Republic of the Philippines
Region XII
Bachelor of Science in Radiologic Technology
ST. ALEXIUS COLLEGE
Koronadal City, South Cotabato
Radiographic Contrast Media
Presented to
Henry C. Omadle Jr., RRT., RSO., LPT, MSHSM
In Partial Fulfillment
of the Requirements for the Subject
RT203: Radiographic Positioning and Radiographic Procedures with Contrast
By
Laruya, Sheena Marie C.
Student
September 2022
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TABLE OF CONTENTS
INTRODUCTION 3
Contrast Media 3
Categories of Contrast Media 4
Osmolality 4
Adverse Reaction 5
Treatment 5
Esophagram 6
Pathological Indications (Esophagram) 6
Positioning (Esophagram) 7
Upper Gastrointestinal Series (UGIS) 8
Pathologic Indications (UGIS) 8
Positioning (UGIS) 8
Positioning (UGIS) 9
Modification in Upper Gastrointestinal Series 10
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I. INTRODUCTION
Contrast media is an any substance that is being introduced to an organ to
create more visible enhancement. It allows visualization of structures that cannot be
seen well or at under normal circumstances.
II. CONTRAST MEDIA
A. Types of Contrast Media
RADIOLUCENT RADIOPAQUE
Negative Contrast agent Positive Contrast agent
X-rays can easily penetrate Absorbs x-ray
Areas appears to be black in Areas appears to be white in
radiograph radiograph
Example: Air and gas Example: Barium and Iodine
B. 2 Basic Types of Contrast Material
BARIUM IODINE
Non- Water Soluble Water Soluble
Powder
Liquid
Ingested Rectally Intravenous Pyelography (IVP) or
Intrathecal
90⁰-120° KVP Below 90° KVP
Oil-based
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C. Categories of Contrast
IONIC NON-IONIC
Considered to be the safest but not
High risk 100% guaranteed
Generally hyperosmolality More hydrophilic
Contains iodine More viscous than ionic
Dissociates into 2 particles in the blood Does not dissociate
Monomer Dimer
D. Osmolality
- Concentration of particles or molecules of solids dissolve or suspended in
solvent.
HIGH OSMOLALITY AGENTS LOW OSMOLALITY AGENTS
Diatrixzoate Sodium (Hypaque) Ioxaglate Meglumine (Hexabrix)
Iodamide Meglumine (Renovue) Gadodiamide (Omniscan)
Iothalamate Meglumine (Contray) Gadoteoridol (ProHance)
Oral Cholecystoraphic Agents Iodixanol (Visipaque)
(Telepaque)
Iopimidol (Isovue)
Ipromide (Ultravist)
Ioversol (Optiray)
Note: High Osmolality Agents has higher risk of reactions, while the Low
Osmolality Agents has lower risk of reactions.
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III. Adverse Reactions
MILD MODERATE SEVERE
Nausea and vomiting Pulse Change Unresponsiveness
Cough Hypotension Convulsions
Warmth (heat) Hypertension Clinically manifest
arrythmias
Flushed Sensation Dyspnea Cardiopulmonary arrest
Headache and Bronchospasm Renal failure
Dizziness
Metallic Taste Laryngospasm DEATH
Diaphoresis (sweats)
Urticaria (hives)
Anxiety
Itching
Pallor
Chills
Tremors (shaking)
Nasal stuffiness
Swelling of eyes or face
A. Treatments
MILD MODERATE SEVERE
Observation and Close observation Requires prompt
reassurance only
Treat symptoms Recognition and
Treatment
Drug therapy or Generally requires
hospitalization hospitalization and drugs
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CONTRAST STUDIES
II. ESOPHAGRAM
- Radiographic study of the form and function of the swallowing aspect of the
pharynx and esophagus utilizing radiopaque contrast media.
