Transcript Contrast Media - El Camino College

1
Radiographic
Contrast Media
RAD TECH 255
SPECIAL PROCEDURES
 WEBPAGE VERSION
MERRILLS VOL2
RTA BOOK
REV: SPRING 2010
2
Subject Contrast

Range of differences in the intensity of the x-ray beam,
after it has been attenuated by the subject (patient).

For LOW CONTRAST stucures:
What can be done to attain medical information- see
the difference between muscle, organs or vessels
Define and outline – organ structure and function




CONTRAST MEDIA used to:
enhance subject contrast or render high subject
contrast in a tissue that normally has low subject
contrast
3
Contrast media

Defines subtle differences in subject
contrast

Increases atomic number of area injected

Results in a SHORTER scale of subject
contrast
4
Radiographic Contrast :
Influenced by…
Radiation Quality (KVP)
 Film Contrast
 Radiographic object (Patient)

Atomic Number
Fat = 6.46
 Water = 7.51
 Muscle = 7.64
 Bone = 12.31

5
KVP

TYPE OF CONTRAST USED
DETERMINES KVP RANGE
BARIUM
_______kVp
IODINES
________kVp
(Ionic / Nonionic
Water or Oil)
6
INJECTABLE
CONTRAST MEDIA
for RT 255 procedures
INVASIVE PROCEDURES
The “o-grams”
7
ALWAYS TAKE
A “SCOUT”
BEFORE
CONTRAST
INJECTION
Why?
List 4 reasons
8
SPECIAL “o-grams”
Venogram
 Arthrogram
 Sialogram
 Myelogram
 Arteriogram
 Angiogram
 Galactogram
 Hystersalpingogram…….. etc

9
CONTRAST INJECTION
KNEE ARTHROGRAM
10
DOUBLE CONTRAST WITH IODINE HIP Arthrogram
11
To check fertility
can be oil or water based contrast
12
Myelogram
13
Myelogram Contrast
Pantopaque was introduced in 1944 as a
oil contrast medium
 The first low-osmolar contrast medium to
be produced was metrizamide (Amipaque)

Oil never completely re –absorbed
 (Pre-employment L.sp)

14
SIALOGRAM
15
Galactography - Breast Duct
16
Cerebral Angiogram
17
18
LYMPHANGIOGRAM
Now largely replaced by ________ ?
19
Dacryocystography
Now largely replaced by CT
20
SPECIAL PROCEDURES
ARE INVASIVE
ALWAYS GET PATIENT’S
HISTORY AND CONSENT
BEFORE BEGINNING
OR GIVING ANY
CONTRAST MEDIA
21
CONSENTS
 SIGNED AND
WITNESSED
 AFTER PROCEDURE HAS
BEEN EXPLAINED
 CHECK DEPARTMENT
PROTOCOL
 WHO’S RESPONSIBLE ??????
22
CONSENTS
ASSAULT
verbal threat of harm
 BATTERY

Unlawful touching - unauthorized treatment
“X-RAY” TAKEN ON WRONG PATIENT

FALSE IMPRISONMENT
Restraints require permission
from patient or authorized person
23
The ARRT has a
published code of ethics.

The ARRT Code of Ethics provides the
radiologic technologist with an operational
blueprint of norms of professional conduct.
24
Review of Ethics
(Pt Care Book –Professional Ethics)
The science of rightness and wrongness of
human conduct and character is termed
ethics.
 __________is the ethical principle that
means that “above all, do no harm.”
 _________ principle that means that
being truthful is right.
 __________ is the ethical principle that
means that actions benefit others.
25
Review of Contrast Agents
Types of Contrast
Routes of Adminstration
Chemical Components
26
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
27
Contrast Media (review)


Negative contrast
(AIR OR CO2)

Positive contrast
(all others)

Radiolucent

Radiopaque

Low atomic # material

High atomic #
material

Black on film

White on film

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Types of Contrast Media




Radiolucentnegative contrast agent
x-rays easily penetrate
areas- appear ____ on films
Negative Contrast Media
 Air and gas



complications
emboli-air pockets in
vessels
lack of oxygen




Radiopaquepositive contrast agentabsorbs x-rays
areas- appear ____ on films
Positive Contrast Agents
 BARIUM
 IODINES
Both + & - can be used in same
study
29
2 BASIC TYPES
OF CONTRAST material

