PATIENT PREPARATION

FOR RADIOLOGICAL
PROCEDURE

BARIUM SWALLOW,BARIUM MEAL

AND BARIUM ENEMA
NUR SHAHIRAH BINTI MHD NOOR
01201210038

Content

Indications
Contraindications
Complications
Patient preparation

Barium swallow
Indications :
Dysphagia
Anaemia
Pain
Assessment of tracheo-oesophageal
fistulae
Assessment of site of perforation

Contraindications :
Suspected perforation
Risk of aspiration
Bowel obstruction
Complications
Leakage from an unsuspected
perforation
Aspiration

Patient preparation :
Overnight fasting
Avoid smoking and chewing gum
decrease secretions in oral cavity and
pharynx

Barium meal
Methods :
Single contrast :children and very ill adults to
demonstrate gross pathology
Double contrast : demonstrate mucosal pattern

Indications :
Dyspepsia
Weight loss
Upper abdominal mass
GI haemorrhage iron deficiency anaemia
Partial obstruction
Assessment of site of perforation gastrograffin
or LOCM

Contraindications :
Complete large bowel obstruction
Complications :
Leakage from unsuspected perforation
Aspiration of stomach contents due to
Buscopan
Partial large bowel obstruction->into a
complete obstruction-the impaction of
barium
Barium appendicitis
Side effects of pharmacological
agents used

Patient preparation :
Nil per oral for 6 hours prior to the
examination
Stop smoking on the day of
procedure -> increases gastric
motility
No contraindications to the
pharmacological agents used

After care :
The patient should be warned that his
bowel motions will be white for a few
days after the examination and may be
difficult to flush away.
The patient should be advised to drink
adequate volumes of water to avoid
barium impaction.
Laxatives may be taken if required.
Patient must not leave the department
until any blurring of vision produced by
Buscopan has resolved.

Barium enema
Methods :
Double contrast : demonstrate mucosal pattern
Single contrast :
- children
-reduction of intussusception
Indications :
Melena or anaemia
Intestinal obstruction
Pain
Mass
Change in bowel habit

Contraindications :
1) Absolute :
) Toxic megacolon
) Pseudomembranous colitis
) Rectal biopsy via:
-rigid endoscope within previous 5 days
-flexible endoscope within previous 24h
2) Relative :
) Incomplete bowel preparation
) Recent barium meal wait for 7-10 days
) Patient frailty

Complications :
Bowel perforation. Increased risk in :
-infants and elderly
-obstructing neoplasm
-ulceration of bowel wall
-inflation of Foley catheter balloon in
colostomy or the rectum
-patient on steroid therapy
-hypothyroidism
Transient bacteraemia

 Side effects of pharmacological agents

used
Cardiac arrhythmia -> d/t rectal
distension
Intramural barium
Venous intravasation -> barium
pulmonary embolus (80% mortality).

Patient preparation
3 days prior to examination :
- Low residue diet
On the day prior to examination :
- Fluids only
- Picolax at 0800h and 1800h
On the day of examination :
- Pt with prosthetic heart valves,a
previous h/o endocarditis or a surgically
constructed systemic pulmonary shunt
or conduit require antibiotic

Adults
Not allergic to penicillin :
- Amoxicillin 1 g + gentamycin 120mg
iv 15 min prior to procedure
- Followed by amoxicillin 500mg orally
6 hr later
Allergic to penicillin or who have
had a penicillin more than once in
the previous month
- Vancomycin 1g by slow iv infusion
over 100 min + gentamycin 120mg iv
immediately

Children ( <10 years)

Not allergic to penicillin
- Amoxicillin 500mg + gentamicin
2mg/kg iv 15 min prior to procedure
- Followed by amoxicillin (0-4 yrs
125mg ,5-9 yrs 250mg) orally 6hr
later

Allergic to penicillin
- vancomycin 20mg kg-1 by slow iv
infusion over 100 min + gentamicin 2mg
kg-1 iv immediately prior to start of
procedure
OR
- Teicoplanin 6mg kg-1 iv + gentamicin
2mg kg-1 iv immediately prior to start
of procedure

Aftercare :
Patients should be warned that their
bowel motions will be white for a few
days after the examination
Keep their bowels open with laxatives
to avoid barium impaction
Patient must not leave the department
until any blurring of vision produced
by the Buscopan has resolved

THANK YOU!

