INTRODUCTION
In medical imaging, compare press have been search because the variations in density among body tissues is too small. Contrast marketing is used to provide more satisfactory contrast for good visualization and dissimilarities of anatomical details. This will be advantages to radiographer to provide more obviously image that can be easily to anylize. It is necessary to increase or lower thickness of interested organ to provide desired comparison. Because the use of computed tomography(CT), magnetic resonance imaging(MRI) and digital subtraction angiography(DSA) increase, the use of contrast mass media is can also increase. Example methods using contrast press is barium enemas and excretory urograms. Beforehand procedures they increase the region of interest denseness by addition of radiopaque material that render organ opaque. However, in a few situation density of organ can be cut down by addition of radiolucent product. Amount of compare multimedia that being use are greater than those used for therapeutic drugs. This process was created to make contrast mass media remain in organ appealing for very brief time frame which not cause any changes biologically or chemically in the body.
TYPES OF CONTRAST AGENTS
Contrast agencies are categorized into two group that depending on their relationship with x-ray rays. Positive contrast realtors that is radiopaque and negative distinction agencies that is radiolucent.
There are four negative agencies that always be used in medical imaging. That is the air, oxygen, skin tightening and and nitrous oxide. This is actually the most commontly used as radiolucent compare agents. Negative distinction providers are also found in conjuction with positive compare providers. It known as common technique double compare barium enema. This negative distinction providers has it negatives that air and air can cause gas emboli using treatment. However diffrently for skin tightening and and nitrogen that not create threat of gas emboli though it can be used with relatively safeness. Moreover skin tightening and and nitrogen in a position to be absorbed speedily by the body. This is beneficial when rapid absorption is needed but not suited in a cases when many radiographs are used.
Positive contrast brokers are use because they have high atomic quantity that can cause an boosts in the attenuation of x-rays, thats why it is considered as radiopaque. It produce an area decreased radiographic thickness on the image receptor. Positive distinction providers that commonly used in radiographic method is iodine, bromine and barium. When this distinction agents is filled up in organ, it will make that organ become radiopaque and image appears clear or white on radiograph (image receptor). It could be used form of liquids, tablets and powders can also be placed to body through a variety of routes. This contrast are relatively nontoxic generally but certain patient may show reactions of varying seriousness especially to brokers including iodine and in some cases small amount of these agents may cause death.
Classes Of Radiopaque Comparison Media
Osmolarity and osmolality refer to the osmotic pressure of a remedy. Osmolarity make reference to the awareness per level of solution while osmolality make reference to weight or milliosmols per kilogram of normal water.
The contrast realtors used for intravenous shots has two major classes. That's ionic and non ionic. The ionic materials are further subdivided into high osmolarity ionic compounds(HOCA) and low osmolality ionic compounds(LOCA). All positive contrast agent used intravenous treatment are organic and natural iodine chemical substance that use iodine as the substance that provides the contrast
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Characteristic Of Radiopaque Distinction Media
Characteristics that very important to radiopaque contrast agent is viscocity, toxicity, iodine content, miscibility and persistence. When contrast agent the iodine focus increase, viscosity increase. More viscous cotrast agent need higher injections to send same amount of materials then icrease possibilities of patient trauma and catheter damage.
The miscibility or immiscibility of contrast agent is important as angiographic distinction medium must completely miscibility with the blood vessels to avoid any possibilities of contrast medium embolization.
Contast agent continual in body is important. It was foreign chemical that instilled into body organs. It more good they can be excreted fastly from body nevertheless they must stay and concentratein your body organs for long enough to provide an adequate radiographic research.
Selective localization has become more a part of the course of eradication of the chemicals rather than means to obtain it to specific location. Mostly positive contrast realtors eliminated through urinary tract tha make blood urea nitrogen(BUN) and creatinine test is important. If urinary tract is already stressed, additional load will caused some major patient effect.
Exretory Pathways
Every distinction solution that being use has it eradication routes. The main routes used to eliminate positive contrast real estate agents used in the vascular international studies are urinary tract and hepatic portal system. Those real estate agents that utilize the hepatic portal system are primarily used to review the organs from the sysem. The mainly road for the elimination of almost all of the organic and natural iodide chemical substances is through the urinary system. So that it is important to learn the position of the kidney's potential to take this task before the exam. Patient must take both BUN and creatinine test to ascertain renal position. And results must be inspected before doing the assessment. Renal insufficiency is suggested if the BUN surpass 30mg/dl and creatinine is above 1. 5mg/dl. Medical professional should be recognized about the results of the tests prior to the injection.
