The document discusses the history and types of contrast media and emergency drugs used in radiology. It provides details on: - The development of contrast media from early toxic substances like bismuth and sodium iodide to safer iodine-based agents. - How contrast media are classified based on osmolality as high osmolar, low osmolar, and iso-osmolar, and whether they are ionic or non-ionic. - Common reactions to contrast media ranging from mild nausea to life-threatening emergencies, and the emergency equipment and drugs needed to treat reactions.

1. CONTRAST MEDIA AND EMERGENCY
DRUGS
ROHIT BANSAL (Assistant Professor Radio-Physics)
technicallycontrast

2. HISTORY:
• 1896-WALTER BRADFORD discovered contrast media.
• 1897-first reported GI Contrast study performed using
BISMUTH.(TOXIC)
• 1910-Barium sulphate used(SAFER).
• 1920-SODIUM IODIDE (TOXIC)used to treat syphilis .iodine
was found to be radio-opeque to x-ray.
• First suitable/SAFER iodine contrast media was PYRIDINE.
• 1927-First radiological contrast for IVU was uroselection.

3. :
• CONTRAST AGENTS are used in many studies
like
angiography,arteriography,venography,IVP,RGU,
MCU,HSG, Myelography,Barium
studies,Bronchography,Sialography,Sinography,
CT Scan,MRI,USG,etc....

4. • Orally.
• Rectaly.
• Intravenous.
• Intracavity.
• Intramuscular.
• Direct puncture.

5. • Osmolality.
• Viscosity.
• Chemo toxicity.
• Hydrophilicity.

6. • Can be expressed as concentration of particles per kg of
solvent.(in medicine milliosmoles per kg of water).
• The closer the osmolality of radiological contrast media is
to that of body fluids the better the general tolerance.
• Osmolality of blood- 290 mOsmo/kg H2O.
• Iso-osmolar CM- 290 mOsmo/kg H2O.
• LOCM- 600-800 mOsmo/kg H2O.
• HOCM- 1400 mOsmo/kg H2O.

7. • Viscosity describes the thickness or resistance to flow of a
contrast agent.
• The thickness of a contrast agent is related to the
concentration, the size of the molecules in a specific
contrast agent and the temperatre of the contrast agent.
• The Viscosity affects the rate that the contrast media can
be injected.

8. • The clinical effect of contrast agent not only result from
high osmolality, but also from their own specific
pharmacology which mediates chemo toxic effects.
of CM is its preference for aqueous
solvents.
of contrast media is its preference for fat-
like organic solvents.
refers to the percentage of CM
which becomes bound to plasma proteins in blood
stream. Ionic agents have high degree of protein binding
So, these can't be rapidly eliminated by kidneys.

9. The contrast media are of
two types:
• Positive contrast agent.
• Negative contrast agent.

10. • Radio-opeque.
• High atomic number.
• high atomic weight.
• radiation dosen't penetrate easily.
• bright on radiograph.
• example-Barium sulphate and organic iodine compounds.

11. • High atomic number(56).
• High radio-opaque.
• It is insoluble in water or lipid.
• non toxic.
• It is non absorbable.(rapid removed)
• It is suitable for double contrast studies.
• better coating properties over the lining of gut.
• form- white crystalline powder.
• pH-5.3.
• particle size- 5-12 micrometer.

12. • Strawberry
• Lemon.
• Mint.
• Metallic.

13. • Sodium bicarbonate.
• Tartaric acid.
• Citric acid.
• ENO
• Coke.

14. • Microbar paste: 100% high density and viscosity paste
used in oseophagus and stomach studies.
• Microbar suspention: 95% modrate density and viscosity
paaste used in small intestine ,large intestine and rectum
studies.
M/S ESKEY FINE CHEMICAL LIMITED.

15. • Chemical peritonitis due to extravasation of
contrast.(Inflammation of peritoneum).
• Extravasation into bronchial tree, urinary track and other
body cavities may cause inflammation.
• Intravascular entry of barium can cause
Embolism.(blockage of vessels).
• Barium Encephalopathy.(abnormal brain function).
• After exam sometimes may solidify, difficult to evacuate.

16. • Barium swallow.
• Barium meal.
• Barium meal follow through.
• Barium small bowel enema.
• Barium enema.

17. • High atomic number.(53).
• High atomic weight.(127).
• High radio-opaque.
• Less toxic.
• Total iodine content in the
body is 50 mg.
• Not metallic.
• High density.
• High osmolality.

18. • All are derivatives of tri-
iodinated benzene ring.
• In ionic contrast acidic group
with sodium and meglumine is
attached at C1.
• In non-ionic contrast amide
group is attached at C1.
• Iodine atom attached at C2,C4
and C6.

19. • HOCM (High osmolar contrast media).
• LOCM (low osmolar contrast media).
• IOCM ( Iso-osmolar contrast media).

