62．欧乃派克
出处：按学科分类—医药、卫生 军事医学科学出版社《临床常用进口药物手册》第348页（23032字）
【中文释文】：
(碘海醇)
X线检验用的造影剂，可供血管内(第一部分)、椎管内(第二部分)和体腔内(第三部分)使用。
〔描述〕
碘海醇(三碘三酰苯，iohexol)，(2，3-二羟基丙基)-5-[N-(2，3-二羟基丙基)乙酰胺基]-2，4，6-三碘异苯二酰胺，是一种含有三个碘分子的非离子水溶性造影剂，分子量为821(碘含量为46．4%)。
欧乃派克以经过消毒的水溶液为剂型，随时可用，并有不同的碘浓度，分别为每ml溶液含有140mg，180mg，240mg，300mg或350mg碘。这些可注射的溶液也含有1．21mg／ml氨丁三醇(TRIS)和0．1mg／ml依地酸钠钙。pH值用盐酸调整到6．8～7．6之间。
〔药理学〕
动物实验结果显示，欧乃派克在小鼠和大鼠的静脉和椎管内的急性毒性作用都非常低，甚至比非离子造影剂甲泛葡胺的毒性还低，而甲泛葡胺的耐受性已证实比离子造影剂为低。小鼠和猴接受多次注射后，其中枢神经系统对欧乃派克的耐受性仍然非常好。
兔接受蛛网膜下注射后，血清中的碘海醇浓度于术后2～5h最高。约83%的磺海醇于注射后24h内在尿液中排出，而一周内复原的比率高达96%。
在大鼠、兔及狗中进行的排泄研究显示，碘海醇大多在尿液中排出，但亦有小部分在粪便中排出(大鼠：5%，狗：1%)。
没有发生任何器官吸收碘海醇的现象，也探测不到任何代谢物的产生。
蛋白质结合率非常低(少于2%)。
狗只接受肾动脉造影后产生蛋白尿的情况，在使用欧乃派克时比使用单体离子造影剂轻微得多。据在狗和兔进行的测试显示，欧乃派克对血流动力参数和生化药理参数的影响很微，进一步证实欧乃派克的耐受性良好。
造影剂的局部耐受性可从大鼠主动脉内皮的损伤程度来评定，结果指出欧乃派克优于常用的离子造影剂。在体外细胞培养物中进行的实验也显示出欧乃派克的内皮耐受性良好。
对大鼠和兔的生殖研究并未显示欧乃派克会损害生育能力或导致产下畸形婴儿。
〔临床药理学〕
通过静脉注射到体内的碘海醇，于24h内以原形在尿液中排出的，近乎百分之百。尿液中碘海醇浓度最高的情况，出现在注射后的1h内。没有代谢物产生。
健康志愿者接受静脉内注射欧乃派克后，其血流动力学参数、临床化学参数及凝结参数与接受注射前的数值差别甚微。在实验室参数上记录到的轻微变化毫无临床重要性。
碘海醇在脑脊液和血清中的浓度状况与甲泛葡胺相近。
一、血管内应用
1．临床研究 临床研究证明，欧乃派克作为一种注射到血管内的造影剂，适用于成人及儿童的尿路造影和心血管造影，以及成人的大脑血管造影、外周及各种动脉造影、静脉造影、数字减影和CT增强电脑扫描。
欧乃派克在动物实验中表现的低毒性和高耐受性，在临床研究中得到佐证。欧乃派克对血流动力学参数，电生理参数和临床化学参数的影响微不足道，更被认定为毫无临床重要性。
病人主观反应的发生率较目前使用的离子单体造影剂显着为低，与其他非离子造影剂，例如甲泛葡胺，相同与其它血管内应用的造影剂相比，欧乃派克的影像更佳或质量相等。
2．适用范围 血管造影、尿路造影、静脉造影及造影增强CT。
3．预防措施 含碘质造影剂可能会引起过敏性样反应或其他过敏现象。虽然，欧乃派克引起剧烈反应的风险甚微，但仍应事先制定紧急救治程序，以便发生严重的反应时能马上进行治疗。
有过敏症或哮喘病史，或是曾对含碘质造影剂有不良反应的病人，于使用此造影剂时需要特别小心。
在上述情况下，可考虑在造影前使用皮质类固醇及抗组胺剂。体外试验表明非离子型造影剂对止血(即血凝固)机理的抑制作用比浓度相似的离子型造影剂为低。因此，血管造影应按标准步骤进行。血管造影导管应经常冲洗并避免血液和造影剂在注射器及导管中长时间接触。
患有严重肝或肾功能失调，甲状腺疾病及骨髓白血病的病人，使用时应特别小心，这类病人应避免脱水。血清内肌酸酐浓度超过500μmol／L的糖尿病病人，应避免用此造影剂，除非检验为病人带来的益处，明显的超过冒险成分。
所以含碘质造影剂均可能妨碍甲状腺功能的检验。甲状腺组织的碘结合能力可能会受造影剂影响而降低，并且需要数日甚至两周才能完全恢复。
造影剂也不应与其他药物混合，应使用专用的注射剂和针管。虽然动物实验并未显示欧乃派克会损害生育能力或导致产下畸形婴儿，但怀孕期间应尽量减少使用，直至在病人中进行受严格控制的研究有明确的结论为止。
此造影剂被排入母乳的程度，虽然估计是相当轻微，但实际情况尚无法确定。
4．不良反应 欧乃派克所引起的不良反应，在频度和严重性上，皆显着地比现时所用的离子造影剂为低。
少数病人可能会产生一些轻微的反应，例如：短暂温感、微痛、潮红、恶心／呕吐，轻微胸口作痛、皮肤痕痒及皮疹等。
5．剂量 剂量视检验的类别及采用的技术而定。所用的碘浓度和分量，一般与现时采用的各种血管造影剂相同。
请参考以下的剂量表：
表21 欧乃派克不同应用项目的剂量
二、蛛网膜下应用
1．临床研究
对欧乃派克的临床研究包括腰、胸和颈脊髓造影。
临床研究证实了欧乃派克在动物实验中表现的低神经毒性和高耐受性。研究显示，欧乃派克对血实验室参数和脑脊液实验室参数的影响极微，且没有任何临床重要性。
欧乃派克引起脑电图变化的频率较甲泛葡胺为低。在神经检验中的变化毫无临床重要性。
欧乃派克和甲泛葡胺的临床比较试验显示，前者引发的不良反应较少。
影像的质量很高，与甲泛葡胺相同。
2．适用范围及用途 欧乃派克适用于成人及儿童的腰、胸及颈脊髓造影，以及应用于蛛网膜下注射后进行底池CT检查。
3．禁忌及预防措施 有癫痫病史的人，不宜在蛛网膜下腔使用欧乃派克。由于剂量问题，即使造影时技术失灵，也不宜即时进行重复造影。(见剂量建议表)。有严重的局部感染或系统感染问题，而可能形成菌血症的病人，不应采用腰椎穿刺术。使用时要避免脱水；有充足水分的病人产生不良副作用的机会较低。
若已知或怀疑病人对含碘质造影剂过敏，便必须密切留意。此类病人和其他有过敏倾向的病人，可在检验前使用皮质类固醇或抗组胺剂。但在脊髓造影时，则要避免在椎管内施用皮质类固醇。
一切使用造影剂的过程均带有引起不良反应的风险，虽然反应多属轻微，但也可能有严重的情况，因此，应事先制定紧急救治程序，以便一旦发生严重反应，能马上进行治疗。
