocuments.net/reader033/viewer/2022052411/628ad321b3f47d4f5f552ec3/html5/thumbnails/48.jpg)
References
• ACRManualonContrastMedia,Version8.0.Reston,VA:AmericanCollegeofRadiology,2012.
• ACR-SPRPracticeGuidelinefortheUseofIntravascularContrastMedia.Reston,VA:AmericanCollegeofRadiology,2012rev.
![Page 49: NIS - Cothron Hartman Daffner McDonald Contrast Media](https://reader033.vdocuments.net/reader033/viewer/2022052411/628ad321b3f47d4f5f552ec3/html5/thumbnails/49.jpg)
END