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Radiographic Contrast RTEC - A 2010 1.SUBJECT & FILM CONTRAST 2.CONTRAST MEDIA

Radiographic Contrast RTEC - A 2010 1.SUBJECT & FILM CONTRAST 2.CONTRAST MEDIA

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Page 1: Radiographic Contrast RTEC - A 2010 1.SUBJECT & FILM CONTRAST 2.CONTRAST MEDIA

Radiographic Contrast RTEC - A 2010

1. SUBJECT & FILM CONTRAST

2. CONTRAST MEDIA

Page 2: Radiographic Contrast RTEC - A 2010 1.SUBJECT & FILM CONTRAST 2.CONTRAST MEDIA

2 types of Radiographic “Contrast”

1. Subject contrast – patient

2. Film contrast– Inherent in equipment – The BLACKS & WHITES ON THE FILM / IMAGE

Page 3: Radiographic Contrast RTEC - A 2010 1.SUBJECT & FILM CONTRAST 2.CONTRAST MEDIA

“Subject” Contrast

Page 4: Radiographic Contrast RTEC - A 2010 1.SUBJECT & FILM CONTRAST 2.CONTRAST MEDIA

Subject Contrast

• Range of differences in the intensity of the x-ray beam

• After it has been attenuated by the subject.

Page 5: Radiographic Contrast RTEC - A 2010 1.SUBJECT & FILM CONTRAST 2.CONTRAST MEDIA

SUBJECT CONTRASTRadiographic object - influenced by

1. Atomic Number of object2. Density of object3. Thickness of object4. 5 materials seen on a radiograph,

– Gas/air, fat, soft tissue (muscle/organs), – bone and metals

Page 6: Radiographic Contrast RTEC - A 2010 1.SUBJECT & FILM CONTRAST 2.CONTRAST MEDIA

Atomic Number

1. Fat = 6.46

2. Water = 7.51

3. Muscle = 7.64

4. Bone = 12.31

Page 7: Radiographic Contrast RTEC - A 2010 1.SUBJECT & FILM CONTRAST 2.CONTRAST MEDIA

TissueSubject Contrast

1. Atomic # of object

2. Density of object

3. Thickness of object

1. Higher atomic # = more attenuation

2. Denser = more attenuation

3. Thicker = more attenuation

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PATHOLOGY

1.Pleural Effusion

2.Excessive fluid in lung

3.More dense than air

Page 9: Radiographic Contrast RTEC - A 2010 1.SUBJECT & FILM CONTRAST 2.CONTRAST MEDIA

Pneumothorax

1. Lung collapses

2. No tissue in space

3. Easy to penetrate with x-ray photons

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Film Contrast AKA Radiographic Contrast

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Radiographic Contrast influenced by:

1. Radiation Quality (KVP)

2. Film attributes

3. Radiographic object (Patient)

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What is good contrast ?

1. High contrast (black and white)

2. Low contrast (more shades of gray)

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RADIOGRAPHIC IMAGE Radiation Quality = kVp

1. High kVp ↑ 802. Low contrast3. Lots shades of gray4. Long Scale5. Little differences in

adjacent structures

1. Low kVp ↓ 702. High contrast3. Black and White4. Short Scale5. Great differences in

adjacent structures

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Contrast changes with the use of a grid

Less scatter radiation – shorter scale = “better contrast”

With Grid No Grid

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QUALITY – KVP

• A visible change in contrast will not be seen until kVp is changed 4-12 %

– kVp level change change in kVp

• 30-50 kVp 4-5 % 1-3 kVp• 50-90 kVp 8-9 % 4-8 kVp• 90-130 kVp 10-12 % 9-16 kVp

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Scenario• Low subject contrast in the area of interest.

– You want to see the difference between muscle & fat & organs?

• What can be done to attain medical information and define organ structure and function?

• _____________________________________

Page 19: Radiographic Contrast RTEC - A 2010 1.SUBJECT & FILM CONTRAST 2.CONTRAST MEDIA

Scenario• Low subject contrast in the area of interest.

– You want to see the difference between muscle & fat & organs?

• What can be done to attain medical information and define organ structure and function?