General Precautions
Before injection, patient must be notify about the task and its own risk. Obtain an informed consent from the patient for precaution and establish a group of baseline vital indication for the pation for our reference.
Know the individual, by verifying the graph for record of allergy or hypersensitivity to take care patient and avoid from any fault. Make certain patient have a blood work ensure that you checking the result of the patient's blood vessels work before evaluation. Test of blood work is to research about bloodstream urea nitrogen, creatinine, prothrombintime in situations of arterial gain access to, incomplete thromboplastin time and platelet count number.
Check whether patient has other medical problems about hepatic or renal disease, being pregnant, multiple myeloma, congestive center failure, Graves' disease, Homozygosity for sickle cell disease, known or suspected pheochromocytoma(stable tumors of neurogenic origin), severe coronary disease bronchial asthma, severe coronary disease bronchial asthma and finally Hyperthyroidism.
Know about the procedure of contraindications and limits to the specific special technique. Know the possibilities reaction that can occur with the compare agent used. Verifying the disaster equipment and know the location and articles of crash cart.
After injection we must know where doctor may be reached. Evaluate patient's essential functions for abnormalities, respiration rate, pulse rate, blood circulation pressure and occurrence of cyanosis. Must continue to be with and monitor the patient for at least 20 minutes after treatment.
Reactions
In this assessment, approximately 70% reactions take place within five minutes of the shot. 16% will occur more than five minutes after injection ans finally 14% occur 15 minutes after injection. So that it is recommended to radiographer remain with patient at least quarter-hour after the shot. You can find five major band of reactions happen during contrast assessment:
Overdose reactions; toddler, adults with severe renal failure, individuals with cardiac failing initially stage, and men and women with hepatic failure and ascites are particularly at risk obtaining an increased osmotic fill.
Anaphylactic reactions; considered allergic-type reactions brought on by hypersensitivity to the element.
Cardiovascular reactions; have a tendency to cause peripheral vasolidation and a decrease in systemic blood pressure which can lead to reflex tachycardia because they are related to the effect of the vagus nerve on cardiovascular system, they are known as vasovagal or vagal-type reaction. Vasovagal reactions make a difference myocardial contractility and cardiac electrophysiology and can ultimately be serious. The most unfortunate of cardiac effect is cardiac arrest.
Psychogenic reactions; if patient are overanxious, they could respond to the subjective part effects produced therefore of the introduction of the comparison agent with an autonomic response. The response becomes the basis for the adverse reaction. Substances less likely to cross the blood-brain hurdle and enter into the central anxious system decrease the odds of reactions precipitated by this mechanism.
Activation system-triggering reactions; activation of variety system such as supplement, coagulation, fibrinolysis and histamine can be induced as a response to damage to the vascular endothelium at the injections site. These system do not cause the same kind of reaction in every patient because of individual versions in the presence and action of inhibitors in the pathways.
Symtoms of rections to compare agents administered intravenously
Mild to moderate symptoms
Severe symptoms
Sneezing
Nausea
Chest pain
Shivering
Flushing
Facial swelling
Abdominal pain
Heat sensation
Vomiting
Warm feeling
Vascular pain
Itching
Edema
Hoarseness
Coughing
Urticaria
Pain at injection site
Paralysis
Loss of consciousness
Paresthesias
Cardiac arrest
Dyspnea
Convulsions
Tissue necrosis
Sudden drop in blood vessels pressure
The possibility of your reaction should be expected, and proper crisis medication should be available in the special method suits. The next is the list of typical emergency equipment:
Oxygen wall structure system and air reservoir and mask
Airways(pediatric and mature)
Physiologic saline
Suction apparatus
Emergency drugs(by medical doctor preference)
- hydrocortisone sodium succinate
- metaraminol
- phenylephrine hydrochloride
- diphenylhydramine hydrochloride
-epinephrine
Aromatic spirits of ammonia
Syringes and fine needles for medication injection
Blood pressure device(sphygmomanometer) and stethoscope
Complications
The complication is divide into three categories that is those occuring at the puncture site, systemic problem and problem induced by the catheter during the procedure.
