1 Radiographic Contrast Media RAD TECH 255 RAD TECH 255 SPECIAL PROCEDURES SPECIAL PROCEDURES...

11

RadiographicRadiographicContrast MediaContrast Media

RAD TECH 255RAD TECH 255

SPECIAL PROCEDURESSPECIAL PROCEDURESWEBPAGE VERSIONWEBPAGE VERSION

MERRILLS VOL2MERRILLS VOL2

RTA BOOK RTA BOOK

REV: SPRING 2010REV: SPRING 2010

22 Subject ContrastSubject Contrast

Range of differences in the intensity of the x-ray beam, after it has been attenuated by the subject (patient).

For LOW CONTRAST stucures: What can be done to attain medical information- see

the difference between muscle, organs or vessels Define and outline – organ structure and function

CONTRAST MEDIA used to:CONTRAST MEDIA used to: enhanceenhance subject contrast or render high subject subject contrast or render high subject

contrast in a tissue that normally has low subject contrast in a tissue that normally has low subject contrastcontrast

33

Contrast mediaContrast media

Defines subtle differences in subject Defines subtle differences in subject contrast contrast

Increases atomic number of area injectedIncreases atomic number of area injected

Results in a SHORTER scale of subject Results in a SHORTER scale of subject contrastcontrast

44 Radiographic Contrast : Radiographic Contrast :

Influenced by…Influenced by…Radiation Quality (KVP)Radiation Quality (KVP)Film ContrastFilm ContrastRadiographic object (Patient)Radiographic object (Patient)

Atomic NumberAtomic NumberFat = 6.46Fat = 6.46Water = 7.51Water = 7.51Muscle = 7.64Muscle = 7.64Bone = 12.31Bone = 12.31

55

KVPKVP TYPE OF CONTRAST USED DETERMINES KVP RANGE

BARIUM _______kVp

IODINES ________kVp(Ionic / Nonionic Water or Oil)

66

INJECTABLEINJECTABLECONTRAST MEDIACONTRAST MEDIA

for RT 255 proceduresfor RT 255 procedures

INVASIVE PROCEDURESINVASIVE PROCEDURES

The “o-grams”The “o-grams”

77ALWAYS TAKE

A “SCOUT”

BEFORE CONTRAST INJECTION

Why?

List 4 reasons

88

SPECIAL “o-grams”SPECIAL “o-grams”

VenogramVenogramArthrogramArthrogramSialogramSialogramMyelogramMyelogramArteriogramArteriogramAngiogramAngiogramGalactogramGalactogramHystersalpingogram…….. etcHystersalpingogram…….. etc

99

CONTRAST INJECTIONCONTRAST INJECTION

KNEE ARTHROGRAM

1010DOUBLE CONTRAST WITH IODINE - DOUBLE CONTRAST WITH IODINE - HIP ArthrogramHIP Arthrogram

1111To check fertilityTo check fertility

can be oil or water based contrastcan be oil or water based contrast

1212

MyelogramMyelogram

1313

Myelogram ContrastMyelogram Contrast

Pantopaque was introduced in 1944 as a Pantopaque was introduced in 1944 as a oil contrast medium oil contrast medium

The first low-osmolar contrast medium to The first low-osmolar contrast medium to be produced was metrizamide (Amipaque)be produced was metrizamide (Amipaque)

Oil never completely re –absorbedOil never completely re –absorbed (Pre-employment L.sp)(Pre-employment L.sp)

1414

SIALOGRAMSIALOGRAM

1515 Galactography - Galactography - Breast Breast Duct Duct

1616

Cerebral AngiogramCerebral Angiogram

1818

LYMPHANGIOGRAMLYMPHANGIOGRAM

Now largely replaced by ________ ?

1919

DacryocystographyDacryocystography

Now largely replaced by CT

2020SPECIAL PROCEDURESSPECIAL PROCEDURES

ARE ARE INVASIVEINVASIVE

ALWAYSALWAYS GET PATIENT’S GET PATIENT’S HISTORY AND CONSENTHISTORY AND CONSENT

BEFORE BEGINNING BEFORE BEGINNING

OR GIVINGOR GIVING ANY ANY CONTRAST MEDIACONTRAST MEDIA

2121

CONSENTSCONSENTS

SIGNED AND WITNESSEDSIGNED AND WITNESSEDAFTER PROCEDURE HAS AFTER PROCEDURE HAS

BEEN EXPLAINEDBEEN EXPLAINEDCHECK DEPARTMENT CHECK DEPARTMENT

PROTOCOLPROTOCOLWHO’S RESPONSIBLE ??????WHO’S RESPONSIBLE ??????

2222

CONSENTSCONSENTS

ASSAULT ASSAULT

verbal threat of harmverbal threat of harmBATTERYBATTERY

Unlawful touching - unauthorized treatmentUnlawful touching - unauthorized treatment

““X-RAY” TAKEN ON WRONG PATIENTX-RAY” TAKEN ON WRONG PATIENTFALSE IMPRISONMENTFALSE IMPRISONMENT

Restraints require permissionRestraints require permission

from patient or authorized personfrom patient or authorized person

2323

The ARRT has a The ARRT has a published code of ethics.published code of ethics.

The ARRT Code of Ethics provides the The ARRT Code of Ethics provides the radiologic technologist with an operational radiologic technologist with an operational blueprint of norms of professional conduct.blueprint of norms of professional conduct.

2424Review of EthicsReview of Ethics

(Pt Care Book –Professional Ethics)(Pt Care Book –Professional Ethics)

The science of rightness and wrongness of The science of rightness and wrongness of human conduct and character is termed human conduct and character is termed ethics. ethics.

____________________is the ethical principle that is the ethical principle that means that “above all, do no harm.”means that “above all, do no harm.”

__________________ principle that means that principle that means that being truthful is right.being truthful is right.

____________________ is the ethical principle that is the ethical principle that means that actions benefit others.means that actions benefit others.