• USE CONTRAST MEDIA

Page 20: Radiographic Contrast RTEC - A 2010 1.SUBJECT & FILM CONTRAST 2.CONTRAST MEDIA

Changing Subject Contrast with CONTRAST MEDIA

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21

Barium has a higher z#more asorbtion of photons

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Page 23: Radiographic Contrast RTEC - A 2010 1.SUBJECT & FILM CONTRAST 2.CONTRAST MEDIA

Contrast Media changes the density of the organs

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Purpose of Contrast Media

1. To enhance subject contrast or render high subject contrast

1. In a tissue that normally has low subject contrast.

2. Creates bigger differences in atomic number (z #’s)

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Categories of Contrast Media

Negative contrast1. (AIR OR CO2)

2. Radiolucent

3. Low atomic # material

4. Black on film

Positive contrast 1. (all others)

2. Radiopaque

3. High atomic # material

4. White on film

Page 26: Radiographic Contrast RTEC - A 2010 1.SUBJECT & FILM CONTRAST 2.CONTRAST MEDIA

1. RADIOLUCENT - dark on image– AIR, CO2

2. RADIOPAQUE - white on image– BARIUM– IODINE

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Negative Contrast

1. AIR / CO2

2. Naturally seen in the

– LUNGS – STOMACH– (gas in intestines)

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POSTIVE CONTRAST MEDIA

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2 BASIC TYPES OF ‘”Positive” CONTRAST MEDIA

BARIUM Z# 56KVP 90 – 120*

1. NON WATER SOLUABLE

2. GI TRACT ONLY INGESTED OR RECTALLY

IODINE Z# 53KVP BELOW 90*USUALLY 70 – 80 KvP

1. WATER SOLUABLE1. POWDER2. LIQUID3. INTRAVENOUS OR4. GI TRACT

2. OIL BASED1. DUCTS /ORGANS

Page 32: Radiographic Contrast RTEC - A 2010 1.SUBJECT & FILM CONTRAST 2.CONTRAST MEDIA

Positive Contrast Material INGESTED /INSTILLED

– (ORALLY OR RECTALLY)

1. BARUIM

2. IODINES

– GASTROGRAFIN– HYPAQUE POWDER

INJECTED– IV – INTO BLOOD VESSELLS– Organs and ducts

1. IODINES – IONIC OR NON-IONIC

• VESSELLS & ORGANS

2. OIL BASED– DUCTS /ORGANS ONLY

Page 33: Radiographic Contrast RTEC - A 2010 1.SUBJECT & FILM CONTRAST 2.CONTRAST MEDIA

Methods of Administrationof Contrast Material

1. INGESTED / INSTILLED

– (ORALLY OR RECTALLY)

2. INJECTED

– IV – INTO BLOOD VESSELLS

1. RETROGRADE – AGAINST NORMAL FLOW (Vessels

& Organs)

2. INTRATHECAL – Spinal canal

3. PARENTERAL 4. (IV, Intrathecal)

– Injecting into bloodstream

– (anything other than oral)

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BARIUM

BARIUM SULFATE

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HISTORY OF BARIUM BaSo 4

1. LEAD SUBSTRATE – TOXIC

2. BISMUTH SUBNITRATE – TOXIC

3. THORIUM – RADIOACTIVE

4. BARIUM SULFATE - INERT1. (goes in and comes out the same – not absorbed)

5. NOTE SOME PATIENT MAY SHOW ALLERGY TO SUSPENSION SOL.

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Barium Sulfate BaSO+

1. High atomic number

2. Not soluble in water

3. Used to coat the lining of organs

4. Supplied in different thicknesses

5. Used1. Esophogram, UGI, Small Bowel,Lower GI or BE

Page 37: Radiographic Contrast RTEC - A 2010 1.SUBJECT & FILM CONTRAST 2.CONTRAST MEDIA

Barium Sulfate BaSO+

1. Because it is not water soluble – it must be mixed in a SUSPENSION with water

2. FLOCCULATION – when barium clumps (separates from the water)

3. Barium residue in the colon can dry and cause an obstruction

4. Drink plenty of fluids after exam

Page 38: Radiographic Contrast RTEC - A 2010 1.SUBJECT & FILM CONTRAST 2.CONTRAST MEDIA

BARIUM

1. MIXED IN A SUSPENSION

2. MUST BE SHAKEN

3. CHECK THE CAP (LID) FIRST !!!!!!!

4. SUSPENSION – sodium citrate, vegetal gums, flavoring and sweeteners to improve palatability

Page 39: Radiographic Contrast RTEC - A 2010 1.SUBJECT & FILM CONTRAST 2.CONTRAST MEDIA

ADVERSE REACTIONS

1. SUSPENSION MAY CAUSE ALLERGY2. OCG TABLETS (IODINE) ALLERGY3. AFTER EXAM – MAY SOLIDIFY DIFFICULT TO

EVACUATE4. INCREASE FLUIDS, MILD LAXATIVE

5. EXTRAVASATION OF CONTRAST INTO PERITONEUM

Page 40: Radiographic Contrast RTEC - A 2010 1.SUBJECT & FILM CONTRAST 2.CONTRAST MEDIA

