Continuous X Ray Contrast Biology Essay

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X-ray contrast media are compounds shown to increase the contrast of radiographic images such as X-ray: computed tomography (CT), a decrease of digital angiography (DSA), digestive sytem system, gall bladder, intravenous urography, phlebography legs, Venography, arteriography, imaging of the body cavity (arthrography hysterosalpingography for example, fistulography, dacrycistography), mielografi, ventriculography, cisternography and other diagnostic procedures. 

Unlike preparation MEDIUM 

There are three preparations of contrast material used in barium X-ray, (BA), iodine (I) and thorium (Thursday), but only in preparation for barium and iodine used x-ray examination yet. 

Barium preparation 

This is a suspension of barium sulfate in water. Barium sulfate is insoluble and chemically inert. Soluble barium salts are highly toxic barium sulfate and high drug use. For radiopacity of barium depends on the electron density (indirectly reflected by the number of atoms) much greater opacity, and software radio network radio shows bone opacity. Barium sulfate, white powder unsolved. It is mixed with water and some additives to make the contrast agents. Barium sulfate as a soluble, a mixture of types of agents against white blur. It is used only in the digestive tract, but is usually given as an enema (for osepahogography, stomach, and tenue intestinum) or through the rectum into the colon .. After review, it leaves the body with dirt. 

Should a leak of barium Force network channels or into the body cavity, for example.mediastinum or peritoneum, may cause fibrogranulomatous response. Spilled into the bronchial tree is handled, except the gross problems, when death may occur; preparations were weak barium bronchography. After oral, may be compact and colon causing constipation can sometimes cause a blockage if you have a tendency to pathological. 

Barium sulfate is an ideal blend / water has been developed, but the following characteristics are very important. 

A) particle size. Barium sulfate particles are more or less normal, measuring a few millimeters in size, but the ultrafine grinding results of barium sulfate in 50 percent of the raw particle size of between 5 and ECM l5lCm. As sedimentation is comparable to the size of particles, small particles of barium sulfate suspensions are more stable. 

(B) Non-ionic medium. Barium sulfate particles influence the level of aggregation of particles. Charged particles attract each other and form larger particles sediment more easily. They tend to make it even more sediment in the gut and therefore more easily in the stomach. 

(C) pH of the solution. Barium sulfate solution pH should be about 5 • 3, acid solutions are more likely to be more so in the intestines and stomach and speed up more easily. 

(D) preferred. No doubt many of reducing the sense of ultrafine grinding of limestone embedded in barium sulfate / water mixtures, but commercial preparations contain a lot of flavoring agents are posing a more unpleasant taste. Barium sulfate mixture / water is usually 1 / 4 weight / volume, and viscosity of CP 15-20, but the suspension is thick or thin can digunakan.Banyak commercial preparations containing cellulose carboxymethyl (Raybar, Barosperse), which maintain the fluid and prevent deposition from normal small intestine Ahahshaiaberiom. 

Development of double-contrast techniques have emphasized the need for adequate levels of mucosal and many manufacturing operations designed to achieve this.Sputum collection of fluid that does not necessarily preclude the stomach, so sufficient levels of gastric mucosa, and hypermotility of the stomach. 

To achieve a double contrast examination of air, carbon dioxide or abdomen should be introduced and there is no doubt that the Knesset air or gas through pipes nasogastrik is the best way to get the title of a controlled gastric distention. However, some gastric tube is an unpleasant procedure and is not acceptable to all patients.As a result, most radiologists use effervescent tablets (sodium bicarbonate 35 mg, 35 mg of tartaric acid, calcium carbonate and 5 to 0 mg) to comment on the contents of the stomach to produce carbon dioxide. 

Total gas produced by these methods is variable and the overdistension of the stomach and double-contrast technique is related to poor strata, from the perspective of diagnosis, such as catastrophic as poor distention. Some commercial products containing carbon dioxide gas under pressure with a mixture of barium, but usually the amount of gas is insufficient to produce a double contrast of good food. Anti-foaming agent can be added to some preparations of barium to prevent the formation of bubbles. 

Water-soluble contrast media containing iodine is the value when there is a suspected perforation or leak water after surgery. Radio - opacity of iodine is lower than barium, and high osmolarity resulted in dilution in the small intestine, making it has little value to be used routinely in the investigation of the small intestine. Soluble contrast media are water and label if there is a danger of aspiration into the lungs. 