BARUIM Z# 56



NON WATER
SOLUABLE





GI TRACT ONLY
INGESTED OR
RECTALLY
KVP 90 – 120*




IODINE
Z# 53
WATER SOLUABLE
POWDER
LIQUID
INTRAVENOUS OR
Intrathecal
GI TRACT
Also OIL based
KVP BELOW 90*
30
Methods of Administration
of Contrast Material
 INGESTED

(ORAL)
 RETROGRADE

AGAINST NORMAL FLOW
 INTRATHECAL
 Spinal
canal
 PARENTERAL
 Injecting
(IV, Intrathecal)
into bloodstream
 (anything other than oral)
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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
32
LAB TESTS to check function of kidneys
prior to injection of contrast
WATCH THE UPPER LIMITS
 BUN = BLOOD UREA NITROGEN
 Merrills pg 214 range is 8 to 25
pg 242 range is 10 - 20

always check with RAD when level above 20
CREATININE levels range:
 pg 214 (0.6 - 1.5) pg 242 (0.05 - 1.2)

always check with RAD when level above 1.2
Indicates function of kidneys
 Diseases / dehydration / kidney failure

33
EGFR (new test)
Estimated
 Glomerular
 Filtration
 Rate

More advanced test for
 CREATININE levels
 Why is this important?
34
various water-soluble contrast media for
urography and angiography
Both ionic and non-ionic monomers*
 are all extracellular contrast media
 are excreted unmetabolized by glomerular
filtration
 Approximately 85-90% of the injected
dose is found in urine within the first 6
hours
 95-100% within the first 24 hours

35
monomers*
The ionic monomeric agents are salts that
 dissociate into two molecules
 one anion containing the radiopaque
property due to three iodine atoms
 and one cation without radiopaque
properties


More on this later in the lecture…..
36
BARIUM – a review
BARUIM SULFATE
Not used in Special Procedures
37
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

38
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

39
Extravasation of BA in abd
40
Ingested CONTRAST
Gastrografin or Hypaque

High atomic #

Close to iodine

Water soluble

Similar usage as
Barium
41
GASTROGRAFIN
Adverse Reactions
 Water
soluble, safe in the abdominal
cavity
 Safe to use if perforation is
suspected
 Very harmful to the lung tissue
 Do not use if aspiration is possible
42
Gastro – Pathology present




Bowel
Obstruction
Note contrast
Seen in
kidneys as
well
43
IODINE
IONIC OR NON IONIC
WATER OR OIL BASE
44
IODINATED CONTRAST
iodine z # 53

WATER BASED







INJECTED
VESSELLS/DUCTS
INGESTED
Organ function/flow
OPEN WOUNDS




OIL BASED
INJECTED
NEVER
VESSELLS
ONLY DUCTS
NOT INGESTED
OPEN WOUNDS
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INJECTION OF IODINE
into Vessels



ALWAYS A WATER
BASED IODINATED
COMPOUND
BOLUS INJECTION
INFUSION DRIP




IONIC VS
NON IONIC
CONTRAST
50 -70 %
CONCENTRATE
46
IODINE WATER BASED
CONTRAST


IONIC
LESS $$$

NON IONIC
MORE $$$

MORE REACTIONS

LESS REACTIONS

47
CONTRAST MEDIA
IODINE
is either: IONIC or NON-IONIC
 Osmolarity
 # Of Particles (Cations + And Anions -)


In Solution Per Kilogram Of Water
High Osmolarity

=more Cations And Anions
Can Upset Homeostasis
 Nonionic Have No Charged Particles

48
Contrast Agents
IONIC
 High Osmolality
(Higher risk of
complications)
 Diatrizoate
sodium
(Hypaque)
 Iothalamate
meglumine
(Conray)
NON-IONIC
 Low Osmolality
(Lower risk of
complications)

Gadodiamide
(Omniscan)
 Iodixanol
(Visipaque)
 Iopamidol (Isovue)
 Iopromide
(Ultravist)
 Ioversol (Optiray)
49


Less money
More reactions


More money
Less reactions
50
OIL – BASED
IODINE CONTAST
Instilled in ORGAN – Not vessells
Oil-based iodine contrast media
are made from fatty acids
of poppy seed oil containing 48% and 37% iodine
51


