CONTRAST MEDIA

Positive CM

Ba.sulfate Iodine compound

Water soluble CM Solid CM Oily CM

Ionic CM Non-ionic CM Tablets or capsules powder

Negative CM

Air (O2, CO2)

Water soluble contrast mediaWater soluble contrast media

Water soluble contrast media for IV injection

Urographin (most popular).Isovist Telebrex Water soluble contrast media for oral

useGastrographin.Water soluble CM for intra thecal

injection (Myelographic contrast).Iohexol (Omnipaque).UNIT VII 2

Water soluble CM for IV Water soluble CM for IV injectioninjectionIntravenous Urography.All CT examination using contrast

material.- CT chest (while fasting).- CT abdomen and pelvis.- CT angiography of any vessel. Carotid

Pulmonary Aorta Lower limb vessels Coronary vessels.

UNIT VII 3

Water soluble contrast media Water soluble contrast media for intra- thecal injectionfor intra- thecal injectionCervical myelography.Dorsal myelography.Lumber myelography.

N.B. The usage of myelography is so limited because the great advances of MRI

UNIT VII 4

Water soluble contrast media Water soluble contrast media used for any canal or duct used for any canal or duct opacificationopacification

Evaluation of the salivary gland (Sialography).

Evaluation of the Urethera and Urinary bladder (Cysto urethrography).

Evaluation of the uterus and tubes (Hystero salpingiography).

Injection of any external opening in the skin (Fistulography).

UNIT VII 5

H.S.G

Vascular And Urographic C.M. Vascular And Urographic C.M.

• They are organic iodine compounds.They are organic iodine compounds.• Iodine has an atomic number of 53 Iodine has an atomic number of 53

** They form the major positive contrast They form the major positive contrast

media used in diagnostic imaging media used in diagnostic imaging

* * They are categorized as: They are categorized as: (a) high osmolality, (a) high osmolality,

(b) low osmolality contrast media (b) low osmolality contrast media

What is Osmolality?What is Osmolality?Osmolality is a variation of molality that

only takes into account solutes that contribute to a solution's osmotic pressure.

In chemistry, the molality, of a solution is defined as the amount of substance (in mol) of solute, , divided by the mass (in kg) of the solvent, (not the mass of the solution).

It is measured in osmoles of the solute per kilogram of water.

UNIT VII 7

The high osmolality contrast The high osmolality contrast mediamedia

-- (HOCM) have very high osmolalities (HOCM) have very high osmolalities e.g., of 1200-2000 mosmo /kg e.g., of 1200-2000 mosmo /kg (about 4-7 times the osmolality (about 4-7 times the osmolality of cell and tissue fluid )and are of cell and tissue fluid )and are hypertonic. hypertonic.

--They are solution of the sodium They are solution of the sodium and /or meglumine salts of and /or meglumine salts of monomeric tri-monomeric tri-

iodinated substituted benzoic acids iodinated substituted benzoic acids e.g., e.g.,

Diacetrizoic, iothalmic, or metrizoic Diacetrizoic, iothalmic, or metrizoic acids acids

-These salts are dissociate, -These salts are dissociate, completely in solution, each completely in solution, each molecule providing one cation and a molecule providing one cation and a large organic iodine containing anion. large organic iodine containing anion. Hence another name for these HOCM Hence another name for these HOCM is “Ionic contrast media”. Both anion is “Ionic contrast media”. Both anion and cation have equal osmolar and cation have equal osmolar effects but only the anion is effects but only the anion is radiopaque radiopaque

-Many of the adverse effects of -Many of the adverse effects of contrast media are the result of high contrast media are the result of high osmolality.osmolality.

The Low Osmolality Contrast The Low Osmolality Contrast Media Media The low osmolality contrast media The low osmolality contrast media

(LOCM) have an osmolality ranging (LOCM) have an osmolality ranging from 291-702 mosm /kg.from 291-702 mosm /kg.