INTRAVENOUS
PYELOGRAPHY (IVP)
NURUL ARLIYA SHAHIDAH BT
ABD KADIR
01201210004

CONTENT

IVP
INDICATION
CONTRAINDICATION
COMPLICATIONS
PATIENT PREPARATION

IVP
An intravenous pyelogram (IVP)
is an x-rayexamination of the
kidneys,uretersand
urinarybladderthat uses
iodinatedcontrast
materialinjected into veins.

INDICATIONS
The exam is used to help to diagnose symptoms
such as blood in the urine or pain in the side or
lower back.
The IVP exam can detect problems within the
urinary tract resulting from:
kidney stones
enlarged prostate
tumors in the kidney, ureters or urinary bladder
scarring from urinary tract infection
surgery on the urinary tract
congenital anomalies of the urinary tract

Kidney stone seen on

IVP

CONTRAINDICATIONS
Allergy to dye.
Diabetes mellitus, taking pills to
controlblood sugar:
Pregnancy
Asthma
Multiple myeloma
Sickle cell disease
Pheochromocytoma or adrenal tumor
Kidney disease or kidney failure

COMPLICATIONS
In some people, the injection of X-ray dye can
cause side effects such as:
A feeling of warmth or flushing
A metallic taste in the mouth
Nausea
Itching
Hives

Rarely, severe reactions to the dye occur, including:

Extremely low blood pressure
A sudden, full-body allergic reaction that can cause
breathing difficulties and other life-threatening
symptoms (anaphylactic shock)
Cardiac arrest

PATIENT PREPARATION
To obtain images properly, it is necessary to prepare
the bowel to reduce the quantity of intestinal feces
and gas, so that they do not interfere with the
visualization of the UT. This preparationentails:
1)Abundant
hydration24hbeforeperformingtheexam.
Althoughdehydrationenhancesthe
concentrationofthecontrastmedium,itimplieshigher
renalrisk.

2) Bowel preparation:
Food restrictions:
putting the patient on a lowresidue diet, avoiding
dairy products,
fruit,vegetables,nuts,rice,wholegrainbreads,andred
meat48hbeforetheexamand
totalfastingforatleast69hbefore
Sodium dihydrogen phosphate (ENEMACASEN):
oneenema12handanother30mbe foretheexam.
*Alternatively,theadministrationofanoralbowel
evacuantsuchassodium picosulfate/magnesium
citrate(CITRAFLEET) dissolved in a glassof cold
water takenintwodoses18and12hbeforethe
scan.Patientsmustdrink250mlofwaterorother
clearfluidsperhouruntilbowelmovementshave
ceased.

MICTURATING
CYSTOURETHROGRA
M (MCUG)

CONTENT

MCUG
INDICATION
CONTRAINDICATION
COMPLICATIONS
PATIENT PREPARATION

MCUG
A cystourethrogram produces specialised x-ray
pictures. These help assess the structure and
function of the lower urinary tract, in particular
the bladder ('cysto') and the urethra (a tube
which takes urine to the outside of your body).
Images are also taken while the patient passes
urine.
Passing urine can be called micturating or
voiding, hence the name. This is done to see
whether urine flows away correctly from the
bladder.

INDICATIONS
Urinary tract infection (most common in children)
To find the cause ofurinary incontinence
To look for a cause of repeated urinary tract
infections.
To check for structural problems of the bladder
and the urethra.
To look forenlargement (hypertrophy) of the
prostateornarrowing of the urethra in men
(urethral stricture)
To look for injuries to the bladder or urethra.

CONTRAINDICATIONS
Pregnant woman
Active clinically UTI
Allergy to the contrast

COMPLICATIONS

An allergic reaction to the dye (contrast agent) used.