2525

Review of Contrast AgentsReview of Contrast Agents

Types of ContrastTypes of Contrast

Routes of AdminstrationRoutes of Adminstration

Chemical ComponentsChemical Components

2626Contrast Media changes the Contrast Media changes the

density of the organsdensity of the organsTherefore changing the

Subject contrast

will change the

Radiographic contrast and film contrast

May need to INCREASE TECHNIQUE FROM SCOUT IMAGE* f/s

2727

Contrast Media Contrast Media (review)(review)

Negative contrastNegative contrast (AIR OR CO2)(AIR OR CO2)

RadiolucentRadiolucent

Low atomic # materialLow atomic # material

Black on filmBlack on film

Positive contrastPositive contrast (all others)(all others)

RadiopaqueRadiopaque

High atomic # High atomic # materialmaterial

White on filmWhite on film

2828 Types of Contrast MediaTypes of Contrast Media

Radiolucent-Radiolucent- negative contrast agentnegative contrast agent x-rays easily penetrate x-rays easily penetrate areas- appear areas- appear ________ on films on films

Negative Contrast MediaNegative Contrast Media Air and gasAir and gas

complicationscomplications emboli-air pockets in emboli-air pockets in

vesselsvessels lack of oxygenlack of oxygen

Radiopaque- Radiopaque- positive contrast agent- positive contrast agent- absorbs x-raysabsorbs x-rays areas- appear areas- appear ________ on films on films

Positive Contrast AgentsPositive Contrast Agents BARIUM BARIUM IODINESIODINES

Both + & - can be used in same Both + & - can be used in same studystudy

2929 2 BASIC 2 BASIC TYPESTYPESOF CONTRAST materialOF CONTRAST material

BARUIM BARUIM Z# 56 Z# 56

NON WATER NON WATER SOLUABLESOLUABLE

GI TRACT ONLY GI TRACT ONLY INGESTED OR INGESTED OR RECTALLYRECTALLY

KVP 90 – 120*KVP 90 – 120*

IODINE IODINE Z# 53 Z# 53 WATER SOLUABLEWATER SOLUABLE POWDERPOWDER LIQUIDLIQUID INTRAVENOUS ORINTRAVENOUS OR IntrathecalIntrathecal GI TRACTGI TRACT Also OIL basedAlso OIL based KVP BELOW 90*KVP BELOW 90*

3030Methods of AdministrationMethods of Administration

of Contrast Materialof Contrast MaterialINGESTED INGESTED

(ORAL)(ORAL)

RETROGRADE RETROGRADE AGAINST NORMAL FLOWAGAINST NORMAL FLOW

INTRATHECAL INTRATHECAL Spinal canalSpinal canal

PARENTERAL (IV, Intrathecal)PARENTERAL (IV, Intrathecal)Injecting into bloodstreamInjecting into bloodstream(anything other than oral)(anything other than oral)

3131Contrast media for Contrast media for

SPECIAL PROCEDURESSPECIAL PROCEDURES

Diagnostic agents

that are injected intoCirculatory System, Joint Spaces, DuctsCirculatory System, Joint Spaces, Ducts

Body orifices/organs: uterus, breast, Body orifices/organs: uterus, breast,

salivary & lymph glandssalivary & lymph glands

3232 BLOOD WORKBLOOD WORK LAB TESTS to check function of kidneys LAB TESTS to check function of kidneys

prior to injection of contrastprior to injection of contrast WATCH THE UPPER LIMITSWATCH THE UPPER LIMITS BUN = BLOOD UREA NITROGENBUN = BLOOD UREA NITROGEN Merrills Merrills pg 214pg 214 range is range is 8 to 258 to 25 pg 242pg 242 range is range is 10 - 20 10 - 20

always check with RAD when level above always check with RAD when level above 2020

CREATININE levels rangeCREATININE levels range:: pg 214pg 214 (0.6 - 1.5)(0.6 - 1.5) pg 242pg 242 (0.05 - 1.2) (0.05 - 1.2)

always check with RAD when level above always check with RAD when level above 1.21.2

Indicates function of kidneys Indicates function of kidneys Diseases / dehydration / kidney failureDiseases / dehydration / kidney failure

3333

EGFR (new test)EGFR (new test)

Estimated Estimated Glomerular Glomerular Filtration Filtration RateRate

More advanced test for More advanced test for CREATININE levelsCREATININE levelsWhy is this important?Why is this important?

3434various water-soluble contrast media for

urography and angiography

Both ionic and non-ionic Both ionic and non-ionic monomers*monomers*are all extracellular contrast mediaare all extracellular contrast mediaare excreted unmetabolized by glomerular are excreted unmetabolized by glomerular

filtrationfiltrationApproximately 85-90% of the injected Approximately 85-90% of the injected

dose is found in urine within the first 6 dose is found in urine within the first 6 hourshours

95-100% within the first 24 hours95-100% within the first 24 hours

3535monomers*monomers*

The ionic monomeric agents are salts thatThe ionic monomeric agents are salts thatdissociate into two moleculesdissociate into two moleculesone anion containing the radiopaque one anion containing the radiopaque

property due to three iodine atomsproperty due to three iodine atomsand one cation without radiopaque and one cation without radiopaque

propertiesproperties

More on this later in the lecture…..More on this later in the lecture…..

3636

BARIUM – BARIUM – a reviewa review

BARUIM SULFATEBARUIM SULFATE

Not used in Special ProceduresNot used in Special Procedures

3737

Barium SulfateBarium Sulfate

High atomic number High atomic number Z #? ______Z #? ______Not soluble in waterNot soluble in waterUsed to coat the lining of organsUsed to coat the lining of organsSupplied in different thicknessesSupplied in different thicknessesUsedUsed

Esophogram, UGI, Small Bowel,Lower Esophogram, UGI, Small Bowel,Lower GI or BEGI or BE

3838

BaBa ADVERSE REACTIONS ADVERSE REACTIONS

BARIUM INERTBARIUM INERTSUSPENSION MAY CAUSE ALLERGYSUSPENSION MAY CAUSE ALLERGYOCG TABLETS (IODINE) ALLERGYOCG TABLETS (IODINE) ALLERGYAFTER EXAM – MAY SOLIDIFY AFTER EXAM – MAY SOLIDIFY

DIFFICULT TO EVACUATEDIFFICULT TO EVACUATE INCREASE FLUIDS, MILD LAXATIVEINCREASE FLUIDS, MILD LAXATIVEEXTRAVASATION OF CONTRAST INTO

PERITONEUM

3939

Extravasation of BA in abdExtravasation of BA in abd

4040

Ingested CONTRASTIngested CONTRASTGastrografin or HypaqueGastrografin or Hypaque

High atomic #High atomic # Close to iodineClose to iodine

Water solubleWater soluble

Similar usage as Similar usage as BariumBarium

4141GASTROGRAFINGASTROGRAFINAdverse ReactionsAdverse Reactions

Water soluble, safe in the abdominal Water soluble, safe in the abdominal cavitycavitySafe to use if perforation is Safe to use if perforation is

suspectedsuspected Very harmful to the lung tissueVery harmful to the lung tissue

