In early 1886, Wilhelm Conrad Roentgen was the first held arteriography in a hand-cut. The concentrated lime water was used as contrast media and injected into the hand. Contrast media are water-soluble iodine was found and adopted in 1920. It was discovered by chance, which was then the diagnosis of syphilis in the era of treatment that uses Sodium Iodide dalah. Its use has been left 'image effect' on the radiographic images of the kidneys, but the Sodium Iodide is too dangerous because they contain toxic content is too high. Efforts to find a safe contrast media, and effective progress. The study was started about 1920 and it continued until the discovery of the largest, iodine contrast media containing low toxic content.
Since the invention of the era of the 1950s, iodine contrast media (ICM) is apparently more secure have been used extensively, almost daily use and is a widely used drug in medical history. Various forms and types of contrast media was used for the development of medical imaging. Most current diagnostic imaging contrast agents depends on this. Such as pharmaceutical drugs most others, this contrast agent was almost no negative effects even with a good safety record and proven medicine / drug is safe for use.
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Contrast media is an opaque material used to make a difference or 'contrast' of an organ, or structure, specific tissues and fluids in the body. This difference can be seen on the radiographic images. The drug will be used in various ways, including eating, put into the anus, inhaled or injected through the respiratory system through the circulatory system. Most of both types of contrast media is iodine compound or barium compounds.
Types and Uses
Contrast media are classified based on the features available on the physical and chemical properties, including chemical structure, the osmolality, iodine content, and its ionization. Classification according to the osmolality is often used. Based on the structure below, benzene was described as a six-sided structure of contrast media (hexagonal). Each side is marked 'I' is shown bonding molecular iodine atom. In the monomer structure of radiation, the COO of ions (either sodium or meglumin) is acidic. To stabilize the structure, the amino group acts as a stabilizer and reduce the toxicity of the molecular structure.
Three stuctures other than ionic monomer is an integral part of the contrast agents of low osmolality ionizing. In the non ionic monomer, benzene bond(tri-di-iodination) causing it to dissolve in water through the addition of hydrophilic hydroxyl groups (3 atoms) in the bonding position 1, 3 and 5. Lack of carboxyl groups, it may not be able to ionize / dissolve in water. According to the concentration of iodine, non-ionic monomer does not have nearly half the osmolality of the ionic monomer. This state of non ionic monomer causes often preferred because of less toxicity than the ionic monomer and contains a low osmolality rate. Ionic dimer is a combination of two ionic monomer and removing a carboxyl group in bonding. Each monomer consists of six atoms of iodine. The best example for the ionic dimer ioxaglate, where its concentration is 59% (320mg I / mL) and the osmolality was 600 mOsm / kg. Because of high permeability, ioxaglate is often used for peripheral arteriography procedures. Meanwhile, non ionic dimer similar characteristics to the ionic dimer. However, non ionic dimer was accompanied by two non ionic monomer. Non ionic dimer contrast agent is the lowest value of its osmolality. The concentration of not more than 60%, this agent is iso-osmolar with plasma. In addition, the high permeation rate caused very limited use. Among the examples of non ionic dimer are iotrol and iodixanol.
Positive Contrast Agents
Positive contrast agents are agents that have the atomic mass and a high rate of obstruction (attenuation) high. So these agents are indeed radiopaque material. Positive contrast media are as iodine, bromine, and barium.
Typically, these materials will be incorporated into the body (according to appropriate procedures) and contrast agents will meet the target organ. Effects resulting radiopaque would explain the situation and structure of the organ / tissue targeted at radiographic images. Generally, a positive contrast agent is the key to ensuring that the patient has allergies or not for the selection of the contrast media can be tailored to the patient to avoid the effects of anaphylactic shock.
Negative Contrast Agent
Always on Time
Marked to Standard
Oxygen, air, carbon dioxide and nitrogen oxides.Negative contrast agents can be used to:
Classification of Contrast Media
There are two parts: the ionic and non ionic.
Ionic compound is divided into two parts; high osmolar contrast media(hocm), and low-osmolar contrast media(locm). This classification is based on the iodine concentration of particles (generally as elements of contrast media is frequently used in the procedure IVU) absorbed / dissolved into the blood. If the rate of absorption of iodine is too high, it can slow the blood flow into the central nervous system (hyperosmolality). This situation is a major factor many negative reactions to patients due to contrast media that are not appropriate.
Rate of osmolality(mOsm/kg)
High-osmolar contrast media
low-osmolar contrast media
Content molecules tightly to the anion and cation (positive and negative) in the blood causing high osmolality - toxic / reaction high.Properties of molecules containing benzene rings, for example - salt compound meglumine diatrizoate and diatrizoate sodium (Renografin 60 and Hypaque 76 - osmolaliti high)
Characteristics of iodine contrast agents;
i Osmolality (no liquid particles in 1 kg of water)
ii viscosity - the size of the rejection of (resistant) to the flow of fluids (viscosity / concentration)
iii Toxicity - (poisoning / injury), it is based on the molecular configuration.