Blood in the urine after two days.
Pain in the lower part of the tummy (abdomen).
Signs of a urinary tract infection. These signs include:
Pain or burning upon urination.
An urge to urinate frequently, but usually passing only
small amounts of urine.
Dribbling or leaking of urine.
Urine that is reddish or pinkish, foul-smelling, or cloudy.
Pain in the back just below the rib cage on one side of the
body (flank pain).
High temperature (fever) or chills.
Feeling sick (nausea) or being sick (vomiting).

PATIENT PREPARATION
Children can eat and drink normally unless specifically instructed
otherwise by the Paediatric Consultant.
Please ensure patient takes their usual prescribed medications
Inform the x ray staff if the patient has any allergies or if they
have diabetes.
One parent / guardian can remain with the child
An MCUG is an x ray procedure therefore metal objects appear on
x ray images; avoid dressing the child in clothing with snappers
and zips. Replace metal nappy pins with adhesive tape.
Girls of twelve years and over will be asked to tell the
Radiographer when the first day of their last period was.
Current radiation legislation policy dictates that female patients
who have not gone through the menopause must have had a
period within ten days before the x ray test.

REFERENCES
http://www.radiologyinfo.org/en/info.cfm?pg=ivp
http://seattleclouds.com/myapplications/jpburgues
/practicalurologyipad/uiv.pdf
http://www.mayoclinic.org/tests-procedures/intra
venous-pyelogram/basics/risks/prc-20018949
http://patient.info/health/micturatingvoiding-cy
stourethrogram-mcugvcug

URETHROGRAM AND
HYSTEROSALPINGOGRAP
HY (HSG)
CLARE MUSIH
012012100068

OUTLINE
INDICATION
CONTRAINDICATION
COMPLICATION
PATIENT PREPARATION

URETHROGRAM
Commonly performed via the retrograde injection of
radiopaque contrast into the urethra to diagnose urethral
pathology such as trauma or urethral stricture. Most
commonly in male patients.

INDICATIONS
TRAUMA : The most common indication when there is

present of blood at the urethral meatus after blunt or

penetrating trauma.
LOWER URINARY TRACT SYMPTOMS : Symptoms of
urinary urgency, urinary frequency, and poor blood
emptying (risk for urethral stricture)
POST OPERATIVE EVALUATION : Performed for the
imaging and evaluation of the urethral after a surgical
procedure such as urethroplasty.

CONTRAINDICATION
Relative contraindication is a patient allergic to

radiopaque contrast.
Should not be performed with patients who have an active
urinary tract infection.

COMPLICATION
Adverse reactions are rare when using the contrast

medium.
Due to technique :
Acute urinary tract infection
Urethral trauma

PATIENT PREPARATION
There is generally no special preparation for a

urethrogram.
It is desirable to treat any urinary tract infection
before the procedure is done.

HSG ( HYSTEROSALPINGOGRAPHY )
It is a radiographic diagnostic study of the uterus and

fallopian tube most commonly used in the evaluation of

infertility.

INDICATION
Infertility
Recurrent miscarriages
Following tubal surgery
Assessment of the integrity of a caesarean uterine scar

CONTRAINDICATION
Known contrast allergy
Pregnancy
Active pelvic infection
Heavy uterine bleeding

COMPLICATION
Due to contrast medium :
ALLERGIC
Due to technique :
PAIN
BLEEDING
TRANSIENT NAUSEA, VOMITING AND HEADACHE
INFECTION
ABORTION ( operator must ensure that the patient is not

pregnant)
INTRAVASATION (passage of contrast media into the veins
due to local or systemic abnormalities)

PATIENT PREPARATION
Patient should abstain from intercourse between
booking the appointment and the time of examination
unless she is reliable method of contraceptions,
or,
the examination can be booked between the 4th and
10th days in a patient with regular 28 day cycles.
2. Prior to procedure, a mild sedative or over the counter
medication can be given to minimize any potential
discomfort.
3. Patient will be ask to remove any metal (jewelry, etc.)
before the procedure because it can interfere with the xray machine.
1.