Do not use if aspiration is possibleDo not use if aspiration is possible

4242

Gastro – Pathology presentGastro – Pathology present

Bowel Bowel ObstructionObstruction

Note contrastNote contrast Seen in Seen in

kidneys as kidneys as wellwell

4343

IODINEIODINEIONIC OR NON IONICIONIC OR NON IONIC

WATER OR OIL BASEWATER OR OIL BASE

4444IODINATED CONTRASTIODINATED CONTRAST

iodine z # 53iodine z # 53 WATER BASEDWATER BASED

INJECTEDINJECTED VESSELLS/DUCTSVESSELLS/DUCTS INGESTEDINGESTED Organ function/flowOrgan function/flow OPEN WOUNDSOPEN WOUNDS

OIL BASEDOIL BASED INJECTEDINJECTED NEVER NEVER

VESSELLSVESSELLS ONLY DUCTSONLY DUCTS NOT INGESTEDNOT INGESTED OPEN WOUNDSOPEN WOUNDS

4545INJECTION OF INJECTION OF IODINEIODINE

into Vesselsinto Vessels ALWAYS A ALWAYS A WATER WATER

BASED IODINATED BASED IODINATED COMPOUNDCOMPOUND

BOLUS INJECTIONBOLUS INJECTION INFUSION DRIPINFUSION DRIP

IONIC VSIONIC VS NON IONICNON IONIC CONTRASTCONTRAST

50 -70 % 50 -70 % CONCENTRATECONCENTRATE

4646IODINE WATER BASED IODINE WATER BASED

CONTRASTCONTRAST IONICIONIC LESS $$$LESS $$$

MORE REACTIONSMORE REACTIONS

NON IONICNON IONIC MORE $$$MORE $$$

LESS REACTIONSLESS REACTIONS

4747CONTRAST MEDIACONTRAST MEDIA

IODINEIODINE

is either: IONIC or NON-IONIC is either: IONIC or NON-IONIC OsmolarityOsmolarity# Of Particles (Cations + And Anions -) # Of Particles (Cations + And Anions -)

In Solution Per Kilogram Of WaterIn Solution Per Kilogram Of WaterHigh OsmolarityHigh Osmolarity

=more Cations And Anions=more Cations And AnionsCan Upset HomeostasisCan Upset HomeostasisNonionic Have No Charged ParticlesNonionic Have No Charged Particles

4848

Contrast AgentsContrast AgentsIONICIONICHigh Osmolality High Osmolality

(Higher risk of (Higher risk of complications) complications)

Diatrizoate sodium Diatrizoate sodium (Hypaque) (Hypaque)

Iothalamate Iothalamate meglumine meglumine (Conray) (Conray)

NON-IONICNON-IONICLow Osmolality Low Osmolality

(Lower risk of (Lower risk of complications) complications)

Gadodiamide Gadodiamide (Omniscan) (Omniscan) Iodixanol Iodixanol

(Visipaque) (Visipaque) Iopamidol (Isovue) Iopamidol (Isovue) Iopromide Iopromide

(Ultravist) (Ultravist) Ioversol (OptirayIoversol (Optiray) )

4949

Less moneyLess money More reactionsMore reactions

More moneyMore money Less reactionsLess reactions

5050OIL – BASEDOIL – BASED

IODINE CONTASTIODINE CONTAST

Instilled in ORGAN – Instilled in ORGAN – Not vessellsNot vessells

Oil-based iodine contrast media Oil-based iodine contrast media

are made from fatty acidsare made from fatty acids

of poppy seed oil containing 48% and 37% iodine of poppy seed oil containing 48% and 37% iodine

5151Oil Based IodineOil Based Iodine

Fatty AcidsFatty Acids Insoluble in waterInsoluble in water

White on the radiograph = RadiopaqueWhite on the radiograph = Radiopaque UsesUses

Broncography (lungs)Broncography (lungs) Tear ductsTear ducts Salivary glandsSalivary glands Lymphatic systemLymphatic system HysterrosalpingogramHysterrosalpingogram Galactography (breast ducts)Galactography (breast ducts)

FAT EMBOLUS FAT EMBOLUS IF IT GETS INTO IF IT GETS INTO BLOOD VESSELBLOOD VESSEL

5252CONTRAST MEDIACONTRAST MEDIA

CHEMICAL PROPERTIESCHEMICAL PROPERTIESTRIIODINATED COMPOUNDSTRIIODINATED COMPOUNDSBASED ON THE BENZOID ACID RINGBASED ON THE BENZOID ACID RING

IODINE IS USED DUE TO THE HIGH IODINE IS USED DUE TO THE HIGH ATOMIC NUMBERATOMIC NUMBER

5353

The benzene ring is associated with the anion.The benzene ring is associated with the anion.

5454 CONTRAST MEDIACONTRAST MEDIA IONIC CONTRASTIONIC CONTRAST

NON IONIC NON IONIC CONTRASTCONTRAST

5555 Iodine Contrast MaterialIodine Contrast Material

Ionic ContrastIonic Contrast Anion -Anion - Cation +Cation + More patient allergic reactionsMore patient allergic reactions

Ionic contrast media Ionic contrast media dissociates into two dissociates into two molecular particles in blood molecular particles in blood plasma =plasma =

Causing pt reactionsCausing pt reactions The benzene ring is The benzene ring is

associated with the anion.associated with the anion.

•Non-Ionic Contrast

•Less patient allergic reactions

Nonionic contrast media is associated with low osmolality.

5656

Iodine Contrast MaterialIodine Contrast Material

ANIONS ANIONS - CHARGE IONS- CHARGE IONS Responsible For Responsible For

Stabilizing And Stabilizing And Detoxifying The Detoxifying The Contrast MediaContrast Media

CATIONSCATIONS + CHARGED IONS+ CHARGED IONS Responsible For Responsible For

Increasing The Increasing The Solubility Of The Solubility Of The MediumMedium

The benzene ring is associated with the ________ ?The benzene ring is associated with the ________ ?

5757Newer Contrast Newer Contrast Agents BalanceAgents Balance

Safety and Visualization Safety and Visualization

•In addition to osmolality, toxicity is a concern

•Although the mechanism of contrast medium toxicity is not completely understood

•it is believed that "chemotoxicity" is related to the protein-binding capacity of the medium,

•which is caused by non-specific weak interactions between the contrast medium and surrounding enzymes.

5858What contributes to What contributes to

discomfort, side effects, reactions:discomfort, side effects, reactions:VISCOSITYVISCOSITY – (thick, sticky) – (thick, sticky)

thicker – harder to inject, more heat and thicker – harder to inject, more heat and vessel irritation (higher = greater viscosity)vessel irritation (higher = greater viscosity)

Warming contrast will helpWarming contrast will helpTOXICITYTOXICITY - (higher = greater viscosity) - (higher = greater viscosity)MISCIBILITY MISCIBILITY - easily mixes with blood- easily mixes with bloodOSMOLALITY - OSMOLALITY - is a measure of the total is a measure of the total

number of particles in solution.number of particles in solution.