Iodine preparation 

Since its launch in 1950, medium organic iodinasi radiographic contrast (ICM) were among the prescription drugs most often in the history of modern medicine. The phenomenon of current radiologic imaging agents will be less without him. ICM typically has a good safety record. Side effects of intravascular administration of ICM is generally self-limited mild, the reaction using ekstravaskuler PTT rare. However, severe reactions or life-threatening can occur when the wall is a chemical change of the ICM is the benzene ring of 2,4,6-Tri-iodinasi. They are classified according to chemical and physical properties, including chemical structure, osmolality, sodium, ionization in solution. In clinical practice, classification based on osmolality widely used. The i two tracks of the government. 

Type of contrast medium iodinasi 

Iodine, a lot more influence "solid" x-ray. There are a variety of molecules. Some examples of organic iodine molecule iohexol, iodixanol, ioversol. Iodine-based contrast material are soluble in water and can be harmful to the body. Contrast material is sold as a water clear color solution, the concentration is expressed usually I mg / ml. Unlike modern media iodinasi can be used almost anywhere in the body.They are often used intravenously, but some they can also be used intraarterially, intrathecally (spinal) and intraabdominally - almost all the body cavity or potential space. Are ionic contrast material and non-ionic monomer complex (1 BENZOIC acid ring) and dim (2 rings of BENZOIC ACID). 

High-osmolality contrast media 

Ionic monomer 

High-osmolality contrast media benzene ring consists of Tri-iodinasi with two side chain carboxyl groups of organic. Iodinasi anion, diatrizoate or iothalamate, was coupled with the sodium or meglumine cation, the result is ionic monomer. Ionization of the carboxyl-cation bonding agent soluble in water. Therefore, for each of three atoms of iodine, 2 particles in solution (ie, a ratio of 3:2). 

Osmolality of solutions range 600-2100 mOsm / kg, compared with 290 mOsm / kg of human plasma. osmolality associated with few side effects as opposed media.Ionic monomer is subclassified by molecular weight contrast agents in solution 


Low osmolality contrast media 

There are three types of low-osmolality ICM: (1) ion dimer, (2) monomer nonionik and (3) nonionik dimer. 

Ionic dimer 

ionic dimer formed by joining two removes ionic monomer carboxyl group. This agent contains six atoms of iodine in any two particles in solution (ie, a ratio of 6:02). Dimer ions are only commercially available ioxaglate. Ioxaglate concentration of 59%, or 320 mg I / mL, and osmolality of 600 mOsm / kg. Due to high viscosity, ioxaglate produced higher concentrations. Ioxaglate used primarily for peripheral arteriography.

Nonionik monomer 

In nonionik monomer, benzene ring Tri-made water-soluble iodinasi by the addition of hydrophilic hydroxyl groups and organic side chains placed at 1, 3, and 5 positions.Absence of carboxyl group, nonionik monomer ionization no solution. Therefore, for each of three atoms of iodine, only one particle exists a solution (that is, a ratio of 3:01). Therefore, the concentration of iodine is given, nonionik monomer-monomer was about half osmolality ionic solution. Concentrations commonly, 25-76%, nonionik monomer was 290-860 mOsm / kg. 

Nonionic monomers are subclassified by the number of milligrams of iodine in 1 ml of solution (eg, 240, 300, or 370 mg I / mL). 

Large networks with increasing the viscosity of the monomer compared nonionik ionic monomer. Nonionik increasing monomer viscosity makes it difficult to inject, but does not seem related to the frequency of side effects. 

Monomer is usually nonionik iohexol, iopamidol, ioversol, and iopromide. 

Unlike Nonionik monomer agents are preferred. In addition to their environmental osmolalities nonionik low, as are potential chemotoxic ionic monomer. 


Nonionik dimer 

Nonionic dimer composed of two monomers joined nonionik. Materials containing six atoms of iodine on each one particle in solution (ie, a ratio of 6:01). For the concentrations of iodine is given, dimer nonionik has the lowest of any osmolality contrast agents. Concentration of about 60% wt, this agent ISO-osmolar with plasma.They are also very thick, and prevented the clinical use 


Adult type of the medium, however, Thorotrast is based on two thorium, but was abandoned because it is carcinogenic. 

Property iodine contrast medium 

Osmolality, viscosity, iodine concentration and physical and chemical properties of three interrelated, are also affected vy the molecular structure of iodine binding size.Expression of individual hotels can vary greatly between the contrast material 

Over the past decade, innovations in X-ray contrast media focused on the manipulation of this hotel. However, because they are close to, changes in a hotel can make other changes, sometimes not so good. For example, efforts to reduce product viscosity and osmolality were ISO-osmolar, other hand, has been highly desirable payments. 