 AFTER CARE :
After HSG, you can expect to have pelvic cramps and a

sticky vaginal discharge as some of the fluid drains out of

the uterus. It may be tinged with blood.
A pad can be used for the vaginal discharge and tylenol
may be taken as indicated after the procedure for pain
relief.
If experience increased pain, fever, or heavy bleeding
after the exam, contact doctor immediately.

REFERENCES :
http://emedicine.medscape.com/article/1893948-overview
http://www.healthline.com/health/hysterosalpingography#o
verview1
S.CHAPMAN, and R.NAKIELNY. A Guide to
RADIOLOGICAL PROCEDURES.4TH EDITION.

HEPATOBILIARY SYSTEM
PROCEDURES

DIVIAHLINI
SELVARATNAM
012012050311

LEARNING OUTLINE
ENDOSCOPIC RETROGRADE
CHOLANGIOPANCREATOGRAPHY (ERCP)
PERCUTANEOUS TRANSHEPATIC
CHOLANGIOGRAPHY (PTC)

ENDOSCOPIC RETROGRADE
CHOLANGIOPANCRETOGRAPHY
(ERCP)

ENDOSCOPIC RETROGRADE
CHOLANGIOPANCRETOGRAPHY
(ERCP)

Is a diagnostic and therapeutic radiological

procedure that combines upper gastrointestinal

(GI) endoscopy and x rays(fluoroscopy) for

examination and intervention of thebiliary

treeandpancreatic ducts.
Contrast material is directly injected into common bile duct
through which a catheter is inserted into ampulla of Vater via
endoscope positioned in duodenum.

INDICATIONS OF ERCP
DIAGNOSTIC
Evaluation of extrahepatic biliary obstruction suspected or known
Evaluation of Pancreatic duct obstruction suspected or known
Evaluation of signs/symptoms suggesting pancreatic malignancy
Investigation of diffuse biliary disease, e.g. sclerosing cholangitis
Post cholecystectomy syndrome.

INDICATIONS OF ERCP
THERAPEUTICS
Stent placement
Balloon dilatation of ductal strictures
Tissue biopsy from biliary or pancreatic ducts
Sphincterotomy

CONTRAINDICATIONS OF
ERCP
1. HIV positive individual.
2. Esophageal obstruction Varices, pyloric stenosis.
3. Previous gastric surgery.
4. Acute pancreatitis.
5. Pancreatic pseudocyst.
6. When glucagon or Buscopan are contraindicated.
7. Severe cardiorespiratory disease.

PATIENT PREPARATION FOR

ERCP
Nil by mouth 6 hours prior to the procedure ( no bowel prep
needed ).
Pre medication checklist - Patients current medications, and
any allergies to medications.
Before the procedure begins, you may give local anesthetic
4% Xylocaine spray to anaesthesize the pharynx.
IV sedation patient not usually intubated .
Antibiotic cover.

AFTERCARE FOR ERCP

1) Nil orally until sensation has returned to the pharynx
( 0.5-3 H).
2) Monitor pulse, temperature and blood pressure
every 30 minutes for 6 hours.
3) If there is biliary or pancreatic obstruction, then
maintain antibiotics.
4) Check serum / urinary amylase if pancreatitis is
suspected.

COMPLICATIONS OF ERCP
A. Due to the contrast medium
. 'Allergic reactions' - rare.
. Acute pancreatitis - more likely with large volumes,
high pressure injections.

COMPLICATIONS OF ERCP
B. Due to the technique
Local
Damage by the endoscope, e.g. rupture of the
oesophagus, damage to the ampulla, proximal pancreatic
duct and distal common duct, duodenal perforation.
Distant
Bacteremia, septicemia, aspiration pneumonitis,
hyperamylasemia(70%), acute pancreatitis(0.7-7.4%).

