Contrast medium

Radiation technique 2
NRRT 3680
Ms C.Nabasenja

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 Objectives
• By the end of this lecture, the student should
be able to;
1. Define contrast medium and give examples
2. List methods of administration of the contrast
media
3. Mention types of contrast media (contrast
medium)
4. List the characteristics of air as a contrast
medium
5. Describe the characteristics that determine
choice of contrast medium
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 Definition
• Radiopaque substance that is introduced into
the body in order to facilitate radiographic
imaging of internal structures that otherwise
are difficult to visualise radiographically.
• Examples include air, barium sulphate,
iodinated contrast agents

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 Working principle
• mass density and atomic weight of substance
affects its ability of attenuate radiation or x-
rays

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 Methods of administration
Enteral –
• Oral – barium swallow/ meal
• Rectal – barium enema
• Nasogastric – small bowel enema
• Inhalation
• Topical
• Sublingual or buccal routes - sialogram

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 Methods of administration
Parenteral
• Intramuscular
• subcutaneous
• intradermal
• Intravenous - urography
• intra-arterial - angiography
• intra-thecal (if medication irritates the GIT) -
myelography

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 • Directly into structures – cholangiography
(visualisation of common bile) & arthrography
(joint capsule)
• contrast medium may be injected slowly by
means of a dilute high volume IV infusion
OR
• As a bolus – delivered rapidly e.g. in CT by
use of programmed pressure injectors
• Timing is important for this

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 Types of contrast media
• Air
• Iodinated contrast medium
• Barium sulphate

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Air & Gas as contrast medium
- characteristics
• Light therefore absorbs x-rays at lesser degree
than soft tissue
• Appears black or dark (radiolucent) on a
radiograph
• Referred to as negative contrast
• Must be non-toxic
• Must be readily absorbed by body but not too
rapidly that it disappears before exam is
complete

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 Carbon dioxide
• Non-toxic
• Readily absorbed by the body – body
absorbs it faster than nitrogen
• Commercially available e.g. in cylinders

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Where can air/ Gas be used?
• double contrast studies of colon, stomach
• arthrography (contrast studies of joints)
• myelography (spinal canal) for patients allergic
to iodinated contrast medium – been replaced
by less invasive imaging with CT and MRI
• Fiberoptic studies of the female reproductive
system
• biliary system when filled into the peritoneal
cavity

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Iodinated contrast medium
• Contains iodine (atomic number of 53 and
mass number of 127)
• Heavy element compared to composition of
body and blood
• Absorbs radiation greater than blood and
soft tissue
• Body organs injected with iodine appear
radiopaque compared to those without iodine
• Iodine allows visibility of different structures
more clearly than non-contrast radiography

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characteristics of iodinated
contrast medium
• Has water as principle solvent
• Readily mixes with blood and other body fluids
• Only contrast medium suitable for IV injection

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 Examples of iodinated
contrast medium
1. ethiodized oils,
2. water soluble iodine compounds

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Ethiodized oils
• Are oily iodine compound
• Used when mixing of contrast medium with
body fluids & surrounding tissues is not desired
• Neither absorbed & not excreted readily
• Stay in body for long time
• Must therefore be prepared for allergic
reactions though very rare or even severe
• Inflammation at site of administration if they are
injected into tissues (extravasation occurs)
• Decompose on exposure to light, heat or air
• Must be stored in a cool dark place
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Ethiodized oils…
• ALWAYS CHECK FOR SIGNS OF
DECOMPOSITION
• Colour – clear with pale amber/ yellow colour
when fresh
• Darker yellow when decomposed – DON’T USE
• Use glass syringe for injection as they may
absorb toxic substances from the plastic
composition of disposable syringes

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 Used in;
• Myelography
• bronchography (replaced by newer aqueous
iodine agents)
• lymphography

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Water soluble iodine compounds
• Most commonly used contrast agents besides
Barium
• Available in wide variety of type, volume and
strength
• Are carbon based organic compounds
composed of molecules containing iodine atoms
& other atoms

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 characteristics that determine
choice of contrast medium
• The characteristics of contrast medium that
affect their strength and chemical nature
include;
• Iodine concentration
• Osmolality
• Ionic / non-ionic
• Viscosity
• toxicity

