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Contrast Studies Flashcards

1
Q

what are the 3 most common types of contrast studies?

A

GI, urogenital, spinal cord

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2
Q

why do we use contrast agents?

A

they cause a difference in the density and organ visibility

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3
Q

types of contrast agents

A

positive (appears white or radiopaque) and negative (appears black or radiolucent)

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4
Q

what are the two positive contrast medias?

A
  1. Barium sulfate and BIPs (barium impregnated polyethylene spheres)
  2. water-soluble organic iodides (can be ionic or non-ionic)
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5
Q

Barium sulfate

A

used for GI studies, administered orally or rectally, high atomic # (high atomic # = higher density), insoluble

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6
Q

what are the 2 systems to measure Barium sulfate?

A
  1. weight to volume (w/v)
  2. weight to weight (w/w)
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7
Q

what forms is Barium sulfate available in?

A

powder, liquid suspension, paste

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8
Q

disadvantages of Barium sulfate

A

can’t use if perforation is suspected, aspiration in lung can be fatal, and blocks ultrasound waves

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9
Q

advantages of Barium sulfate

A

low cost, delineates mucosal walls well, palatable, not absorbed through intestine, doesn’t become diluted with secretions

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10
Q

BIPS

A

used to determine motility issues
comes in capsule form
better evaluation of gastric emptying times

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11
Q

water-soluble organic iodides

A

mix readily with blood/body fluids and are excreted through the kidneys

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12
Q

what are the 2 types of water-soluble organic iodides?

A

ionic (molecules dissociate and cause changes in osmolality) and non-ionic (molecules remain whole)

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13
Q

ionic water-soluble organic iodides

A

triiodinated compounds derived from benzoic acid ring structure
made up of an anion (-) and a cation (+)
cation: salt (sodium or megulumine)
anion: includes benzene ring with 3 iodine atoms + carboxyl group + other side chains (Diatrizoate or iothalamate)

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14
Q

when are ionic water-soluble organic iodides used?

A

when GI perforations are suspected
comes in oral form: Meglumine diatrizoate and sodium diatrizoate (Gastrografin)
disadvantages: bitter taste, expensive, hypertonicity effects

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15
Q

injectable form of ionic water-soluble organic iodides

A

used for excretory urography, intraarticular studies, draining wound studies, and fistulography
ex: sodium diatrizoate (Hypaque), meglumine diatrizoate (Hypaque M), iothalamate meglumine (Conray)
advantages: less viscous
disadvantages: hypertonicity effects, irritating to brain and spinal cord, anaphylaxis

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16
Q

nonionic water-soluble organic iodides

A

doesn’t dissociate
doesn’t increase osmolality of plasma
ideal for studies involving spinal cord (myelography) and respiratory tract

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17
Q

injectable form of nonionic water-soluble organic iodides

A

Iohexol (Omnipaque), iopamidol (Isovue), ioversol (Opitray), iopromide (Ultravist), Iotrolan (Isovist, Osmovist), ioxilan (Oxilan), nonionic dimer iodixanol (Visipaque)
advantages: fewer side effects, rapid transit time, reabsorbed after extraluminal leakage, doesn’t become dilute
disadvantages: expensive

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18
Q

how else can ionic and nonionic injectable contrast media be classified?

A

monomer and dimer
monomer: 1 benzene ring
dimer: 2 benzene ring
osmolality decreases when there are more iodine molecules
ionic monomer has highest osmolality and nonionic dimer has the lowest

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19
Q

negative contrast media

A

radiolucent gases: air, nitrous oxide, oxygen, CO2)
less mucosal detail compared to positive
cons: overinflation, use of room air can produce air embolism that can cause cardiac arrest

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20
Q

what is it called when negative contrast medias are used with positive contrast medias?