一旦发现有大量造影剂流入病人脑内的迹象，可考虑使用巴比妥盐进行抗惊厥治疗。
4．术前护理及术前用药 倘病人需要镇静剂，可使用地西泮，病人若感觉到强烈的痛楚，便可能需要服用止痛药。
需确保病人在进行检验前充足的水分。
5．术后护理及术后用药 病人接受脊髓造影后，须仰卧病床，头部保持高抬至少6h，并在24h内不得自行移动。若怀疑病人的癫痫发病阈有所降低，便需密切留意。
倘若癫痫发作，须马上给予抗癫痫治疗，例如把10mg地西泮缓慢的注射入静脉；要防止复发，可在停止发病20～30min后，肌注200mg苯巴比妥。
鼓励病人进食流质食品和可以接受的固体食物。
若发生持续的恶心或呕吐现象，宜立即考虑进行静脉输注，以更换体液。倘有需要，更可给予止吐剂。
6．后备术后护理 近期迹象显示，在脊髓造影后，病人挺身端坐在轮椅上，可能会最大限度减少发生不良反应。这种挺身端坐姿势，可能有助于延迟造影剂向上身散播，并加强腰部蛛网膜的吸收能力。切记要告诫病人，在术后24h内不可弯腰下俯。同时要指导病人，应尽量避免挪动身体，以减少脑脊液泄漏。
7．不良反应 头痛、恶心及呕吐都是脊髓造影中最常见的不良反应。使用欧乃派克进行脊髓造影后头痛的发生率比较使用甲泛葡胺为少，持续数天的剧烈头痛可能偶尔发生。
迄今所察觉的其他轻微不良反应有短暂的头晕、背痛、颈痛或四肢痛楚，以及各种感觉异常现象。脑电图记录显示不明确的短暂变化(慢波)，也曾出现。
用水溶性造影剂作脊髓造影后曾发现无菌性脑膜炎。使用碘海醇作脊髓造影也曾报道过类似情况，但十分轻微且持续时间短暂。
严重不良反应甚少出现，而不良反应大多是轻微的，其情况大致与接受腰椎穿刺后的反应相同。
8．剂量及用法 剂量及浓度视检验的类别、采用的技术及蛛网膜下腔的大小而定。
一般注射方法是腰椎穿刺术，在腰椎第3、4节间穿刺(腰部及颈部脊髓造影)，或在颈椎第1、2节间作侧颈穿刺(颈部脊髓造影)。
若采用腰椎穿刺术作颈脊髓造影，病人倾斜时要非常小心，以免大量的高浓度造影剂进入脑内。
宜采用1～2min的缓慢注射方法，以减少造影剂与脑脊液混合(在所有实际应用的浓度中)。欧乃派克之比重均比脑脊液为高。
9．建议的剂量
表22 欧乃派克不同应用项目的剂量
总含碘量不应超过3g，以减低产生不良反应的可能性
三、体腔内应用
1．临床研究 欧乃派克曾应用于各种体腔检验，包括口服。没有引起严重的或持续的病人反应。病人对欧乃派克的耐受程度，与其他作比较的造影剂相同。在大部分的病例中，影像都属良好或优异。研究也显示欧乃派克极适合在各种检验中使用。
2．适用范围 关节造影，内窥镜逆行胰管造影，内窥镜逆行胆管及胰管吻合造影，疝造影，子宫输卵管造影，涎管造影，以及各种使用口服水溶造影剂进行的胃肠道检验。
3．预防措施 含碘质造影剂可能引起过敏性样或其他过敏性反应。虽然欧乃派克引起强烈反应的风险很微，但仍应事先制定紧急救治程序，以便一旦发生严重反应时，能马上进行治疗。
有过敏症或哮喘病史，或是曾对含碘质造影剂有不良反应的病人，于使用此造影剂时需要特别小心。在这些情况下，考虑在造影前使用皮质类固醇及抗组胺剂。
4．不良反应 在体腔内，欧乃派克引起不良反应的频率及严重性，与一同作比较的其它造影剂相似。
5．剂量 剂量视检验的类别及所用技术而定。所用的碘浓度及分量，一般与现时采用的各种血管造影剂相同。
请参考以下的剂量表：
表23 欧乃派克不同应用项目的剂量
〔贮存〕
室温，避免光线照射。
每瓶欧乃派克只供应一名病人使用，剩余的部分应弃掉。
〔包装〕
1．碘140mg／ml 10小瓶装，每小瓶50ml；6瓶装，每瓶200ml。
2．碘180mg／ml 10小瓶装，每小瓶10ml；10小瓶装，每小瓶15ml；10小瓶装，每小瓶50ml；6小瓶装，每小瓶200ml。
3．碘240mg／ml 10小瓶装，每小瓶10ml；6小瓶装，每小瓶20ml；25小瓶装，每小瓶20ml；10小瓶装，每小瓶100ml。
4．碘300mg／ml 10小瓶装，每小瓶10ml；6小瓶装，每小瓶20ml；25小瓶装，每小瓶20ml；6小瓶装，每小瓶200ml。
5．碘350mg／ml 6小瓶装，每小瓶20ml；25小瓶装，每小瓶20ml；10小瓶装，每小瓶100ml。
〔规格〕
碘300mgI／ml×10ml
碘300mgI／ml×20ml
碘300mgI／ml×50ml
碘300mgI／ml×100ml
碘300mgI／ml×20ml
碘300mgI／ml×50ml
〔生产厂家〕
挪威奈科明造影剂公司
【外文释文】：
X-Ray contrast medium for intravascular(part Ⅰ)and intrathecal(part Ⅱ)use，and use in body cavities(part Ⅲ)。
Description
Iohexol，N，N’-bis(2，3-dihydroxypropyl)-5-[N-(2，3-dihydroxypropyl)acetamido]-2，4，6-triiodoisophthalamide，is a triiodinated，non-ionic water-soluble contrast medium with a molecular weight of 321(iodine content 46．4%)．
Omnipaque is supplied ready for use as sterile solutions with iodine concentrations：140 mg Ⅰ／ml，180 mg Ⅰ／ml，240 mg Ⅰ／ml，300 mg Ⅰ／ml and 350 mg Ⅰ／ml．The injectable solutions contain 1．2 mg／ml Trometamol(TRIS)and 0．1 mg／ml sodium calcium edetate．pH Is adjusted with hydrochloric acid to 6．8-7．6．
Pharmacology