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Iodine concentration
• Determines degree to which contrast medium
attenuates x-rays
• Higher iodine concentration results in high x-ray
attenuation therefore greater positive contrast
• Different concentrations are available and choice
of which contrast medium depends on which
organ is studied
• E.g. higher concentration is required for aorta
study compared to visualisation of veins & small
arteries
• contrast medium with greater iodine
concentration has great viscosity, high osmolality
& tend to be more toxic
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Osmolality
• Refers to number of particles in solution per kg of
water
• Human blood – 300milliosmoles/kg
• Water soluble contrast medium – 300-
100mOsm/kg
• Hyperosmolar – higher osmolality
• Isoosmolal – same osmolality
• Hyposmolal – lower osmolality
• IV injection of contrast medium with higher
osmolality than blood affects the blood osmotic
pressure resulting in side affects of contrast
medium
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Osmolality continued

• contrast medium that contains more iodine

atoms per molecule provides adequate contrast
with fewer molecules, therefore lower osmolality
• Osmolality is largely responsible adverse effects
of contrast medium therefore lower osmolality
decreases risk of these

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Ionic / non-ionic
• Some contrast medium dissociate into 2 charged
particles when placed in solution referred to as
ionisation
• Therefore referred to as ionic contrast medium
• contrast medium that doesn’t dissociate is non-ionic
• Ionic contrast medium results in high osmolality
since it dissociates to form more particles in solution
osmolality is the particles per kg of water
• For contrast media with lower osmolality, a small
amount is required to produce good contrast & also
rarely causes side effect
• Newer contrast medium has equal osmolality with
blood (isosmolar)
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Viscosity
• Measure of resistance of fluid to flow thereby referred to as
thick (high viscosity) or thin/ watery (low viscosity)
• Viscosity is determined by the;
1. Number of particles
2. Size of particles
3. Attractions among particles &
4. specific nature of molecules in the solution
• contrast medium with high iodine concentrations are more
viscous
• Viscosity of contrast medium determines injection time, flow
rate & needle size
• Solutions with high viscosity require high injection pressure
• Viscosity may be reduced by warming contrast medium to
body temperature before injection
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Toxicity
• Toxicity of contrast medium on body tissues &
organs is related to;
• Chemical configuration of molecules
• Iodine concentration
• Osmolality
• Ionization characteristics
• Rate of injection
• Dosage of contrast medium administered

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• Nonionic, low osmolality, low iodine
concentration contrast medium injected contrast
medium – less toxic, less likely adverse effects
• Intra-arterial injection of contrast medium
produces fewer toxic effects compared to IV as
the IA doesn’t circulate with blood thru the heart
and lungs

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 IONIC AGENTS
• HOCA ionic agents – Renografin-60 &
Hypaque 76
• LOCA ionic agents – high concentration of
iodine with fewer particles in solution e.g.
Amipaque

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 Nonionic LOCA
• Iopamidol (Isovue and Niopam)
• Iohexol (omnipaque)
• Iodixanol (Visipaque) – Isosmolal; suitable for
patients experiencing mild to moderate renal
insufficiency , expensive
• Fewer adverse effects associated with LOCA
• LOCA adopted by most departments

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 ? DECIDE BEST CONTRAST
MEDIUM

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 Risk factors for choice of
contrast medium
• history of compromised renal, cardiac or
respiratory function
• history of allergies
•

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Pharmacodynamics , adverse effects

• Water soluble contrast medium circulates in

blood when administered IV & excreted by
kidneys
• contrast medium injected into other structures is
gradually absorbed into the blood stream b4 its
excreted
• contrast medium may have mild, moderate or
severe/ life threatening side effects
• contrast medium side effects influenced by
osmolality, ionization & molecular toxicity
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Osmolality
• HOCA result in dehydration as water passes to
the region of high osmolality the contrast
medium by osmosis from the cell membranes
• Causing adverse changes in pulmonary artery
pressure, blood volume & cardiac output

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 Ionization
• Ionic contrast medium results in increased
levels of ions in blood which may interfere
with normal electrical activity of the body
when they reach the central nervous system
• Side effects may include seizures, cardiac
dysfunction, warm sensation thru body, light-
headedness, nausea, vomiting

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Toxicity
• As result of excessive dose, failure of kidneys to
excrete contrast medium, contrast medium
combined with incompatible medication thereby
forming solid particles that may precipitate
• Precipitation has been noted with
diphenhydramine, papaverine hydrochloride,
cimetidine, protamine
• Important to flush IV or IA catheter with saline b4
& after contrast medium injection to avoid
complications

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 ANY QUESTIONS?

THANK YOU

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