Evaluation of Radiographic Contrast-Induced Nephropathy by Functional Diffusion Weighted Imaging

Contrast-induced nephropathy (CIN) resembles an important complication of radiographic contrast medium (XCM) displayed by a rise in creatinine levels 48–72 h after XCM administration. The purpose of the current study was to evaluate microstructural renal changes due to CIN in high-risk patients by diffusion weighted (DWI) and diffusion tensor imaging (DTI). Fifteen patients (five CIN and ten non-CIN) scheduled for cardiological intervention were included in the study. All patients were investigated pre- and post-intervention on a clinical 3T scanner. After anatomical imaging, renal DWI was performed by a paracoronal echo-planar-imaging sequence. Renal clinical routine serum parameters and advanced urinary injury markers were determined to monitor renal function. We observed a drop in cortical and medullar apparent diffusion coefficient (ADC) and fractional anisotropy (FA) before and after XCM administration in the CIN group. In contrast, the non-CIN group differed only in medullary ADC. The decrease of ADC and FA was apparent even before serum parameters of the kidney changed. In conclusion, DWI/DTI may be a useful tool for monitoring high-risk CIN patients as part of multi-modality based clinical protocol. Further studies, including advanced analysis of the diffusion signal, may improve the identification of patients at risk for CIN.

Cardiac Catheterization Nurses Knowledge of Contrast-Induced Nephropathy: A Quality Improvement Project

Contrast-induced nephropathy (CIN) is the development of acute kidney failure after radiographic contrast media administration. CIN is the third leading cause of hospital acquired kidney failure and is associated with increased risk for morbidity and mortality. Currently no treatment exists for CIN and only supportive care is provided with the anticipation renal function will resolve eventually. Cardiac angiogram or catheterization is one of the most commonly performed procedures with an average of 2 million cases annually. Cardiac catheterizations require large amounts of radiographic contrast media placing patients at risk for the development of CIN. Prevention of CIN is key and requires early identification of risk factors, timely precautions and patient education, which is conducted largely by nursing staff. For this quality improvement project, an informal needs assessment was conducted within the cardiac catherization laboratory at Landmark Medical Center which identified nurse’s had limited knowledge of CIN. All staff nurses in the cardiac catheterization laboratory were invited to participate in an education seminar on CIN. A pretest, educational program, posttest design was used to identify change in nurse’ knowledge of CIN. Nine out of eleven nurses (82%) participated in the educational seminar, completed the pretest and posttest. The posttest scores had a 51-percentage point increase and every posttest question improved in comparison to the pretest. Findings from this quality improvement project suggest that nurses’ ability to recognize CIN risk factors and knowledge of preventative strategies increased significantly after participation in an educational program.

Validation of radiographic quality of simulation software - ImaSim

BACKGROUND: Virtual radiographic simulation has been found educationally effective for students to practice their clinical examinations remotely or online. A free available virtual simulator-ImaSim has received particular attention for radiographic science education because of its portability, free of charge and no constrain of location and physical facility. However, it lacks evidence to validate this virtual simulation software to faithfully reproduce radiographs comparable to that taken from a real X-ray machines to date. OBJECTIVE: To evaluate imaging quality of the virtual radiographs produced by the ImaSim. Thus, the deployment of this radiographic simulation software for teaching and experimental studying of radiography can be justified. METHODS: A real medical X-ray examination machine is employed to scan three standard QC phantoms to produce radiographs for comparing to the corresponding virtual radiographs generated by ImaSim software. The high and low range of radiographic contrast and comprehensive contrast-detail performance are considered to characterize the radiographic quality of the virtual simulation software. RESULTS: ImaSim software can generate radiographs with a contrast ranging from 30% to 0.8% and a spatial resolution as low as 0.6mm under the selected exposure setting condition. The characteristics of contrast and spatial resolution of virtual simulation generally agree with that of real medical X-ray examination machine. CONCLUSION: ImaSim software can be used to simulate a radiographic imaging process to generate radiographs with contrast and detail detectability comparable to those produced by a real X-ray imaging machine. Therefore, it can be adopted as a flexible educational tool for proof of concept and experimental design in radiography.

ANALYSIS OF COMPLICATIONS INDUCED BY IODINE-BASED RADIOGRAPHIC CONTRAST MEDIA AND OF METHODS OF THEIR PREVENTION (A literature review)

The existence of modern medical practice is impossible without the use of radiological diagnostic methods. Due to the introduction of evidence-based medicine, most diagnoses need to be confirmed by imaging techniques, and some diseases require radiographic contrast media. Despite the medical and scientific breakthrough in these technologies, there are still risks of developing an individual body reaction to the contrast agent. In view of this, the purpose of the work was to substantiate the choice of iodine-containing radiographic contrast agents, to study the possible complications caused by these substances during the X-ray examination, and the methods of prevention of such conditions. To determine these key points, an analytical review of the literature was conducted. Analysis of iodine-containing radiographic contrast agents, which differ in their chemical structure and properties, showed the advantage of non-ionic radiographic contrast media over the ionized ones. The work considers hypersensitive reactions and thyroid dysfunctions caused by the introduction of iodine-containing contrast agents. The allergic reactions may occur occur regardless of the dose of the drug, immediately or after some time after the examination. Due to the fact that the average duration of radiographic examination is from a few minutes to an hour, the appearance a certain reaction to iodine-containing radiographic contrast agents in a patient may not be established in time. That is why, it important to monitor a patient in the radiology department for 30 minutes after the examination. When establishing an increased risk of hypersensitivity reactions, due to the collection of anamnesis, it is necessary to carry out premedication with glucocorticoids is recommended according to the scheme that is described in the literature and is used in the modern medical practice. The development of hyperthyroidism or hypothyroidism depends on the initial level of hormones and the correct operation of the response system. In the presence of anamnestic and laboratory risk factors that can cause the occurrence of these conditions (TSH, free T4, total T3 and Thyroid peroxidase antibodies), it is recommended to consult an endocrinologist and, based on his/her judgement, to carry out premedication with the control of the TSH levels according to the schemes presented in the literature review or, alternatively, to correct the existing pathological conditions before the examination.