Outcomes classification of problem to Arteriographic types of procedures referred to the result of the problem on the patient or the level of treatment required
Classification level
Resultant potential outcomes
Minor complications
No healing intervention
Minor healing intervention
Admission for observation-minimum 24 hours
No permenant effect
Major complications
Requires restorative intervention
Observation for
Major therapeutic intervention
Hospitalization for >48 hours
Permanent effects
Death
*Outcomes from your Society of Interventional Radiology(SIR)
Potential for medicine or medication considered by patient to interaction with contrast advertising must be taking seriously. Example mixture of contrast medium with metformin hydrochloride(glucophage used by patient with type 2 diabetes) increase risk for buildup of lactic acid in the bloodstream. It is referenced as lactic acidosis. By natural process by mitochondria, breakdown of sugars and unwanted fat to make energy will produce lactic acid(misuse product). Normally this lactic acid will be breakdown into simpler product and it is eliminated from the body, but under some circumstances mitochondria is damaged and lactic acid will not break down then it accumulates in the body. This condition will show a symptoms of nausea, muscle weakness, throwing up, weight loss, abs pain, dyspnea and cardiac tempo abnormalities.
Also radiographer must alert to patient creatinine level before the examination. If it wihin normal level under 1. 5mg/dL risk for patient to use contast is reduced but if creatinine level above normal boundaries, suspend or substituted use of metformin.
Complications that occur in puncture site is hematoma, occlusion, and pseudoaneurysm, extravasation of the compare agent. Risk factor for extravasation is tourniquets will not release during injections, inappropriate use of the automatic injections devices, indwelling catheters set up more than a day, tapes and bandages over intravenous gain access to site that prevent sufficient monitoring of shot site, injection into small peripheral veins almostly in the dorsum of foot and hand, multiple attempts to gain vessel access, use of metal needles rather than plastic catheters, use of high osmolarity contrast agents, examination requiring large amounts of contrast agents, abnormalities caused by atherosclerotis vessels, diabetic vascular disease and venous thrombosis, patients with a history of compromised lymphatic or venous drainage, increased risks in children, infants, the elderly, and chronically ill patients.
Specialty comparison agent
Problems take place for magnetic resonance imaging(MRI) procedures because organic and natural iodine compound can't be contrast agents because of this process as it only function through absorption of x-ray beam. MRI does not use x-ray to produce image. So, iodinated contrast mass media only useful in special process of radiography and computed tomography(CT). The compound that has been found ideal to becoming compare advertising for MRI is gadolinium diethylenetriamine penta-acetic acid solution (Gd-DTPA) since it is metal chelate. This metallic ion have have a tendency to bind wih certain body tissues like in kidneys, liver, heart, brain, bone, spleen and lungs to allow them to remain in the system for an extended period of time. Also it does not cause unneeded side effect and not has shows toxicity to organs system. Major excretory pathway is via kidneys, 80% Gd-DTPA removed in 3hours, 98% taken out through urination and defecation within 1week of supervision.
INTRAVENOUS UROGRAPHY(IVU)
Introduction
Intravenous urography(IVU) also known as intravenous pyelogram(IVP) is a radiological procedure used to visualize urinary tract by using intravenous contrast agent. Its show the kidneys, ureters and bladder in radiographic film in white and clear image because comparison radiopaque are being used. This will likely easily for radiographer to anylize and watch any abnormalities in patient urinary system. The intravenous treatment of a comparison agent is the typically ways that had been use to acquire images of the urinary system. Although, ultrasound or computed tomography (CT), are better for a few disease processes. When intravenous is injected into blood flow, the kidneys excrete the contrast into the urine and becomes noticeable when x rayed (radiopaque), creating images of the urinary collection system.
There are method name antegrade pyelography differentiates from retrograde pyelography, the distinction agent are injected directly into the low end of the system that make comparison agents flow backward. That why its name is retrograde. This retrograde pyelography is the best option x-ray procedure to see the low ureters when kidneys are non-functional.
Nephrotomography or also known as tomographic slices of the kidney, considered by moving x-ray source emit x-ray vulnerability onto a film and relocating opposite direction. The image upper and lower degree of the kidney are blurred that allowing a far more precise image of the kidneys with no over imposed material such as gas or fecal material.
Many available tests suitable for detecting kidney abnormalities, with differing hazards and costs:
In a save, simple, quick and inexpensive way to obtain views of interior organ is by using ultrasound. By using ultrasound, renal size can be assessed as well as the visualization of abnormalities of cysts, renal calculi, hydronephrosis, and tumors. But small stones in the ureters are not as well visualized and the function of the kidneys cannot be determined.
Then by using nuclear renal scans that rely on the radiation given off by certain atoms (isotopes), that are injected in to the bloodstream. It'll reach the kidneys, and images are constructed by measuring rays emitted. The radiation is risk-free as standard x-rays. However, this exam has limited applications, including the analysis of reflux, chronic obstruction, and renal function. Additionally it is used to evaluate high blood pressure that is refractory to treatment, and is often used to judge the kidney of an renal transplant patient for early on rejection where renal artery stenosis is suspected as the reason.
