The document discusses various contrast x-ray examination methods and their clinical importance. It describes different types of contrast agents and their classification. It also covers potential side effects. Various contrast radiography techniques are outlined for examining organs like the brain, lungs, abdomen, urinary system and vascular structures. These include angiography, urography, cholangiography, pneumography and arthrography. Complications are minimized by pre-testing for contrast agent sensitivity. The methods allow visualization of internal structures and any abnormalities.

1. Special contrast x-ray
methods of
examination and their
clinical importance

2. The classification of the
contrast substances
X-ray positive
X-ray negative
(carbon dioxide
CO2, air, O2,
N2O)
Substances
without Iodine
(BaSO4, water
insoluble)
Iodine substituted substances:
1.Nonorganic (sodium iodine,
potassium iodine)
2.Oil solutions and
suspensions (lipoiodol,
iodolipol)
3.Organic iodine substances
(water soluble)
Monosubstituted
(sergosin,
uroselectan)
Bisubstituted
(diodone,
cardiotrast)
Trisubstituted
(urographine,
bilignost)

3. Modern nonionic monomeric
substances
- Omnipak;
- Ultravist;
- Magnevist;
- Omniscan.

4. Side effects
Local:
- irritation of the intima;
- spasm of vessels;
- pain.

5. Sponsored
Medical Lecture Notes – All Subjects
USMLE Exam (America) – Practice

6. General effects:
- Toxic influence on the organism;
- Neurovascular reactions;
- Reactions combined with the
hypersensitivity of the organism to the
contrast media.

7. Tests
1. Conjuctival test.
2. Intracutaneous or subcutaneous tests.
3. Intravenous test.

8. І. Methods with x-ray negative
substances (pneumographic) :
1. Pneumoencephalo- and ventriculography.
2. Artificial pneumothorax.
3. Pneumoperitoneum.
Contrast methods

9. 4. Pneumourography:
А) pneumopyelography;
Б) pneumocystography.
5. Pneumogastrography.
6. Pneumoparietography.
7. Pneumomammography.

10. Pneumoencephalography

11. Artificial pneumothorax

12. Pneumopyelography

13. Pneumogastrography

14. Pneumoparietography

15. Pneumomammography

16. ІІ. Methods of examination with the
use of x-ray positive contrast media
with large atomic weight :
1. Angiography of the cerebral arteries.
2. Angiocardiography.
3. Aortography.
4. Angiography of the vessels of
extremities.
5. Arteriography.
6. Phlebography.
7. Lymphography.

17.  Angiography is based on the introduction
of blood water-soluble organic
compounds of iodine. Depending on the
mode of administration of contrast
distinguish general and selective
angiography.
 During the general angiography contrast
injected into a vein, automatic injector at
high speed (40 ml / s) .At serial
angiogram obtained images of the
superior vena cava, right atrium and
ventricle, blood vessels of the pulmonary
circulation, left atrium and ventricle,
aorta.

18.  Selective angiography is used to study blood
flow to certain organs. For this purpose
catheterization of the femoral artery or vein.
 Coronary angiography - methods of study of the
coronary vessels, the localization of
atherosclerotic narrowings and occlusions, the
state of collateral circulation. The technique is
often the first step in endovascular intervention
(dilatation, thrombolysis, stenting). Coronary
angiography is used to decide on surgical
treatment (coronary artery bypass), and
evaluating the effectiveness of the operation.

19.  For this hold the skin puncture of the femoral artery and
in ascending aorta under control monitor X-ray apparatus
introduced catheter, then conduct a series of photos.

20. Coronary angiography,
endovascular intervention

21. Coronary angiography

22. Arteriography

23. Angiography of the cerebral
arteries

24. Aortography

25. Angiography of the lower
limbs

26. Angiography of the lower limbs before and
after stenting

27. Angiography of the liver

28. Lymphography

29. Phlebography

30. Mammography

31. Methods of the hepatobiliary system
examination
Cholangiography (Greek cholē bile + angeion vessel +
graphō write, represent )
 X-ray examination method biliary after direct injection into
them radiopaque substance.
 Developed four ways cholangiography : endoscopic
retrograde cholangiopancreatography , percutaneous
transhepatic , intraoperative and postoperative
cholangiography .

32. Endoscopic retrograde pancreato-
cholangiography.
Retrograde cholangiopancreatography
( ERCP ) (Endoscopic retrograde
cholangiopancreatography (ERCP)) - a
method that combines endoscopy with
simultaneous fluoroscopic examination .
Endoscope is inserted into the duodenum
to the major duodenal papilla , the mouth of
which opens into the duodenum . A
channel of the endoscope tube extends
with an internal channel for supplying a
contrast agent . In the bile and pancreatic
ducts enter a radiopaque substance .
Then, with the help of X-ray equipment is
an image ducts.

33. Normal "tree" bile ducts and
cholecystolithiasis. Clearly visible contrast
intra-and extrahepatic bile ducts, and
pancreatic duct stones in the gallbladder.
Endoscopic retrograde pancreato-
cholangiography.

34. Cholangiography
Percutaneous transhepatic H. was popular
after the appearance of ultrafine needles to
ensure the relative safety of puncture of the
intrahepatic ducts through which is an artificial
opacification of the biliary tract . The method is
used to refine the location, nature and character
of the bile duct occlusion caused by a stone,
stricture , tumor, when you can not conduct
retrograde cholangiography . After sedation and
local anesthesia produce a percutaneous
puncture of the abdominal wall. Under control of
X-ray television set end of the needle in the
lumen of one of the intrahepatic bile ducts, and it
is administered to the required amount ( 20 to 60
ml) radiopaque substance. The procedure for
diagnostic testing can go to a treatment if
detected dilated bile ducts and there is a need of
temporary or permanent drainage .