Oil Based Iodine
Fatty Acids
Insoluble in water


Uses








White on the radiograph = Radiopaque
Broncography (lungs)
Tear ducts
Salivary glands
Lymphatic system
Hysterrosalpingogram
Galactography (breast ducts)
FAT EMBOLUS IF IT GETS INTO
BLOOD VESSEL
52
CONTRAST MEDIA
CHEMICAL PROPERTIES
TRIIODINATED COMPOUNDS
 BASED ON THE BENZOID ACID RING


IODINE IS USED DUE TO THE HIGH
ATOMIC NUMBER
53
The benzene ring is associated with the anion.
54

CONTRAST MEDIA
IONIC CONTRAST

NON IONIC
CONTRAST
55

Iodine Contrast Material
Ionic Contrast






•Non-Ionic Contrast
Anion Cation +
More patient allergic
reactions
Ionic contrast media
dissociates into two
molecular particles in
blood plasma =
Causing pt reactions
The benzene ring is
associated with the anion.
•Less patient allergic
reactions
Nonionic
contrast media
is associated
with low
osmolality.
56
Iodine Contrast Material



ANIONS
- CHARGE IONS
Responsible For
Stabilizing And
Detoxifying The
Contrast Media



CATIONS
+ CHARGED IONS
Responsible For
Increasing The
Solubility Of The
Medium
The benzene ring is associated with the ________ ?
57
Newer Contrast
Agents Balance
Safety and Visualization
•In addition to osmolality, toxicity is a concern
•Although the mechanism of contrast medium
toxicity is not completely understood
•it is believed that "chemotoxicity" is related to
the protein-binding capacity of the medium,
•which is caused by non-specific weak
interactions between the contrast medium and
surrounding enzymes.
58
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.
59
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.
60
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
61
Hypovolemia is the
most common cause
of
 Orthostatic hypotension


What? __________
62
High osmolality of the contrast media is related
to adverse reactions.
63
CONTRAST MATERIAL
ADVERSE REACTIONS
ALWAYS GET PATIENT’S
HISTORY BEFORE ANY
CONTRAST MEDIA IS
GIVEN
SEE Ch. 19 Table 19-7 pg 296
Carlton Pt Care (3 ed)
RD
64
Reaction classification

Immediate reactions were defined as
those occurring within the department
(within one hour)

Delayed as those occurring between the
time the patients left the department and
up to seven days later
65
Delayed Side Effects to Contrast




Skin effects included itching,
rash, and hives.
Nausea, vomiting, and
diarrhea were the
gastrointestinal side effects
General side effects included
headache, dizziness, and
fever.
Infants and patients older
than 60 years are at increased
risk of developing a side
effect.
66
General Factors for
Contrast Reactions
 Nonionic vs ionic
Risk Factors
Severity of Reactions
Renal toxicity
 Glucophage
Diabetic?
 Screening Creatinine
 Pretreatment
67
CONTRAST MEDIA
& ADVERSE REACTIONS
RISK
 Any foreign substance introduced in the
body
 Chance the body will react negatively to
the material
 Minor to Life Threatening

Minor = 5%
Major 0.1%
68
GOOD PATIENT HISTORY





Kidney problems
Diabetes
Heart conditions
Allergies
Asthma





Previous reaction
Current medications
Beta Blockers
Antihypertensive
medications
VITAL SIGNS
69
CONTRAST REACTIONS

General
>
10 million diagnostic procedures
per year
 Conventional ionic contrast
reactions - 10%
 1 in 1000 severe
70
Contraindiatons for Contrast

Renal Failure (Check BUN & Creatinine)
Elevated levels could cause renal shutdown
Anuria (no urine production)
 Asthma (possible allergies)
 Hx of Contrast Allergy / Reactions
 Diabetes - get a hx of medications taken



glucophage must be stopped 48 hrs before contrast injection
Multiple Myeloma
71
MORE Risk Factors
for Contrast Reaction

Older patient age
Allergic Rhinitis, medication or Food
Allergy
 Cardiovascular disease


WHO are at increased risk of developing
a side effect? (2 age classifications?)
72
CONTRAINDICATIONS