Magnetic resonance imaging (MRI) are mainly using magnetic areas and radio frequency signals and does not use ionizing rays to generate computerized images. This method using magnetic field energy are safe so long as no steel in patient body. It has limited applications and usually is not done for common problems, such as pain and hematuria (blood in the urine). MRI usually is performed if other assessments are inconclusive. MRA (magnetic resonance angiography) may be done to judge the renal arteries, specifically is renal artery stenosis is suspected as a reason behind hypertension that is refractory to treatment. MRI need special equipment and installation and is also an extremely costly exam.
Retrograde pyelography is the most suitable to identify problems in the lower part of the ureters, which is the only path to totally opacify the ureters in patients with mulfunction kidney. This exam is performed within an operating room by a urologist. A cystoscope is positioned in to the bladder and a catheter is located into each ureter to inject the contrast agent. The benefit of this method is that small stones can be removed immediately by the urologist.
Lastly is computed tomography scans (CT or CAT scans) use a fine beam of x-rays creating images at accurate levels in the body. The info is processed by way of a computer and imaged onto film using laser printing device. Three-dimensional images will be made of this technique of imaging. An injections of a compare agent is required to imagine the kidneys at length. The CT check out is done without IV comparison to look for stones (calculi). In some centers, this modality has substituted IVPs and ultrasound because of this program. Special equipment is necessary and the exam can be expensive.
Indication
This procedure is being made to research of patient bladder control problems, anuria, hematuria or pyuria not due to the low urogenetal tract, suspect urinary bladder disease when bladder can't be catheterized, abnormal size, shape and position of urinary system, investigation of rretroperitoneal swellings, believe ureteric disease such as ectopic ureters and recognition of kidneys you should definitely visible on plain radiographs.
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Example radiograhic image of urinary tract with intravenous distinction.
Diagnoses
This process are also being designed to identify any abnormalities or disease in urinary system such as persistent pyelonephritia, renal cell carcinoma, kidney stone, polycystic kidneys, transitional cell carcinoma, anatomical variant like horeshoe kidney or duplex collecting system and also obstruction commonly at the pelvic-ureteric junction or PUJ and the vesicoureteric junction or VUJ.
Purpose
An intravenous urogram is perform to demonstrate the composition and function of the kidneys, ureters, and bladder. Patients that compalin about their abdominal pain at the trunk may needed to do this exam to eliminate kidney stones. Patients with high blood pressure (hypertension) and has bladder infections could also would liketo do intravenous urogram (but hypertension usually is imaged with MRA or nuclear medicine imagery and this exam is done when renal artery stenosis is the suspected cause of refractory hypertension). Hematuria can also be a sign of kidney rocks, contamination, or tumors. Sometimes the exam is organized to evaluate the function of the kidney in a renal transplant patient. The transplanted kidney is positioned in the iliac fossa, so special films of the pelvis area are done as a replacement for of the standard boring views. The radiographic technologist can also be required to take x-rays in the operating room when a retrograde pyelogram is bought by a urologist during a C and P (cystoscopy and pyelography).
Emergency patients with blunt stomach stress are usually assessed with a CT check out or sometimes ultrasound rather than an intravenous urogram.
Precautions
A serious issue of an intravenous urogram can be an allergic reaction to the iodine-containing distinction agent. Severe reactions are uncommon, but can be dramatic and even lethal and dangerous. Because of this, all radiology departments undertaking this exam are prepared and well prepared with emergency drugs and oxygen in the x-ray room itself.
Description
The patient will be asked to change into a medical center wedding dress andtake off any artifact from the region appealing. The x-ray technologist will confirm that the individual has adopted the bowel preparation and complete an in depth questionnaire on the recent health background of the patient. This includes previous contrast reactions, known allergies, current medications and dangers of motherhood. The x-ray technologist will explain the exam at length to the patient as well as the potential risks of the compare material that'll be injected intravenously. The individual must signal a consent form before the examination is started to give us enable to do our job to patient. The x-ray technologist will spread these details to the radiologist who'll decide on what type of contrast will be used. Patients who have had an treatment with no reaction can get less costly iodine-based compare, whereas patients who take various heart and soul medications or people that have known allergies or asthma will be injected with a far more expensive contrast agent (known as non-ionic compare) that has fewer area results. Some departments use the non-ionic contrast exclusively.