35. Radiographs obtained at transhepatic
percutaneous cholangiography in patients
with cholelithiasis: the bile duct (1) and
common bile duct (2) expanded in the
distal common bile duct stone has its
occlusive (3).

36. Intraoperative H. operate on the
operating table after opening the
abdominal cavity. The method allows to
determine the state of the bile duct .
Intraoperative H. performed in the
operating room , equipped with an X-ray
unit. Used diluted (30-50 % ) solutions of
contrast media . .
Postoperative H. is used to assess the
results of surgical intervention in order to
identify the remaining gallstones
Radiographs obtained at intraoperative
cholangiography in patients with
cholelithiasis: the common bile duct (1),
into which the catheter is expanded to its
distal part defined by stones (2), X-ray
contrast agent goes into the duodenum (3)

37. Methods of the urinary system
examination
-Plain radiography;
- Antegrade pyelography
- Intravenous (excretory) urography
- Retrograde urography;
- Retrograde cystography;
- Miction cystography;
- Angiography kidneys;

38. Plain radiography.
The method allows to estimate only the presence of
concrements.
Intravenous urography is based on the use of radiopaque
drugs that are excreted by the kidneys by filtering
mechanism .
Applying IVU, we must determine the reaction of the
patient to X-ray contrast agents. To perform this test on
individual sensitivity to iodine intravenously before the
study 2 ml radiopaque substance.

39. Indications IVU:
•Gross hematuria of unknown origin;
•The pain, the source of which is localized in urinary ways;
•Recurrent urinary tract infections;
•Suspected urolithiasis;
•Suspected ureteral obstruction concrements, tromb,
tumor;
•Diagnosis of congenital anomalies of the kidneys and urinary
tract.
Technique :
Patient intravenously injected 40-60 ml radiopaque
substance. Next, conduct research, consisting of a series of
images. The first image perform at 1 min after injection ( we can
to see contrast in renal parenchyma ), the second - to 5-minute
(getting images of all structures of the urinary system), the third
- on the 15th minute.

40. Contraindications iVU:
•Increased sensitivity to radiopaque substances;
•Anuria;
•Multiple myeloma;
•Diabetes;
•Severe liver disease or kidney disease;
•Heart defects
•Acute and chronic renal failure.

41. Plan film radiography

42. Plan film radiography
Ureteroscopy, the installation of an
internal ureteral stent drainage.
Completed survey urography - control
stent standing on the left. The stent is
satisfactory

43. Intravenous (excretory)
urography  Excretory urography of
renal pelvis with cancer in
60-year-old woman with
complaints of intermittent
pain in the left loin and
microhematuria. In the
photo, taken 18 minutes
after the introduction
contrast shows a small
papillary tumor that grows
from the medial wall of the
left renal pelvis

44. Intravenous (excretory) urography
the identification of the defect filling,
bladder wall thickening, pelvic
extension

45. Intravenous (excretory)
urography
Not complete doubling of kidney Complete doubling of kidney

46. Abnormality of the kidney

47. Retrograde urography.
Performed method using radiopaque substance that is injected
through katetr placed in the corresponding ureter. With
retrograde urography can detect changes in shape and size cups,
bowls, ureters. The patient is placed on a special table that have
cystoscopic addition. Urologist introduces a cystoscope through
the urethra into the bladder. After examination of the bladder
doctor enters ureteral catheters into one or both ureters. The
end of the catheter is brought to the renal pelvis. After
catheterization spend Plain radiography (control placement of
catheters). A catheter introducing 3-5 ml radiopaque substance
into the bowl one or two kidneys.

48. Retrograde pyelography

49. Right-sided antegrade
pyelography
during the operation catheter is inserted
into the renal pelvis, then injected
contrast

50. Left-sided antegrade
pyelography
Ultrasound-guided puncture is performed
extended left kidney renal pelvis, introduced
contrast agent. Performed left-sided
antegrade pyelography. Stasis of contrast is
seen in the lower third of the left ureter.

51. Retrograde cystography.
Performed method using radiopaque substance that is injected into
the bladder through the catheter . The patient is placed on a
special table. Urologist catheter enters through the urethra into
the bladder. Next bladder filled radiopaque substance with
volume 150-500 ml.
 Contraindications to retrograde cystography is an acute
inflammation processes urethra, bladder, prostate gland.
Miction cystography.
Radiopaque substance is injected into the bladder through
catheter. After filling the bladder patient produces urine and
currently performing X-ray. The technique allows to diagnose
active bladder-ureteral reflux and abnormalities of the urinary
bladder.

52. Miction cystography
In this radiograph seeing active-
passive vesico-urinary reflux on
the left . Expressed dilatation of
the calyx-pelvis system,
deformation cups.
a- in the phase of maximum filling of
the bladder, passive reflex
b - in the phase of urination, active reflex.

53. Downward cystography.
Visible filling defect of the urinary
bladder near the mouth of the left
ureter

54. CT with contrast
 renal cell carcinoma in
59-year-old woman with
microhematuria with no
complaints (arrow).

55. Angiography of the kidneys.
There are general and selective
arteriography kidneys. In general,
arteriography catheter introduced into
the femoral artery ,abdominal aorta and
set its end over the place where the
renal arteries, then introducing
radiopaque substance. In case of
selective arteriography catheter through
the femoral artery, abdominal aorta
injected into the right or left renal
artery. Arterial blood flow was assessed
by using radiopaque substance.