CONTRAST AGENTS

RADIOLUCENCY VS RADIOPACITY
• Radiolucent tissue
• attenuates few x-rays and appears
black on the radiograph

• Radiopaque tissue absorbs x-rays

• appears white on the radiograph

• What is the impact of atomic

number on radiography?
Contrast agents
• Substances or materials with
high or low atomic number
• that gives varying contrast on
radiograph
• group of chemical agents
developed to aid in the
characterization of pathology
• by improving the contrast
resolution of an imaging modality
• many structures in the body remain invisible when X-rays alone are used
• can only be made visible after administration of a contrast medium.
• All of the examinations designated as special or advanced procedures
• require the introduction of some type of material into the area of interest to
provide contrast.
• Contrast in an X-ray image
• differences in absorption of X-rays by the tissues being irradiated
• Absorption is dependent on
• atomic number of the atoms present in the molecules
• the concentration of these molecules
 POSITIVE VS. NEGATIVE
CONTRAST MEDIA
• positive contrast media
• attenuate X-rays more than do the
body soft tissues and can be
divided into water soluble
• iodine agents and non water
soluble barium agents.

• Negative contrast media

• attenuate X-rays less than do the
body soft tissues.
 NEGATIVE CM POSITIVE CM
• AIR OR CARBON DIOXIDE • ALL OTHER CM
• LOW ATOMIC NUMBER • iodine, bromine, and barium

• RADIOLUCENT • HIGH ATOMIC NUMBER

• BLACK ON FILM • RADIOPAQUE
• WHITE ON FILM
 Requirements of ‘the ideal’ contrast medium
and types of contrast agent
• currently no contrast medium on the market that is considered to be ideal, but the ideal
contrast medium should fulfil certain requirements for safe and effective application. It should
be:
• easy to administer
• non-toxic
• a stable compound
• concentrated in the required area when injected
• rapidly eliminated when necessary
• non-carcinogenic
• of appropriate viscosity for administration
• tolerated by the patient
• cost-effective.
 4 PHYSICAL STATES OF CONTRAST
MEDIA
• Oil
• Pantopaque, Dionosil – Myelogram , Bronchogram.
• Tablets
• Telepaque, (Iopanoic Acid) . Biloptin (Iopodate) Cholebrine (iocetamic acid)
Bilisectan (Iodoalphanoic acid) - hepatobiliary
• Powder
• Barium Sulphate, BASO4 – Baryntgen-
• Liquid
• all iodinated and non-ionic contrast medium
VISCOSITY
• a measure of a fluid's resistance to flow
• describes the internal friction of a moving fluid
• A fluid with large viscosity resists motion
• because its molecular makeup gives it a lot of internal friction.
• A fluid with low viscosity flows easily
• because its molecular makeup results in very little friction when it is in
motion.
• The higher the viscosity of the solution
• the longer it will take for the contrast medium to be diluted by blood to
diagnostically un useful concentrations.
• Osmolality
• measures the total number of dissolved particles per unit of solution (in
mmol/L or mOsm/kg water)
• number of particles dissolved in one kilogram of water
• Hyperosmolality of the ionic organic iodine contrast agents
• root of many of the major reactions that occur during radiographic
procedures.
• degradation of the ionic contrast agents into electrically charged particles that
• can potentially disrupt the heart’s electrical activity
• thereby increasing the risks for arrhythmia.
• IODINE : (I) • BARIUM (Ba)
• Atomic number : 53 • Atomic number : 56
• Iodine is the only chemical
element • NON WATER SOLUABLE
• Which combines three properties
essential for the production of a • GI TRACT ONLY INGESTED
successful CM: • RECTALLY
• High contrast density
• low toxicity
Iodine Agents
• Water soluble iodinated contrast agents
• Diffuse throughout the extracellular space
• used for angiography, computed tomography (CT), conventional radiography.
• can also be administered directly into the body cavities
• gastrointestinal tract, urinary tract, HSG

• divided into two groups

• ionic and nonionic
 NON-IONIC VS. IONIC
• Ionic contrast media
• water soluble because they dissociate into negative and positive ions
• which attract the negative and positive poles of the water molecules.
• their injection into the blood plasma results in a great increase in the number
of particles present in the plasma
• High Osmolality
• Higher risk of complications

• Nonionic contrast media

• do not dissociate and are rendered water soluble by their polar OH groups.
 ADVANTAGES OF NON-IONIC CM
• neural tolerance of nonionic CM
• proved to be considerably better than that of ionic CM.

• general reactions
• such as nausea and vomiting, and of the sometimes life-threatening, acute allergy-like or
idiosyncratic reactions
• apparently far lower when nonionic CM are given

• contain no electrical charges,

• contain no cations, such as sodium or meglumine, and are considerably better shielded by
hydrophilic side chains.
• results in minimal protein binding and enzyme inhibition
• producing less anxiety in the patient, and psychogenic responses are
less likely to occur.
• Because the nonionic contrast media are less apt to damage the blood-brain
barrier
• they demonstrate a very low neurotoxicity.

• The nonionic agents also exhibit a high compatibility with other

intravascular medications
• used during angiography and the treatment of allergic reactions
 HOCM VS LOCM
• High osmolar contrast media

• Low osmolar contrast media

• Iso-osmolar contrast media

• Visipaque
 four different classes of iodinated contrast
• Ionic monomeric contrast media (high-osmolar contrast media, HOCM)
• e.g. amidotrizoate, iothalamate, ioxithalamate
• Ionic dimeric contrast media (low-osmolar contrast media, LOCM)
• e.g. ioxaglate
• Nonionic monomeric contrast media (low-osmolar contrast media,
LOCM),
• e.g. iohexol, iopentol, ioxitol, iomeprol, ioversol, iopromide, iobitridol,iopamidol
• Nonionic dimeric contrast media (iso-osmolar contrast media, IOCM),
• e.g. iotrolan, iodixanol