Prepared by: Marina Chong (DMI14042309)

Norhaima(DMI14042313)
Visnie(DMI14042316)
What is Contrast Media?
Contrast media is a substance used to enhance the contrast of structures or fluids
within the body in medical imaging.

What is the purpose of Contrast Media?
It is commonly used to enhance the visibility of blood vessels and the gastrointestinal tract.

Contrast Media can be divided into positive and negative contrast media.
Positive contrast media :- Barium or Iodine based, contains elements of high atomic
number.
They attenuate x rays more than do the body soft tissues.
These compounds can be used to fill or outline a hollow organ (Eg: alimentary tract, urinary
bladder), or can be injected into a blood vessel for immediate visualisation of the vascular
supply or for subsequent excretion evaluation.

Negative contrast media ;- Gases with low specific gravity; air, oxygen and carbon
dioxide are most frequently used.
They are not commercially available.
They appear black on a radiograph.

Barium based contrast
media
Iodine based contrast media
Certain materials or gases can be injected into veins, arteries, lymphatics, or hollow
cavities to obtain contrast with the surrounding tissues.
A contrast medium is a radiopaque substance which obstructs the passage of x-rays
so that the structures containing it appear white on the x-ray film, thus delineating
abnormal pouches or growths and defining the contour of body structures on x-ray.
Examples of radiopaque material are Hypaque and Renografin, dyes used in
intravenous pyelogram (IVP) and barium (the substance used in gastrointestinal
series)
Some of the more common radiographic examinations which use contrast media are:
A.Angiography
The radiographic study of the vascular system
A. Cerebral angiogram
X-ray of the vessels of the brain
B. Cardiac angiogram
X-ray showing the functions of the heart and large
blood vessels
C. Lymphangiogram
X-ray study of the vessels of the lymphatic system
D. Arteriography
X-ray examination of the arteries
E. Venography:
X-ray examination of the veins
B.Urography
Radiologic study of the urinary tract
C.Urogram (Pyelogram)
X-ray of the kidney and ureter with emphasis on the pelvis
of the kidney by intravenous injection of a contrast
medium
D.Cystogram
X-ray of the urinary bladder by intravenous injection of a
contrast medium
E.IVP (Intravenous Pyelography)
A succession of x-ray films of the urinary tract following
the injection into a vein of an iodine-containing substance
which is collected by the kidneys, passing into the ureters
and subsequently the bladder, allowing the study of
urinary tract function (also known as Intravenous
Urography, IVU)
Heart and Brain Angiography
Urogram
Cystogram
The name of the contrast media: Barium sulphate
Barium sulphate is an inert inorganic salt of the chemical element barium
Administered either orally or rectally.
Used to visualise the gastrointestinal tract consist of a suspension of insoluble barium
sulphate particles which are not absorbed by the gut.
Depending on how it is to be administered the compound is mixed with water,
thickeners, de-clumping agents, and flavourings to make the contrast agent.
As the barium sulphate doesn't dissolve, this type of contrast agent is an opaque
white mixture.
It is only used in the digestive tract; it is usually swallowed or administered as an
enema. After the examination, it leaves the body with the feces.
Types of barium based contrast media:
1. Barium enema
2. Barium swallow
3. Barium meal
4. Barium follow through
Barium swallow powder
Iodine based contrast media is a form of intravenous radio contrast (radiographic dye) containing iodine,
which enhances the visibility of vascular structures and organs during radiographic procedures.
Iodinated contrast media may either be oil-based or water-soluble.
Oil-based contrast medium is slowly absorbed by body tissue and is usually only used in sialographic and
hysterosalpingographic examinations.
Water-soluble iodinated medium, which is more quickly absorbed, may be used in place of barium
sulphate for gastrointestinal studies that are contraindicated by the use of barium for that reason.
Iodinated medium may also be either ionic or non-ionic.
The ionic type tends to create a high osmolality in blood and may cause a contrast media reaction in some
individuals, which may be life-threatening for those with certain medical conditions.
The non-ionic form decreases this risk, but is much more expensive. The non-ionic contrast media is much
more widely used today
Compound Name Type Iodine content Osmolality
Ionic
Diatrizoate (Hyp
aque 50)
Monomer 300 mgI/ml 1550 High
Ionic
Metrizoate (Isop
aque 370)
Monomer 370 mgI/ml 2100 High
Ionic
Ioxaglate (Hexa
brix)
Dimer 320 mgI/ml 580 Low
Compound Name Type Iodine content Osmolality
Non-ionic
Iopamidol (Isovu
e 370)
Monomer 370 mgI/ml 796 Low
Non-ionic
Iohexol (Omnipa
que 350)
Monomer 350 mgI/ml 884 Low
Non-ionic
Ioxilan (Oxilan
350)
Monomer 350 mgI/ml 695 Low
Non-ionic
Iopromide (Ultra
vist 370)
Monomer 370 mgI/ml 774 Low
Non-ionic
Iodixanol (Visipa
que 320)
Dimer 320 mgI/ml 290 Low
Carbon Dioxide
Carbon dioxide also has a role in angiography. It is low-risk as it is a natural product with no
risk of allergic potential. However, it can be used only below the diaphragm as there is a risk
of embolism in neurovascular procedures. It must be used carefully to avoid contamination
with room air when injected. It is a negative contrast agent in that it displaces blood when
injected intravascularly.
Air
Air can be used as a contrast material because it is less radio-opaque than the tissues it is
defining. An example of a technique using purely air for the contrast medium is an air
arthrogram where the injection of air into a joint cavity allows the cartilage covering the ends
of the bones to be visualised.