Pregnancy (risk of fetal Thyroid
toxicity)
+ Radiation concerns
Allergic Reaction
Pathologic Conditions
Infection
73
Allergic to Iodine
General Rule:
 No Iodine Contrast will be
given
 Pre – medication is
available

 May
or may not react if
previous iodine given
74
Aseptic Technique for injection
betadine scrub
Contains iodine
75
76
REACTIONS &
Treatment
USUALLY** WITHIN FIRST 5 MINUTES
 Nausea & Vomiting & Urticaria
 Hypotension (bradycardia)
 Hypotension (tachycardia)
 Bronchospasm
 Anaphylactoid
 Seizures

Extravasation
77
Categories of Adverse Reactions
MILD
Carlton – Patient Care Book:
Vol 3 Ch. 19 pg 297 or Vol 4 Ch. 20 pg 337
nausea, vomiting
 Uticaria (hives) rash – itching
 Flush face – feeling of warmth
 Headace, Chills, Anxiety
 Diaphoresis
Treatment – does not usually get worse
Watch patient and reassure
(cool cloth on forehead, emesis basin

78
Catagories of Adverse Reactions
MODERATE
Carlton Pt Care
Hypotension (bradycardia)
 Hypertension (tachycardia)
 Dyspnea
 Bronchospasms /wheezing
 Laryngeal Edema
TREATMENT:
Needs immediate treatment –GET RN/RAD
Needs Meds* – (Keep IV line in)
could lead to severe reactions

79
Catagories of Adverse Reactions
SEVERE
Carlton Pt Care
Laryngeal edema
 Convulsions
 Profound hypotension
 Clinically manifested arrhythmias
 Unresponsiveness
 Cardiopulmonary Arrest

PROMPT TREATMENT – CODE BLUE!
80
Rx for REACTIONS
have ready on Emergency cart or Crash Cart

UTICARIA (HIVES) –
Benadryl (diphenhydramine)
Vistaril (hydorxyzine)
Tagament or Zantac

Facial/Laryngeal Edema/Bronchospasms
Epinephrine , Oxygen
81
Contrast Reactions/MYTHS

not caused by iodine

Ionic vs non ionic - binding elements
not related to shellfish
 not true allergy (no drug-antibody)
 mechanism remains unknown

82
Anaphylactoid (idiosyncratic)
unpredictable
 dose independent
 prevalence 1-2% (0.04 - 0.22% severe)
 fatal 1 in 75,000

83
RENAL TOXICITY
(increased serum creatinine > 0.5 mg%)
 2-7%
 5 – 10 x increase with pre-existing renal
insufficiency
 direct relationship between serum
creatinine and likelihood nephrotoxicity
 Hydrate 100 ml/hr Normal saline 4 hrs
prior to procedure, continue for 24 hours

84
GLUCOPHAGE
Vol 4 Ch. 19 pg 297 or

Pt is DIABETIC =

MUST STOP __ DAYS BEFORE EXAM
withhold drug for 48 hrs after contrast
administration
patients with renal insufficiency may develop
lactic acidosis


oral diabetic agent

The signs of lactic acidosis are deep and rapid breathing, vomiting, and
abdominal pain

What is the name of the medication given for GI peristalsis?
85
Pre-Medications
Steroids (Prednisone)
 Benadryl (diphenhydramine)
 Epinephrine

86
EXTRAVASATION

Contrast material has seeped outside of
vessel

Local redness and swelling
Apply WARM Compress 1st 24 hours
 Cool compress for swelling

87
EXTRAVASATION

The act of injecting a drug/contrast into an
area other than the vessel (soft tissue)

RTA BOOK: Pharmacology Chapter

Defines as: Discharge or escape of fluid from a vessel
into the surrounding tissue that can cause localized
vasoconstriction, resulting in sloughing of tissue and
tissue necrosis if not reversed with an antidote.
88
Extravasation of Contrast
into soft tissue of arm
89
90
Contrast leaking from bladder
91
Summary 




Delayed side effects persist in IV iodinated
contrast media
History of asthma and allergy predisposes
patients to increased incidence of adverse
reactions
Intravenous iodinated contrast agents are
generally safe.
Though the frequency of side effects has fallen
significantly since the introduction of nonionic,
monomeric contrast agents,however, side
effects remain an important issue.
Late adverse reactions were first recognized in
the mid-1980s
92
Summary of Contrast Reactions




