contrast media part 1 Flashcards
What is (Radiographic) Contrast?
The difference in density between adjacent structures.
Of critical importance in radiographic images as it is the way various structures are identified.
What are Contrast Agents?
Any substance which when introduced into the body demonstrates organs or systems of the body in radiographic contrast to the surrounding tissue.
These substances therefore enhance the radiographic contrast of the area being imaged.
Classification of Contrast Agents
Negative Agents (Radiolucent)
All gasses (air or CO2)
Positive Agents (Radio-opaque)
Barium based
Iodine based
These are generally used in projectional radiography, fluoroscopy and CT scanning.
Other Types of Contrast Agents
MRI
Gadolinium based (most commonly used)
Manganese based
(all need to have some magnetic properties)
US
Microbubbles based
(an inert gas encapsulated by a shell which affects the vibrations/intensity of the US signal )
Negative Contrast Agents
Air
Occurs naturally in the body (in the airways, lungs, gastrointestinal tract).
Readily available!
CO2
Available in tablet, granules and powder form.
Both can be combined with a positive contrast medium to create a ‘double contrast’ effect.
Refers to the use of positive and negative contrast agents to increase the sensitivity of the examination.
Why CO2?
Ease of swallowing
Rapid disintegration
No residue
No bubble formation
No interference with Barium coating
Adequate gastric distension (200-500ml)
Quicker reabsorption into the body
Generally preferred over ‘room air’
Positive Contrast Agents
Barium Based
Barium Sulphate (non-soluble)
Iodine Based (soluble)
Ionic
Non-ionic (main form currently used)
(Can be administered by ingestion, per rectum or intravenously)
How do Contrast Agents Work?
The transmission of the an x-ray beam depends on the attenuation caused by the intervening structures within the body.
The attenuation caused by the contrast agent and soft tissue are responsible for the visualisation of the structures on the radiograph.
How do Contrast Agents Work?
(Linear) Attenuation Coefficient
The attenuation coefficient (µ) describes the fraction of a beam of x-rays that is absorbed or scattered per unit thickness of the absorber.
Attenuation Coefficient
It = Ioe-µx
Io = incident beam
It = transmitted beam
µ = attenuation coefficient
X = thickness of body part imaged
How do Contrast Agents Work?
Positive Contrast Agents
The intensity of radiation transmitted through the contrast agent is less than that transmitted through the soft tissue.
This is because the linear attenuation coefficient of the soft tissue is less than that for the contrast agent.
How do Contrast Agents Work?
Attenuation Coefficient
Attenuation coefficients are proportional to:
the density of the medium
the number of atoms present in a given volume
Positive Contrast Agents
Densities:
Iodine: 4940 kg/m3
Barium: 3600 kg/m3
Soft tissue: 1000 kg/m3
Atomic Numbers:
Iodine: 53
Barium: 56
Soft tissue: 7.5
The higher the density and the atomic number, the higher the attenuation coefficient and the more radiation is absorbed.
How do Contrast Agents Work?
Negative Contrast Agents
The intensity of radiation transmitted through the contrast agent is more than that transmitted through the soft tissue.
The linear attenuation coefficient of the soft tissue is more than that for the contrast agent.
Negative Contrast Agents
Atomic Numbers:
Air: 7.6 (effective)
Soft tissue: 7.5
Densities:
Air: 1.3 kg/m3
CO2: 2 kg/m3
Soft tissue: 1000 kg/m3
Soft tissue has a very high density compared to air and CO2, meaning a higher attenuation coefficient and more radiation absorbed.
Positive Contrast Agents
Barium Based
Barium Sulphate (non-soluble)
Iodine Based (soluble)
Ionic
Non-ionic (main form currently used)
Barium Sulphate BaSO4
Properties:
Properties:
Pure Barium is toxic
BaSO4 insoluble and inert
Used as a suspension in water
Is not absorbed by the GI tract
Has a ph of about 5.3 which is stable in gastric acid
Can have several additions added to it such as coating agents, anti-foaming agents and flavouring/colouring
Barium Sulphate BaSO4
Can be used as:
Powder: for mixing/diluting as per the required concentration
Liquid suspension: pre-mixed, usually in cans
Barium Sulphate BaSO4
Viscosity: Thickness or resistance to flow
- BaSO4 can be prepared to more or less viscous depending on the requirement
Density: Mass per unit volume
- Measure of the amount of contrast (radio-opaque component) per unit volume
- Will determine how radio-opaque the BaSO4 is
- Measured in % weight/volume (%w/v)
Fluoroscopic Examinations Using BaSO4
Barium Follow Through - Small Bowel (A)
Barium Enema - Large Bowel (B)
Barium Swallow – Oesophagus (C)
Barium Meal – Stomach (D)
BaSO4 Contraindications
Large bowel obstruction
Suspected perforation
Toxic Megacolon (acute colonic distention usually as a complication of inflammatory bowel disease)
Insoluble
Can cause constipation
BaSO4 Complications
Perforation
Obstruction
Water intoxication (Rare)
Toxic allergic reaction (Rare)
Venous intravisation of barium (Very rare)
Pharmacology
What is a drug?
Any chemical agent that affects living processes
The way in which drugs exert their effects is known as Pharmacodynamics
Drugs may act on:
Receptors
Cellular / extra cellular physiology
Enzymes
Pharmacology
The magnitude of a drug action is related to the dose
To produce their effects, drugs must be present in sufficient concentrations at their site of action
Therefore, in addition to dose, drug action will be influenced by a number of factors
Pharmacokinetics:
The way in which drugs move into, around and out of the body:
Administration & Absorption;
Distribution;
Metabolism;
Excretion (ADME)
Pharmacological Agents used with BaSO4
Buscopan (Hyoscine Butylbromide)
- Anti-spasmodic drug
- Relaxes smooth muscle of the organs in the abdominal and pelvic cavities
- Often used in various fluoroscopic examinations using BaSO4 and in CT Colongraphy
- Dosage: 1-2ml for a Barium enema/CT Colon
Buscopan
Side effects:
- Dryness of mouth
- Temporary loss on eye accommodation (ability of the eye to change its focus from distant to near objects and vice versa)
- Tachycardia (fast heart rate)
- Contraindicated in cases of Glaucoma
- A group of eye conditions that damage the optic nerve
- Damage is often caused by an abnormally high pressure in the eye
Pharmacological Agents used with BaSO4
Glucagon
- Smooth muscle relaxant
- Rapid onset of action
- Dilates stomach and inhibits gastric motility for between 5 & 15 minutes – then acts as a hurrying agent
- Raises blood glucose levels and used as an emergency for hypoglycaemia
Pharmacological Agents used with BaSO4
Maxolon (Metoclopramide)
- Increases gastric peristalsis
- Decreases gastric emptying time
- Speeds up transit time of BaSO4
- Mainly used for Barium Follow Through and CT Enterography
