A double contrast exam uses both a radiopaque and a radiolucent contrast agent. Double contrast is for example used in gastrointestinal examinations to show the pattern of mucosal ridges. The walls of the intestine are coated with the radiopaque barium and the lumen is filled with radiolucent air.

The industry standard of computed tomography (CT) contrast media power injectors changed over time from single-head to dual-head systems. The advantage of a power (or pressure) injector with two syringes is that a saline solution can be injected first to open the veins, followed by a second injection with contrast agent. Then the first head flushes the saline to maintain contrast flow. As a result, much less contrast agent is needed (about 30 percent less), helping to reduce costs. Dual-head contrast media injectors also provide greater patient safety by reducing the pressure of the flow rate, helping to prevent damage to the veins.
Contrast delivery is much more controlled and efficient when using a dual-head power injector (also called double-piston injector). Also, these medical devices are required to accommodate the quick imaging times typical for a multi-detector CT scanner.

See also Contrast Media Injector, Single-Head CT Power Injector, CT Power Injector, Multi-Head Contrast Media Injector, Syringeless CT Power Injector.

A barium enema is an x-ray examination of the colon and rectum to find abnormalities such as polyps, diverticulosis, cancer, or inflammatory disease.
Liquid barium is administered through a small tube inserted into the rectum. In case of an air-contrast or double-contrast barium enema, the added air improves the evaluation of the lining of the large intestine.
Barium enemas require a bowel preparation with laxatives, starting one day before the examination.

See also Colonoscopy and Virtual Colonoscopy.

An arthrography is a radiographic examination of a joint (such as the knee, shoulder, hip, elbow or wrist) that requires an injection of a contrast medium into the joint space.
For an opaque x-ray arthrography a water-soluble iodinated contrast agent is injected and a series of fluoroscopic controlled images is produced. Magnetic resonance arthrography combines the arthrogram with MRI. A small quantity of gadolinium contrast agent is added to the injection into the joint space. The traditional radiographic images are followed by an MRI of the extremities. A non-invasive possibility is an indirect MR arthrography, which doesn't require the injection into the joint. The dye is given prior to the imaging procedure.
The contrast fluid produces a bright signal and allows evaluation of small defects of the joint capsule, assessment of articular surface and labral cartilage, and in case of an indirect arthrogram also of the surrounding soft tissue. If a gaseous medium is used, this exam is called pneumoarthrography and a combination with liquid contrast is used in double-contrast arthrography.
MR arthrography is often used to evaluate hip and acetabular labrum, shoulder rotator cuff and glenoid labrum (see Shoulder MRI), and less often in wrist and knee MRI studies. Also combinations of CT and nuclear medical techniques with arthrography are available.

Iodinated contrast agents (typically iodine-substituted benzene derivatives) are bound either in nonionic or ionic compounds. Ionic contrast agents consist of the negatively charged anion and the positively charged cation. Used components of the anion are for example diatrizoate, iodamide, iothalamate or metrizoate and of the cation the sodium or meglumine ion. The osmotic pressure depends on the number of particles in solution. Ionic contrast agents have a greater osmolarity; double that of nonionic contrast agents due to delivering more iodine atoms per molecule.
Ionic contrast agents were developed first and are still in use depending on the examination. Iodine based contrast media are water soluble and as harmless as possible to the body. However, ionic agents have more side effects compared to nonionic contrast agents due to their high osmolarity.

See also Ionic Dimer.