Animal studies
It has been shown that Omnipaque has a very low acute intravenous and intrathecal texicity in mice and rats，even lower than that of the non-ionic metrizamide which has been shown to be better tolerated than the ionic media．
CNS Tolerability after repeated doses in mice and monkeys is likewise found to be very good．
Serum concentration of iohexol after subarachnoid administration in rabbits reached a maximum at 2-5 hours．About 83%of iohexol was recovered from urine within 24 hours after injection and total recovery within one week was 96%．
Excretion studies in rats，rabbits and dogs have shown that iohexol is mainly excreted in the urine，but also to a minor extent in the faeces(rats：5%，dogs：1%)．
No specific organ enrichment of iohexol has been found，and no metabolites have been detected．
The protein binding is very low(less than 2%)．
Proteinuria induced by renal angiography in dogs was significantly less with Omnipaque than with monomeric ionic media．Testing of the effect of Omnipaque on haemodynamic and biochemical-pharmacological parameters in dogs and rabbits further demonstrated the good tolerability of Omnipaque．
Local tolerability of Omnipaque expressed as degree of endothelial injury to rat aorta，has been found superior to conventional ionic media．The same good endothelial tolerability of Omnipaque has also been demonstrated by in vitro experiments in cell cultures．
Reproduction studies in rats and rabbits have revealed no evidence of impaired fertility or teratogenicity due to Omnipaque．
Clinical pharmacology
Close to 100 percent of the intravenously injected iohexol is excreted unchanged through the kidneys within 24 hours．The maximum urinary concentration of iohexol appears within approximately l hour after injection．No metabolites have been detected．
For most of the haemodynamic，clinical-chemical，and coagulation parameters examined following intravenous injection of Omnipaque in healthy volunteers，no significant deviation from preinjection values has been found．The few changes observed in the laboratory parameters were minor and considered to be of no clinical importance．Concentration patterns of iohexol in CSF and serum is similar to those of metrizamide．
Part I intravascular use
Clincal studies with Omnipaque have confirmed its suitability as an intravascular contrast medium for urography and cardioangiography in adults and children and cerebral arteriography，peripheral and various arteriographies，phlebography，DSA and CT-enhancement in adults．
