SPECIAL RADIOGRAPHIC PROCEDURES

- These are studies that require special equipment that are performed routinely
- With contrast connotes an examination done radiographically or fluorospically in different
organs or structure after administering, injecting, or introducing a high or low atomic
element called CONTRAST MEDIA

PURPOSE OF CONTRAST MEDIA

- In order to visualize anatomic detail, the area of interest must differ in radiographic density
from its surrounding tissue.
- Contrast media are diagnostic agents that are instilled into the body orifices or injected
into vascular system, joints, and ducts to enhance subject contrast in anatomic areas
where low subject contrast exists.

TWO KINDS OF CONTRAST MEDIA

1. Positive contrast media

2. Negative contrast media

 Positive Contrast Media

- These are substances that have high atomic number and greater attenuation density than
the surrounding tissues.
- They usually appear white on the radiograph
Examples:
a. Iodine Base Contrast Medium- examples are urographin or omnipaque which
are most commonly used in radiology due to its relatively harmless interaction in
the body
- It is primarily used to visualize vessels, but can also use for tests of urinary tract,
uterus and fallopian tube.
- This can be:
 Ionic- higher osmolality contrast media
- EXAMPLES OF IONIC CM:
 diatrizoate (Hypaque/ Gastrografin)
 metrizoate (Isopaque)
 iothalamate (Conray)
 ioxaglate (Hexabrix)

 Non-ionic- lowerosmolality contrast media

- EXAMPLES OF NON-IONIC CM:
 iopamidol (Isovue)
 iohexol (Omnipaque)
 ioxilan (Oxilan)
 iopromide (Ultravist)
 iodixanol (Visipaque)
 b. Barium Sulfate (BaSO4)
- The most frequently chosen contrast medium
for radiology examinations of the GI tract.
- It is a white crystalline powder that is mixed
with water to make a suspension.
- It may be administered by mouth for
examination of the GI tract, or by rectum for
examination of the lower GI tract, or by
infusion of a thin suspension through a
duodenal tube to visualize the jejunum and
ileum.
 PROPERTIES OF BARIUM SULFATE
1. It absorbs water.
2. It has high atomic number (64).
3. It is insoluble in water.
4. It is non-toxic.
5. It has no relative contraindication in the gastrointestinal tract.

 Negative Contrast Media

- Are substances having lower atomic
number than the surrounding tissues
- Appear black on radiographs
- Examples:
 Air
 Carbon dioxide
 Oxygen

FOUR PHYSICAL STATES OF CONTRAST MEDIA

1. Oil- used in myelogram and bronchogram studies

Examples: Pantopaque, Dionisil
2. Tablets- used in gallbladder studies
Examples: Biloptin, Cistobil
3. Powder- used in GI tract, esophagogram, barium enema, and small intestines
Example: Barium Sulfate
4. Liquid- used in IVP, angiography, PTC, and other forms of contrast studies that uses
liquid form of contrast
Example: all iodinated form of contrast
METHODS OF ADMINISTERING CONTRAST MEDIA
1. Direct method
Example: barium enema, retrograde pyelography and cystography
2. Indirect method
a. Oral method- contrast medium is taken by mouth
b. Parenteral method- contrast medium is introduced via injection
c. Intramuscular method- contrast medium is injected in the muscles
d. Intravenous method- contrast medium is injected through the veins

FOUR VEINS WHERE YOU CAN INJECT CONTRAST MEDIA

1. Median Cephalic Vein

2. Veins in the Neck
3. Veins in the Head
4. Veins on the Ankle
5. Veins on the scalp (for infants)
METHODS OF INTRODUCING SENSITIVITY TEST

1. Scleral method
- one drop of contrast media is put into the sclera (white eye ball of the eye)
- Positive reaction: irritation, swelling
2. Sub-lingual method
- one drop of contrast medium is deposited into the inferior base of the tongue
- Positive reaction: formation of hives, swelling
3. Intradermal method
- 1 cc of contrast medium is injected just beneath the skin
- Positive reaction: irritation, swelling, formation of larger wheal
4. Intravenous method
- 1 cc of contrast medium is injected into the vein
- Positive reaction: nausea, vomiting, shock

TWO KIND OF REACTION

1. Minor reaction- usually no treatment needed other than reassurance and provision of a
vomit bowl
 Urticaria/hives
 Sneezing
 Flushing
 Nausea
 Vomiting
2. Major reaction
a. Bronchospasm caused by wheezing
b. Laryngeal angioneuretic edema caused by choking
c. Vascular - patient is pale and sweating, has Trudy pulse, and may lose consciousness
d. Respiratory failure- patient becomes cyanosed and may stop breathing
e. Convulsion and coma
 All these major reactions require prompt and efficient treatment for the patient to
survive.

PATIENT PREPARATION

 After a patient is requested for a special radiographic examination, preparation of the

patient follows.
 The preparations depend upon the studies to be performed and the routine preparation
of the department.
1. Internal preparation
- Includes cleansing enemas so that the structures in the abdomen are not obscured by gas
and fecal material.
- The radiologist will usually establish his method of choice to help cleanse the bowel.
- There are cathartics and insertion of suppositories and withholding of food intake for many
hours.
2. External preparation
- For some, it includes or requires:
a. Removal of clothing
b. Removal of metallic objects
c. Removal of anything that may cover the area of the body through which x-rays may
pass
- Failure to do so results in inadequate double dose of radiation to the patient because the
radiograph must be retaken.