PERCUTANEOUS
TRANSHEPATIC
CHOLANGIOGRAPHY (PTC)

PERCUTANEOUS
TRANSHEPATIC
CHOLANGIOGRAPHY
(PTC)
Is a radiologic technique used to visualize the
anatomy of the biliary tract (bile ducts).

A contrast medium is injected into a bile duct through

the liver, after which X-rays are taken.

INDICATIONS OF PTC
Biliary drainage procedure therapeutic.
Evaluation of biliary anatomy in presence of biliary obstruction
when endoscopic retrograde cholangiopancreatography (ERCP)
is unsuccessful.
History of anatomy- altering surgical procedures ( Billroth II
procedure, Roux-en-Y gastric bypass surgery, and the Whipple
procedure).
ERCP not feasible (e.g. patients with gastro-jejunostomy).

INDICATIONS OF PTC
Assessment of high biliary obstruction especially at
hilar region (Porta hepatic).
To identify causes of obstructive jaundice; and
differentiate from medically treatable cause.
Introducing stents across the obstruction.
Inaccessible papilla (eg, in ampullary carcinoma or
duodenal obstruction from malignancy).

CONTRAINDICATIONS OF
PTC
1. Bleeding tendency :
.Platelets < 100 000 .
.Prothrombin time is 2sec greater than control .
2. Biliary tract sepsis .
3. Non-availability of prompt surgical facilities
or unfit patient for surgery.
4. Hydatid disease.

PATIENT PREPARATION FOR

PTC
1. Haemoglobin, prothrombin time and platelets are

checked and corrected if necessary.

2. Prophylactic antibiotics T. Ampicillin 500 mg q.d.s.

to commence 24 h before and continue for 3 days

after the examination.
3. Nil by mouth for 5 hours prior to the procedure.
4. Premedication.

COMPLICATIONS OF PTC

Morbidity is approximately 3% while mortality is <

0.1%.

A. Due to the contrast medium

Allergic/idiosyncratic reactions - very uncommon.

COMPLICATIONS OF PTC
B.

Due to the technique

1.
2.
3.
4.
5.
6.
7.

Local :
Puncture of extrahepatic structures.
Intrathoracic injection.
Cholangitis.
Bile leakage - may lead to biliary peritonitis (incidence 0.5%).
Subphrenic abscess.
Haemorrhage .
Shock - owing to injection into the region of the coeliac plexus.

COMPLICATIONS OF PTC
Generalized:
1. Bacteraemia.
2. Septicaemia.
3. Endotoxic shock.
The likelihood of sepsis is greatest in the presence of
choledocholithiasis because of the higher incidence of
pre-existing infected bile.

REFERENCES
1) Chapman S, Nakielny R, A Guide to Radiological
Procedures, 6th edition, Saunders Ltd. USA, 2013
2)
http://patient.info/doctor/endoscopic-retrograde-ch
olangiopancreatography
3) http://radiopaedia.org/articles/percutaneous-transhe
patic-cholangiography

Angiography &
Image guided
biopsy
Nasyrah Iskandar
012012100229

Angiography
Angiography is an imaging technique used to
assess blood vessels and blood flow.
Images created during angiography are called
angiograms.
The results help determine treatment options.
Types
- Head & neck (cerebral angiography)
- Heart (coronary angiography)
- Lungs (pulmonary angiography)
- Arms & legs (extremity angiography)
- Kidneys (renal angiography)

Patient preparation
Before:
Patient history
- Allergy history
- Medications (anticoagulants cause excessive
bleeding)
Detailed explanation of procedure, possible risks and
complications. Obtain informed consent.
No solid food 8h before procedure (reduce risk of
aspiration). Note the hydration status of patient
(reduce risk of contrast induced renal damage)

 Vital signs recorded. Pulse in the extremity distal

to selected puncture site checked.
Puncture site : shaved, cleaned, draped
Draw blood before starting the procedure (assess
coagulation profile & kidney function)

During:
Seldinger technique
The technique of catheter insertion via double-wall
needle puncture and guide-wire
Four vessels are typically considered for
catheterization:
1) Femoral artery most frequently used
2) Brachial artery
3) Axillary artery
4) Aorta of historical interest only

Selection will be made based on the strong presence

of a pulse and the absence of vessel disease.
The femoral artery is the preferred site for an arterial
puncture because of its size and the location (easy
access) . It is punctured just inferior to the inguinal
ligament.
If a femoral artery puncture is contraindicated
because of previous surgical grafts, the presence of
an aneurysm, or occlusive vascular disease, other
arteries my be used instead.
The femoral vein would be the vessel of choice for
venous access.