5959Iodinated CONTRAST AGENTSIodinated CONTRAST AGENTS

Adverse ReactionsAdverse ReactionsOsmolarities higher than body fluidsOsmolarities higher than body fluidsViscousViscousGreater chance for contrast reactionsGreater chance for contrast reactionsAnaphylatic shock is the most severeAnaphylatic shock is the most severeInjection of ionic contrast media may Injection of ionic contrast media may

lead to lead to hypovolemia.hypovolemia.

6060HypovolemiaHypovolemia

basically means low blood volume basically means low blood volume Symptoms of hypovolemia may includeSymptoms of hypovolemia may include

cold hands and feet, light headedness, infrequent cold hands and feet, light headedness, infrequent urination, increased heart rate, and weakness.urination, increased heart rate, and weakness.

Low blood volume can result in multiple organ Low blood volume can result in multiple organ failure, kidney damage, brain damage, and deathfailure, kidney damage, brain damage, and death

hypovolemiahypovolemia differs from dehydration (which is differs from dehydration (which is excessive loss of body waterexcessive loss of body water

hypovolemiahypovolemia can lead to dehydration can lead to dehydration

6161

Hypovolemia is the Hypovolemia is the most common causemost common cause

ofofOrthostatic hypotensionOrthostatic hypotension

What? __________ What? __________

6262

High osmolality of the contrast media is related to adverse reactions.

6363CONTRAST MATERIALCONTRAST MATERIALADVERSE REACTIONSADVERSE REACTIONS

ALWAYSALWAYS GET PATIENT’S GET PATIENT’S HISTORY BEFORE HISTORY BEFORE ANYANY CONTRAST MEDIA IS CONTRAST MEDIA IS

GIVENGIVEN

SEE Ch. 19 Table 19-7 pg 296 SEE Ch. 19 Table 19-7 pg 296 Carlton Pt Care Carlton Pt Care (3 (3RDRD ed) ed)

6464

Reaction classificationReaction classification

Immediate reactionsImmediate reactions were defined as were defined as those occurring within the department those occurring within the department (within one hour)(within one hour)

DelayedDelayed as those occurring between the as those occurring between the time the patients left the department and time the patients left the department and up to seven days later up to seven days later

6565

Delayed Side Effects to ContrastDelayed Side Effects to Contrast

Skin effects included itching, Skin effects included itching, rash, and hives. rash, and hives.

Nausea, vomiting, and Nausea, vomiting, and diarrhea were the diarrhea were the gastrointestinal side effectsgastrointestinal side effects

General side effects included General side effects included headache, dizziness, and headache, dizziness, and fever.fever.

Infants and patients older than 60 years are at increased risk of developing a side effect.

6666General Factors for General Factors for Contrast ReactionsContrast Reactions

Nonionic vs ionicRisk FactorsSeverity of ReactionsRenal toxicity

Glucophage Diabetic?

Screening Creatinine Pretreatment

6767CONTRAST MEDIA CONTRAST MEDIA

& ADVERSE REACTIONS& ADVERSE REACTIONSRISK RISK Any foreign substance introduced in the Any foreign substance introduced in the

body body Chance the body will react negatively to Chance the body will react negatively to

the materialthe materialMinor to Life ThreateningMinor to Life Threatening

Minor = 5% Major 0.1%Minor = 5% Major 0.1%

6868

GOOD PATIENT HISTORYGOOD PATIENT HISTORY

Kidney problemsKidney problems DiabetesDiabetes Heart conditionsHeart conditions AllergiesAllergies AsthmaAsthma

Previous reactionPrevious reaction Current medicationsCurrent medications Beta BlockersBeta Blockers Antihypertensive Antihypertensive

medicationsmedications

VITAL SIGNSVITAL SIGNS

6969

CONTRAST REACTIONSCONTRAST REACTIONS

General General

> 10 million diagnostic procedures > 10 million diagnostic procedures

per year per year Conventional ionic contrast Conventional ionic contrast

reactions - 10% reactions - 10% 1 in 1000 severe1 in 1000 severe

7070

Contraindiatons for ContrastContraindiatons for Contrast

Renal Failure (Check BUN & Creatinine)Renal Failure (Check BUN & Creatinine) Elevated levels could cause renal Elevated levels could cause renal

shutdownshutdown

Anuria (no urine production)Anuria (no urine production)Asthma (possible allergies)Asthma (possible allergies)Hx of Contrast Allergy / ReactionsHx of Contrast Allergy / ReactionsDiabetes - get a hx of medications takenDiabetes - get a hx of medications taken

glucophage must be stopped 48 hrs before contrast injectionglucophage must be stopped 48 hrs before contrast injection

Multiple Myeloma Multiple Myeloma

7171 MORE Risk Factors MORE Risk Factors for Contrast Reactionfor Contrast Reaction

Older patient age Older patient age

Allergic Rhinitis, medication or Food Allergic Rhinitis, medication or Food AllergyAllergy

Cardiovascular disease Cardiovascular disease

WHO are at increased risk of developing a side effect? (2 age classifications?)

7272

CONTRAINDICATIONSCONTRAINDICATIONS

Pregnancy (Pregnancy (risk of fetal Thyroid toxicity)

+ Radiation concerns

Allergic Reaction Pathologic Conditions Infection

7373

Allergic to IodineAllergic to Iodine

General Rule: General Rule: No Iodine Contrast will be No Iodine Contrast will be

givengivenPre – medication is Pre – medication is

availableavailableMay or may not react if May or may not react if

previous iodine givenprevious iodine given

7474

Aseptic Technique for injectionAseptic Technique for injection

betadine scrub

Contains iodine

7676

REACTIONS & Treatment

USUALLY** WITHIN FIRST 5 MINUTES Nausea & Vomiting & Urticaria Hypotension (bradycardia) Hypotension (tachycardia) Bronchospasm Anaphylactoid Seizures Extravasation

7777 Categories of Adverse Reactions

MILDMILD Carlton – Patient Care Book:

Vol 3 Ch. 19 pg 297 or Vol 4 Ch. 20 pg 337

nausea, vomitingnausea, vomitingUticaria (hives) rash – itchingUticaria (hives) rash – itchingFlush face – feeling of warmthFlush face – feeling of warmthHeadace, Chills, AnxietyHeadace, Chills, AnxietyDiaphoresis Diaphoresis