20. • HOCM have the osmolality of 1400 mOsmo/kg of water.
• Most of HOCM are ionic.
• 5-8 time more osmolality then plasma.
• LOCM have the osmolality of 600-800 mOsmo/kg of
water.
• Consist of both ionic and non-ionic.
• 2-3 time more osmolality then plasma.

21. • IOCM have the osmolality of more then 290 mOsmo/kg of
water.
• Present in only non-ionic form.
• Have same osmolality as plasma.

22. • Ionic.
• Non-ionic.

23. • Less cost.
• More adverse reaction.
• High osmolality.
• Creates hypertonic conditions.
• Dissociate into separate ions when injected.
• Example- Meglumine iothalamate, Sodium
iothalamate,Sodium diatrizoate,Meglumine diatizoate.

24. • High cost.
• Less adverse reaction.
• Less osmolality.
• Remains nearly isotonic.
• Doesn't dissociate into small particles when injected.
• Example- Hexabrix.

25. • Also known as high osmolar
contrast media or conventional
contrast media.
• These are salt consisting of a
sodium or meglumine cation and
triodinated benzoate anion.
• Ratio of 3 iodine atom per
molecule to 2 particles in solution.
i.e. 3:2
• Examples are diatrizoate
(urografin), Iothalamate (conray).

26. • Two benzene rings (each with
3 iodine atom) are linked by a
bridge to form a large
compound.
• Carries only one carboxylic
group. so, known as monoacid
dimers.
• Iodine particle ratio is 6:2.
• Example- Ioxaglate (hexabrix).
• Conc. of 59%(320mg/ml),
relatively low osmolality of 600
mOsmo/kg.

27. • Carboxyl group of monomeric salts is replaced by a non-
ionising radical and CONH2 producing a iodine particle
ratio of 3:1.
• Metrizamide was the earliest non-ionic monomer and
proved as an excellent contrast media but was very
expensive, impossible to autoclave and unstable in
solution.
• Relatively low osmolality (600-800 mOsmo/kg).
• Example- Iohexol, Iopamidol, Ioversol, Iopentol etc.

28. NON-IONIC MONOMER AND NON-IONIC DIMER

29. • A ratio of 6 iodine atoms for each molecule in solution with
satisfactory iodine concentration at iso-osmolality.so,
known as iso-osmolar contrast media.
• These agents have very low toxicity because of iso-
osmolality, non-ionic character and also these posses a
very large number of hydroxyl group.
• Examples- Iotrolan (isovist), Iodixanol (visipaque).

30. Sodium bromide, Bishmuth in oil and lipiodol were earliest
intravenous contrast media.
Sodium iodide was also used but found to be toxic.
The first organic iodide to be used were pyridine ring
containing one atom of iodine per molecule.

31. • An iodinated benzene ring compound was synthesized in
early 1950's hippuran. This was precursor of modern
ionic water soluble contrast agents which are tri-iodinated,
fully substituted benzene ring derivatives. Hexabrix
molecules belong to this generation.

32. • The direction of molecular modification in these ionic
compounds was changed to focus on their osmolality, with
the addition of non-ionising glucose moiety, the tri-
iodinated benzoic acid derivative become a non ionic
compound, metrizamide, Iohexol, Iopromide, Iopamidol,
Ioversol, Iopentol, Ioxilan etc.

33. • In this generation of contrast media the osmolality was
reduced further. A dimer that is complete non-ionic is
iotasul. Iotasul has less then half the osmolality of
metrizamide at extremely high concentration of 400
mg/ml/plasma. others in this group are iotrol, iotrolan
(isovist) and Iodixanol (visipaque).

34. • Water soluble.
• Chemical and heat stability.
• Biological inertness.
• Less viscosity.
• Lower and same osmolality as human serum.
• Rapid execration.
• Safe.
• Low cost.

35. • Avoid high risk patient(over 50 years).
• Avoid patient with history of coronary artery disease,
obesity, alcoholic, cardiac or renal failure.
• Use beta blockers.
• Prior reaction to contrast media.
• Any allergic reaction from any drug.
• Asthma.
• Diabetes mellitus.
• Anxiety patients.

36. • 1 in 20 cases=5%
• Nausea, Vomiting, Mild rash, Light headache and mild
dyspnoea.
• Need no treatment but require assurance.
• 1 in 100 cases=1%.
• Extensive urticaria, facial edema, bronchospasm,
laryngeal odema, dyspnea, mild chest pain and
hypertension.

37. • Require treatment but generally there is no need of
hospitalization.
• 1 in 2000 cases=0.05%.
• Circulatory collapse, pulmonary odema, severe angina,
myocardial infraction, convulsions, coma, cardiac and
respiratory arrest.
• Require hospitalization and intensive care.
1 in 40000 cases=0.0025%.

38. • Oxygen- piped or in a cylinder.
• Suction or catheters.
• Face mask- adults or pediateric size.
• Airway- adult or pediateric size.
• Laryngoscope.
• Endotracheal tubes.
• Ventilation bag.
• Needles and syringes.
• IV giving set.
• Scalpel,blade and French's needle.
• Stethoscope and sphygmomanometer.