Radiologic Contrast Examinations 2024 PDF

RADIOLOGIC CONTRAST EXAMINATIONS James Lawrence Aduche, RRT, RSO, MSRT (ip) Review Lecturer License No: 0023749 TOPIC OUTLINE: Types of Contrast Media ‒ Characteristics and properties ‒ Factors in selecting contrast medium ‒ Adverse reaction to contrast media ‒ Mode of administrat...

RADIOLOGIC CONTRAST EXAMINATIONS James Lawrence Aduche, RRT, RSO, MSRT (ip) Review Lecturer License No: 0023749 TOPIC OUTLINE: Types of Contrast Media ‒ Characteristics and properties ‒ Factors in selecting contrast medium ‒ Adverse reaction to contrast media ‒ Mode of administration TOPIC OUTLINE: 1. Mouth & Salivary Glands ‒ Sialography 2. Anterior part of the Neck ‒ Palatography ‒ Nasopharyngography ‒ Positive CM Nasopharyngography ‒ Pharyngography ‒ Laryngopharyngography ‒ Tomolaryngography TOPIC OUTLINE: 3. Biliary Studies ‒ Oral Cholecystography ‒ Intravenous Cholangiography ‒ Percutaneous Transhepatic Cholangiography ‒ Operative-Immediate Cholangiography ‒ Post-Operative Cholangiography ‒ Endoscopic Retrograde Cholangiopancreatography ‒ Operative Pancreatography TOPIC OUTLINE: 4. Digestive System ‒ Abdominal Fistulae & Sinuses ‒ Esophagography ‒ Upper Gastrointestinal Series ‒ Hypotonic Duodenography TOPIC OUTLINE: Small Intestinal Series ‒ Upper GI & SIS combination ‒ SIS only ‒ Accelerated SIS ‒ Enteroclysis ‒ Intubation Method ‒ Complete Reflux Examination Large Intestine ‒ Barium Enema ‒ Modifications of Barium Enema TOPIC OUTLINE: 5. Urinary System ‒ Intravenous Urography ‒ Retrograde Urography ‒ Retrograde Cystography ‒ Urethrography ‒ Voiding Cystourethrography ‒ Metallic Bead Chain Cystourethrography TOPIC OUTLINE: 6. Reproductive System ‒ Hysterosalpingography ‒ Pelvic Pneumography ‒ Vaginography ‒ Fetography ‒ Placentography TOPIC OUTLINE: 6. Other Special Procedures: ‒ Diskography ‒ Cerebral Angiography ‒ Myelography ‒ Pelvimetry ‒ Angiography ‒ Lymphography SPECIAL PROCEDURES OVERVIEW ON SPECIAL PROCEDURES RADIOLOGIC CONTRAST EXAMINATIONS A method of studying organs using X- rays and the administration of a special dye, called a contrast medium. This test allows the radiologist to evaluate structures that are not clearly evident on conventional X-ray exams. X-rays work by passing through the body. 12 CONTRAST MEDIA Are used in order to see the shadow of an organ it must lie next to another organ of greater or lesser density itself. It is a radiopaque substance that is absorbed rapidly and leaves no residue. It may also be used with barium contrast as in air contrast for colon studies. 13 WHAT IS A CONTRAST MEDIA? Substance introduced to the body for visualization of certain structures and body parts which has to be physiologically harmless. Substance having higher or lower atomic number than surrounding tissues which are used to represent organs in the body which are not visualize in plain radiograph. 14 CLASSIFICATION 15 FOUR PHYSICAL STATES OF CONTRAST MEDIA Used in Myelogram and Bronchogram Studies OIL Example: Pantopaque, Dionosil Used in Gall Bladder Studies TABLETS Example: Biloptin and Cistobil Used in GIT, Esophagram, Barium Enema, and Small Intestinal Studies. POWDER Example: Barium Sulfate Used in IVP, Angiography, PTC, and other forms of contrast studies that uses liquid form of contrast. LIQUID Example: All iodinated form of contrast 16 TYPES OF CONTRAST MEDIA 1. POSITIVE CONTRAST MEDIA (Radiopaque) –Are substance having high atomic number than the surrounding tissue. –They usually appear white in the radiograph. –This are the: IODINE-BASED CONTRAST MEDIA BARIUM BASED CONTRAST MEDIA 17 TYPES OF CONTRAST MEDIA 2. NEGATIVE CONTRAST MEDIA (Radiolucent) – Are substance having lower atomic number than the surrounding tissues. – It appears black in the radiograph. 