BARIUM CONCENTRATION

1. DIFFERENT FOR EXAMS

2. W/W RATIO (weight/weight)

3. Mixture of barium to water – 100 g suspension

4. “THICK” VS “THIN” BARIUM

Page 41: Radiographic Contrast RTEC - A 2010 1.SUBJECT & FILM CONTRAST 2.CONTRAST MEDIA

BARIUM “THICK & THIN”1. THICK –

1. DOUBLE CONTRAST

2. THIN – 1. SINGLE CONTRAST

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BARIUM ORAL OR RECTAL

1. LABELS ARE DIFFERENT

2. CHECK CAREFULLY BEFORE GIVING TO THE PATIENT

Page 45: Radiographic Contrast RTEC - A 2010 1.SUBJECT & FILM CONTRAST 2.CONTRAST MEDIA

Palatability OF BARIUM

1. Chalky taste with barium sulphate/water mixture

1. Contain a flavoring agent, sweetners 1. To disguise the unpleasant taste

2. Thicker or thinner suspensions may be used

3. Many commercial preparations contain carboxymethyl cellulose (Raybar, Barosperse)

1. Which retains fluid and prevents precipitation of the barium suspension in the normal small bowel

Page 46: Radiographic Contrast RTEC - A 2010 1.SUBJECT & FILM CONTRAST 2.CONTRAST MEDIA

GASTOINTESTINAL exams

• BARIUM COATS LINING OF INTESTINE

1. SINGLE CONTRAST - BARIUM ONLY2. DOUBLE CONTRAST – WITH AIR

• CARBON DIOXIDE TABLETS –• FIZZIES / CRYSTALS

3. SODA4. ROOM AIR (LOWER GI)

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EXTRAVASATION

1. LEAKAGE THROUGH A DUCT OR VESSEL OR ORGAN INTO THE SURROUNDING TISSUE

2. Barium should not be given in cases of suspected perforation

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Extravasation

1. Following a Colonoscopy with biopsy

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Extravasation of BA in abd

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GASTROINTENSTIALCONTRAST

MEDIAPROCEDURES

1. ESOPHOGRAM / OPMS2. UPPER GI (UGI)3. SMALL BOWEL (SMBFT)4. BARIUM ENEMA (BE)5. GASTRO ENEMA

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Drinking Ba for Esophogram

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Hiatal Hernia Reflux “heartburn”

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Supplies for BE

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“DOUBLE CONTRAST” studies with Barium

1. Air used with other contrast agents2. Better to see internal structures

BE – room air mixed with Ba UGI – gas “fizzies” used

Page 60: Radiographic Contrast RTEC - A 2010 1.SUBJECT & FILM CONTRAST 2.CONTRAST MEDIA

DOUBLE CONTRAST EXAMS

1. To achieve double contrast examination of the stomach, air or carbon dioxide gas must be introduced

2. Most radiologists use effervescent tablets (sodium bicarbonate , tartaric acid & calcium carbonate)

3. To react with the gastric contents to produce carbon dioxide

Page 61: Radiographic Contrast RTEC - A 2010 1.SUBJECT & FILM CONTRAST 2.CONTRAST MEDIA

BESINGLE DOUBLE (AC)

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UGI double contrast single contrast

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DOUBLE CONTRASTWITH IODINE

• Iodine mixed with air of a bladder (canine)

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IODINE CONTRAST

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Iodine1. Water Soluble2. High atomic # 533. Radiopaque4. Used to radiograph

– Vessels– Arteries– Veins– Function of internal

organs– Gastrointestinal system– Ducts

Page 66: Radiographic Contrast RTEC - A 2010 1.SUBJECT & FILM CONTRAST 2.CONTRAST MEDIA

IODINATED CONTRASTWATER BASED

1. INJECTED

2. VESSELLS/DUCTS1. Ionic2. Non-ionic

3. INGESTED or instilled

4. OPEN WOUNDS

OIL BASED

1. INJECTED

2. NEVER VESSELLS

3. ONLY DUCTS

4. NOT INGESTED

5. OPEN WOUNDS

Page 67: Radiographic Contrast RTEC - A 2010 1.SUBJECT & FILM CONTRAST 2.CONTRAST MEDIA

Gastrointestinal studies:Gastrograffin or Hypaque (Iodine)

1. High atomic #– Close to iodine

2. Water soluble

3. Similar usage as Barium

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Gastrograffin

• Water soluble iodine-containing contrast media are of value when there is a suspected perforation or leakage of an anastomosis after operation

• Oral or Rectal use

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GASTROGRAFIN

• POWDERED FORM – MIXED WITH H20

• LIQUID IN BOTTLE – MAY BE MIXED

• USED WHEN PATIENTS ARE ILL,• SUSPECTED PERFORATIONS• PRE-OPERATIVELY• (BITTER TASTE) • CAN INCREASE PERISTALSIS (SMB STUDY)