These are non- ionic dimmers which These are non- ionic dimmers which have a ratio of six iodine atoms for have a ratio of six iodine atoms for each molecule in the solution.each molecule in the solution.

The terms low osmolar and non-The terms low osmolar and non-osmolar are not synonymous. The osmolar are not synonymous. The major difference between the two major difference between the two groups is that ionic contrast media groups is that ionic contrast media cannot be used in the sub-arachnoids cannot be used in the sub-arachnoids space.space.

The osmolality was eliminated or The osmolality was eliminated or reduced by reducing the number of reduced by reducing the number of the cation in these contrast media the cation in these contrast media which does not contribute to the which does not contribute to the radiopacity, but is responsible for up radiopacity, but is responsible for up to 50% of the osmotic effect (Toxicity to 50% of the osmotic effect (Toxicity of C.M.).of C.M.).

The ratio of iodine atom in the The ratio of iodine atom in the molecule to the number of particles molecule to the number of particles in solution is 3:2 for HOCM compared in solution is 3:2 for HOCM compared to 3:1 in LOCM. to 3:1 in LOCM.

The LOCM include iohexol The LOCM include iohexol (Omnipaque),(Omnipaque),

iopamidol (isovue), iopromide, and iopamidol (isovue), iopromide, and ioversol.ioversol.

XENETIX®300Xenetix® )lobitridol( is a non-ionic, low osmolality iodinated contrast agent indicated for whole-body imaging in adults and children. It is also indicated for conventional

intravascular and cardiac imaging.حساسية هناك يكون عندما يستخدميكون هنا المؤين اليود من المريض لدى

حر أيون وليس مركب اليود

TELEBRIX®Telebrix® )loxitalamate( is an ionic, high osmolality iodinated contrast agent, which is available over a broad range of concentrations with vascular and non-vascular indications.

Ionic and Non Ionic water soluble Ionic and Non Ionic water soluble CM for IV injectionCM for IV injection

Intravenous UrographyIntravenous UrographyRenal colicRenal painRenal massHematuria

UNIT VII 13

Normal IVU The collecting systems ureter and bladder

Urographic pathologyUrographic pathology

Horseshoe kidney

UNIT VII 14

Delayed contrast excretion due to ureteric Delayed contrast excretion due to ureteric stonestone

Renal stoneRenal cell carcinoma

UNIT VII 15

CT Renal CT Renal angiographyangiographyCystogramEvaluation of the bladder

UNIT VII 16

Before micturation

Cytogram before and after Cytogram before and after voidingvoiding

UNIT VII 17

Factors Influencing The choice of Factors Influencing The choice of Contrast Media Contrast Media 1. Appropriateness:1. Appropriateness:

The C. M. chosen should be appropriate for The C. M. chosen should be appropriate for the necessary examination or investigation the necessary examination or investigation e.g. e.g.

- - Barium-sulphate for Barium meal,Barium-sulphate for Barium meal,

- - Omnipaque for myelogramOmnipaque for myelogram

2.Acheivable radio-opacity:2.Acheivable radio-opacity:

The contrast medium should provide the The contrast medium should provide the desirable degree of radio- opacity.desirable degree of radio- opacity.

myelogram

Barium meal

myelogram

3.Toxicity and /or side effects:3.Toxicity and /or side effects: The contrast medium must be safe and non-The contrast medium must be safe and non-

toxic both locally where it is administered and toxic both locally where it is administered and elsewhere in the body that it may reach. elsewhere in the body that it may reach.

i.e. it should not produce any unwanted effect i.e. it should not produce any unwanted effect on the body in general. on the body in general.

4. Viscosity:4. Viscosity: For some examinations such For some examinations such

angiocardiographyangiocardiography a relatively low viscosity is desirable to a relatively low viscosity is desirable to

enable rapidenable rapid injection of a large volume of contrast injection of a large volume of contrast

medium . medium .

