RADIOGRAPHIC SPECIAL
PROCEDURES
KENNETH M. LUCIANO, RRT
DEFINITION OF
CONTRAST MEDIA
CM are diagnostic agents that are instilled into body
orifice or injected into the vascular system, joints and
ducts to enhance subject contrast in anatomic areas
where there is low subject contrast.
A material that is being ingested or injected into the
body for visualization of the organ.
Substance having either a higher or lower atomic
number than the surrounding tissues which are used
to represent organs of the body which are not
visualized in a plain radiography.
DEFINITION OF
CONTRAST MEDIA
Serves as a diagnostic and therapeutic aid to
physician to visualize certain tissues/ organ
The ability of the CM to enhance subject contrast
depends on:
1. Atomic number of CM.
2. Atoms concentration of the element/volume of the
medium.
TYPES OF
CONTRAST MEDIA
Radiopaque
Appears white (decreased density) on the radiograph (ex.
Barium sulfate, iodine).
Also known as positive contrast media.
Composed of elements with high atomic number.
Radiolucent
Appears black (increased density) on the radiograph (air,
nitrogen, carbon dioxide).
Also known as negative contrast media.
Composed of elements with low atomic number.
FOUR PHYSICAL STATES OF
CONTRAST MEDIA
1. OIL
Example: Pantopaque, Dionosil
- Used in Myelogram and Bronchogram Studies
2. TABLETS
Example: Biloptin (Iopodate), Telepaque, (Iopanoic Acid)
Cholebrine (iocetamic acid) Bilisectan (Iodoalphanoic
acid) and Cistobil
- Used in Gall Bladder Studies
3. Powder- Barium Sulphate (Baryntgen)
4. Liquid – all iodinated and non-ionic contrast medium
FOUR PHYSICAL STATES OF
CONTRAST MEDIA
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Example: Barium Sulfate (Baryntgen)
- Used in GIT, Esophogram, Barium Enema, and Small
Intestinal Studies.
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Example – all iodinated and non-ionic contrast medium.
POSITIVE
CONTRAST MEDIA
1. BASO4 (BARIUM SULFATE)
For examination of the esophagus
For small intestine
For upper GI series
2. IODINATED FORM
Are used in the examinations of the GI, kidneys,
gallbladder, pancreas, heart, brain, uterus, spinal
column, arteries, veins and joints.
Atomic number of 53.
IMPORTANT FACTORS IN SELECTING
CONTRAST MEDIUM
It must be non toxic and must be safe both
locally where administered.
It must clearly shows the structures
creating a different contrast
It must have a suitable viscosity
Physiologically inert
It must have miscibility or immiscibility as
appropriate
- eliminated unchanged
PHYSIOCHEMICAL PROPERTIES
Water solubility
in vascular applications an immediate dilution with blood.
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.
Osmolality-
Adverse reactions to CM have been related to
osmolality.
A measure of the total number of particles in a
solution/kg of water.
BARIUM SULFATE
BaSO4 – 1 atom of barium, 1 atom of sulfur and 4 atoms of
oxygen thus it is a compound.
The most common type of contrast used in imaging of
the GI system.
Inert powder composed of crystals (colloidal suspension)
that has a tendency to clump and come out of suspension
(flocculation).
Stabilizing agents such as sodium carbonate or sodium
citrate are used to prevent flocculation.
Atomic number of 56.
BARIUM SULFATE
It absorbs water
Has a high atomic number
It is insoluble in water
It cannot be absorbed by GIT
It is non toxic
It has a relative contraindication in the GIT
TYPES OF BARIUM SULFATE
1. COMMERCIAL
It has flavoring and additives
BARODENSE
BAROSPERSE
BARYTGEN
2. PLAIN BaSo4
Has a very unpalatable taste but its advantage lies in the
fact that it adheres well on the mucosa of the organ
BARIUM SULFATE
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.
Room temperature water (85°-90° F) is recommended by
most experts to produce a more successful examination
with maximal patient comfort.
The RT should never use hot water because it may scald
(burn) the mucosal lining of the colon.
INTRODUCTION TO
CONTRAST MEDIA
IONIC
CM
are contrast agent salts of electrically negatively charged
acids containing iodine that ionizes in solution and
causes more patient discomfort.
high chance of allergic reaction
Urovision
Urografin
Angiografin
Hypaque
Cardio-conray
Conray
Uromiro
Urovist
NON-IONIC
CM
a contrast agent that does not ionize in solution and is
safer, less painful, and better tolerated by the patient.
Trade name - Generic name
Ultravist - Iopromide
Iopamiro - Iopamidol
Omnipaque - Iohexol
Amipaque - Metrizamide
Isovist - Iotrolan
CONTRAST MEDIA
SENSITIVITY TEST
TEST DONE TO CHECK PATIENT TOLERANCE TO
CM.
TO SERVE AS TEST DOSE
1cc OF CONTRAST MEDIUM
ANTIHISTAMINE INJECTED TO PATIENT FOR ANY
ALLERGIC REACTION.
