Kontras media

KONTRAS MEDIA digunakan untuk :

meningkatkan kontras subjek atau membuat
kontras subjek yang tinggi dalam jaringan yang
biasanya memiliki kontras subjek rendah
Meningkatkan jumlah atom daerah
disuntikkan
 Indikasi
Kontras untuk radiografi
Kontras paramagnetik
Kontras untuk ultrasonografi

Interaksi dengan sinar X

1. Radiolusen kontras negatif CO2, O2, udara
2. Radioopak kontras positif barium, iodium
Kontras radiografi dipengaruhi oleh
Kualitas Radiasi (KVP )
Film Kontras
Objek radiografi ( Pasien )
Nomor atom Lemak = 6.46 Air = 7.51 Otot =
7.64 Tulang = 12,31
SPECIAL o-grams
Venogram
Arthrogram
Sialogram
Myelogram
Arteriogram
Angiogram
Galactogram
Hystersalpingogram.. etc

5
 CONTRAST INJECTION

KNEE ARTHROGRAM

6
DOUBLE CONTRAST WITH IODINE -
HIP Arthrogram

7
 To check fertility
can be oil or water based contrast

8
Myelogram

9
SIALOGRAM

10
Galactography - Breast Duct

11
Cerebral Angiogram

12
13
 LYMPHANGIOGRAM

Now largely replaced by ________ ?

14
Dacryocystography

Now largely replaced by CT

15
SPECIAL PROCEDURES
ARE INVASIVE

ALWAYS GET PATIENTS HISTORY AND CONSENT

BEFORE BEGINNING
OR GIVING ANY CONTRAST MEDIA
 CONSENTS

SIGNED AND WITNESSED

AFTER PROCEDURE HAS BEEN EXPLAINED
CHECK DEPARTMENT PROTOCOL
WHOS RESPONSIBLE ??????
Review of Contrast Agents

Types of Contrast
Routes of Adminstration
Chemical Components
Contrast Media changes the density of
the organs
Therefore changing the
Subject contrast
will change the
Radiographic contrast and film contrast
May need to INCREASE TECHNIQUE
FROM SCOUT IMAGE* f/s
Negative contrast Positive contrast
(AIR OR CO2) (all others)

Radiolucent Radiopaque

Low atomic # material High atomic # material

Black on film White on film

 Types of Contrast Media
Radiolucent- Radiopaque-
negative contrast agent positive contrast agent-
x-rays easily penetrate absorbs x-rays
areas- appear ____ on films areas- appear ____ on films

Negative Contrast Media

Air and gas Positive Contrast Agents
BARIUM
complications IODINES
emboli-air pockets in vessels
lack of oxygen Both + & - can be used in same study
Methods of Administration
of Contrast Material
INGESTED
(ORAL)
RETROGRADE
AGAINST NORMAL FLOW
INTRATHECAL
Spinal canal
PARENTERAL (IV,
Intrathecal)
Injecting into
bloodstream
(anything other than
oral)
 Contrast media for
SPECIAL PROCEDURES

Diagnostic agents
that are injected into
Circulatory System, Joint Spaces, Ducts

Body orifices/organs: uterus, breast,

salivary & lymph glands
 BLOOD WORK
LAB TESTS to check function of kidneys
prior to injection of contrast

WATCH THE UPPER LIMITS

BUN = BLOOD UREA NITROGEN
range is 10 - 20
always check with RAD when level above 20
CREATININE levels range:
(0.6 - 1.5) (0.05 - 1.2)
always check with RAD when level above 1.2
Indicates function of kidneys
Diseases / dehydration / kidney failure
 EGFR (new test)

Estimated
Glomerular
Filtration
Rate

More advanced test for

CREATININE levels
Why is this important?
Klasifikasi media kontras
 STRUKTUR
KONTRAS MEDIA

Kontras negatif : CO2, O2 dan udara

Kontras positif
BaSO4
Monomer ionik
(CH3-COHN) (COOH) 3 (I) CONH-
CH3)-C6
Monomer non ionik
(CH3-COHN) (CONHCH2CH2OH)
(CONHCH2CH2OH) 3 (I) C6
Osmolalitas cairan tubuh 300 miliosmol
Monomer ionik 6 7 kali osmolalitas cairan
tubuh
Monomer non ionik 1 kali osmolalitas cairan
tubuh
Dimer non ionik sama dengan cairan tubuh
Dimer ionik diantara monomer ionik dan non
ionik
 PENGGOLONGAN
KONTRAS IODIUM
Larut dalam minyak : lipiodol
Larut dalam air
1. Monomer ionik : turunan
diatrizoate, iothalamate,
metrizoate
2. Monomer non ionik :
iopamidol, iohexol,
iopromide dan iobitridol
3. Dimer ionik : ioxaglat
4. Dimer non ionik : iotrolan,
iodixanol
Turunan Monomer Ionic
Turunan Monomer Non-Ionic
DIMER IONIC
DIMER NON-IONIC
 KONTRAS IODIUM
YANG IDEAL

Konsentrasi iodium tinggi

Larut dalam air
Viskositas minimal
Tekanan osmotik rendah
Tidak mengalami metabolik degradasi
Protein Binding minimal
Stabil terhadap panas
 Barium Sulfate

High atomic number Z #? ______

Not soluble in water
Used to coat the lining of organs
Supplied in different thicknesses
Used
Esophogram, UGI,
Small Bowel,Lower GI
or BE
Ba ADVERSE REACTIONS

BARIUM INERT
SUSPENSION MAY CAUSE ALLERGY
OCG TABLETS (IODINE) ALLERGY
AFTER EXAM MAY SOLIDIFY DIFFICULT TO
EVACUATE
INCREASE FLUIDS, MILD LAXATIVE
EXTRAVASATION OF CONTRAST INTO
PERITONEUM
 What contributes to
discomfort, side effects, reactions:

VISCOSITY (thick, sticky)

thicker harder to inject, more heat
and vessel irritation (higher = greater viscosity)
Warming contrast will help
TOXICITY - (higher = greater viscosity)
MISCIBILITY - easily mixes with blood
OSMOLALITY - is a measure of the total
number of particles in solution.
Iodinated CONTRAST AGENTS
Adverse Reactions

Osmolarities higher than body fluids

Viscous
Greater chance for contrast reactions
Anaphylatic shock is the most severe
Injection of ionic contrast media may lead to
hypovolemia.
 Hypovolemia
basically means low blood volume
Symptoms of hypovolemia may
include
cold hands and feet, light headedness,
infrequent urination, increased heart
rate, and weakness.
Low blood volume can result in multiple
organ failure, kidney damage, brain
damage, and death

hypovolemia differs from dehydration

(which is excessive loss of body water
hypovolemia can lead to dehydration