The patient will be instructed to lie supine (face-up) on the x-ray table and a general KUB test will be achieved. This is an stomach view of the kidneys, ureter, and bladder used to make certain patient prep, centering, and the radiographic approach needed to demonstrate all the required structures.
Kidney rocks may or may well not be visualized on the initial film. The x-ray technologist will put together the mandatory amount of comparison to be utilized with regards to the weight of the individual (1 ml per pound). Normally 50-75 cc of contrast for an average-sized patient. The compare will be injected all at one time (bolus treatment) or in some instances, via an intravenous drip. Some radiologists choose to begin an intravenous drip with saline as a precautionary measure while others inject with a little butterfly needle. The needle usually remains in place for 10-15 minutes, in case more contrast is needed or in case drugs have to be administered because of allergic attack. Most reactions occur immediately but some can take place 10 or 15 minutes after the injections.
The first film is taken right away following the injection to see a depth of the renal outline (nephrogram). Motion pictures are usually considered at five-minute intervals depending on the agenda of the radiologist. Compression may be employed to the lower abdomen with a huge band to keep carefully the contrast material stay in the kidneys much longer. This may creates a more precise image of the renal collecting system. When the compression is released after around ten minutes the contrast materials drains quickly and an in depth, packed image of the ureters is obtained. Videos is manufactured in the erect or susceptible (face-down) position can also be planned to improved upon visualization of the lower ureters. Some departments require usual renal tomographic images to be achieved as well when the kidneys are well visualized. This enables the kidneys to be seen free of gas or fecal shadows. Sometimes the radiologist requires oblique views of the kidneys or bladder to determine the exact location of calculi (stones). At roughly 20 minutes after the shot a film devoted to the bladder may be necessary. The x-ray pipe is angled marginally caudad (towards your feet) so that there is no superimposition of the pubic section of the pelvis on the bladder. The videos are shown to the radiologist if no further videos are necessary the individual will be asked to void (urinate) and a post-void film will be taken. The exam can take from 30 minutes to one hour depending on the number of movies required. When the kidney is obstructed, postponed films may be asked to complete the exam.
Preparation
To have the best visualization of the kidneys, ureters, and bladder, the intestines must be free from gas and fecal material. Most include a laxative such as X-Prep or Dulcolax tablets used around 4 p. m. the day preceeding the exam. Followed with a light fat-free supper which includes lean meats, noodles, white grain, bread with no butter, and tea or dark-colored coffee. Essential fluids are allowed until midnight, and no food or liquid is allowed until after the intravenous urogram is completed. Patients who are diabetic are occasionally done early in the morning to avoid any complications. Patients who've had a earlier reaction to a contrast materials can be given a series of steroids and antihistamines the day before the exam as well as the morning of the exam. The patient must consult with their medical professional before this is given. In patients with known or suspected renal inability, lab tests, including BUN and creatinine, may be bought prior to the IVP.
Complications
An allergic attack to the contrast agent is the most crucial risk, even though kidney harm is also a potential problem. Patients with a possible iodine allergy or a past reaction to a radiographic comparison agent should advise the x-ray technologist. A detailed history of known allergies, risk of pregnancy, and current medications is necessary before an intravenous urogram. All radiology departments have consent varieties that must definitely be signed by the individual before starting the exam. Disaster equipment and specific drugs such as adrenaline, antihistamines (Benadryl), and atropine are retained in the x-ray room. All radiography technologists will need to have specific training and education on the various signs or symptoms of an allergic reaction. A mild response consists of a skin allergy or hives, whereas a far more serious response includes bloating of the larynx, troubles in breathing, asthmatic episodes, and a severe drop in blood circulation pressure (hypotension).
Since x-rays are involved during this procedure, there is a minimal risk anticipated to radiation. This exam is not done on women that are pregnant or women who think they might be pregnant.
Results
A normal intravenous urogram will implies no noticeable abnormality in the composition or function of the urinary tract. The radiologist searches for a clean non-lobulated outline of every kidney, no clubbing or other abnormality of the renal calyces (collecting system), no unnatural liquid collection in the kidneys that could suggest as blockage. The ureters must contain no filling up defects (stones) or deviations due to a adjacent tumor. The bladder must have a smooth outline and vacant normally as visualized on the post-void film.
Abnormal results include hydronephrosis (distension of the renal pelvis and calices scheduled to obstruction) therefore of tumors or calculi (stones). Cysts or abscesses can also be present in the urinary system. A hold off in renal function can also reveal renal disease. An abnormal amount of urine in the bladder after voiding may reveal prostate or bladder problems.
