1. CONTRAST MEDIUM-1

2. contrast Types of contrast media :
The word contrast media means chemical substance sthat due to its high attenuation of X-ray or differential absorption of X-rays from the surrounding tissues permit clear demonstration of an organs or tubular structure .
Types of contrast media :
1. Intravascular :
A. High osmolar-cm or ionic.
B. Low osmolar or nonionic.
2. Oral.

3. HOCM or ionic: Various HOCM are:
Sodium iodide and sodium acetrizoate (UROKON) were the first ionic contrast media. Later various benzoic acid derivatives were introduced which were combine with Na+ and Meg+
Various HOCM are:
Diatrazoate (urografin)
Iothalmate (Hypaoue)
Metrizoate (Conry)
Iodamide
These are monomeric ionic contrast
RCoo I I + Na R R I

4. HOCM or ionic:
Ionic contrast media are hypertonic with osmolality of per lit wich is 4-7 time more than osmolality of plasma.
Almost all the adverse effect of these contrast media are due to hyper tonicity.
An ideal contrast agent should be :
Non toxic.
Painless to patient.
Low osmolar.
It should not be expensive
The ratio of iodine atoms to ions in HOCM is 3:2

5. Low Osmolar Nonionic Contrast
In order to reduce the osmolarity and increase the ratio of iodin atom to particle in solution dimericionic contrast agent were produced such as ioxgalate.These compound were having 6 iodine atom for two molecules + Na
Coo + Na
MEG
Coo I I I I I I R R R
(Ioversol) I I I
Dimeric Compound
This Agent is low osmolar but ionic
Monomeric
nonionic
Iodine 3:1

6. 3.Iopromide (Ultravist) 4.Ioversol 5 Iotrolon(isovist) 6 .Iodoxinal
ROH
ROH I I I I
ROH R
ROH I I
DIMERIC
NONIONIC
IODINE RITIO
6:1
These Compound are :
1.Iopamidol (Niopam)
2.Iohexol (omnipaque)
3.Iopromide (Ultravist)
4.Ioversol 5 Iotrolon(isovist) 6 .Iodoxinal
These agent have low osmolality as compared to HOMC and fewer side effect.
The only disadvantage is there cost these agent are very expensive.

7. Clinical Applcation Urinary system: Biliary system: IVU \ EU.
Ascending Uretnrography.
Cystography.
Micturating cystouretnorography.
Antegraded Retbograde Pyeldgraph.
Biliary system:
Intravenous cholangiography.
T .Tube cholangiography.
P.T.C
E.R.C.P

8. Clinical Applcation Cardiovascular system : Arteriography. Venography.
Angiocardiography.
Contrast enhanced CT .
Contrast enhanced M.R.I .

9. Minor Reaction / Effect
Moderate adverse effects :
Maintain I / v line
Antihistamine mg paeds 2 mg / kg body wite
Wheeze :
Hydrocortisone 100 I / V , O2 therapy.
Hypotension with bradycardia O2 , I / V Flaid
Atropine 0.6 mg repeat sm total 3 mg.

10. Contrast Media Used In M.R.I
It enhanced the inherent tissue contrast causes T1 and T2 shortening .
Type :
A. Paramagnetic
EX : Gadolinium D.TPA. Causes T1 shortening signal appear bright.
B. Super paramagnetic
EX : Iron oxide manganese for causes T2 shortening signal appear dark .

11. Adverse Reactions Minor : 2. Moderate Reactions : Nausea Vomiting
Sneezing
Urticaria
Pain in arm
Sensation of warmness
2. Moderate Reactions :
Persistant headache
Severe urticaria and bronchospasm
Wheezes abdominal cramps
Hypotension with bradycardia…………
Severe vomiting G

12. Adverse Reactions 3. Severe and life threatening Laryngeal edema
Angioneurotic edema
Hypotension with tachycardia
Anaphylaxis (2nd) severe
Seizure
Cardiac arrest
Pulmonary edema
Unconciousness / no response / pulse less /cardiopulmonary collapse and death

13. Mechanism of contrast media reactions: 1:Over dose 2:Anxiety 3:Chemotoxicity 4:Endothelial damage 5:Release of histamine and other enzymes 6:Anaphylaxis.