Packaging of Injectible CM
vials - glass container with rubber stopper circled
by a metal band
-vailable in 5-, 20-, 30-, & 50- ml sizes
ampules - made entirely of glass & is always a
single-dose container
SENSITIVITY TEST
1. Scleral Method- one drop of contrast
medium is put into the sclera (white part of
the eyeball)
2. Sublingual Method- one drop of contrast
medium is deposited into the inferior base of
the tongue.
3. Intradermal Method- one cc. of contrast
medium is just beneath the skin
4. Intravenous Method – One cc. of contrast
medium is injected into the vein.
Rules of Giving Contrast
media
6 R’s
Right Drug
Right Amount
Right Time
Right Patient
Right Route
Right Documentation
CONTRAST MEDIA
EFFECTS OF C.M.
1. Histamine imbalance (patient cannot tolerate c.m.)
2. Hemodynamic (occurs during administration of c.m.) –
systemic shock, Myocardial Infarction, Renal Shutdown,
Hypertension, Urticaria
3. Psychosomatic reaction (mild transient effect if patients
are experiencing fatigue or anxiety)
4. Extravasation with burning pain and hematoma.
5. Pyrogenic Reaction
6. Organ Reaction (Chemotoxic and Idiosyncratic)
METHODS OF ADMINESTERING
CM
1. DIRECT METHOD
Barium enema; Retrograde pylography; Cystoscopy
, Arthrography
2. INDIRECT METHOD
a. Oral Method
Contrast media is taken by mouth.
b. Parenteral Method
topical
subcutaneous
intradermal
intramuscular (IM)-deltoid muscle, gluteal muscle
intravenous (IV) - median cephalic vein
-vein at the back of the hand
-vein at the ankle
-vein at the scalp
intrathecal
Categories for CM Reaction
1. Mild/Minor
Non allergic Reaction
Does not require drug or medication
Not life-threatening
Symptoms:
a. Anxiety
b. Light-headedness
c. Nausea/vomiting
d. Metallic taste
e. Mild erythema
f. Warm flush sensation during injection
g. Itching
h. Mild hives
Categories for CM Reaction
2. Moderate/allergic reaction/anaphylactic reaction
Require drug intervention
Symptoms:
a) Urticaria (moderate-severe hives)
b) Laryngeal swelling
c) Bronchospasm
d) Angioedema
e) Hypotension
f) Tachycardia/bradycardia
Categories for CM Reaction
3.) Severe/ Vasovagal reaction
Life-threatening requiring immediate response of medical
emergency team.(code)
Stimulation of the vagus nerve (CN X) by CM causing BP and
heart rate to drop.
Symptoms:
a) Hypotension
b) Bradycardia
c) Cardiac arrhythmias
d) Laryngeal swelling
e) Possible convulsion
f) LOS
g) Cardiac and respiratory arrest
h) No pulse rate – most devastating reaction
Categories for CM
4.) Organ Specific
a) Cardiac system- pulseless electrical activity
b) Respiratory system- pulmonary edema
c) Vascular system- venous thrombosis
d) Nervous system- seizure
e) Renal system- temporary/permanent renal failure
f) Extravasations-leakage of iodinated CM outside of the
vessel and to surrounding tissues.
CONTRAST MEDIA
IMPORTANT DRUGS TO HELP RELIEVE C.M. REACTIONS.
•Ampoule Benadryl (Diphenhydramine HC) –
intramuscular administration. (moderately severe
reactions)
•Antistine – relieves itching and irritation affecting the
eyes within 5-10 mins. After administration and will last up
to 2-6 hrs.
•Epiniphrine – bronchodilator
Extravasations
Response of RT for extravasations:
notify nurse/physician
elevate affected site higher than the heart
cold compresses followed by warm compresses
and document the incident.
TYPES OF RADIOGRAPHIC
CONTRAST STUDY
SINGLE CONTRAST STUDY- use one kind of contrast media
TYPES OF RADIOGRAPHIC
CONTRAST STUDY
DOUBLE CONTRAST STUDY- use to kind of contrast
(Positive and negative CM) media with the same
route.
TYPES OF RADIOGRAPHIC
CONTRAST STUDY
DUAL CONTRAST STUDY- USES TWO KIND OF CM IN A
DIFFERENT MANNER OF INTRODUCTION
EXAMPLE: SIALOGRAPHY STUDY( IGLAUER STUDY) FILL THE
MOUTH WITH AIR AND PUFF THE CHEEKS
MUCOSAL STUDY- USES A SMALL AMOUT OF CM TO COAT
OR POINT THE LINING MEMBRANE OF THE HOLLOW
ORGAN UNDER STUDY( CHOLECYSTOANGIOGRAPHY)
FILLING PHASE STUDY- USES A FULL DOSE OF CM TO STUDY
THE GENERAL OUTLINE SHAPE SIZE AND POSITION AS WELL
AS THE ANATOMICAL COUNTOUR AND PHYSICAL
DEFORMITIES