Anaphylactoid reactions may present with
mild symptoms such as skin rash, itching, nasal
discharge, nausea, and vomiting
moderate symptoms like facial or laryngeal
edema, bronchospasm, dyspnea, tachycardia,
and bradycardia
severe symptoms such as life-threatening
arrhythmias, hypotension, bronchospasm,
laryngeal edema, pulmonary edema, seizure,
syncope, and death
93





Summary of Contrast Reactions
Nonanaphylactoid reactions are due to the ability of the
contrast media to upset the body homeostasis,
especially the blood circulation.
Increasing iodine concentration increases the risk of
these reactions, which is also affected by the volume
and route of administration of contrast.
Larger volumes or intra-arterial administration are more
likely to produce a reaction.
The cardiovascular, respiratory, urinary, gastrointestinal,
and nervous systems are most commonly affected by
physiologic changes produced by contrast media.
The symptoms of nonanaphylactoid reactions are
warmth, metallic taste, nausea, vomiting, bradycardia,
hypotension, vasovagal reactions, neuropathy, and
delayed reactions
94
SCHEDULING CONSIDERATIONS

Diabetics – first


(Insulin= low blood sugar occurs while fasting)
After Nuclear Medicine Tests

(iodine goes to thyroid and will alter results)
Iodine BEFORE Barium
 BE before UGI ( IVP before BE)


WATER – OIL - BARIUM
95
SPECIAL PROCEDURS
CONTRAST MEDIA
ARTHROGRAMS
Injected
into JOINT SPACES
IODINE (positive contrast)
WATER
soluble
(Ionic or Non-Ionic)
AIR (negavitve contrast)
96
SPECIAL PROCEDURS
CONTRAST MEDIA
MYELOGRAMS
Injected INTRATHECALLY
(into the subarachnoid space)
Nonionic water-soluble contrast
 (NO IONIC CONTRAST)

97
31 y/o male DIES
after Myelogram Procedure
Myelography is safely performed using
 nonionic water-soluble radiographic
contrast media intended for this route of
administration
 Misadministration of ionic contrast media
intrathecally can result in a syndrome of
spasms and convulsions, often leading to
death
 ISOVUE –M ( 20 or 30 cc)

98
mix-up between look-alike vials
ionic
HYPAQUE
(diatrozoate meglumine)
 nonionic OMNIPAQUE 300
(iohexol)
Each type of contrast media
should be stored separately,
based on its use.
99
SPECIAL PROCEDURS
CONTRAST MEDIA
SIALOGRAPHY
– injected into Salivary Ducts
 IODINE –
 WATER
(ionic or nonionic)
 OR OIL BASED
 SINOGRAPHIN
 RENOVUE
(OIL)
(WATER)
100
MRI Contrast
101
MRI with contrast
Without
With
What is the name of the contrast used for MRI ?
102
Gadolinium
z# 64
Once injected, gadolinium accumulates
in abnormal tissues of the brain and body.
 Provides a greater contrast between
normal and abnormal tissues

MORE dilute
than used for Radiology
103
gadolinium
On its own gadolinium is toxic to the
human body, but when coated in a special
chelating agent, it is safe to use.
 When the chelating agent breaks down
prematurely, or the kidneys are unable to
excrete the gadolinium from the body,
gadolinium poisoning can occur

104
Gadolinium Side Effects

With impaired kidney function, gadolinium
could lead to a serious and potentially fatal
disorder called Nephorgenic Systemic
Fibrosis. (NSF)

More common conditions associated with
exposure includes
impaired kidney function
irritation of blood vessels
facial swelling
skin conditions, including rashes, itching and
hives




105
CT Contrast

Oral/Rectum

– Barium or Iodine

IV: Iodine

Usually less dilute
than for Radiology

106
CT w contrast
107
CT Contrast

CT Scan Contrast
Indications

CT Scan Contrast Side
Effects

History of tumor, cancer,
or surgery
Looking for infection,
inflammation

Mild to life-threatening
allergic reaction
Flushing/redness and
hives
Shortness of breath
Nausea, vomitting
Blood clots
Dizziness





Evaluating blood vessels
Investigate a finding in a
scan done without
contrast



10
8
PATIENT PREP
COVERED WITH EACH EXAM
109
REVIEW
SPECIAL PROCEDURS
CONTRAST MEDIA
ONLY Water





Arthrograms
Myelograms
Angio/Arterio grams
Cardiac Cath
Venograms
Water or OIL
sol.