18 METHODS OF ADMINISTERING CONTRAST MEDIA DIRECT METHOD – Barium enema; Retrograde pyelography; Cystoscopy INDIRECT METHOD – ORAL: CM introduced through mouth – PARENTHERAL: CM introduced via injection 19 METHODS OF ADMINISTERING CONTRAST MEDIA DIRECT METHOD – Barium enema; Retrograde pyelography; Cystoscopy INDIRECT METHOD – ORAL: CM introduced through mouth – PARENTHERAL: CM introduced via injection 20 IODINE-BASED CONTRAST MEDIA IODINE-BASED CONTRAST MEDIA Are placed in organs and blood vessels to provide contrast between the structures and their surrounding tissues. It is relatively high atomic number, that is why x-ray do not really pass through it. They can be non absorbable oil. 22 IODINE-BASED CONTRAST MEDIA 1. It provides good radio opacity. 2. Are used in the examinations of the GI, kidneys, gallbladder, pancreas, heart, brain, uterus, spinal column, arteries, veins and joints. 3. Atomic number of 53. 23 CLASSIFICATION OF IODINE-BASED CM Contrast agents used for intravenous injections fall into one of two major classes: 1. Ionic 2. Non-ionic 24 IV CONTRAST PROPERTIES 25 IV CONTRAST PROPERTIES 26 IV CONTRAST PROPERTIES 27 OSMOLARITY 28 IONIC COMPOUNDS CONTRAST MEDIA The ionic compounds are further subdivided into: –High osmolality ionic compounds (HOCA) –Low osmolality ionic compounds (LOCA) The ionic compounds have a greater tendency to pass the blood-brain barrier owing to their hyperosmolality. 29 IONIC COMPOUNDS CONTRAST MEDIA The following list provides the osmolalities of the various types of organic iodine contrast agents and both plasma and cerebrospinal fluid: 30 OSMOLARITY 31 IDEAL IV CONTRAST 32 IONIC COMPOUNDS CONTRAST MEDIA Note: –This are contrast agent salts of electrically negatively charged acids containing iodine that ionizes in solution and causes more patient discomfort. 33 IONIC COMPOUNDS CONTRAST MEDIA Examples of IONIC CM: –Urovision –Conray –Urografin –Uromiro –Angiografin –Urovist –Hypaque –Telebrix –Cardio-conray 34 IV CONTRAST PREPARATIONS 35 IV CONTRAST PREPARATIONS DIET RESTRICTIONS: ‒ NPO for 6 to 8 hours ‒ Post hydration RENAL FUNCTION EVALUATION: ‒ CREATININE – 0.6-1.5mg/dL ‒ BUN – 8-25mg/dL ‒ GFR – 90-120 36 ALLERGY PREMEDICATION 37 KEY CONCEPT Osmolality depends on the number of particles in solution. The non-ionic compounds exhibit less osmolality then they provide fewer osmotically active particles. This results in fewer patient reactions. Their main advantage is in the reduction of both subjective and objective side effects in the patient 38 BARIUM-BASED CONTRAST MEDIA BARIUM-BASED CONTRAST MEDIA Commonly used in Gastrointestinal Studies. It is inert dense and cannot be absorbed by the body. It mixed with water and given by mouth or rectum to outline the said tract to be studied. Thin or thick mixtures are used. 41 BARIUM-BASED CONTRAST MEDIA BaSO4 – 1 atom of barium, 1 atom of sulfur and 4 atoms of oxygen thus it is a compound. Inert powder composed of crystals (colloidal suspension) that has a tendency to clump and come out of suspension (flocculation). 42 BARIUM-BASED CONTRAST MEDIA Stabilizing agents such as sodium carbonate or sodium citrate are used to prevent flocculation. Atomic number of 56. 43 PROPERTIES OF BARIUM SULFATE 1. It absorb water 2. It has high atomic number 3. It is insoluble in GIT (Gastro Intestinal Tract) 4. It is non-toxic 5. It has no relative contraindication in GIT. 44 BARIUM SULFATE 1. It is generally recommended that barium sulfate is mixed with cold tap water (40°-45° F) to reduce irritation to the colon and aid the patient in holding the enema (increase retention of CM) during the examination. – The cold water reduces spasm and cramping and reported to have anesthetic effect on the colon. 45 BARIUM SULFATE 2. Room temperature water (85°-90° F) is recommended by most experts to produce a more successful examination with maximal patient comfort. 3. The RT should never use hot water because it may scald (burn) the mucosal lining of the colon. 