Treatment – does not usually get worse Treatment – does not usually get worse

Watch patient and reassureWatch patient and reassure

(cool cloth on forehead, emesis basin(cool cloth on forehead, emesis basin

7878 Catagories of Adverse ReactionsCatagories of Adverse Reactions

MODERATEMODERATE Carlton Carlton Pt CarePt Care

Hypotension (Hypotension (bradycardiabradycardia)) Hypertension (tachycardia)Hypertension (tachycardia) DyspneaDyspnea Bronchospasms /wheezingBronchospasms /wheezing Laryngeal EdemaLaryngeal EdemaTREATMENT:TREATMENT:Needs immediate treatment –GET RN/RADNeeds immediate treatment –GET RN/RADNeeds Meds* – (Keep IV line in)Needs Meds* – (Keep IV line in) could lead to severe reactionscould lead to severe reactions

7979 Catagories of Adverse ReactionsCatagories of Adverse Reactions

SEVERESEVERE Carlton Carlton Pt Care Pt Care

Laryngeal edemaLaryngeal edemaConvulsionsConvulsionsProfound hypotensionProfound hypotensionClinically manifested arrhythmiasClinically manifested arrhythmiasUnresponsivenessUnresponsivenessCardiopulmonary ArrestCardiopulmonary Arrest

PROMPT TREATMENT – CODE BLUE!PROMPT TREATMENT – CODE BLUE!

8080Rx for REACTIONSRx for REACTIONS

have ready on Emergency cart or Crash Carthave ready on Emergency cart or Crash Cart

UTICARIA (HIVES) –UTICARIA (HIVES) –

Benadryl (diphenhydramine)Benadryl (diphenhydramine)

Vistaril (hydorxyzine)Vistaril (hydorxyzine)

Tagament or ZantacTagament or Zantac

Facial/Laryngeal Edema/BronchospasmsFacial/Laryngeal Edema/Bronchospasms

Epinephrine , OxygenEpinephrine , Oxygen

8181

Contrast Reactions/MYTHSContrast Reactions/MYTHS

not caused by iodinenot caused by iodine Ionic vs non ionic - binding elements Ionic vs non ionic - binding elements

not related to shellfish not related to shellfish not true allergy (no drug-antibody) not true allergy (no drug-antibody) mechanism remains unknown mechanism remains unknown

8282

Anaphylactoid (idiosyncratic)Anaphylactoid (idiosyncratic)

unpredictable unpredictable dose independent dose independent prevalence 1-2% (0.04 - 0.22% severe) prevalence 1-2% (0.04 - 0.22% severe) fatal 1 in 75,000 fatal 1 in 75,000

8383

RENAL TOXICITYRENAL TOXICITY

(increased serum creatinine > 0.5 mg%) (increased serum creatinine > 0.5 mg%) 2-7% 2-7% 5 – 10 x increase with pre-existing renal 5 – 10 x increase with pre-existing renal

insufficiency insufficiency direct relationship between serum direct relationship between serum

creatinine and likelihood nephrotoxicity creatinine and likelihood nephrotoxicity Hydrate 100 ml/hr Normal saline 4 hrs Hydrate 100 ml/hr Normal saline 4 hrs

prior to procedure, continue for 24 hours prior to procedure, continue for 24 hours

8484GLUCOPHAGEGLUCOPHAGE

Vol 4 Ch. 19 Vol 4 Ch. 19 pg 297 or pg 297 or

Pt is DIABETIC = oral diabetic agent Pt is DIABETIC = oral diabetic agent

MUST STOP __ DAYS BEFORE EXAMMUST STOP __ DAYS BEFORE EXAM withhold drug for 48 hrs after contrast withhold drug for 48 hrs after contrast

administrationadministration patients with renal insufficiency may develop patients with renal insufficiency may develop

lactic acidosis lactic acidosis The signs of lactic acidosis are deep and rapid breathing, vomiting, and The signs of lactic acidosis are deep and rapid breathing, vomiting, and

abdominal pain abdominal pain

What is the name of the medication given for GI peristalsis?What is the name of the medication given for GI peristalsis?

8585

Pre-MedicationsPre-Medications

Steroids (Prednisone) Steroids (Prednisone) Benadryl (diphenhydramine)Benadryl (diphenhydramine)EpinephrineEpinephrine

8686

EXTRAVASATION

Contrast material has seeped outside of Contrast material has seeped outside of vesselvessel

Local redness and swellingLocal redness and swelling

Apply WARM Compress 1Apply WARM Compress 1stst 24 hours 24 hoursCool compress for swellingCool compress for swelling

8787

EXTRAVASATION

The act of injecting a drug/contrast into an The act of injecting a drug/contrast into an area area other than the vessel (soft tissue)other than the vessel (soft tissue)

RTA BOOK: Pharmacology ChapterRTA BOOK: Pharmacology Chapter Defines as: Discharge or escape of fluid from a vessel

into the surrounding tissue that can cause localized vasoconstriction, resulting in sloughing of tissue and

tissue necrosis if not reversed with an antidote..

8888Extravasation of ContrastExtravasation of Contrast

into soft tissue of arminto soft tissue of arm

9090

Contrast leaking from bladderContrast leaking from bladder

9191

Summary -Summary - Delayed side effects persist in IV iodinated Delayed side effects persist in IV iodinated

contrast media contrast media History of asthma and allergy predisposes History of asthma and allergy predisposes

patients to increased incidence of adverse patients to increased incidence of adverse reactionsreactions

Intravenous iodinated contrast agents are Intravenous iodinated contrast agents are generally safe. generally safe.

Though the frequency of side effects has fallen Though the frequency of side effects has fallen significantly since the introduction of nonionic, significantly since the introduction of nonionic, monomeric contrast agents,however, side monomeric contrast agents,however, side effects remain an important issue.effects remain an important issue.

Late adverse reactions were first recognized in Late adverse reactions were first recognized in the mid-1980s the mid-1980s

9292

Summary of Contrast ReactionsSummary of Contrast Reactions AnaphylactoidAnaphylactoid reactions may present with reactions may present with mild symptomsmild symptoms such as skin rash, itching, nasal such as skin rash, itching, nasal

discharge, nausea, and vomiting discharge, nausea, and vomiting moderate symptomsmoderate symptoms like facial or laryngeal like facial or laryngeal

edema, bronchospasm, dyspnea, tachycardia, edema, bronchospasm, dyspnea, tachycardia, and bradycardiaand bradycardia

severe symptomssevere symptoms such as life-threatening such as life-threatening arrhythmias, hypotension, bronchospasm, arrhythmias, hypotension, bronchospasm, laryngeal edema, pulmonary edema, seizure, laryngeal edema, pulmonary edema, seizure, syncope, and deathsyncope, and death

9393 Summary of Contrast ReactionsSummary of Contrast Reactions Nonanaphylactoid reactionsNonanaphylactoid reactions are due to the ability of the are due to the ability of the

contrast media to upset the body homeostasis, contrast media to upset the body homeostasis, especially the blood circulation. especially the blood circulation.