Molecules are not resolved in the fluid / blood.For example, a compound of sodium diatrizoate (iopamidol, isovue, iohexol / omnipaque)
- Measures of care;
i. Can not exceed the dose.
ii. Stay away from the sun.
iii. Stored at room temperature.
Reactions to contrast agents - iodine:
Use of Iodine contrast media (ICM) can cause unwanted side effects and manifestations of anaphylaxis. Symptoms include nausea, vomiting, erythema area, generally a hot sensation, headache, coryza or larynx edema, fever, sweating, astenia, dizziness, dyspnoea, paleness, and moderate hypotension. Other severe reactions involving such vasodilatation cardiovasluar system with pronounced peripheral hypotension, tachycardia, dyspnoea, action, loss of awareness and cyanosis , may demand emergency care. On behalf of this reason the use of contrast media should be limited in cases of diagnostic procedures must be shown. Side effects associated with use of intravascular contrast medium is constant iodinated of natural light to moderate and temporary, and less often by non-ionic than ionic preparations. Side effects to ICM are classified as special and nonidiosyncratic. The pathogenesis of these adverse reactions may involve direct effects of mobile phone; enzyme induction, and activation of quinine, fibrinolytic complement, and other systems.
Contrast media management
Reactions that occur while the procedure of contrast media are not predictable, and the patient should be observed carefully during the procedure. The following is general advice to be given by an x-ray contrast media as well as introduced to the patient.
explain to the patient about the procedure in detail
the patient and medical history
approved by completing the patient consent form
check the serial number or code and expiry date of contrast material
free virus check on each appliance and packaging that will be used
ensure that emergency equipment used are provided
patients are encouraged to drink plenty of water and make sure the patient's body dehydration. Most of the contrast media will be out through the urine after four hours
make sure the contrast agent used was based on body temperature
need to take special precautions and be aware of additional risks that can be derived as severe cardiovascular disease, severe renal impairment, asthma or a history of allergies, suspected a high sensitivity of iodine, a very old (> 65 years) and very young (<6 months) , severe respiratory diseases, diabetes and had suffered a reaction to the medication.
ATTENTION AND CONTRAST AGENTS CONTROL MEASURES.
Firstly, check the history of the patient.Make sure the reading of the BUN-blood urea nitrogen (8-25mg/dl kretinin) - (0.6-1.5 mg / dl).Actions taking steroid / anti-histamine before contrast examination. Check patient heart condition.If the patient have Multiple myeloma or myelo dysplastic syndrome or severe diabetes (preferred drink a lot of water).
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The other name is Vasogenic shock. Histamine is released in response to an antigen (foreign substance). They give effect to;smooth muscle - causing bronchial spasm (bronchospasm) respiratory (sneezing, wheezing, a pilot). Increased vascular permeability - (urticaria, edema of the mucosa, red spots (rash). Increased secretion of mucous glands (nausea, vomiting).
Sign of the symptom(anaphylactic shock) are patients will begin to be Agitated. Rate of pulse will be increased dramatically.The patient appeared pale and weak and lifeless body.They do not have the ability to think too long.The patient feels cold, sticky and itchy skin.skin of the patient will be reddish and spotted (urticaria). Patient's neck like a choking / strangulation and Trouble breathing.
Weak symptoms include the following disease: dispersed urticaria, which is the very commonly stated as adverse reaction; sickness of pruritus; rhinorrhea; brief retching or nausea or vomiting; dizziness, diaphoresis; coughing. Patients with mild symptoms should be noticed about the progression or development of a more severe effect, which needs treatment.
medium symptoms include the following: constant vomiting; diffuse urticaria; pain in head; facial oedema; laryngeal oedema; weak bronchospasm or difficulty in breathing; palpitations, rapid heart beat(tachycardia), or slowness of heart beat (bradycardia);high blood pressure; and abdominal spasms or cramps.
Acute symptoms include the following: life-threatening arrhythmias (in example; ventricular tachycardia), laryngeal oedema, faint, over bronchospasm, pulmonary oedema, spasm, low blood pressure, and death.
Comparison of contrast agents:
Toxicity - high risk of allergy
Toxicity - less / low risk
Contrast media needed for Radiological examination:
To distinguish the path of blood in the urine or blood vessel, usually just the bones and the air will be visible on x-ray and to improve the density of urine or blood.
Advantages of contrast media:
Provide better mucosal detail
There is no osmotic effect, so the radio density is long-lasting.
Disadvantages of contrast media:
Aspiration pneumonia if inhaled.
If got leakage into the cavity or organs of the body. It canâ€™t survive indefinitely and may cause granulomatous reactions.
Contrast media is a chemical used in diagnostic imaging procedures to improve the quality of a radiograph. As radiographers, it is important to investigate the background of the patient's health to prevent untoward incidents occurred. Most of the critical reaction occurs not more than 20 minutes after injection. Currently, radiographers must be vigilant and monitor the patient's condition. The doctor on duty is also required to identify the appropriate type of contrast media and can act quickly to recognize the early symptoms of allergy to contrast media before the situation worse.