Intravenous urograms are often done on children to eliminate a rapid growing tumor in the kidneys, called a Wilm's tumor. Children are also susceptible to microbe infections of the bladder and kidneys credited to urinary reflux (come back backflow of urine).
Health treatment team roles
The x-ray technologist must work in coincidence with the doctors and nurses in making sure the individual has not had a previous allergic reaction to a compare agent. All private hospitals have an emergency team ready to react in such a situation, so the technologist should be aware of the task to follow when assistance is essential scheduled to a severe reaction. Information on patient preparation must also be communicated to a healthcare facility wards. In a few nursing homes the radiologic technologists are trained to provide injections, but if this isn't the case nurses may be asked to install an intravenous drip before the patient is brought to the radiology office.
Patient education
The x-ray technologist must describe the risks of allergic reaction to each patient even though severe reactions are especially rare due to the advances manufactured in the planning of contrast providers. The x-ray technologistmust explains to the individual a warm, flushed feeling or a metallic flavour in the oral cavity are normal reactions in a few patients. Deep breathing instructions are also important since the kidneys change position with regards to the period of respiration also to prevent action artifacts. Sometimes an emergency patient with renal colic (severe abdominal pain) is asked to urinate through a particular filtration used to trap small stones. All radiographic technologists must be accredited and listed with the North american Population of Radiologic Technologists or an comparative organization. Continuing education credits are required to remain documented.
BARIUM MEAL
Introduction
A barium swallow is a radiographic examination for top of the gastrointestinal tract that use barium founded as the comparison agent. Top gastrointestinal tract region is the pharynx (again of the mouth and throat) and the esophagus (hollow pipe of muscle increasing from below the tongue to the stomach). A barium meal, is a radiographic examination of an top gastrointestinal tract this is the esophagus, tummy and duodenum are taken after barium sulfate is ingested by a patient. Barium meals are of help in the identification of structural and motility abnormalities of the foregut. This process is taken in AP (anteriorposterior) and lateral projection.
Barium solution is a white, dry out, chalky, metallic natural powder that contain been blended with amount of normal water and must be solid, milkshake-like drink. Barium is a good distinction agent because than it has high atomic number that make it as a x-ray absorber. It categorized as radiopaque and always be used as compare agent for gastrointestinal tract process in radiographic imaging. When swallowed, a barium drink will jackets at the wall membrane of pharynx and esophagus so that swallowing motion inside wall coating and size with form of these organ can be seen white, clear and obvious in x-ray film (film receptor). This process shows difference that might not be seen on the whole or standard x-rays. Barium is used only for diagnostic studies of gastrointestinal tract.
Radiographic image for barium meals can be taken by using cineradiography record whereas ongoing active x-ray image is open during swallowing and copy of barium from mouth area to stomach. It is suitable for the studies of esophagus condition and gastro-esophagus sphincter. Fluoroscopy is taken when patient drink the barium, x-ray tube is give attention to upper gastrointestinal tract of patient. Process of swallowing barium is documented in training video.
Indications
Indication for this exam is to find or see theres any cancers of the head, throat, pharynx, and esophagus tumors. The hiatal hernia signify upward movement of the abdomen, either into or alongside the esophagus. The structural problems, such as diverticula, strictures, or polyps (expansion). An esophageal varices mean engorged veins. Muscle disorders such as dysphagia, oesophageal stricture(esophagus become small cause difficult in swallowing) or spasms(pharyngeal or esophageal). An achalasia wheres the lower esophageal sphincter muscle does not relax and invite food to complete into the abdomen. And in addition gastroesophageal reflux (irregular reflux of the gastric acid cause mucosal harm to the esophagus) disease and ulcers. Foreign bodies such as large bolus. Oesophageal atresia is incomplete development of esophagus.
Containdications
Barium established is insoluble solution that cannot be ingested by body. So it is dangerous to human systems. It is dangerous for patient that has perforated gastrointestinal tract. Patient that suspected has bowel perforation, bowel obstruction or severe constipation, pregnancy and severe swallowing difficulty in a way that aspiration (access of substances into lungs) of barium will probably occur. As the answer, patient with this problem can use iodinated base contrast medium. It could be assimilated by body and can be easily eliminate through digestive system.
