Its is technique to using the oil contrast for radio-logical procedures

2. CONTRAST MEDIA
NEGATIVE
AIR & ITS CONSTITUTION
POSITIVE
IODINE COMPOUND BaSo4
GIT
WATER SOLUBLEPOWDEROILY

3. 1) POWDER CONTRAST in a form of tablets
e.g. Biloptin, Cistobil.
2) OILY CONTRAST
e.g. myodil, dinosil & lipidol.
3) WATER SOLUBLE ( addition of sugar).

4. OIL BASED CONTRAST MEDIA
 It was first introduced in myelography by
sicard as first generation contrast media in
1921 then It was used for Bronchography,
HSG,Pyelography and Lymphography
 It is rarely used now a days in some
special Cases like COPD & Pulmonary
hypertension

5.  Made from fatty acids
 Iodine added to Easter groups
 Insoluble in water
 Long persistence in body
 Infrequently used except for specific exam
 Cannot be used with plastic syringes
 High viscosity
 High surface tension
 Slow absorption & excretion
 Chances of embolism

6. PROPERTY WATER SOLUBLE OIL SOLUBLE
VISCOSITY Low High
SURFACE TENSION Low High
DRAINAGE Permit filling of Ductal system
under low pressure&facilitate
prompt drainage
Diameter of duct may be distorted
& it is poorly eliminated from
finer duct. It may cause Ductal
obstruction
PHYSIOLOGIC PROPERTY More physiologic,i.e.miscibility
with saliva is more
Less physiologic
PATIENT DISCOMFORT Ductal injection accompanied by
little pain or discomfort
Greater degree of discomfort
,pressure may push calculi
backward & it may damage ductal
epithelium
ALLERGIC REACTION Not significant reaction occur May cause severe foreign body
react
OPACIFICATION Opacification is low but it can coat
& outline calculi more adequately
Opacification satisfactory. Denser
contrast may obscure debris &
small non-opaque calculi
ABSORPTION & EXCRETION Rapid slow
EMBOLISM No chances Chances of embolism

7. Myodil (Glaxo) is an oily organic iodine containing
contrast material which was used for myelography.
Residual contrast remains for years. Has been
implicated in development of arachnoiditis, perhapse of
the order of 1%.
EXAMPLE :
1. Arachnoiditis
2. Myelogram

8. Lipiodol is a ethiodized oil, is a poppyseed oil used by injection as
a radio-opaque contrast agent that is used to outline structures in
radiological investigations.
Ethiodized oil is composed of iodine combined with ethyl esters of fatty
acids of poppyseed oil, primarily as ethyl monoiodostearate and ethyl
diiodostearate.
EXAMPLE :
1. HYSTEROSALPINGOGRAPHY
(HSG)
2. LYMPHANGIOGRAPHY

9.  Pantopaque was introduced in 1944 as a oil contrast medium
 The first Low- Osmolar Contrast Medium(LOCM) to be produced
was Metrizamide (Amipaque)
 Oil never completely re- absorbed
DOSAGE
 Generally 6-17 ml
 Recommended by manufacturer and varies with the medium
concentration.

10. PANTOPAQUE MYELOGRAPHY CONTRAST

11. MYELOGRAPHY PROCEDURE

12.  Rubin insufflated oxygen (later carbon dioxide) under pressure
through the cervical canal into the uterine cavity. Tubal patency was
determined by presence of air under the diaphragm on X-ray, by
auscultation of air flow into the abdomen or a drop in pressure
during insufflation
 Heuser was the first to report on the use of lipiodol in HSGs
(Heuser, 1925)
 Lipiodol- oil soluble, low viscosity, less toxic, became widely
accepted

13. HSG PROCEDURE

14. CONTRAST MEDIA
LIPID SOLUBLE
CONTRAST (lipiodol)
 Sharp image
 Minimal pain
 Delayed absorption
 Risk of lipogranuloma formatation
in case of tubal block or
hydrosalpinx
 Intravasation of contrast and
possible risk of oil embolism
 Need of delayed film
 Pregnancy rate doubled
 Less often used
WATER SOLUBLE
CONTRAST (urograffin)
 Ampullary rugae clearly visualised
 Gets absorbed within hours, does
not leave residue
 Granuloma formation rare
 Pain persists after procedure
 Prompt demonstration of tubal
patency, delayed film not needed.
 Widely used and preferred

15. DACRYOCYSTOGRAPHY
 Involves the injection of radio-opaque contrast medium into the canaliculi followed
by capture of magnified images.
 The test is usually performed on both sides simultaneously.
 Not to be performed in a patient with acute dacryocystitis.
TECHNIQUE
 The inferior puncta are dilated.
 Plastic catheters are inserted into the inferior canaliculi on either side; alternatively
the upper puncta may be used.
 Contrast medium, usually 1–2 mL of Lipiodol, is simultaneously injected on
both sides and postero-anterior radiographs are taken.
 Ten minutes later an erect oblique film is taken to assess the effect of gravity on
tear drainage. Digital subtraction provides a higher quality image capture than
conventional

17.  Ethiodol and Lipiodal
 Directly injected into a vessel of an extremity
 Blue dye used –absorbed by lymphatic vessel
 Oil based usually used for lymph Angiogram
 Water based is irritating to the Lymphatic System causes
Pain and buming to patient

19.  Duct orifice is sprayed with topical anaesthetic
 Duct is cannulated, (dialator may be required), contrast
introduced with fluoroscopic guidance
 Contrast (oil based or water soluble iodinated)
(concentration = 240mg/ml)
 Should be injected manually until pt feels discomfort
 Quantity needed may vary btw 1-2 ml
SAILOGRAPHY

20. Lateral Submandibular
radiographs
Cannulation of duct with
intravenous catheter (22 gauge).

21.  Densely radiopaque ,that shows good contrast
 High viscosity, that shows excretion from the gland
 Adequate radio-opacity for demonstration of leakage.
 If leakage occurs to the bronchi and lungs, these contrast
Media could be considered relatively safe as they are not
Hyperosmolar and are in any case the CM normally used for
bronchography

22.  The oily contrast is a high viscosity but not fill the nerve roots
well.
 Too dense, hence poor visibility of spinal cord through contrast
column.
 High incidence of arachnoiditis(25%).
 It Cannot be used in CT.
 Oil Embolism May Occur By Accidental Intravascular Injection.
 Absorbed at the rate of one ml per year and hence persists for a
long time .
 Due to high viscosity ,there is increased possibility of CSF leak.

23. DISCOMFORT ,SIDE EFFECT & REACTIONS
VISCOSITY: (Thick, sticky)
Thicker-Harder to inject, more heat and Vessel irritation
Warming contrast will help
1. TOXITY-(higher=greater viscosity)
2. MISCIBILITY – easily mixes with blood
3. OSMOLALITY – is a measure of the total
4. Number of particles in solution