Hysterosalpingogram
Sialogram
Lymphangiograms
Lasts longer – may cause
FAT EMBOLI
110
REVIEW
(Bontrager Slides)
111
SEE :
PT CARE : Pharmacology 4th Ed Ch.20 (charts p293/p.299 )
112
113
114
115
116
117
118
119
PT CARE : Pharmacology 4th Ed Ch.20 (charts p293/p.299 )
Sample CRASH CART Medications
MEDICATION
Atropine
 Benadryl
 Dilantin
 Epinephrine
 Heparin
 Lasix
Sodium Bicarbonate
 Xylocaine


Spring 2010
INDICATION
(used for what?_








______________
________________
_________________
___________________
___________________
_________________
_________________
__________________
120
REVIEW
TYPES OF CONTRAST & USES
 ADVERSE AFFECTS OF CONTRAST
USAGE
 CONTRAINDICATIONS FOR CONTRAST

12
1
Review Questions
RTA Book –
Contrast Media
122
Contrast media are used in radiographic
imaging to
a) increase the radiographic density of the
area of interest
b) enhance the subject contrast of the area
of interest
c) decrease the radiographic density of the
area of interest
d) lower the subject contrast of the area of
interest
123
Radiographic images that demonstrate few
density differences define
a) low subject contrast
b) high subject contrast
c) low x-ray photon absorption
d) high x-ray photon absorption
124
A negative contrast agent will
a) increase density and is radiopaque
b) decrease density and is radiopaque
c) decrease density and is radiolucent
d) increase density and is radiolucent
125
Perforation of the colon during a lower GI
barium study may result in complications
resulting from
a) flocculation
b) bronchospasm
c) convulsion
d) extravasation
126
Depending on the environment of the
barium sulfate,such as acid in the
stomach, the powder may have a
tendency to clump – this is called
a) flocculation
b) bronchospasm
c) convulsion
d) extravasation
127
4. Perforation of the vessel while injecting a
contrast media may resulting in
a) flocculation
b) bronchospasm
c) convulsion
d) extravasation
128
Barium sulfate:
1. is filtered by the kidneys
2. is absorbed by the stomach
3. coats the gastrointestinal lining
4. is absorbed by the jejunum
129
High atomic number elements absorb x-rays
at a greater rate than low atomic number
elements.
1. true
2. false
130
Barium sulfate is contraindicated if the
patient is suspected of having a
gastrointestinal tract perforation.
1. true
2. false
131
Radiolucent contrast media:
1. are positive contrast agents
2. appear dark on radiographs
3. are composed of elements with high
atomic numbers
4. none of the above
132
Radiopaque contrast media:
1. are positive contrast agents
2. appear light on radiographs
3. are composed of elements with high
atomic numbers
4. all the above
133
Each of the following is an example of a
negative contrast media except:
1. air
2. soda water
3. barium sulfate
4. gas-producing crystals
134
An air embolus can form as a complication
of negative contrast media administration.
1. true
2. false
135
An fat embolus can form as a complication
of AN OIL BASED contrast media
administration.
1. true
2. false
136
Ionic contrast media dissociates into two
molecular particles in blood plasma.
1. true
2. false
137
Most adverse reactions associated with
Ionic contrast media are significantly
decreased with the non-ionic contrast
media
1. true
2. false
138
Which of the following acute reactions to
contrast media usually requires no medical
treatment?
a) bronchospasm
b) laryngeal edema
c) urticaria
d) convulsions
139
Which of the following acute reactions to
contrast media usually requires immediate
medical treatment?
a) Bronchospasm / laryngeal edema
b) Nausea & Vomiting
c) Urticaria
d) Warn flush /metallic taste
140
What can be done for a patient who will receive
water- soluble iodine contrast media to reduce
allergic-like effects?
a) premedicate with steroids and antihistamines
b) give intravenous fluids
c) instruct the patient to drink warm salt water
before the procedure
d) give a negative contrast agent with the iodinated
medium
141
When you schedule multiple procedures,
what examination is usually done last?
a) thyroid function tests
b) Upper GI
c) air-contrast colon (BE-AC)
d) Intravenous pyelogram (IVP)
142
When you schedule multiple procedures,
what examination is usually done last?
a) thyroid function tests
b) Upper GI
c) air-contrast colon (BE-AC)
d) Intravenous pyelogram (IVP)
It will take the BA the longest to travel
through the GI tract
143
When you schedule multiple procedures,
using contrast media – which examination
must be done first?
a) thyroid function tests (Nuc Med)
b) Upper GI
c) air-contrast colon (BE-AC)
d) Intravenous pyelogram (IVP)
144
When you schedule multiple procedures,
using contrast media – which examination
must be done first?
a) thyroid function tests (Nuc Med)
b) Upper GI
c) air-contrast colon (BE-AC)
d) Intravenous pyelogram (IVP)
WHY?
145
Antihistamines are used to prevent and
treat nausea and vomiting.
 1. true
 2. false

