Last updated: May 14, 2019
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X-ray contrast media are compounds shown to increase the contrast of radiographic images such as X ray: computed imaging ( CT ) , a lessening of digital angiography ( DSA ) , digestive sytem system, saddle sore vesica, endovenous urography, phlebography legs, Venography, A arteriography, imagination of the organic structure pit ( arthrography hysterosalpingography for illustration, fistulography, dacrycistography ) , mielografi, ventriculography, cisternography and other diagnostic procedures.A

Unlike readying MEDIUMA

There are three readyings of contrast stuff used in Ba X ray, ( BA ) , iodine ( I ) and Th ( Thursday ) , but merely in readying for Ba and I used x-ray scrutiny yet.A

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Barium preparationA

This is a suspension of Ba sulphate in water.A Barium sulphate is indissoluble and chemically inert.A Soluble Ba salts are extremely toxic Ba sulphate and high drug use.A For radio-opacity of Ba depends on the negatron denseness ( indirectly reflected by the figure of atoms ) much greater opacity, and package wireless web wireless shows bone opacity.A Barium sulphate, white pulverization unsolved.A It is assorted with H2O and some additives to do the contrast agents.A Barium sulphate as a soluble, a mixture of types of agents against white blur.A It is used merely in the digestive piece of land, but is normally given as an clyster ( for osepahogography, tummy, and tenue intestinum ) or through the rectum into the colon..A After reappraisal, it leaves the organic structure with dirt.A

Should a leak of Ba Force web channels or into the organic structure pit, for example.mediastinum or peritoneum, may do fibrogranulomatous response.A Spilled into the bronchial tree is handled, except the gross jobs, when decease may happen ; readyings were weak Ba bronchography.A After unwritten, may be compact and colon doing irregularity can sometimes do a obstruction if you have a inclination to pathological.A

Barium sulphate is an ideal blend / H2O has been developed, but the undermentioned features are really important.A

A ) atom size.A Barium sulphate atoms are more or less normal, mensurating a few millimetres in size, but the ultrafine grinding consequences of Ba sulphate in 50 per centum of the natural atom size of between 5 and ECM l5lCm.A As deposit is comparable to the size of atoms, little atoms of Ba sulphate suspensions are more stable.A

( B ) Non-ionic medium.A Barium sulphate atoms influence the degree of collection of particles.A Charged atoms attract each other and form larger atoms sediment more easily.A They tend to do it even more sediment in the intestine and hence more easy in the stomach.A

( C ) pH of the solution.A Barium sulphate solution pH should be about 5 aˆ? 3, acerb solutions are more likely to be more so in the bowels and tummy and rush up more easily.A

( D ) preferred.A No uncertainty many of cut downing the sense of ultrafine grinding of limestone embedded in Ba sulphate / H2O mixtures, but commercial readyings contain a batch of seasoning agents are presenting a more unpleasant gustatory sensation. Barium sulfate mixture / H2O is normally 1 / 4 weight / volume, and viscousness ofA CP 15-20, but the suspension is thick or thin can digunakan.Banyak commercial readyings incorporating cellulose carboxymethyl ( Raybar, Barosperse ) , which maintain the fluid and prevent deposition from normal little bowel Ahahshaiaberiom.A

Development of double-contrast techniques have emphasized the demand for equal degrees of mucosal and many fabrication operations designed to accomplish this.Sputum aggregation of fluid that does non needfully prevent the tummy, so sufficient degrees of stomachic mucous membrane, and hypermotility of the stomach.A

To accomplish a dual contrast scrutiny of air, C dioxide or venters should be introduced and there is no uncertainty that the Knesset air or gas through pipes nasogastrik is the best manner to acquire the rubric of a controlled gastric distention.A However, some stomachic tubing is an unpleasant process and is non acceptable to all patients.As a consequence, most radiotherapists use sparkling tablets ( Na hydrogen carbonate 35 milligram, 35 milligram of tartaric acid, Ca carbonate and 5 to 0 milligram ) to notice on the contents of the tummy to bring forth C dioxide.A