46 CHEMICAL PROPERTIES OF BARIUM SULFATE 3. The RT should never use hot water because it may scald (burn) the mucosal lining of the colon. 47 CHEMICAL PROPERTIES OF BARIUM SULFATE 3. The RT should never use hot water because it may scald (burn) the mucosal lining of the colon. 48 CHEMICAL PROPERTIES OF BARIUM SULFATE 3. The RT should never use hot water because it may scald (burn) the mucosal lining of the colon. 49 TYPES OF BARIUM SULFATE Commercial type: – Barodense – powdered form with flavorizing agent – Barosperse – powdered form with flavor – Barytgen – powdered and liquid form with flavor – Baro-cat – Baritop Plain Barium Sulfate: – This has a very unpalatable but its advantage lies in the fact that it adheres well on the mucosa of the organ. 50 NEGATIVE CONTRAST MEDIA NEGATIVE CONTRAST MEDIA Air or Gas – Used as negative contrast media that is widely penetrated by x- ray. – It provides contrast between the lung tissue, vessels masking and their air sacks themselves. – It is a radiolucent substance that is absorbed rapidly and leaves no residue. 52 NEGATIVE CONTRAST MEDIA Air or Gas – It may also be used with barium contrast, as in air contrast for colon studies. – Examples of radiolucent, or negative, contrast agents are air, oxygen, carbon dioxide, and nitrous oxide. 53 FACTORS IN SELECTING A CONTRAST MEDIA 1. It must be non toxic and must be safe both locally where administered. 2. It must provide adequate contrast 3. It must have a suitable viscosity 54 FACTORS IN SELECTING A CONTRAST MEDIA 4. It must have a suitable persistence 5. It must have miscibility or immiscibility as appropriate – It may also be used with barium contrast, as in air contrast for colon studies. – Examples of radiolucent, or negative, contrast agents are air, oxygen, carbon dioxide, and nitrous oxide. 55 PHYSIOCHEMICAL PROPERTIES OF CONTRAST MEDIA 1. Water solubility – In vascular applications an immediate dilution with blood. 2. Viscosity – Is a measure of the fluidity of solutions – Measured in millipascals (mPa) per second. – The higher the viscosity of the solution, the longer it will take for the contrast medium to be diluted by blood. 56 PHYSIOCHEMICAL PROPERTIES OF CONTRAST MEDIA 3. Osmolality – Adverse reactions to CM have been related to osmolality. – A measure of the total number of particles in a solution/kg of water. 57 WHAT ARE THE ADVERSE REACTIONS TO CONTRAST MEDIA? In a medium, it may cause or create reactors, and for this reason a history of allergies must be obtained before the examination. KINDS OF REACTION 1. Mild Reaction 2. Moderate Reaction 3. Severe Reaction 58 MILD REACTIONS Typically does not require drug intervention or medical assistance. Two of these symptoms are also considered side effects. May be based on anxiety and/or fear. Although this may not be a life-threatening situation, the technologist must be attentive to all needs of the patient. Symptoms of a mild reaction include the following: – Anxiety – Lightheadedness – Nausea – Vomiting 59 MILD REACTIONS Metallic taste (common side effect) Mild erythema Warm flushed sensation during injection (common side effect) Itching Mild scattered hives 60 MILD REACTIONS LOCAL REACTIONS (AT THE SITE OF ADMINISTRATION) – Many patient are sensitive in varying degrees to the iodine compounds. – Pain – Burning – Itching – Numbness TECHNOLOGIST RESPONSIBILITES: – PROVIDE WARM TOWEL FOR EXTRAVASATION. – DOCUMENT PATIENT REACTION 61 MODERATE REACTIONS This second type of reaction is a true allergic reaction (anaphylactic reaction) that results from the introduction of iodinated contrast media. Symptoms of a moderate reaction include the following: – Urticaria (moderate to severe hives) – Possible laryngeal swelling – Bronchospasm – Angioedema – Hypotension – Tachycardia (>100 beats/min) or bradycardia (