The low toxicity and good tolerability of Omnipaque demonstrated in animal experiments are confirmed in clinical studies．The influence of Omnipaque on haemodynamic，electrophysiological and clinical-chemical parameters is insignificant and considered to be of no clinical importance．
The incidence of subjective patient reactions is substantially reduced compared to ionic monomeric media in current use and similar to other non-ionic contrast media，e．g．Amipaque(metrizamide)．
Compared to other intravascular contrast media improved or equal quality of radiographs has been obtained with Omnipaque．
Indications
Angiography，urography，phlebography and CT-enhancement．
Precautions
Iodinated contrast media may provoke anaphylactoid reactions or other manifestations of hypersensitivity．Although the risk of severe reactions in connection with use of Omnipaque is regarded as very minor，a course of action should be planned in advance for immediate treatment，should a serious reaction occur．
A positive history of allergy，asthma or untoward reactions to iodinated contrast media indicates a need for special caution．
Premedication with corticosteroids and possibly antihistamines may be considered in these cases．
The inhibitory effects of non-ionic contrast media on mechanisms of haemostasis have been shown，in vitro，to be less than for ionic contrast media at comparable concentrations．For this reason standard angiographic procedures should always be followed．Angiographic catheters should be fluched frequently and prolonged contact of blood with contrast media in syringes and catheters should be avoided．
Particular care should be exercised in patients with severe functional disturbances of the liver or kidneys，in severe thyrotoxicosis and in myelomatosis．Dehydration should be avoided in these patients．Diabetics with serum creatinine concentration above 500 μmol／L should not be examined unless the benefit clearly outweighs the risk．
All iodinated contrast media may interfere with tests on thyroid function．The iodine binding capacity of the thyroid tissue may be reduced for a few days or even up to two weeks．
Other drugs should not be mixed with the contrast medium．A separate syringe and needle should be used．
Although animal studies have revealed no impaired fertility or teratogenicity due to Omnipaque，its use during pregnancy should be restricted to a minimum until well-controlled human studies are available．
The degree of excretion into human milk is still not known，although expected to be low．
Adverse reactions
Adverse reactions are significantly less frequent and less intense with Omnipaque than with the ionic media currently used．