Increasing iodine concentrationIncreasing iodine concentration increases the risk of increases the risk of these reactions, which is also affected by the volume these reactions, which is also affected by the volume and route of administration of contrast.and route of administration of contrast.

Larger volumesLarger volumes or intra-arterial administration are more or intra-arterial administration are more likely to produce a reaction.likely to produce a reaction.

The cardiovascular, respiratory, urinary, gastrointestinal, The cardiovascular, respiratory, urinary, gastrointestinal, and nervous systems are most commonly affected by and nervous systems are most commonly affected by physiologic changes produced by contrast media. physiologic changes produced by contrast media.

The symptoms of nonanaphylactoid reactions are The symptoms of nonanaphylactoid reactions are warmth, metallic taste, nausea, vomiting, bradycardia, warmth, metallic taste, nausea, vomiting, bradycardia, hypotension, vasovagal reactions, neuropathy, and hypotension, vasovagal reactions, neuropathy, and delayed reactionsdelayed reactions

9494

SCHEDULING CONSIDERATIONSSCHEDULING CONSIDERATIONSDiabetics – first Diabetics – first

(Insulin= low blood sugar occurs while fasting)(Insulin= low blood sugar occurs while fasting)

After Nuclear Medicine Tests After Nuclear Medicine Tests (iodine goes to thyroid and will alter results)(iodine goes to thyroid and will alter results)

Iodine BEFORE BariumIodine BEFORE Barium BE before UGI ( IVP before BE)BE before UGI ( IVP before BE)

WATER – OIL - BARIUMWATER – OIL - BARIUM

9595SPECIAL PROCEDURSSPECIAL PROCEDURS

CONTRAST MEDIACONTRAST MEDIA

ARTHROGRAMSARTHROGRAMSInjected into JOINT SPACESInjected into JOINT SPACESIODINE IODINE (positive contrast)(positive contrast)

WATER soluble WATER soluble (Ionic or Non-Ionic)(Ionic or Non-Ionic)

AIR AIR (negavitve contrast)(negavitve contrast)


CONTRAST MEDIACONTRAST MEDIA

MYELOGRAMSMYELOGRAMS Injected INTRATHECALLYInjected INTRATHECALLY

(into the subarachnoid space)(into the subarachnoid space)NonionicNonionic water-soluble contrastwater-soluble contrast (NO IONIC CONTRAST)(NO IONIC CONTRAST)

979731 y/o male DIES31 y/o male DIESafter Myelogram Procedureafter Myelogram Procedure

Myelography is safely performed usingMyelography is safely performed usingnonionicnonionic water-soluble radiographic water-soluble radiographic

contrast mediacontrast media intended for this route of intended for this route of administrationadministration

Misadministration of Misadministration of ionicionic contrast media contrast media intrathecally intrathecally can result in a syndrome of can result in a syndrome of spasms and convulsions, often leading to spasms and convulsions, often leading to death death

ISOVUE –M ( 20 or 30 cc) ISOVUE –M ( 20 or 30 cc)

9898

mix-up between look-alike vialsmix-up between look-alike vialsionic ionic HYPAQUEHYPAQUE

(diatrozoate meglumine)(diatrozoate meglumine) nonionic nonionic OMNIPAQUEOMNIPAQUE 300 300

(iohexol)(iohexol)Each type of contrast media Each type of contrast media

should be stored separately, should be stored separately, based on its usebased on its use..


CONTRAST MEDIACONTRAST MEDIASIALOGRAPHYSIALOGRAPHY

– – injected into Salivary Ductsinjected into Salivary Ducts IODINE –IODINE –

WATER (ionic or nonionic) WATER (ionic or nonionic) OR OIL BASEDOR OIL BASED

SINOGRAPHIN (OIL)SINOGRAPHIN (OIL)RENOVUE (WATER)RENOVUE (WATER)

100100

MRI ContrastMRI Contrast

101101

MRI with contrastMRI with contrast

Without With Without With

What is the name of the contrast used for MRI ?

102102Gadolinium z# 64Gadolinium z# 64

Once injected, gadolinium accumulatesOnce injected, gadolinium accumulates

in abnormal tissues of the brain and body.in abnormal tissues of the brain and body.Provides a greater contrast between Provides a greater contrast between

normal and abnormal tissuesnormal and abnormal tissues

MORE diluteMORE dilutethan used for Radiologythan used for Radiology

103103

gadoliniumgadolinium

On its own gadolinium is toxic to the On its own gadolinium is toxic to the human body, but when coated in a special human body, but when coated in a special chelating agent, it is safe to use. chelating agent, it is safe to use.

When the chelating agent breaks down When the chelating agent breaks down prematurely, or the kidneys are unable to prematurely, or the kidneys are unable to excrete the gadolinium from the body, excrete the gadolinium from the body, gadolinium poisoning can occurgadolinium poisoning can occur

104104 Gadolinium Side EffectsGadolinium Side Effects With impaired kidney function, gadolinium With impaired kidney function, gadolinium

could lead to a serious and potentially fatal could lead to a serious and potentially fatal disorder called Nephorgenic Systemic disorder called Nephorgenic Systemic Fibrosis.Fibrosis. (NSF) (NSF)

More common conditions associated with More common conditions associated with exposure includesexposure includes

impaired kidney function impaired kidney function irritation of blood vessels irritation of blood vessels facial swelling facial swelling skin conditions, including rashes, itching and skin conditions, including rashes, itching and

hives hives

105105

CT ContrastCT Contrast

Oral/RectumOral/Rectum – – Barium or IodineBarium or Iodine

IV: IodineIV: Iodine

Usually less diluteUsually less dilute than for Radiologythan for Radiology

106106

CT w contrastCT w contrast

107107

CT ContrastCT Contrast CT Scan Contrast CT Scan Contrast

Indications Indications

History of tumor, cancer, History of tumor, cancer, or surgery or surgery

Looking for infection, Looking for infection, inflammationinflammation

Evaluating blood vesselsEvaluating blood vessels

Investigate a finding in a Investigate a finding in a scan done without scan done without contrast contrast

CT Scan Contrast Side CT Scan Contrast Side EffectsEffects

Mild to life-threatening Mild to life-threatening allergic reaction allergic reaction

Flushing/redness and Flushing/redness and hiveshives

Shortness of breath Shortness of breath Nausea, vomittingNausea, vomitting Blood clots Blood clots DizzinessDizziness

101088

PATIENT PREPPATIENT PREP

COVERED WITH EACH EXAMCOVERED WITH EACH EXAM

109109 REVIEW REVIEW SPECIAL PROCEDURSSPECIAL PROCEDURS

CONTRAST MEDIACONTRAST MEDIAONLY WaterONLY Water sol.sol.