A

a double contrast study

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21
Q

esophagography

A

used to assess status of esophagus, potential motility issues, and surrounding tissues
ideal to use fluoroscopy
lateral and DV positioning used

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22
Q

indications of an esophagography

A

abnormal swallowing, foreign body obstruction, dysphagia (difficulty swallowing), megaesophagus, regurgitation of undigested food, head/neck trauma

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23
Q

media and doses for an esophagography

A

barium sulfate liquid or paste, oral aqueous iodine if perforation suspected
standard dose: 5-20 mL
use organic iodine agent instead if aspiration and asphyxiation of contrast agent is of concern

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24
Q

double contrast study esophagography

A

obtain images during swallowing and during pause that follows swallowing of contrast
usually anesthetized
if reflux patient, administer only air

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25
upper GI
evaluates the morphology of the stomach and small intestines, visualizes extramural/ mural/ intramural lesions of GI tract, gastric emptying and pyloric function
26
what could be affected in the GI tract if sedation is used?
the GI tract motility could be altered
27
indications of an upper GI study
recurrent vomiting, hematemesis, anorexia, melena, chronic weight loss, suspected foreign body, or if survey radiographs are non-conclusive
28
media and dose for upper GI study
barium sulfate suspension 60% 8-10 mL/kg for dogs and cats <10kg 5-7 mL/kg for dogs 10-40kg 3-5 mL/kg for dogs >40kg iodinated contrast agents: 2-4 mL/kg of body weight added to water to equal 13 mL/kg double/ negative contrast: 20 mL/kg via orogastric tube
29
what is the common patient prep for GI studies?
fast for 12-24 hours before and perform an enema the night before and the day of the procedure
30
positioning for an upper GI study
measurement done at the thickest part of the abdomen over the thoracolumbar region or liver area for both lateral and VD
31
double contrast upper GI study
better visualizes gastric lesions shouldn't be performed if patient hasn't fasted requires sedation tips: slightly increasing the kVp may be needed, administer the entire volume of the barium, set a timer, iodinated agents' transit times are faster than barium
32
BIPS in upper GI studies
used to assist in the diagnosis of GI obstructions as well as motility and gastric emptying disorders eliminates potential for aspiration given with no food for gastric obstruction given with soft food for gastric emptying disorder
33
lower GI study
evaluates the cecum, colon, and rectum done through a process of retrograde administration of a positive contrast agent helps identify and evaluate extramural masses, mucosal lesions, disease of ileocolic valves, and overall morphology of ascending and transverse colon important to remove feces to enhance visualization sedation required
34
indications of a lower GI study
abnormal defecation, excessive mucus, strictures, tenesmus, obstructions, rectal neoplasia, colitis, pelvic/abdominal trauma can also use to view narrowing lumen that prevents passage of endoscope
35
media and dose for lower GI study
barium sulfate 20% warmed to room temp cats and small dogs: 10-20 mL dogs: 30-60 mL double contrast study: 1/2 barium dose is used and 25-50 mL of air for cats
36
positioning for lower GI study
caudal abdomen
37
precautions for lower GI study
avoid perforation of colon during catheterization, avoid overdistention
38
urinary system contrast studies
evaluates kidneys, bladder, ureters, prostate, and urethra contrast agents assist in visualization of size, shape, function, and opacity of renal system use of ultrasound, MRI, and CT has become more common
39
excretory urography
2 stage study of nephrogram and pyelogram
40
indications of an excretory urography
abnormal urine/urination, suspected renal or urethral calculi, dysuria/pyuria, intra-abdominal mass
41
media and dose for excretory urography
water-soluble iodide: 600-700 mg/kg up to 800 mg/kg max dose: 90 mL in dogs and 15 mL in cats ionic iodide: Diatrizoate (sodium hypaque) nonionic iodide: Iohexol (Omnipaque), iopamidol (Isovue), iodizanol (Visipaque)
42
patient prep for urinary studies
enema performed prior, fasted 24 hours prior, removal of urine, place an indwelling IV catheter
43
positioning for an excretory urography
standard abdominal imaging techniques
44
precautions for excretory urography
don't do if anuria/ severe dehydration/ severe uremia/ urethral obstruction present, temperature decreases in renal function may occur after, make sure patient is hydrated, contrast reactions can occur, can be used in both azotemic and non-azotemic patients
45
tips for excretory urography
compression done by using radiolucent sponge and elastic bandaging of an abdomen, right lateral recumbency gives greater imaging of kidney due to separation of right and left kidney, warming solution helps decrease viscosity and allows for easier administration