Entire gas produced by these methods is variable and the overdistension of the tummy and double-contrast technique is related to hapless strata, from the position of diagnosing, such as ruinous as hapless distention.A Some commercial merchandises incorporating C dioxide gas under force per unit area with a mixture of Ba, but normally the sum of gas is deficient to bring forth a dual contrast of good food.A Anti-foaming agent can be added to some readyings of Ba to forestall the formation of bubbles.A

Water-soluble contrast media incorporating I is the value when there is a suspected perforation or leak H2O after surgery.A Radio – opacity of I is lower than Ba, and high osmolarity resulted in dilution in the little bowel, doing it has small value to be used routinely in the probe of the little bowel. Soluble contrast media are H2O and label if there is a danger of aspiration into the lungs.A

Iodine preparationA

Since its launch in 1950, medium organic iodinasi radiographic contrast ( ICM ) were among the prescription drugs most frequently in the history of modern medicine.A The phenomenon of current radiologic imagination agents will be less without him.A ICM typically has a good safety record.A Side effects of intravascular disposal of ICM is by and large self-limited mild, the reaction utilizing ekstravaskuler PTT rare.A However, terrible reactions or life-threatening can happen when the wall is a chemical alteration of the ICM is the benzene ring of 2,4,6-Tri-iodinasi.A They are classified harmonizing to chemical and physical belongingss, including chemical construction, osmolality, Na, ionisation in solution.A In clinical pattern, categorization based on osmolality widely used.A The I two paths of the government.A

Type of contrast medium iodinasiA

Iodine, a batch more influence “ solid ” x-ray.A There are a assortment of molecules.A Some illustrations of organic I molecule iohexol, iodixanol, ioversol.A Iodine-based contrast stuff are soluble in H2O and can be harmful to the organic structure. Contrast stuff is sold as a H2O clear colour solution, the concentration is expressed normally I mg / ml.A Unlike modern media iodinasi can be used about anyplace in the body.They are frequently used intravenously, but some they can besides be used intraarterially, intrathecally ( spinal ) and intraabdominally – about all the organic structure pit or possible space.A Are ionic contrast stuff and non-ionic monomer composite ( 1 BENZOIC acid pealing ) and dim ( 2 rings of BENZOIC ACID ) .A

High-osmolality contrast mediaA

Ionic monomerA

High-osmolality contrast media benzene pealing consists of Tri-iodinasi with two side concatenation carboxyl groups of organic.A Iodinasi anion, diatrizoate or iothalamate, was coupled with the Na or meglumine cation, the consequence is ionic monomer.A Ionization of the carboxyl-cation bonding agent soluble in H2O. Therefore, for each of three atoms of I, 2 atoms in solution ( Internet Explorer, a ratio of 3:2 ) .A

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


Low osmolality contrast mediaA

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

Ionic dimerA

ionic dimer formed by fall ining two removes ionic monomer carboxyl group.A This agent contains six atoms of I in any two atoms in solution ( Internet Explorer, a ratio of 6:02 ) .A Dimer ions are merely commercially available ioxaglate.A Ioxaglate concentration of 59 % , or 320 milligram I / milliliters, and osmolality of 600 mOsm / kg.A Due to high viscousness, ioxaglate produced higher concentrations.A Ioxaglate used chiefly for peripheral arteriography.