14. Risky group of patients to whom HOCM is not recommended.
Extreme age eg infants and old people
Hypertension DM
Asthma
Renal failure
Liver failure
Multiple myeloma
Dehydration

15. MRI contrast media Generally two type of MRI contrast agents
Paramagnetic. Eg Gadolinium and mangnese agents
Gadolinium ion is a paramagnetic agent which has 7 unpaired electrons
It is chelated with DTPA because GAD alone is toxic.It cause T1 shortening due to that T1 weighted image appear bright.Different agents in this group are Gadopentate and Gadodamide.These compound are injected by I/v route

16. MRI cont,
The second group are Superparamagnetic Iron oxide.This agent is specifically used for liver and mainly cause T2 shortening.This has opposing effect and the enhanced area appear black.

17. Adverse effect of MRI contrast
Metalic taste in mouth
Nausea vomitting
Itchin
Nephrogenic fibrosis
Urticaria etc

18. Indication of MRI contrast
CNS tumors
Crdiac imaging
Vascular imaging
Musculoskeletal imaging

19. Ultrasound Contrast agents
Small microbulles
Leovist.Most commonly used
Echovist
Albunex
Echogen

20. Indication Vascular US(Doppler) Harmonic imaging
Sonohysterosalphingography

21. ORAL contraST AGENT .IWater soluble.Gastromiro.It is iopamidol 61% w/v
Gastrographine.It is mixture of sodium and
meglumine diatrozoate 66%w/v

22. Indication Suspected perforation
LOCM is used if aspiration is a possibility
Complications are hypovolumia,pulmonary edema and allergic reaction

23. Barium sulphate Baritop 100 100%w/v for barium follow through
E-Z-HD 250%w/v for barium sallow and barium meal examination.
E-Zpaque 100% w/v for barium follow through
E-Z paque 60% w/v for small boel enema
Plibar 115% w/v for barium enema.

24. Advantages and disadvantages of barium
Barium has excellent coating of mucosa as compared to water soluble contrast.
It is cheap
High mortality if leak occure in to the peritoneal cavity
Make subsequent CT examination difficult

25. Complications
Perforation.The escape of barium in to the peritoneal cavity is dangerous
Aspiration is harmless
Intravasation can result in pulmonary emb

26. Pharmacological agents
Contrast 2
Pharmacological agents

27. Pharmacological agents
Hyoscine –N-butyle bromide(Buscopan)
Adult dose 20mg I/V
It inhibit intestinal motility and gastric secretion
Advantages. Immediate action,short duration of action and it is not expensive
Disadvantages. Blurring of vision,dry mouth,tachycardia and urinary retention.
Contraindications.close angle glaucoma,myasthenia gravis,pyloris stenosis etc
glucogon can be used in these situations

28. Glucogon Adult dose. .3—1mg Childern dose ,5—1microgram/kg
Advantages.more potent smooth muscle relaxant than glucogan,,short duration of action and it do not interfer with ttransit time of bowel
Disadvantages.hypersensetivity teaction is possible,long onset of action and expensive

29. Contraindication of glucogan
Adrenal tumors.glucogan can cause sudden hypertension.if hypertension occure,phentolamine can be used for treatment
Endocrine tumors of pancrease

30. Treatment of contrast media reactions

31. Emergency drugs used in X-ray department
Metacloperamide.For sever vomiting and for fascilitation of barium follow through .
Adrenaline.1:1000 sc or i/m injection.used in cardiac arrest
Atropine.600micg in 1ml.used for treatment of vasovagal shock(hypotension with bradycardia)
Chlorophenirmine.10mg in 1ml.used for sedation and vomiting

32. Drugs Sodium bicarbonate 200ml.used to prevent or treat acidosis
Aminophyline.250mg in 10ml.for the treatment of bronchospasm
Diazepam i/v 10mg.For the sedation and treatment of convulsion
Hydrocortisone 100mg.In any emergency condition.
Dopamine.800mg in 5ml.For treatment of hypotension with tachycardia

33. Drugs Frusemide. For pulmonary edema and diuresis
Nalaxone.400micg in 1ml.used as antidote for morphine.
Protamine sulphate.used as antidote for heparine.
Dextrose5% 50ml.for I/V fluid replacement
Dextrose 50%.as I/V fluid replacement
Normal saline 500ml as fluid replacement.

34. Treatment of toxic reaction of contrast
Angioneurotic edema. I/V line
I/V hydrocortisone
I/V antihistamine
sc adrenaline
Oxygen
Bronchospasm I/V line
Aminophyline
Hydrocortisone
Severe urticaria.antihistamine or sc adrenaline

35. Toxic reactions Hypotension. Elevation of legs
No improvement and bradycardia,then give I/v fluid and atropine
If no improvement and tachycardia,then give I/v fluid or dopamine infusion.