Seldinger technique

After care:
- Bed rest on a day-case basis, at least 4 h.
- Larger catheters require longer bed rest and
observation.
- Careful observation of the puncture site.
- Pulse and blood pressure observation half-hourly
for 4 h and then 4-hourly for the remainder of 24
h, if the larger catheter systems are used.

Complication of catheter technique

Bleeding at the puncture site (hematoma/hemorrhage)
: due to large catheters, frequent catheter changes,
thrombolytic agents(heparin), inadequate
decompression.
Thrombus formation: a blood clot may form in a vessel
and disrupt the flow to distal parts
Embolus formation: a piece of plaque may be
dislodged from a vessel wall by the catheter. A stroke
or other vessel occlusion may result
Damage to local structures: brachial plexus. During
axillary artery puncture.
Infection of puncture site: this is caused by
contamination of the sterile field

Image guided biopsy

Biopsy
A procedure to remove a piece of the
tissue/sample of cells from body so that it can be
analyzed closely.

Image guided biopsy

Combines imaging procedure with needle biopsy.
The biopsy can be done under ultrasound,
mammographic/MRI guidance, depending on
which modality the findings are best seen.
Using real-time images can make sure the needle
reaches the correct spot.

Types
Stereostatic-guided biopsy
Ultrasound-guided biopsy
MRI-guided biopsy
Fine needle aspiration (FNA) biopsy
Image-guided needle localization

Patient preparation
Before:
- Medical history (allergy, medication), menstrual
history(female)
- Wear comfortable clothes with separate top and
bottom.
- Remove all jewelry.
- Need to have pre-procedure exams: blood tests,
ultrasound, CT scan/MRI.

During:
- Image guided biopsies vary depending on the
type.
- Radiologist will use ultrasound to locate the
abnormal tissue.
- The area will be cleansed and anesthetized.
1) Fine needle aspiration (FNA) biopsy
- While watching the ultrasound monitor, the
radiologist will carefully insert very small biopsy
into the abnormal tissue.

2) Needle core biopsy

- Radiologist makes a small incision, about 1/8 of an
inch long, in the skin above the are to be biopsied.
- While watching the ultrasound monitor, the
radiologist will carefully insert the spring loaded
biopsy needle into the area of the abnormal
tissue.
- The needle will be activated, making a clicking
noise, and a small sample of tissue will be
removed.

After care:
- Incision will be cleaned and closed with tape and
a pressure dressing applied.
Complications
The following serious complications occur in less
than 1 percent of biopsies:
-

Hemorrhage
Sepsis
Pneumothorax, hemothorax, or emphysema
Death

THANK YOU

Reference
A guide to radiological procedures, chapman (4th
edition)
www.uhs.nhs.uk
www.webmd.com

PREPARATION
OF
RADIOLOGICA
L
Athina Nashrah binti Abdullah
PROCEDURES
012012100001

Contents

USG HBS and KUB

CT scan
MRI

Ultrasound of the hepatobiliary

system

Indications
Suspected gallstones
Right upper quadrant pain
Jaundice
Fever of unknown origin
Acute pancreatitis
To assess gallbladder function
Guided percutaneous procedures.

Contraindications
There are no contraindications.

Patient preparation
Fast for at least 6 hours before the

ultrasound, preferably overnight.

Eat a fat-free meal the evening before

the ultrasound and then to fast until the

procedure.

Ultrasound of Kidneys, Ureters

and Bladder

Indications
Suspected renal mass lesion
Suspected renal parenchymal disease
Possible renal obstruction
Haematuria
Renal cystic disease
Renal size measurement
To facilitate accurate needle placement in

interventional procedures
Bladder tumour.