46
retrograde cystography
evaluates the bladder with positive, negative, or double contrast study can be used in absence of an ultrasound to determine masses
47
indications of a retrograde cystography
abnormal urine, abnormal urination, trauma, abnormalities on survey rads
48
media and dose for retrograde cystography
positive contrast: water-soluble organic iodide: 3-12 mL/kg negative contrast: CO2, N2O, room air: 3-12 mL/kg double contrast: cat: 0.5-1 mL positive agent + negative agent (3-12 mL/kg) dog <10kg: 1-3 mL positive agent + negative agent (3-12 mL/kg) dog >10kg: 3-6 mL positive agent + negative agent (3-12 mL/kg)
49
common patient prep for urinary studies
fast 24 hours prior, enema 4 hours prior, sedation recommended, aseptic technique, survey rads, collect urine samples if needed
50
positioning for retrograde cystography
standard lateral/ VD imaging of abdomen
51
precautions for retrograde cystography
iatrogenic issues due to urinary catheterization and cystographic procedures, mucosal ulceration and inflammation, gas embolism when performing the negative contrast study
52
tips for retrograde cystography
use right, left, and VD to identify lesions, administering lidocaine without epinephrine decreases spasms, allow bladder to be fully distended, reduction of 6 kVp in cats and 10-15 kVp in dogs commonly used when performing pneumocystogram, removal of contrast agent and bladder contents prior to waking
53
urethrography
evaluates urethra for structures/masses that prevent/alter flow of urine can be performed by retrograde administration of positive, negative, or double contrast studies or by compression of a positive contrasted full bladder
54
indications of a urethrography
abnormal urine passage
55
media and dose for urethrography
positive contrast organic ionic or nonionic agent: best to dilute agent to 150-200 mg of iodine/mL dosing: dogs: 10-15 mL total volume cats: 5-10 mL total volume
56
positioning for urethrography
standard L/VD imaging of abdomen
57
what can you do if a urinary catheter can't be placed?
perform an antegrade/voiding urethrogram 1. gentle pressure applied to bladder filled with positive contrast media using wooden spoon 2. obtain lateral radiograph when urine is noted at urethral orifice
58
precautions for urethrography
avoid trauma to urethra, avoid injection of air into torn urethra, voiding urethrogram may be better for females since it's hard to place catheter
59
tips for urethrography
if catheter is not a Foley a larger diameter catheter may be needed to prevent leakage of contrast agent around catheter, don't leave the balloon on a Foley catheter inflated for an extended time period
60
other contrast studies
myelography, angiography, arthrography, celiography, fistulography
61
myelography
injection of radiopaque contrast into subarachnoid space either at C1-C2 or in the lumbar region of L6-L7 to assist in evaluation of spinal cord
62
indications of myelography
localize and identify the size of the lesion or the extent of cord compression paresis, paralysis, proprioceptive/sensory deficit, spinal pain
63
media and dose for myelography
organic nonionic positive contrast iodine: Iopamidol (Isovue): 200-300 mL Iohexol (Omnipaque): 240 mg/mL dog dosage: caudal skull injection: cervical spine: 0.3 mL/kg, TL spine: 0.45 mL/kg lumbar injection: cervical spine: 0.45 mL/kg, TL spine: 0.3 mL/kg
64
patient prep for myelography
general anesthesia (avoid use of phenothiazine-based drugs), shave hair and aseptically prepare area
65
positioning for myelography
L/VD imaging prior to collection of CSF or administration of contrast agent, positioning should be over the area of concern
66
precautions for myelography
need to be anesthetized, CSF should be evaluated prior, be careful with spinal needle placement, make sure patient is hydrated, best to keep anesthetized with head elevated for 45 minutes-1 hour following procedure to minimize risk of seizures
67
tips for myelography
if blood is obtained during placement of spinal needle don't inject contrast agent, cervical injections tend not to move caudally to the area of concern and have an increased risk of trauma, if thoracolumbar region is the area of concern the best option is to use lumbar region for injection, lateral positioning for lumbar and cervical needle placement is most common
68
angiography
identifies cardiac abnormalities, vessel occlusions, lesions, and tumor locations water-soluble organic iodide injected into cephalic/jugular vein fluoroscopy is the best method for evaluation
69
celiography
identifies abdominal cavity and assists in determining diaphragmatic hernia water-soluble organic iodide injected into abdominal cavity at site of umbilicus
70
fistulography
assists in identifying fistulous tracts, potential foreign bodies in skin/ muscle/ soft tissue regions of body

Diagnostic imaging (13 decks)

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