ArthrogramsArthrograms MyelogramsMyelograms Angio/Arterio gramsAngio/Arterio grams Cardiac CathCardiac Cath VenogramsVenograms

Water or OILWater or OIL HysterosalpingogramHysterosalpingogram SialogramSialogram LymphangiogramsLymphangiograms

Lasts longer – may causeLasts longer – may cause FAT EMBOLI FAT EMBOLI

110110 REVIEW (Bontrager Slides)

111111

SEE : PT CARE : Pharmacology 4th Ed Ch.20 (charts p293/p.299 )

112112

113113

114114

115115

116116

117117

118118

119119 PT CARE : Pharmacology 4th Ed Ch.20 (charts p293/p.299 )

Sample CRASH CARTCRASH CART MedicationsMEDICATIONMEDICATION

Atropine Benadryl

Dilantin Epinephrine

Heparin Lasix

Sodium Bicarbonate Xylocaine

INDICATIONINDICATION(used for what?_(used for what?_

______________ ________________ _________________ ___________________ ___________________ _________________ _________________ __________________

Spring 2010

120120

REVIEWREVIEW

TYPES OF CONTRAST & USESTYPES OF CONTRAST & USESADVERSE AFFECTS OF CONTRAST ADVERSE AFFECTS OF CONTRAST

USAGEUSAGECONTRAINDICATIONS FOR CONTRASTCONTRAINDICATIONS FOR CONTRAST

121211

Review QuestionsReview Questions

RTA Book – RTA Book –

Contrast MediaContrast Media

122122

Contrast media are used in radiographic Contrast media are used in radiographic imaging toimaging to

a) increase the radiographic density of the a) increase the radiographic density of the area of interestarea of interest

b) enhance the subject contrast of the area b) enhance the subject contrast of the area of interestof interest

c) decrease the radiographic density of the c) decrease the radiographic density of the area of interestarea of interest

d) lower the subject contrast of the area of d) lower the subject contrast of the area of interestinterest

123123

Radiographic images that demonstrate few Radiographic images that demonstrate few density differences definedensity differences define

a) low subject contrasta) low subject contrast

b) high subject contrastb) high subject contrast

c) low x-ray photon absorptionc) low x-ray photon absorption

d) high x-ray photon absorptiond) high x-ray photon absorption

124124

A negative contrast agent willA negative contrast agent will

a) increase density and is radiopaquea) increase density and is radiopaque

b) decrease density and is radiopaqueb) decrease density and is radiopaque

c) decrease density and is radiolucentc) decrease density and is radiolucent

d) increase density and is radiolucentd) increase density and is radiolucent

125125

Perforation of the colon during a lower GI Perforation of the colon during a lower GI barium study may result in complications barium study may result in complications resulting fromresulting from

a) flocculationa) flocculation

b) bronchospasmb) bronchospasm

c) convulsionc) convulsion

d) extravasationd) extravasation

126126

Depending on the environment of the Depending on the environment of the barium sulfate,such as acid in the barium sulfate,such as acid in the stomach, the powder may have a stomach, the powder may have a tendency to clump – this is calledtendency to clump – this is called





127127

4. Perforation of the vessel while injecting a 4. Perforation of the vessel while injecting a contrast media may resulting incontrast media may resulting in





128128

Barium sulfate:Barium sulfate:

1. is filtered by the kidneys1. is filtered by the kidneys

2. is absorbed by the stomach2. is absorbed by the stomach

3. coats the gastrointestinal lining3. coats the gastrointestinal lining

4. is absorbed by the jejunum 4. is absorbed by the jejunum

129129

High atomic number elements absorb x-rays High atomic number elements absorb x-rays at a greater rate than low atomic number at a greater rate than low atomic number elements.elements.

1. true1. true

2. false 2. false

130130

Barium sulfate is contraindicated if the Barium sulfate is contraindicated if the patient is suspected of having a patient is suspected of having a gastrointestinal tract perforation.gastrointestinal tract perforation.

1. true1. true

2. false 2. false

131131

Radiolucent contrast media:Radiolucent contrast media:

1. are positive contrast agents1. are positive contrast agents

2. appear dark on radiographs2. appear dark on radiographs

3. are composed of elements with high 3. are composed of elements with high atomic numbersatomic numbers

4. none of the above 4. none of the above

132132

Radiopaque contrast media:Radiopaque contrast media:

1. are positive contrast agents1. are positive contrast agents

2. appear light on radiographs2. appear light on radiographs

3. are composed of elements with high 3. are composed of elements with high atomic numbersatomic numbers

4. all the above 4. all the above

133133

Each of the following is an example of a Each of the following is an example of a negative contrast media except:negative contrast media except:

1. air1. air

2. soda water2. soda water

3. barium sulfate3. barium sulfate

4. gas-producing crystals 4. gas-producing crystals

134134

An air embolus can form as a complication An air embolus can form as a complication of negative contrast media administration.of negative contrast media administration.

1. true1. true

2. false 2. false

135135

An fat embolus can form as a complication An fat embolus can form as a complication of AN OIL BASED contrast media of AN OIL BASED contrast media administration.administration.

1. true1. true

2. false 2. false

136136

Ionic contrast media dissociates into two Ionic contrast media dissociates into two molecular particles in blood plasma.molecular particles in blood plasma.

1. true1. true

2. false 2. false

137137

Most adverse reactions associated with Most adverse reactions associated with Ionic contrast media are significantly Ionic contrast media are significantly decreased with the non-ionic contrast decreased with the non-ionic contrast media media

1. true1. true

2. false 2. false

138138

Which of the following acute reactions to Which of the following acute reactions to contrast media usually requires no medical contrast media usually requires no medical treatment?treatment?

a) bronchospasma) bronchospasm

b) laryngeal edemab) laryngeal edema

c) urticariac) urticaria

d) convulsionsd) convulsions

139139

Which of the following acute reactions to Which of the following acute reactions to contrast media usually requires immediate contrast media usually requires immediate medical treatment?medical treatment?

a) Bronchospasm / laryngeal edemaa) Bronchospasm / laryngeal edema

b) Nausea & Vomitingb) Nausea & Vomiting

c) Urticariac) Urticaria

d) Warn flush /metallic tasted) Warn flush /metallic taste

140140

What can be done for a patient who will receive What can be done for a patient who will receive water- soluble iodine contrast media to reduce water- soluble iodine contrast media to reduce allergic-like effects?allergic-like effects?