Contraindications
No contraindications

Patient preparation .
Must have full bladder
If the bladder is very uncomfortably full,

some urine is voided to relieve the pressure

but try not to empty the bladder.

Computed Tomography
(CT) scan

Indication
Diagnose muscle and bone disorders, such as

bone tumors and fractures

Pinpoint the location of a tumor, infection or
blood clot
Guide procedures such as surgery, biopsy and
radiation therapy
Detect and monitor diseases and conditions
such as cancer, heart disease, lung nodules
and liver masses
Monitor the effectiveness of certain treatments,
such as cancer treatment
Detect internal injuries and internal bleeding

Contraindication
Pregnant
Patient allergic to IV contrast media (IVCM)
Renal impairment

Patient Preparation
Patient is explained of the procedure, the

time it is likely to take, the necessity for

immobility and the necessity for breathholding whilst scanning chest and abdomen.

The patient should be as pain-free as is

practical but too heavy sedation or analgesia

may be counter-productive
- patient cooperation is often required.
Children under the age of 4 years will
usually need sedation
Children should also have an IV cannula
inserted at the time sedation is administered
if IV contrast medium is needed.

Contrast

Intravenous contrast medium

Many CT examinations will require IV contrast medium.
Allergy and atopy should be excluded.
If present, follow the relevant guidelines regarding the use of

steroid prophylaxis and use LOCM.

An explantation of the need for contrast enhancement

should be given to the patient.

The dose will depend on the area examined:
head - 50 ml;
abdomen - 100 ml, given initially as a bolus of 20 ml followed

by 2 ml/s during scanning.

In children a maximum dose of 2 ml/kg body weight (300 mg
I/ml ) should be observed.

Magnetic Resonance Imaging

(MRI)

Indication
Ischemia/infarct
Vascular anomalies
Hemorrhage
Infection
Tumors and masses
Trauma and diffuse axonal injuries
Neurodegenerative disorders and dementias
Inflammatory conditions
Congenital abnormalities
Seizures
Headaches
Cranial neuropathies

Contraindications
No metals or electronic devices.
The following are some items that might be

contraindicated:
Foreign bodies from trauma, mechanical heart valves,

surgical implants, plates, screws, staples and clips, and

prosthetics that contain metal
Pacemakers, cochlear implants, drug infusion ports,
insulin pumps, deep-brain stimulators, and other
electrical devices
Metal tooth implants and fillings
Accessories such as keys, glasses, piercings, jewelry,
hairpins, pagers, watches, wallets, identification badges,
and pens
Oxygen tanks, carts, chairs, IV poles, and other medical
equipment

Patients who are unable to lie still, such as many

children,patients with movement disorders, or patients

in severe pain, also might be unsuitable for an MRI and
can require sedation or general anesthesia. Similarly,
those with severe anxiety or claustrophobia might
require mild sedation or anxiolytics.
While pregnancy is not a contraindication owing to a

lack of ionizing radiation, minimum use of MRI is still

recommended. Gadolinium-based contrast agents are
able to cross the placenta and should not be
administered, particularly during the first trimester.
The use of contrast material is not recommended in

patients with advanced renal insufficiency

Contrast

Gadolinium
Side effects:Warmth
Pain at injection site
Nausea
Headache

Patient Preparation
MRI screening form need to be completed
Patient will be asked to change into a gown

and to remove:
-Jewelry, Hairpins, Eyeglasses, Watches, Wigs,
Dentures, Hearing aids, Underwire bras
If MRI contrast is indicated, IV cannula will

need to be inserted

Reference

Chapman S, Nakielny R, A Guide to

Radiological Procedures, 4th edition
http://www.healthline.com/health/ultras
ound#Preparation3
http://www.radiology.ucsf.edu/patient-ca
re/prepare/mri
http://www.mayoclinic.org/testsprocedures/ct-scan/basics/why-itsdone/prc-20014610