Patient Care Before the procedure
Explain the procedure to patient and provide the ability for patient to ask any questions that might have about the procedure. Patient may asked to hint a consent form that gives your permissions to do the procedure. Browse the form carefully and have questions if something is not clear. If patient is pregnant or believe that she may be pregnant, patient should inform the physician. Notify your physician if patient is very sensitive to or are hypersensitive to any medications aesthetic agents. Notify your physician of most medications and herbs that you patient are taking. Doctor may recommend patient to withhold certain medications prior to the procedure. Make sure equipment has been well prepared for the procedure and sterilized. Make certain crisis troly is prepared. Make certain amount and type of contrast multimedia that being utilized. Check label of element before use. Radiographer and doctor that entail in this process must wear defensive equipment like mask, gloves and apron. Make certain patient is ready. Make sure any digital equipment that'll be used functioning accurately.
Patient Care During the procedure
Radiographer or doctor need to examining patient identification as the individual is a correct patient that will do this process same with identification in form. Once all required x-rays have been taken, patients will be aided from the table. Make sure that vein or artery that is administerated is the correct punture site and got into into it. We must always assist patient whenever they needed. Always watch patient vital indication like heart rate shown by electrocardiogram machine. Give a simple instructions so patient can be easily understand. Never do bad thing to patient and must consent about them. Make sure any elecrical line is released from patient movements range and check to avoid any electrical shock from wire and leakage of electro-mechanical tube or x-ray tube. When doing treatment, give patient radiation security such as gonad shield and others. Also comfort patient with good consent and health care. Avoid from making patient worried. Always responded to when patient ask something. But keep our personal details in a faraway secrectly. Once all required x-rays have been taken, assisted patient from the table. Observe patient condition always.
Patient Care Following the procedure
Tell the individual that treatment has been finished and assist patient when they need. Tell the patient about contrast advertising will out of their bodie with feaces. Keep these things inform any abnormal changes to physician or doctor or radiographer. Show the individual place to longing and collet the survey. For outpatient we must arrange next visit with their doctor. For inpatient, require the help of nurse or personnel to aid patient with their room or ward.
Preparation For The Procedure
Patient are advise to eat low-fiber diet for 2-3 days and nights before the test. Avoid from taking dairy because it can develop precipite or fats part in the belly. High fibers food like rice and bread are advice never to to have it. Always drink drinking water to clear gastrointestinal tract. Patient may be asked to fast about 8 hours before the process, generally start after midnight. Do not smoke before the examination. Do not taking any medicine medication accept it is absolutely required and has been enlightened to doctor. If patient have a disease that need constant time to provide medication like diabetes mellitus patient, they need special teaching and care. Finishing them early on for the procedure is more desirable and good. Ask patient to change to proper outfit by wearing a hospital wedding dress. Make sure patient remove any radiopaque thing from the region of interest. Remove any artifact that stop the region of interest. Make sure patient signal a consent form that gives authorization to do the task. If patient is suspected pregnant or pregnant, please follow the advice from doctor or doctor.
During THE TASK Of Barium Swallow
Patient will be positioned on an x-ray desk that can tilt patient from a horizontal for an upright position. The overall x-ray technique is taken such as chest x-ray and belly x-ray prior to the barium swallow treatment. Patient will also may be asked to change position at intervals during the treatment. The radiologist will ask patient to have a swallow of thickened barium drink. The barium is usually flavoured although it may does not have pleasent style. As the patient swallow the barium, the radiologist will do it work by take single pictures, some x-rays or using fluoroscopy, a video recording to observe the barium moving through pharynx to belly. Patient sometime will be asked to carry a breath at certain time through the strategies. Then patient will be asked to swallow a barium "marshmallow", a small bits of barium-soaked bread that will help to imagine certain structural problems of the esophagus. Once all needed x-rays have been taken, patient will be helped from the table. Durin this process, focus on patient is necessary because any abnormalities can occur in this time.
After The Procedure Of Barium Swallow
Assist patient from the room. Ask patient to change to his proper attire and don't forget any of their belongings. Patient could take up again their normal diet and activities after having a barium swallow, unless your physician advises you in different ways. Barium may cause constipation or potential impaction after the procedure if it is not completely removed from patient body. Patient is adviced to drink plenty of essential fluids and eat foods with high fibre to get rid of the barium from your body. Patient also can be give laxatives or cathartic to help expel the barium out of the body. Due to the barium can't be soaked up by body but will passes through the entire digestive tract, your bowel movement will be more lighter in color until all the barium is secreted out.
Please are accountable to a medical doctor if appear trouble with bowel movements or failure to truly have a bowel progress. Any pain or distention of the tummy. Stools that are smaller in diameter than normal.