Nonionik monomerA

In nonionik monomer, benzene pealing Tri-made water-soluble iodinasi by the add-on of hydrophilic hydroxyl groups and organic side ironss placed at 1, 3, and 5 positions.Absence of carboxyl group, nonionik monomer ionisation no solution.A Therefore, for each of three atoms of I, merely one atom exists a solution ( that is, a ratio of 3:01 ) .A Therefore, the concentration of I is given, nonionik monomer-monomer was about half osmolality ionic solution.A Concentrations normally, 25-76 % , nonionik monomer was 290-860 mOsm / kg.A

Nonionized monomers are subclassified by the figure of mgs of I in 1 milliliter of solution ( eg, 240, 300, or 370 milligram I / mL ) .A

Large webs with increasing the viscousness of the monomer compared nonionik ionic monomer.A Nonionik increasing monomer viscousness makes it hard to shoot, but does non look related to the frequence of side effects.A

Monomer is normally nonionik iohexol, iopamidol, ioversol, and iopromide.A

Unlike Nonionik monomer agents are preferred.A In add-on to their environmental osmolalities nonionik low, as are possible chemotoxic ionic monomer.A


Nonionik dimerA

Nonionized dimer composed of two monomers joined nonionik.A Materials incorporating six atoms of I on each one atom in solution ( Internet Explorer, a ratio of 6:01 ) .A For the concentrations of I is given, dimer nonionik has the lowest of any osmolality contrast agents.A Concentration of approximately 60 % wt, this agent ISO-osmolar with plasma.They are besides really thick, and prevented the clinical useA


Adult type of the medium, nevertheless, Thorotrast is based on two Th, but was abandoned because it is carcinogenic.A

Property I contrast mediumA

Osmolality, viscousness, iodine concentration and physical and chemical belongingss of three interrelated, are besides affected vy the molecular construction of iodine adhering size.Expression of single hotels can change greatly between the contrast materialA

Over the past decennary, inventions in X-ray contrast media focused on the use of this hotel. However, because they are close to, alterations in a hotel can do other alterations, sometimes non so good. For illustration, attempts to cut down merchandise viscousness and osmolality were ISO-osmolar, A other manus, has been extremely desirable payments.A

Osmolality is a count of the figure of atoms in the sample liquid.A Merely calculate moles equal to 6.02 ten 1023 atoms ( Avogadro ‘s figure ) .A Molarity is the figure of atoms of a material sum of liquids ( eg mmol / L ) molal concentration is the entire mass of atoms dissolved in ( mmol kilogram ) of liquid. Osmolality is a count of the figure of osmotically active atoms in solution, and equals the amount of molal concentrations of all solutepresent declaration. most biological systems molar concentration molal concentration of a solution which is about precisely like the denseness of H2O is 1 kilogram to / hold a small difference between molal concentration and molar concentration in plasma as the current non-water constituents such as proteins and fats that make up approximately 6 % of entire volume.A So merely 94 % H2O and molal concentration serum serum stuff is about 6 % more than its molarity.A

Osmolality can be calculated by the undermentioned expression: A


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

Side effects of I contrast media ( ICM ) A

Use of I contrast media ( ICM ) can do unwanted side ffects and the find of anaphylaxis. Symptoms include purging nousea, erythema country, normally a warm feeling, concern, rhinitis, or pharynx hydrops, febrility, sudating, astenia, giddiness, lividness, dyspnoeaA and mild hypotension.A More terrible reactions such as assorted cardiovasluar vasodilatasi system with peripheral hypotension outstanding tachycardia, dyspnea, action, Kahlon and loss of consciousness, may necessitate exigency treatment.A For this ground the usage of contrast media should be limited in instances of diagnostic processs must be displayedA

Side effects associated with usage of intravascular contrast medium is changeless iodinasi moderate natural visible radiation, and less by non-ionic than with the readying of ion..A

Side effects to ICM classified Particular pathogenesis Remarks nonidiosyncratic.The effects may include direct effects of nomadic phone, enzyme initiation, and activation of quinine, fibrinolytic auxiliary systems.A

Particular ReactionA

Particular response normally begins within 20 proceedingss of injection of ICM, depending on dose possible.A Severe reactions may happen after the parties less than 1 milliliter of contrast agents.A

