Expanded competencies for the nuclear medicine advanced associate (nmaa) introduction

Contrast Media Curriculum Content

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Contrast Media Curriculum Content
I. Rationale for the Use of Contrast Media
II. Agents

A. Negative agents

1. Air

2. Carbon dioxide

3. Nitrous oxide

B. Positive agents

1. Barium sulfate

2. Iodinated

a. Water soluble

b. Oily

C. Paramagnetic agents

1. Gadolinium-DTPA

D. Echogenic agents

1. Gas microbubble

III. Contrast preparations

A. Barium sulfate (Ba2SO4)

1. Dry powder or premixed

2. Suspension

3. Paste

4. Tablets

B. Iodinated water soluble

1. Types

a. Diatrizoic acid (Hypaque and Renografin)

b. Iothalamate (Conray)

c. Metrizamide (Amipaque)

d. Iohexol (Omnipaque)

e. Ioxaglate (Hexabrix)

f. Iopamidol (Isovue and Niopam)

g. Ioversol (Optiray)

C. Gas microbubble

1. Particulate suspension or emulsion
IV. Characteristics of Iodinated Contrast Materials

A. Water solubility and hydrophilicity

B. Osmality

1. High osmolar contrast media (HOCM)

a. Molecular structure

2. Low osmolar contrast media (LOCM)

a. Molecular structure

b. Advantages of LOCM

c. Disadvantages of LOCM
C. Viscosity

D. Calcium binding

E. Chemical stability

V. Media in Use

A. Barium sulfate

1. Procedures requiring the use of barium

2. Low occurrence of allergic reaction

3. Cause(s) of allergic reaction

4. Patient risks following the administration of barium

5. Characteristics of patients at risk

6. Glucagon administration

a. Rationale for use

b. Administration

B. Iodinated contrast materials

1. Procedures requiring the use of iodinated contrast

2. Oily iodinated contrast

3. Procedures requiring the use of oily iodinated media

4. Contrast used for intrathecal injections

a. Oily contrast

b. Aqueous contrast

c. Patient management to reduce the rate and severity of adverse reactions

5. Instructions given to diabetes patients receiving antihyperglycemic agents (Metformin, Glucophage)

VI. Strategies for Dealing With Patients With a Known History of Allergic Reaction

A. Steroid premedication for intravascular contrast media

B. Indications for steroid premedication

C. Contraindications for steroid premedication

D. Dosage

1. Nonemergency cases

a. Two-dose regimen

2. Emergency cases E. Suggesting alternative procedures

VII. Adverse Reactions to Contrast Administration, Symptoms, Indicators and Recommended Patient Care

A. Minor reaction

1. Symptoms

2. Recommended response

B. Moderate reaction

1. Symptoms

2. Recommended response

C. Severe reaction

1. Symptoms

a. Early symptoms

b. Late symptoms

2. Recommended response

D. Infiltration

1. Symptoms

2. Recommended response
VIII. Patient Counseling and Recommended Follow-up Care for Patients Undergoing a Procedure Requiring the use of Contrast Media

A. Following barium procedures

B. Following iodinated contrast media procedures

C. Following adverse reactions to administered contrast agents

Radiopharmaceuticals and Interventional Agents


Prior to beginning a nuclear medicine advanced associate program, it is assumed that a nuclear medicine technologist would have a core level of knowledge dealing with the pharmacology of commonly used radiopharmaceuticals and interventional agents. The technologist should also have a clear understanding of the laws and policies related to radiopharmaceuticals in his or her practice setting. At a minimum the technologist should be comfortable with their knowledge of the following information for each radiopharmaceutical or interventional agent.

  • Pharmacology

  • Interventional Agents and Radiopharmaceuticals

      • Class of drug

      • Alternate names

      • Indications

      • Mechanism of action

      • Pharmacokinetics

      • Dosage range

      • Precautions and Contraindications

      • Other drugs

      • Pathological conditions

      • Adverse Effects

        • Management

        • Documentation

NMTCB Pharmaceuticals List   (March 2006)
Please note: Only generic and/or commonly known drug names are used on the NMTCB examination.

Tc99m Labeled Radiopharmaceuticals
     Mo99m/Tc99m Generators
     Tc99m sodium pertechnetate
     Tc99m oxidronate/HDP
     Tc99m medronate/MDP
     Tc99m pentetate/DTPA
     Tc99m macroaggregated albumin/MAA
     Tc99m sulfur colloid
     Tc99m disofenin/mebrofenin
     Tc99m mertiatide/MAG3
     Tc99m pyrophosphate/PYP
     Tc99m sestamibi/MIBI

     Tc99m tetrofosmin

     Tc99m succimer/DMSA
     Tc99m exametazime/HMPAO
     Tc99m bicisate/ECD
     Tc99m gluceptate
     Tc99m labeled RBCs
     Tc99m denatured radiolabeled RBCs
     Tc99m HMPAO tagged WBCs

Iodine Labeled Radiopharmaceuticals
     I123 sodium iodide
     I131 sodium iodide
     I131 MIBG
     I125 serum albumin/RISA
     I131 serum albumin/RISA
     I125 iothalamate

Indium Labeled Radiopharmaceuticals
     In111 chloride      In111 pentetate (DTPA)Tc99m
     In111 oxine labeled WBCs
     In111 labeled MAB (capromab pendetide)
     In111 pentetreotide
     In111 ibritumomab tiuxetan

Miscellaneous Diagnostic Radiopharmaceuticals
     Tl201 thallous chloride
     Ga67 gallium citrate
     Xe133 gas
     Cr51 sodium chromate labeled RBCs

     N-13 ammonia

     Rb-82 chloride
     F18 FDG
     N13 ammonia
     Rb82 chloride
     C14 urea

Therapeutic Radiopharmaceuticals
     P32 chromic phosphate colloid
     P32 sodium phosphate
     Sr89 chloride
     Sm153 EDTMP lexidronam
     I131 sodium iodide
     Y90 ibritumomab tiuxetan
     I131 tositumomab
     Y90 microspheres

Interventional Pharmaceuticals

Miscellaneous Non-Radioactive Agents
     ACD solution
     ascorbic acid
     contrast media
     vitamin B12
     Lugol's solution/SSKI
     Lidocaine (EMLA) cream

     recombinant human TSH

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