Osmolality is a count of the number of particles in the sample liquid. Only calculate moles equal to 6.02 x 1023 particles (Avogadro's number). Molarity is the number of particles of a material amount of liquids (eg mmol / L) molality is the total mass of particles dissolved in (mmol kg) of liquid. Osmolality is a count of the number of osmotically active particles in solution, and equals the sum of molalities of all solutepresent resolution. most biological systems molarity molality of a solution which is almost exactly like the density of water is 1 kg to / have a little difference between molality and molarity in plasma as the current non-water components such as proteins and fats that make up about 6% of total volume. So only 94% water and molality serum serum material is about 6% more than its molarity. 

Osmolality can be calculated by the following formula: 


Many side effects caused hiperosmolar solution injected. That they provide more iodine atoms in a molecule. 

Side effects of iodine contrast media (ICM) 

Use of iodine contrast media (ICM) can cause unwanted side ffects and the discovery of anaphylaxis. Symptoms include vomiting nousea, erythema area, usually a warm feeling, headache, coryza, or throat edema, fever, sweating, astenia, dizziness, pallor, dyspnoea and mild hypotension. More severe reactions such as mixed cardiovasluar vasodilatasi system with peripheral hypotension prominent tachycardia, dyspnoea, action, Kahlon and loss of consciousness, may require emergency treatment. For this reason the use of contrast media should be limited in cases of diagnostic procedures must be displayed 

Side effects associated with use of intravascular contrast medium is constant iodinasi moderate natural light, and less by non-ionic than with the preparation of ion .. 

Side effects to ICM classified Special pathogenesis Comments nonidiosyncratic.The effects may include direct effects of mobile phone, enzyme induction, and activation of quinine, fibrinolytic supplementary systems. 

Special Reaction 

Special response usually begins within 20 minutes of injection of ICM, depending on dose possible. Severe reactions may occur after the parties less than 1 ml of contrast agents. 

Although ICM's response that such expressions have feedback Anefilktti, hypersensitivity reactions are not correct. Immunoglobulin E (IgE) antibodies are terlibat.Selain that sensitivity is not necessary before, or do, the response of patients with recurrence have provided consistently. For this reason, special for ICM Read feedback comments Anefilktti. 

Anaphylactoid reaction 

Anaphylactoid reactions are rare (Karnegis Heinz, 1979, Lesser et al, 1987, Greenberger and Patterson, 1988), but can occur in response to oral contrast injection anus, and retrograde pyelography. They are similar in performance with feedback Anefilktti, but not caused by IgE-mediated immune response. Patients with a history of responding on the other hand, will increase the risk of anaphylactoid reactions (Greenberger and Patterson, 1988, Lang et al, 1993). Early treatment with steroids has been shown to reduce the incidence of side effects (Lesser et al, 1988; to Greenberger et al, 1985; Wittbrodt and Spinler, 1994). Anefilktti Comments symptoms can be classified mild, moderate, and severe. 

Minor symptoms 

Minor symptoms include: spreading urticaria, which is a negative reaction of most frequently reported, itching, runny nose, nausea, vomiting, short, and / or vomiting; diaforesis, cough, dizziness. Patients with mild symptoms should be noted that the development or the development of more severe reactions, requiring medical treatment. 

Mild symptoms 

Moderate symptoms include persistent vomiting, diffuse urticaria, headache, edema face, edema of the throat, shortness of breath easy bronkospasme, heart palpitations, tachycardia, or bradycardia, hypertension, abdominal pain. 

Severe symptoms 

Severe symptoms include: life-threatening arrhythmia (ie ventricular tachycardia), hypotension, edema bronkospasme open, throat, pulmonary edema, seizures, syncope, and death. 

Anaphylactoid reactions ranging from urticaria and itching, and bronkospasme edema on the face and throat. Moderate cases of urticaria and itching, Benadryl (diphenhydramine), oral or IV is appropriate. For more severe reactions, including bronkospasme face or neck edema, albuterol inhaler, or adrenalina subcutaneous or IV, plus diphenhydramine may be required. If breathing is affected, breathing must be established before the medical. 

Nonidiosyncratic response 

Comments Nonidiosyncratic include: bradycardia, decreased blood pressure, and vasovagal reaction, neuropathy, cardiovascular responses; ekstravasasi, and delayed reactions. Comments Nonidiosyncratic include sensations of taste, brown metal mouth, nausea and vomiting. 

Bradycardia, decreased blood pressure, and vasovagal reactions 

To encourage an increase parasimpatis systemic, PTT may trigger bradycardia (eg, reduced flow rate of the sinoatrial node, atrioventricular nodal conduction delay) and vasodilatasi peripherals. The end result is systemic hypotension with bradycardia. It can be accompanied by autonomic manifestations, including nausea, vomiting, diaforesis, sphincter dysfunction, and changes in mental status. Without treatment, these effects can cause the collapse of cardiovascular death. Some of the reaction may result from a vasovagal live with feelings like fear, pain, abdominal compression, PTT administration. 