Toxicity

Viscosity

side effects

angiocardiography

For examinations where the contrast medium is injected For examinations where the contrast medium is injected and stays in the organ or dissipates slowly from it and stays in the organ or dissipates slowly from it (e.g. (e.g. H.S.G.)H.S.G.) , a more viscous contrast medium can be used. , a more viscous contrast medium can be used.

5. Cost:5. Cost: The c. m. should be reasonably priced and The c. m. should be reasonably priced and affordable.affordable. 6. Persistence:6. Persistence: Some contrast may remain in the body for Some contrast may remain in the body for several years and are thus of use in assessingseveral years and are thus of use in assessing progress by continuing to show any change in progress by continuing to show any change in the size of the contrast filled lesion without furtherthe size of the contrast filled lesion without further injection. injection.

7. Miscibility7. Miscibility: :

For some examinations like cyst For some examinations like cyst puncture, the contrast should mix with puncture, the contrast should mix with the fluid into which it is injected. the fluid into which it is injected.

In other words it should mix with the In other words it should mix with the body fluid body fluid e.g. CSF and urine ).e.g. CSF and urine ).

Reactions to contrast mediaReactions to contrast mediaFlushing

(1) Minor reaction:-(1) Minor reaction:- NauseaNausea Urticaria.Urticaria.Sneezing.Sneezing.Flushing.Flushing.Nausea.Nausea.Vomiting. Vomiting.

SneezingSneezing

No, treatment is usually required. No, treatment is usually required.

(2)Major reaction:-(2)Major reaction:-Requires treatment.Requires treatment.They are life-threatening, severe They are life-threatening, severe

reactionsreactionswhich cause real danger and for which which cause real danger and for which

swift treatment is so important. swift treatment is so important. Most such reactions occur within five Most such reactions occur within five

minutes of the injection and the great minutes of the injection and the great majority within thirty minutes so that a majority within thirty minutes so that a doctor should be at hand for this period doctor should be at hand for this period whenever an injection of contrast media whenever an injection of contrast media has been given.has been given.

Major reactions include:-Major reactions include:-

(a) Bronchospasm-wheezing.(a) Bronchospasm-wheezing.(b) Laryngeal(b) Laryngealالحنجرةالحنجرة angioneurotic oedema angioneurotic oedema

..تضخمتضخم(c ) Vascular collapse and lose of (c ) Vascular collapse and lose of

consciousnessconsciousness(d) Cardiac arrest.(d) Cardiac arrest.(e) Respiratory failure.(e) Respiratory failure.Treatment of major reaction dependent on Treatment of major reaction dependent on

immediate availabity of the following:- immediate availabity of the following:-

*The necessary expertise. *The necessary expertise.

The role of the Radiological The role of the Radiological Technologist in case of Technologist in case of emergencyemergency

1)1) Know how to call for help without Know how to call for help without leaving the patient and the room. leaving the patient and the room.

2)2) Know where the nearest supply of Know where the nearest supply of oxygen and how to administer it. oxygen and how to administer it.

3)3) Know how to call the “crash team” and Know how to call the “crash team” and to communicate with the radiologist. to communicate with the radiologist.

4)4) Know where the emergency drugs and Know where the emergency drugs and the key to the drug cupboard/trolleythe key to the drug cupboard/trolley. .

BASIC & Advanced life supportsBASIC & Advanced life supports and emergency equipment.and emergency equipment.

Basic life support (CPR i.e. cardio-pulmonary Basic life support (CPR i.e. cardio-pulmonary Resuscitation.Resuscitation.

Advance life support (Endotracial and Advance life support (Endotracial and Defibrillator).Defibrillator).

Emergency equipment:-Emergency equipment:-1) Oxygen and equipment for artificial 1) Oxygen and equipment for artificial

ventilation.ventilation.2) Drugs.2) Drugs.3) Equipment. 3) Equipment.