146
Antihistamines are used to prevent and
treat nausea and vomiting.
 1. true
 2. false


So what is it used for?
147

Antihistamines are used to prevent and
treat ____________

Allergic reactions to contrast media
148
Glucophage is the brand name for
 __________________________

What is it used for?
 _________________________

149






Glucophage is the brand name for
METAFORMIN
What is it used for?
DIABETICS
RTA BOOK
PHARMACOLOGY CHAPTER
150
Which type of drug is used to prevent and
control the occurrence of seizures?
 1. anticonvulsants
 2. antiemetics
 3. antihistamines
 4. antihypertensives

151
Which type of drug is used to prevent and
control the occurrence of seizures?
 1. anticonvulsants
 2. antiemetics
 3. antihistamines
 4. antihypertensives

152
An intravenous push refers to a rapid
bolus injection.
 1. true
 2. false

153
An intravenous push refers to a rapid
bolus injection.
 1. true
 2. false


What is the name when it is injected
slowly?
154

What is the name when contrast it is
injected slowly?

INFUSION DRIP
155
The act of injecting a drug into a vein is
termed extravasation.
 1. true
 2. false

156
The act of injecting a drug into a vein is
termed extravasation.
 1. true
 2. false


What does it mean? ______________
157
extravasation

What does it mean? ______________

The act of injecting a drug/contrast into an
area other than the vessel (soft tissue) is
termed extravasation.

RTA BOOK: see definiton
158
Contrast media are:
 1. diagnostic agents
 2. dyes
 3. all radiopaque
 4. all radiolucent

159
Contrast media are:
 1. diagnostic agents
 2. dyes
 3. all radiopaque
 4. all radiolucent

160
An air embolus can form as a complication
of negative contrast media administration.
 1. true
 2. false

161
An air embolus can form as a complication
of negative contrast media administration.
 1. true
 2. false

162
Oil-based iodine contrast media are used
for each of the following except:
 1. dacrycystography
 2. bronchography
 3. lymphography
 4. myelography

163
Ionic contrast media dissociates into two
molecular particles in blood plasma.
 1. true
 2. false

164
Iodinated contrast media dissociates into
two molecular particles in blood plasma.
 1. true
 2. false

165
The benzene ring is associated with the:
 1. anion
 2. cation
 3. positive charge
 4. none of the above

16
6
LIST 4 TYPES OF
HIGH RISK PATIENTS
167
Oil-based iodine contrast media are made
from:
 1. fatty acids
 2. carbohydrates
 3. amino acids
 4. none of the above

168
Osmolality is a measure of:
 1. the number of iodine atoms per
molecule
 2. particle density
 3. the total number of particles in solution
 4. none of the above

169
High osmolality of the contrast media is
related to adverse reactions.
 1. true
 2. false

170
Injection of ionic contrast media may lead
to hypervolemia.
 1. true
 2. false

171
Myelography most commonly uses ___
contrast media.
 1. ionic
 2. nonionic
 3. nonionic and ionic
 4. neither ionic nor nonionic

17
2
End of Contrast Media
for Special Procedures
RT 255
Rev Spring 2010