Cardiovascular Reaction 

ICM can cause hypotension and bradycardia. Vasovagal reaction, direct negative effects on inotropik heart muscle, and peripheral vasodilatasi may contribute to this effect. Two years is an action effect vasoaktif cardioactive substances released after anaphylaxis reaction to ICM. These side effects are usually self-limiting, but can also be a response indicator and worse. 

ICM can reduce heart arrhythmia threshold and deposition of arrhythmias and heart attacks. Liquid fluid shifts due to intravascular infusion of hiperosmolar produce intravascular hypervolemic state, systemic hypertension and pulmonary edema. In addition, PTT can lead to angina. 

Similarity of the cardiovascular responses to PTT Anefilktti may cause confusion in identifying the true nature of the type and severity of side effects, this confusion can lead to overtreatment or undertreatment of symptoms. 

Comments Nonidiosyncratic include fainting, seizures, and disorders of the underlying disease, including pheochromocytomas, sickle cell, thyroid, and myasthenia gravis. 


Ekstravasasi PTT when injected into the network software can cause tissue damage due to direct toxicity of contrast agents or effects of stress, such as syndrome of the box. 

Delayed reaction 

Delayed reaction to clear at least 30 minutes after, but within 7 days after injection of ICM. These reactions are identified by% 14-30 of patients after injection of ionic monomer and 80-10% of patients after injection of nonionik monomer. 

Delayed reaction, generally, including the development of flu-like symptoms, such as the following: weakness, fatigue, upper tract respiratory congestion, fever, chills, nausea, vomiting, diarrhea, abdominal pain, rash injected limb pain, dizziness, headaches. 

Manifestations less frequently reported are itching, ear, polyarthropathy, constipation, depression. 

Signs and symptoms almost always resolve spontaneously, usually, little or no treatment is required. Some comments may be delayed coincidence. 


Contrast nephropathy, defined an increase by more than 25% of serum creatinine or an absolute increase in serum creatinine 0.5 mg / dL. Three factors were associated with an increased risk of contrast-induced nephropathy: kidney failure, that already exists (such as creatinine clearance <60 mL / min [1.00 mL / s] Calculator - online calculator), preexisting diabetes, reduced intravascular volume (McCullough, 1997,Scanlon et al, 1999). 

osmolality of the contrast is considered important mdium contrast-induced nephropathy. Ideally, the contrast agent should isoosmolar with blood. Modern communications versus non-ionic iodinasi, older types of ions have a very bad and not used much. 

To minimize the risk, as opposed to induced nephropathy, various actions can be taken if patients have a predisposing condition. It would seem a meta analysis. 

1. The dose of contrast material should be as low as possible and still be able to perform the required tests. 

2. Non ionic contrast medium 

3. Iso-osmolar, contrast medium nonionik. One randomized controlled trial found that agents, iso-osmolar agents nonionik not superior ionic contrast material. 

4. IV fluid hydration with salt. There is debate about the most effective method of IV fluid for hydration. One method is 1 mg / kg on the time of 6-12 hours before and after contrast. 

5. IV fluid hydration with salt plus sodium bicarbonate. As an alternative to IV hydration with salt, sodium bicarbonate 3 mL / kg for 1 hour on the hour before, followed by 1 ml / kg at 6 hours after contrast was better than normal saline in random.It increased and then by experimental randomized controlled multi-center, which also showed that IV hydration with saline sodium bicarbonate-winning music and 0.9%.Effects of bicarbonate renoprotektif considered alkalinization of urine, which creates an environment not agree with the formation of harmful free radicals. 

6. N-asetilsistein (NAC). NAC, 600 mg orally twice a day, the day before surgery if clearnace creatinine, estimated at less than 60 ml / min [1.00 mL / s]). Randomized controlled trial looking for a higher dose of the NAC (1200 mg IV bolus and 1200 mg orally twice daily for 2 days) benefit (relative risk reduction 74%) patients receiving coronary angioplasty with a higher volume of contrast . Recent studies indicate that the number of N-acetylcysteine to protect the kidneys from the toxic effects of Representatives against (Gleason & Bulugahapitiya 2004). This effect, however, is not excessive. Some researchers (eg Hoffman et al 2004) even suggested that these effects because of interference with creatinine laboratory test alone. This is supported by a discrepancy between the levels of creatinine and cystatin C levels 

Other pharmacological agents, such as furosemide, mannitol, theophylline, aminophylline, dopamine, atrial peptide natriuretik have tried, but have not had a positive effect, or have side effects (Solomon et al, 1994; Abizaid et al, 1999).