-
A. Pathologic Indications
Achalasia
Barrett’s Syndrome
Diffuse Esophageal Spasm
Anatomic Anomalies
Carcinosarcoma
Adenocarcinoma
Pseudo carcinoma
Foreign bodies
Gastroesophageal Reflux Disease (GERD)
Esophageal Varices
Zenker’s Diverticulum
Crohn’s Disease
Scleroderma Esophagus
Thymoma
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B. Positioning
POSITION PART POSITION CENTRAL RAY STRUCTURE
SHOWN
Esophagus
The patient’s neck is should be visible
Right Anterior turned to the left, and the Perpendicular to between the
Oblique (RAO) head is placed flat on a Image Receptor vertebral column
pillow. Patients who are and heart.
unable to tolerate this
position may be imaged
in the left posterior
oblique (LPO) position.
Hips and shoulders in Entire esophagus
Swimmers true lateral position; is between
Lateral separate shoulders from Perpendicular to thoracic spine
esophageal region by Image Receptor and heart.
placing upside shoulder
down back.
Posteroanterior The entire
(PA) Hips and shoulder are Perpendicular to esophagus is
not rotated. Image Receptor filled with barium.
Left Anterior Rotate body 35°-40° from Esophagus is
Oblique (LAO) PA, with left anterior Perpendicular to seen between
body against the IR, Image Receptor hilar region of
place left arm down by lungs and
the patients side and thoracic spine.
right arm flexed at elbow
and up by patient’s head;
flexed right knee for
support.
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III. Upper Gastrointestinal Series Procedures (UGIS)
- Radiographic examination of the distal esophagus, stomach and duodenum.
A. Pathologic Indications
Bezoar
Diverticula
Hiatal Hernia
Sliding Hiatal Hernia
Emesis
Gastric carcinoma
Gastritis
Hypertrophic pyloric stenosis
Ulcers
B. Positioning
POSITION PART POSITION CENTRAL RAY STRUCTURE
SHOWN
Right Anterior From prone position Duodenal
Oblique (RAO) rotate 40°-70° right Direct perpendicular to IR bulb is in
anterior body against profile
IR (for hypersthenic Sthenic type: center image
patients, it requires receptor to duodenal bulb
more rotation and at level of L1, midway
less for asthenic between spine and upside
types); flex elbow lateral border of abdomen,
and up by the 45°-55° oblique.
patients head; flex Asthenic type:
left knee for support Center about 2 inches
below level of L1, 40°
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oblique
Hypersthenic type:
Center about 2 inches
below level of L1 and
nearer midline , 70 inches
oblique
Anteroposterior Center about 2 Direct perpendicular to Entire
(AP) inches below level of Image Receptor stomach and
L1 duodenum
Sthenic type: are visible
Center to level of pylorus
and duodenal bulb level of
L1 and about 1 inch left of
vertebral column
Asthenic and hypersthenic:
5cm above level of L1
nearer midline
Posteroanterior Align Midsagittal Direct Perpendicular to Stomach and
(PA) plane to Image Image receptor duodenum
receptor; body is not Sthenic: showing
rotated Image receptor to level of hiatal hernia
L1, midway between above the
middle and left lateral level of the
margin of abdomen diaphragm.
Hypersthenic: 1 inch above
L1
Asthenic: 2inches above
L1
Posteroanterior Modified knee chest Perpendicular to the long Demonstrates
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Oblique position; axis and centered to T6 or the
Projection (wolf compression device T7; 10-20 degrees caudad relationship of
method) placed horizontally angulation stomach to
under the abdomen the
just below coastal diaphragm
margin; 40–45- and is useful
degree RAO in diagnosis a
position, with the hiatal hernia.
thorax centered in
the midline of the
grid
C. Modification in Upper Gastrointestinal Series
MODIFICATION PART POSIITION CENTRAL RAY STRUCTURE
SHOWN
Gordon’s Prone position; 35-45 degrees Demonstration of
Modification body at the center cephalic lesser curvatures,
of a plane that the antral portion of
passes 4 inches to the stomach, the
the left of pylorus to pyloric canal and
the midline of the the duodenal bulb.
table
Gugliantini Prone position; 35 degrees
Modification body at the center cephalic
of a plane that
passes 4 inches to
the left of pylorus to
the midline of the
table
Hampton’s Supine position; Perpendicular to Leaf-like pattern of
Modification (LPO) elevated right body the midpoint of the the pylorus and the
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approximate 45 film bulb
degrees
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