a) premedicate with steroids and antihistamines a) premedicate with steroids and antihistamines

b) give intravenous fluidsb) give intravenous fluids

c) instruct the patient to drink warm salt water c) instruct the patient to drink warm salt water before the procedurebefore the procedure

d) give a negative contrast agent with the iodinated d) give a negative contrast agent with the iodinated mediummedium

141141

When you schedule multiple procedures, When you schedule multiple procedures, what examination is usually done last?what examination is usually done last?

a) thyroid function testsa) thyroid function tests

b) Upper GIb) Upper GI

c) air-contrast colon (BE-AC)c) air-contrast colon (BE-AC)

d) Intravenous pyelogram (IVP)d) Intravenous pyelogram (IVP)

142142

When you schedule multiple procedures, When you schedule multiple procedures, what examination is usually done last?what examination is usually done last?

a) thyroid function testsa) thyroid function tests




It will take the BA the longest to travel It will take the BA the longest to travel through the GI tractthrough the GI tract

143143

When you schedule multiple procedures, When you schedule multiple procedures, using contrast media – which examination using contrast media – which examination must be done first?must be done first?

a) thyroid function tests (Nuc Med)a) thyroid function tests (Nuc Med)




144144

When you schedule multiple procedures, When you schedule multiple procedures, using contrast media – which examination using contrast media – which examination must be done first?must be done first?

a) thyroid function tests (Nuc Med)a) thyroid function tests (Nuc Med)




WHY?WHY?

145145

Antihistamines are used to prevent and Antihistamines are used to prevent and treat nausea and vomiting.treat nausea and vomiting.

1. true1. true2. false 2. false

146146

Antihistamines are used to prevent and Antihistamines are used to prevent and treat nausea and vomiting.treat nausea and vomiting.


So what is it used for?So what is it used for?

147147

Antihistamines are used to prevent and Antihistamines are used to prevent and treat ____________treat ____________

Allergic reactions to contrast mediaAllergic reactions to contrast media

148148

Glucophage is the brand name forGlucophage is the brand name for____________________________________________________

What is it used for?What is it used for?__________________________________________________

149149

Glucophage is the brand name forGlucophage is the brand name for METAFORMINMETAFORMIN

What is it used for?What is it used for? DIABETICSDIABETICS

RTA BOOK RTA BOOK PHARMACOLOGY CHAPTERPHARMACOLOGY CHAPTER

150150

Which type of drug is used to prevent and Which type of drug is used to prevent and control the occurrence of seizures?control the occurrence of seizures?

1. anticonvulsants1. anticonvulsants2. antiemetics2. antiemetics3. antihistamines3. antihistamines4. antihypertensives 4. antihypertensives

151151

Which type of drug is used to prevent and Which type of drug is used to prevent and control the occurrence of seizures?control the occurrence of seizures?

1. anticonvulsants1. anticonvulsants2. antiemetics2. antiemetics3. antihistamines3. antihistamines4. antihypertensives 4. antihypertensives

152152

An intravenous push refers to a rapid An intravenous push refers to a rapid bolus injection.bolus injection.


153153

An intravenous push refers to a rapid An intravenous push refers to a rapid bolus injection.bolus injection.


What is the name when it is injected What is the name when it is injected slowly?slowly?

154154

What is the name when contrast it is What is the name when contrast it is injected slowly?injected slowly?

INFUSION DRIPINFUSION DRIP

155155

The act of injecting a drug into a vein is The act of injecting a drug into a vein is termed extravasation.termed extravasation.


156156

The act of injecting a drug into a vein is The act of injecting a drug into a vein is termed extravasation.termed extravasation.


What does it mean? ______________What does it mean? ______________

157157

extravasationextravasation

What does it mean? ______________What does it mean? ______________

The act of injecting a drug/contrast into an The act of injecting a drug/contrast into an area area other than the vessel (soft tissue)other than the vessel (soft tissue) is is termed extravasation.termed extravasation.

RTA BOOK: see definitonRTA BOOK: see definiton

158158

Contrast media are:Contrast media are:1. diagnostic agents1. diagnostic agents2. dyes2. dyes3. all radiopaque3. all radiopaque4. all radiolucent 4. all radiolucent

159159

Contrast media are:Contrast media are:1. diagnostic agents1. diagnostic agents2. dyes2. dyes3. all radiopaque3. all radiopaque4. all radiolucent 4. all radiolucent

160160



161161



162162

Oil-based iodine contrast media are used Oil-based iodine contrast media are used for each of the following except:for each of the following except:

1. dacrycystography1. dacrycystography2. bronchography2. bronchography3. lymphography3. lymphography4. myelography 4. myelography

163163

Ionic contrast media dissociates into two Ionic contrast media dissociates into two molecular particles in blood plasma.molecular particles in blood plasma.


164164

Iodinated contrast media dissociates into Iodinated contrast media dissociates into two molecular particles in blood plasma.two molecular particles in blood plasma.


165165

The benzene ring is associated with the:The benzene ring is associated with the:1. anion1. anion2. cation2. cation3. positive charge3. positive charge4. none of the above 4. none of the above

161666

LIST 4 TYPES OFLIST 4 TYPES OFHIGH RISK PATIENTSHIGH RISK PATIENTS

167167

Oil-based iodine contrast media are made Oil-based iodine contrast media are made from:from:

1. fatty acids1. fatty acids2. carbohydrates2. carbohydrates3. amino acids3. amino acids4. none of the above 4. none of the above

168168

Osmolality is a measure of:Osmolality is a measure of:1. the number of iodine atoms per 1. the number of iodine atoms per

moleculemolecule2. particle density2. particle density3. the total number of particles in solution3. the total number of particles in solution4. none of the above 4. none of the above

169169

High osmolality of the contrast media is High osmolality of the contrast media is related to adverse reactions.related to adverse reactions.


170170

Injection of ionic contrast media may lead Injection of ionic contrast media may lead to hypervolemia.to hypervolemia.

1. true1. true2. false2. false

171171

Myelography most commonly uses ___ Myelography most commonly uses ___ contrast media.contrast media.

1. ionic1. ionic2. nonionic2. nonionic3. nonionic and ionic3. nonionic and ionic4. neither ionic nor nonionic4. neither ionic nor nonionic

171722

End of Contrast Media End of Contrast Media for Special Proceduresfor Special Procedures

RT 255 RT 255

Rev Spring 2010Rev Spring 2010

1 Radiographic Contrast Media RAD TECH 255 RAD TECH 255 SPECIAL PROCEDURES SPECIAL PROCEDURES...

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