Hazard And SIDE-EFFECT Of Barium Swallow
The truth that barium swallow is a safe evaluation procedure. But since it can form complication in body it dangerous to us if not folllowing the procedure carefully. Moreover all of the human body make some of patient provide a reaction to this substance. The compli cation of barium swallow is anaphlytic reactions considered as allergic-type reaction induced by the hypersensitivity to the compound. Body will respond to a foreign chemical and immune system will make it proceed to protect body from barium that known as international substance. This allergic attack can cause anaphalytic great shock where the cardiac arrest will take place. This will bring death to the individual. After the technique of barium swallow, patient will fell thirsty and may experience constipitation ifpatient will not drink a lot of water for a couple of days. Laxatives is a means for a patient to remove barium in an easy way. Patient will feel bloated and soreness for a few hours following the test.
The symptoms of nausea, throwing up, frustration, coughing, flushing, torso pain, belly pain, pain at shot site, shivering, itching, edema, warmt feeling while others more is a slight average symptoms. Severe indication for this barium side-effect is dyspnea, abrupt drop in blood circulation pressure, cardiac arrest, tissues necrosis, lack of consciousness, paresthesias and others. This process is very bad for some of the individual.
This procedure is very dangerous for the person that being suspected or have perforated in any of gatrointestinal tract because barium can't be operations by body. Iodinated based mostly contrast media is being used in this situation because iodine can be easilt dissolve by body and also easily to eliminate.
DIAGNOSIS
This compare medium, barium sulfate helps radiographer to visualizes and differentiate between your soft tissue and the spot of the eye in radiographic film. With clear image of region appealing will easily for us to anylize patient problems. The narrowing and irritability of esophagus (the muscular cylindrical pipe located between backside of thetube and connected to abdomen) or the cardiac sphincter. Employing this procedures, we can see any disorder process of swallowing or hiatal hernea (upward actions of the tummy, either into or alongside the esophagus). Any structural problem like stricture, polyps or diverticula can be view easily. The esophageal varice that mean enlarge veins is seen. Ulcers, achalasia which there the low esophageal sphincter muscle will not relax and invite food to pass into the belly and gastroesophagealreflux disease(GERD).
BARIUM ENEMA
Introduction
Barium enema can be an x-ray study of intestines. Barium is a chalky material that is placed into the colon before the x-rays are used. The barium coats the inside of the bowel, so that a camera may take images of the lining, or mucosa. The doctor may advise that you get barium enema to check for abnormalities in the digestive tract like cancer of the colon, polyps that could develop into colon cancer, outpouchings of the intestines wall membrane called diverticula. An ulcers or narrowed areas known as strictures and also which may reveal inflammatorybowel disease, other possible triggers for unexplained blood loss or a big change in bowel behaviors.
In order to have the ability to clearly imagine the colon with an x-ray, it must be as unfilled as it can be. In the times before your procedure, your physician will provide you with specific directions on emptying your colon. These can include starting a definite liquid diet a day or two prior to the exam by taking laxatives or enemas to clear feces out of the colon. After you reach the examination, you will be asked to undress and wears clinic dress then you must lay down on an x-ray desk. A lubricated tube will be carefully inserted into your rectum. A tote made up of barium will be attached to the pipe, and the barium will be permitted to flow into the colon. When enough barium has flowed into the colon, you willl be asked to try very hard not to expel any of it while x-rays are used. A tiny balloon attached to the tubing that bears the barium may be inflated to avoid any barium from leaking out during the exam. As the x-ray pictures are being considered, you will be asked to spin laterally, or stand up. Allowing the barium move to different areas so that sufficient x-ray images can be obtained of your complete colon. After many x-ray film is being taken, you willl get a bed pen to your bathroom and asked to expel as much of the barium as you can. A few more x-rays may be studied after you have passed the majority of the barium out of your intestines.
Risk and benefits of this procedure are dizziness during the exam, contamination, unintentional tearing called perforation of intestine or rectum, intestinal blockage triggered by barium remaining in the intestines. Benefits of barium enema is early detction of colon cancer or relatively large polyps, though it is less sensitive then colonoscopy for this function. It really is less invasive than colonoscopy, which is somewhat riskier and requires sedation.
After your barium enema, you can go back home. You won't need to take any special safeguards, and will most probably have the ability to resume your normal diet. Most radiologists instruct patient patients to increase their liquid absorption for a period of time to be certain all the barium is transferred. You'll likely notice more gas than usual, to see barium within the next several bowel motions that you move. Once at home, make sure to contact your physician if you experiences fever or chills, andominal or rectal pain, weakness severe nausea or vomiting, difficulty transferring a bowel movement, blood in your stools that was never there before, light-colored stools days after the examinations or pencil-thin stools.