Patient are screened for the following:-
Previous reactions to iodinated contrast media
All severe allergies and reactions (both medications and food)
History of diabetes, kidney disease, pheochromocytoma, solitary kidney, kidney or other
transplant, or myeloma
Current use of any metformin-containing medications
For women of child-bearing age, currently or possibly pregnant or currently breast-feeding.

Diet restriction avoid solid foods for 36 hours before diagnostic procedures
Diet such clear liquids as vegetable or apple are permitted.
it is important reasons to empty, clean and less likely vomit during procedure.


Creatinine Testing Prior to Contrast Administration
Routine creatinine testing prior to contrast administration is not necessary in all patients. The
major indications are age over 60, history of renal insufficiency, diabetes mellitus, or
hypertension.
Prednisone 50mg po at 13 hours, 7 hours and 1 hour prior to planned administration
of intravenous contrast plus diphenhydramine 50mg po, iv or im at 1 hour prior to
planned administration of intravenous contrast
Or
Methylprednisolone 32mg po at 12 hours and 2 hours prior to planned administration
of contrast plus diphenhydramine 50 mg po, iv or im at 1 hour prior to the planned
administration of contrast
Or
Hydrocortisone 200mg iv at 13 hours, 7 hours and 1 hour prior to planned
administration of intravenous contrast if patient is unable to take po medications

There are a few reaction that patient may encountered during contrast media.
The patient may feel that he or she has urinated on himself or herself.
It also puts a metallic taste in the mouth of the patient.
Nausea
Vomiting
Diarrhea
Hypertension
Intestinal cramping
Pain
Edema
Dizziness


Oral and rectal administration of barium sulphate is usually safe but constipation and
abdominal pain may occur after barium meals or enemas.
Barium fecoliths are rare complications of barium contrast examinations and usually
seen in diverticula of the colon.
It may associated with abdominal pain, appendicitis, bowel obstruction or perforation.
They may even have to be removed surgically.
Leakage of barium into peritoneal cavity - Bowel obstruction.
Allergic reactions to barium preparation Bronchospasm, urticarial.
Symptoms
Allergies
Contrast media reaction
Hay fever
Eczema

Treatments
Make sure patients has done their check ups in making sure they are not allergic to
iodine.
If patient has a reaction from the previous procedure, giving them a non ionic agent
can reduce the risk of a repeat reaction.
Choose the appropriate choice of contrast media and premedication to make sure
patient is not in a risk of a reaction.
In high risk subjects, monitoring for the first hour is recommended.
Nasal congestion
Limited nausea/vomiting
Mild hypertension
Sneezing
Headache
Dizziness
Altered taste
Diffuse erythema
Facial edema
Isolated chest pain
Wheezing

Diffuse edema, or facial edema with dyspena
Diffuse erythema with hypotension
Laryngeal edema
Anaphylactic shock (hypotension + tachycardia)
Convulsion, seizures
Hypertensive emergency
http://www.ncbi.nlm.nih.gov/pubmed/11471623
http://www.aafp.org/afp/2002/1001/p1229.html
http://emedicine.medscape.com/article/422855-overview#aw2aab6b3
http://en.wikipedia.org/wiki/Iodinated_contrast
http://en.wikipedia.org/wiki/Contrast_medium
http://en.wikipedia.org/wiki/Radiocontrast_agent
http://training.seer.cancer.gov/abstracting/procedures/clinical/radiologic/contrast.html
Contrast Media Safety Issues and ESUR Guideline H.S. Thomsen (Ed.)
ACR Manual on Contrast Media Version 9, 2013