Although ICM ‘s response that such looks have feedback Anefilktti, hypersensitivity reactions are non right. Immunoglobulin E ( IgE ) antibodies are terlibat.Selain that sensitiveness is non necessary earlier, or make, the response of patients with return have provided consistently.A For this ground, particular for ICM Read feedback remarks Anefilktti.A

Anaphylactoid reactionA

Anaphylactoid reactions are rare ( Karnegis Heinz, 1979, Lesser et Al, 1987, Greenberger and Patterson, 1988 ) , but can happen in response to unwritten contrast injection anus, and retrograde pyelography.A They are similar in public presentation with feedback Anefilktti, but non caused by IgE-mediated immune response.A Patients with a history of reacting on the other manus, will increase the hazard of anaphylactoid reactions ( Greenberger and Patterson, 1988, Lang et Al, 1993 ) .A Early intervention with steroids has been shown to cut down 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.A

Minor symptomsA

Minor symptoms include: spreading urtications, which is a negative reaction of most often reported, rubing, fluid nose, sickness, purging, short, and / or emesis ; diaforesis, cough, dizziness.A Patients with mild symptoms should be noted that the development or the development of more terrible reactions, necessitating medical treatment.A

Mild symptomsA

Moderate symptoms include relentless emesis, diffuse urtication, concern, edema face, hydrops of the pharynx, shortness of breath easy bronkospasme, bosom palpitations, tachycardia, or bradycardia, high blood pressure, abdominal pain.A

Severe symptomsA

Severe symptoms include: dangerous arrhythmia ( ie ventricular tachycardia ) , hypotension, hydrops bronkospasme unfastened, pharynx, pneumonic hydrops, ictuss, faint, and death.A

Anaphylactoid reactions runing from urtication and itchiness, and bronkospasme hydrops on the face and pharynx. Moderate instances of urtication and itchiness, Benadryl ( Benadryl ) , unwritten or IV is appropriate.A For more terrible reactions, including bronkospasme face or cervix hydrops, Ventolin inhalator, or adrenalina hypodermic or IV, plus Benadryl may be required.A If external respiration is affected, take a breathing must be established before the medical.A

Nonidiosyncratic responseA

Remarks Nonidiosyncratic include: bradycardia, decreased blood force per unit area, and vasovagal reaction, neuropathy, cardiovascular responses ; ekstravasasi, and delayed reactions.A Comments Nonidiosyncratic include esthesiss of gustatory sensation, brown metal oral cavity, sickness and vomiting.A

Bradycardia, decreased blood force per unit area, and vasovagal reactionsA

To promote an addition parasimpatis systemic, PTT may trip bradycardia ( eg, reduced flow rate of the sinoatrial node, auriculoventricular nodal conductivity hold ) and vasodilatasi peripherals. The terminal consequence is systemic hypotension with bradycardia.A It can be accompanied by autonomic manifestations, including sickness, purging, diaforesis, sphincter disfunction, and alterations in mental position. Without intervention, these effects can do the prostration of cardiovascular death.A Some of the reaction may ensue from a vasovagal live with feelings like fright, hurting, abdominal compaction, PTT administration.A

Cardiovascular ReactionA

ICM can do hypotension and bradycardia.A Vasovagal reaction, direct negative effects on inotropik bosom musculus, and peripheral vasodilatasi may lend to this effect.A Two old ages is an action consequence vasoaktif cardioactive substances released after anaphylaxis reaction to ICM.A These side effects are normally self-limiting, but can besides be a response index and worse.A

ICM can cut down bosom arrhythmia threshold and deposition of arrhythmias and bosom attacks.A Liquid fluid displacements due to intravascular extract of hiperosmolar green goods intravascular hypervolemic province, systemic high blood pressure and pneumonic edema.A In add-on, PTT can take to angina.A

Similarity of the cardiovascular responses to PTT Anefilktti may do confusion in placing the true nature of the type and badness of side effects, this confusion can take to overtreatment or undertreatment of symptoms.A

