History:

Air, a negative contrast medium, was used initially in 1918 by Walter Dandy,
a neurosurgeon who did injections of air to study the cerebral ventricles of
children with hydrocephalus.
Dandy’s published articles initiated the use of air to localize tumors within
the brain and spinal cord.
Carbon dioxide, nitrous oxide, and oxygen came to use.

Immediately after Roentgen’s discovery of x-rays, physiologist realized

that the functions of the digestive system could be monitored by giving
animals food mixed with compounds of high atomic number and
watching mixture’s passage by way of a fluorescent screen.
In 1896, lead subacetate was used to study the digestive system of guinea
pig. It later proved to be toxic.

In the same year, Walter Cannon, a Harvard medical student, began a series
of experiments to study the digestive system using bismuth subnitrate. His
subjects include geese, cats, and a 7-year old girl. Bismuth subnitrate
eventually prove to be toxic.
Cannon is credited with awakening the medical profession to the
realization that diseases of the gastrointestinal tract could be studied by
watching the movement of radiopaque media through the tract.
Toxicity remained a problem with many of the high-atomic-number
compounds in these early years.
By 1910, barium sulphate began to appear in medical literature. Its use
increased rapidly because of its lack of toxicity, low cost and its
availability.

In 1927, Egas Moniz introduced the water-soluble iodinated contrast

media. He injected sodium iodide into the cerebrovascular circulation
by way of the carotid arteries. Sodium iodide proved to be a blood
vessel irritant.
Chemical method improved in 1930s, atoms with high atomic numbers,
such as iodine, could be placed on nontoxic water-soluble carrier
molecules. More iodine atoms per molecule were added, which increased
visualization of the vascular and urinary systems.

The 1950s saw the beginning of the use of three iodine atoms per carrier
molecule. These triiodinated molecules are the basic chemical structures
from which ionic and non-ionic water-soluble iodine contrast media
originated.
Contrast Media
Contrast materials, also called contrast agents or contrast media, are used
to improve pictures of the inside of the body produced by x-rays,
computed tomography (CT), magnetic resonance (MR) imaging, and
ultrasound. Often, contrast materials allow the radiologist to distinguish
normal from abnormal conditions.
Contrast materials are not dyes that permanently discolor internal
organs. They are substances that temporarily change the When
introduced into the body prior to an imaging exam, contrast materials
make certain structures or tissues in the body appear different on the
images than they would if no contrast material had been administered.
Contrast materials help distinguish or “contrast” selected areas of the
body from surrounding tissue. By improving the visibility of specific
organs, blood vessels or tissues, contrast materials help physicians
diagnose medical conditions. way x-rays or other imaging tools interact
with the body.
PURPOSE OF CONTRAST MEDIA
o To visualize anatomic detail, the area of interest
must differ in radiographic density form its
surrounding tissue. The ability to distinguish
between radiographic densities enables
differences in anatomic tissues to be visualized.

o Factors that affect the degree of radiographic

density differences:
1. absorption characteristics of the tissues that
comprise the anatomic part
2. Technical factors used
3. Characteristics of the image receptor
4. Automatic image processing
5. The use of contrast media agents
o Contrast media are diagnostic agents that are instilled into
the body orifices or injected into the vascular system,
joints, and ducts to enhance subject contrast media used in
radiographic procedures to enhance subject contrast in
anatomic areas where low subject contrast exist.

o Classification of contrast media:

1. Negative
- Decrease attenuation of the x-ray beam and produce areas
of increased density on the radiograph.

- Negative contrast agents are gases with low specific

gravity; air, oxygen and carbon dioxide are most frequently
used. These appear black on a radiograph. Fizzy drinks are
sometimes given as a form of negative contrast to produce an
outline image of the stomach .
2. Positive
- Increase the attenuation of the x-ray beam and produce areas
of decreased density on the radiograph. This means that the
contrast looks more opaque than the surrounding tissue
when seen in x-ray.

- Positive contrast agents, such as barium or iodine compounds,

contain elements of high atomic number. These absorb more x-
rays than do soft tissues or bones. Positive contrast media are
radiopaque and appear white on radiographs. These
compounds can be used to fill or outline a hollow organ, or
can be injected into a blood vessel for immediate visualisation
of the vascular supply or for subsequent excretion evaluation.
Positive contrast media:

• Iodine based contrast medium

- Primarily used to visualized vessels, but can also be used
for tests of urinary tract, uterus and fallopian tubes.
- Iodine based contrast medium such as Urografin or
Omnipaque is used most commonly in radiology, due to
its relatively harmless interaction with the body.

• Non –iodine based contrast media

- Efforts to decrease the many side effects of iodine contrast
media resulted in the development of molecules that do not
dissociate into anions and cations (nonionics) or that are
ionic but too big to have osmotic effects, such as ioxaglate
(Hexabrix). These agents are identified as lower-osmolality
contrast media.
• An additonal advantage of the lower-osmolality contrast
media is that they are more hydrophilic (water-soluble) than
the higher- osmolality contrast media. As a result, they may
be less like to be reactive with the cells that can trigger
allergic effect.
• Barium sulfate (BaSO4)
- Is the most frequently choosen contrast medium for
radiographic of the GI tract. It is white, crystalline powder
that is mixed with water to make suspension.
- It may be administered by mouth for examination of the
lower GI tract, or by infusion of a thin suspension through
a duodenal tube to visualize the jejunum and ileum. The
use of high contrast barium solution in the alimentary canal
reveals organ outline and demonstrates pathologic
conditions of the visceral walls. By using double contrast of
barium and air the ability to detect small lesions is
improved.
o Properties of BaSO4
- Absorbs water
- Has high atomic number (64)
- Insoluble in water
- Cannot be absorbed in the GIT
- Non-toxic
- Has a relative contraindication in the GIT
o Types of BaSO4
- Barodense
- Barosperse
- Barytgen
- Baro-Cat
- Baritop