The Ameliorative Role of Acacia senegal Gum against the Oxidative Stress and Genotoxicity Induced by the Radiographic Contrast Medium (Ioxitalamate) in Albino Rats

Arabic gum (Acacia senegal, AG) is proven effective antioxidant and cytoprotective agent. The present study was designed to test this notion by investigating the possible role of AG against the radiographic contrast medium (Ioxitalamate, Telebrix-35®, TBX)-induced oxidative stress and genotoxicity. Albino rats were divided into four groups and supplied with either; distilled water, daily 10% (w/v) AG, an intravenous dose of TBX (1600 mg I/kg b.wt) and co-administration of TBX and AG. Rats were sacrificed and blood samples were collected to assess the genotoxicity employing the peripheral blood leucocytes fluorescent double staining; namely the acridine orange/ethidium bromide (AO/EB) staining and alkaline comet assay. Further, chromosomal analyses were done in bone marrow cells. Serum urea and creatinine levels, in addition to malondialdehyde (MDA), nitric oxide (NO), catalase (CAT) and glutathione (GSH) levels in kidney tissues were measured. Liquid chromatography-mass spectrophotometry (LC-MS-MS) was performed to identify the chemical composition of AG extract. Kidney functions, single/double-stranded DNA damage, chromosomal aberrations, mitotic index, MDA and NO levels were significantly (p < 0.001) increased in TBX-treated group compared to the control and AG-treated one. Meanwhile, CAT and GSH activities were significantly diminished and the AG supplementation significantly (p < 0.001) ameliorated these effects compared with the control and AG-treated groups. Five compounds have been identified using GNPS networking including 7,3′,4′-Trihydroxyisoflavone, Noscapine, Tetrahydropapaveroline, Costunolide, Hesperidin. In conclusion, results of the present study suggest that AG exerted a protective role against TBX-induced oxidative stress and genotoxicity which may be attributed to the active metabolites in the gum.

Omental wrap: Radiographic diagnosis confirmed surgically – Report of two cases in Grenada

Omental wrapping is a common cause of peritoneal catheter malfunction. This diagnosis should be confirmed by radiography before proceeding with surgical omentectomy. We report two cases of peritoneal dialysis (PD) catheter outflow obstruction from our developing PD program in Grenada, in which contrast studies accurately diagnosed omental wrap, allowing for prompt surgical correction. In both cases, the contrast study indicated the presence of omental wrapping, confirmed at time of surgical correction. Radiographic features of omental wrap are distinctive, which allows for reliable differentiation from other causes of obstruction. Radiographic contrast study reliably diagnoses the cause of peritoneal catheter obstruction, permitting prompt diagnosis and treatment. This is vital for regions with limited access to haemodialysis.

Therapeutic effects of hysterosalpingography contrast media in infertile women: what do we know about the H2O in the H2Oil trial and why does it matter?

ABSTRACT Recent interest in the use of oil-soluble contrast media (OSCM) for hysterosalpingography (HSG) and other tubal flushing procedures is largely the result of publication of the large, multicentre, randomized controlled H2Oil trial in the New England Journal of Medicine in 2017, addressing the long-held suspicion that pregnancy rates following HSG with OSCM are higher than if a water-soluble contrast media (WSCM) is used. However, the findings of this trial have been compromised by the WSCM selected for comparison with OSCM. The chosen WSCM belongs to a superceded class of ionic media, with an iodine concentration, osmolality and viscosity all lying at the extreme end of the range for water-soluble radiographic contrast. The requirement for safe, cheap, versatile WSCM for intravascular use during computerized tomography, angiography and interventional procedures has resulted in considerable refinement of WSCM, with current widespread use of non-ionic, low osmolality or iso-osmolar WSCM in radiology, including for HSG. However, the use of the earlier ionic, high osmolality agents such as that selected for the H2Oil trial persists for HSG in some centres, despite potential adverse effects on the endometrium and fallopian tubal epithelium compared with more modern, less toxic WSCM. Knowledge of the variety of physical and chemical characteristics of the available WSCM is essential for interpretation of the current literature and establishing the most effective and safe water-soluble agent to use for HSG. Design of future clinical trials to establish the potential superiority of OSCM over WSCM for fertility enhancement must include the use of the readily available, inexpensive modern WSCM. While the fertility rates following OSCM HSG have been shown to be high in women with idiopathic infertility, more robust trials are required before the widespread use of OSCM for HSG or other modalities such as ultrasound and laparoscopy should be adopted.