Remarks Nonidiosyncratic include fainting, ictuss, and upsets of the implicit in disease, including phaeochromocytoma, reaping hook cell, thyroid, and myasthenia gravis.A


Ekstravasasi PTT when injected into the web package can do tissue harm due to direct toxicity of contrast agents or effects of emphasis, such as syndrome of the box.A

Delayed reactionA

Delayed reaction to unclutter at least 30 proceedingss after, but within 7 yearss 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.A

Delayed reaction, by and large, including the development of flu-like symptoms, such as the followers: failing, weariness, upper piece of land respiratory congestion, febrility, icinesss, sickness, purging, diarrhoea, abdominal hurting, roseola injected limb hurting, giddiness, headaches.A

Manifestations less often reported are rubing, ear, polyarthropathy, irregularity, depression.A

Signs and symptoms about ever decide spontaneously, normally, small or no intervention is required.A Some remarks may be delayed coincidence.A


Contrast nephropathy, defined an addition by more than 25 % of serum creatinine or an absolute addition in serum creatinine 0.5 milligram / dL.A Three factors were associated with an increased hazard of contrast-induced kidney disease: kidney failure, that already exists ( such as creatinine clearance & lt ; 60 milliliter / min [ 1.00 milliliter / s ] Calculator – online reckoner ) , preexisting diabetes, reduced intravascular volume ( McCullough, 1997, Scanlon et Al, 1999 ) .A

osmolality of the contrast is considered of import mdium contrast-induced nephropathy.A Ideally, the contrast agent should isoosmolar with blood.A Modern communications versus non-ionic iodinasi, older types of ions have a really bad and non used much.A

To minimise the hazard, as opposed to bring on nephropathy, assorted actions can be taken if patients have a predisposing condition.A It would look a meta analysis.A

1.A The dosage of contrast stuff should be every bit low as possible and still be able to execute the needed tests.A

2.A Non ionic contrast mediumA

3.A Iso-osmolar, contrast medium nonionik.A One randomized controlled test found that agents, iso-osmolar agents nonionik non superior ionic contrast material.A

4.A IV fluid hydration with salt.A There is argument about the most effectual method of IV fluid for hydration.A One method is 1 milligram / kilogram on the clip of 6-12 hours before and after contrast.A

5.A IV fluid hydration with salt plus Na bicarbonate.A As an option to IV hydration with salt, Na hydrogen carbonate 3 milliliter / kilogram for 1 hr on the hr before, followed by 1 milliliters / kilogram at 6 hours after contrast was better than normal saline in random.It increased and so by experimental randomized controlled multi-center, which besides showed that IV hydration with saline Na bicarbonate-winning music and 0.9 % .Effects of hydrogen carbonate renoprotektif considered alkalinization of piss, which creates an environment non hold with the formation of harmful free radicals.A

6.A N-asetilsistein ( NAC ) .A NAC, 600 milligram orally twice a twenty-four hours, the twenty-four hours before surgery if clearnace creatinine, estimated at less than 60 ml / min [ 1.00 milliliter / s ] ) .A Randomized controlled test looking for a higher dosage of the NAC ( 1200 milligram IV bolus and 1200 milligram orally twice daily for 2 yearss ) benefit ( comparative hazard decrease 74 % ) patients having coronary angioplasty with a higher volume of contrastA .A Recent surveies indicate that the figure of N-acetylcysteine to protect the kidneys from the toxic effects of Representatives against ( Gleason & A ; Bulugahapitiya 2004 ) .A This consequence, nevertheless, is non excessive.A Some research workers ( eg Hoffman et al 2004 ) even suggested that these effects because of intervention with creatinine research lab trial alone.A This is supported by a disagreement between the degrees of creatinine and cystatin C levelsA

Other pharmacological agents, such as Lasix, Osmitrol, Elixophyllin, aminophylline, Dopastat, atrial peptide natriuretik have tried, but have non had a positive consequence, or have side effects ( Solomon et al, 1994 ; Abizaid et Al, 1999 ) .A