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GASTROGRAFIN

1. Bitter taste

2. Better if chilled or mixed with ice

3. Monitor patient closely

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Gastrograffin via NG tube

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Peptic ulcer

1. Use Gastro2. Contrast may leak 3. Into the peritoneum4. Causing peritonitis

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Gastric neoplasm w/ perforation

• EXTRAVASATION OF CONTAST INTO THE PERITONEUM

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Gastrografinenema

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SINGLE CONTRAST ENEMA

BARIUM (110 KVP) GASTROGRAFIN (90 KVP)

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GASTROGRAFINAdverse Reactions

1. Water soluble, safe in the abdominal cavity

– Safe to use if perforation is suspected

2. Very harmful to the lung tissue

– Do not use if aspiration is possible

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Never force contrastPatient might aspirate into the lungs!

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INJECTABLECONTRAST MEDIA

INVASIVE PROCEDURESIVP / IVU

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Intravenous injections are INVASIVE

ALWAYS GET PATIENT’S HISTORY AND CONSENT

BEFORE BEGINNING OR GIVING ANY CONTRAST

MEDIA

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Patient Assessment Check List

• Information update !!

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INJECTED CONTRAST

1. IODINE BASED

1. IONIC

1. NON IONIC

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IODINATED Contrast Agents

IONIC• High Osmolality (Higher

risk of complications)

1. (Hypaque)

2. (Conray)

NON-IONIC• Low Osmolality (Lower

risk of complications)

1. (Isovue)

Page 83: Radiographic Contrast RTEC - A 2010 1.SUBJECT & FILM CONTRAST 2.CONTRAST MEDIA

Iodine Contrast Material

1. Ionic Contrast– Anion -– Cation +– More patient allergic

reactions

2. Ionic contrast media dissociates into two molecular particles in blood plasma =

3. Causing pt reactions

1.Non-Ionic Contrast

• Less patient allergic reactions

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Newer Contrast Agents Balance Safety and Visualization

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IODINE WATER BASED CONTRAST

1. IONIC

2. LESS $$$ – $25 per bottle

3. MORE REACTIONS

1. NON IONIC

2. MORE $$$– $200 per bottle

3. LESS REACTIONS

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CONTRAST REACTIONS

1. > 10 million diagnostic procedures / year

2. Conventional ionic contrast reactions - 10%

3. 1 in 1000 severe

Page 87: Radiographic Contrast RTEC - A 2010 1.SUBJECT & FILM CONTRAST 2.CONTRAST MEDIA

Allergic to Iodine

General Rule:

1. No Iodine Contrast will be given1. Pre – medication is available

2. May or may not react if previous iodine given

Page 88: Radiographic Contrast RTEC - A 2010 1.SUBJECT & FILM CONTRAST 2.CONTRAST MEDIA

REACTIONS & Treatment

USUALLY** WITHIN FIRST 5 MINUTES1. Nausea & Vomiting & Urticaria 2. Hypotension (bradycardia) 3. Hypotension (tachycardia) 4. Bronchospasm 5. Anaphylactoid 6. Seizures 7. Extravasation

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ALWAYS –know the locationof drug trays and crash carts

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INJECTED IODINE STUDIESGENITOURINARYContrast injected into the VEIN

1. IVP / IVU

2. CYSTOGRAMS3. (Retrograde may use a foley catheter)

4. GASTROINTESTINAL5. ERCP – (CBD)

Page 92: Radiographic Contrast RTEC - A 2010 1.SUBJECT & FILM CONTRAST 2.CONTRAST MEDIA

15 MIN POST CONTRAST INJECTION - IVP

CYSTOGRAM

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Cholelithiasis

GB STONES

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Normal ERCP (checks for stones/blockage in bile duct)

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GB STONES

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Other InjectedContrast Studies

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Cerebral Angiogram

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Renal Arteriogram

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MYELOGRAM (SPINAL CORD)INTRATHECAL INJECTION

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Extravasation

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“To BE or not to BE”

1. Massive retroperitoneal air

2. pneumomediastinum3. subcutaneous air4. secondary to bowel

perforation 5. after barium enema

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Extravasation of Contrastinto soft tissue of arm

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Contrast leaking from bladder

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OIL – BASED

IODINECONTRAST

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Oil Based Iodine

1. Fatty Acids2. Insoluble in water

1. White on the radiograph = Radiopaque3. Uses

1. Bronchography (lungs)2. Tear ducts3. Salivary glands4. Lymphatic system5. Hysterrosalpingogram6. Galactography (breast ducts)

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To check fertility

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LYMPHANGIOGRAM

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Galactography - Breast Duct

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Oral & IV contrast

CT Scan

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CT showing Abnormal GB

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ORAL & IV CONTRAST (CT/ MRI)