Minor reactions，such as transient heat sensation，light pain，flushing，nausea／vomiting，mild chest pain and slight skin reactions(itching，urticaria)may occur in a few patients．
Dosage
The dosage depends on the type of investigation and the technique used．Usually the same iodine concentration and volume is used as for other intravascular contrast media in current use．
The following dosages may serve as a guide．
Table 21
Clinical studies
Omnipaque has been clinically tested for lumbar，thoracic and cervical myelography．
The low neurotoxicity and good tolerability of Omnipaque demonstrated in animal experiments are confirmed in clinical studies．The influence of Omnipaque on blood-and CSFlaboratory parameters was found to be insignificant and of no clinical impotrance．Likewise the minor cardiovascular and electrophysiological changes observed were of no clinical significance．
EEG Changes were less frequent after Omnipaque than after use of metrizamide．No change of clinical significance was found in the neurological examinations．
The incidence of adverse reactions was lower with Omnipaque than with metrizamide in comparative clinical trials．
The radiographs were of the same high quality as those obtained with metrizamide．
Indications and use
Omnipaque is indicated in adults and children for lumbar，thoracic and cervical myelography and for use in computed tomography of the basal cisterns following subarachnoid injection．
Contraindications and precautions
A history of epilepsy is considered to be a relative contraindication to the use of Omnipaque in the subarachnoid space．
Immediate repeat myelography in the event of technical failure，is usually contraindicated because of dosage considerations．(See separate paragraph on Recommended Dosage)．
Lumbar puncture should not be performed in the presence of significant local or systemic infection where bacteraemia is likely．
Dehydration should be avoided，the risk of adverse effects is reduced in a well hydrated patient．
Patients with known or suspected hypersensitivity to iodinated contrast media must be closely observed．Corticosteroids or antihistamines may be given as premedication to those patients and also to other patients with known allergic disposition．Intrathecal administration of corticosteroids in connection with myelography should be avoided．All procedures utilizing contrast media carry a risk of adverse reactions．While most reactions are minor，serious reactions may occur．It is therefore important that a course of action is carefully planned in advance for the immediate treatment should a serious reaction occur．Anticonvulsant treatment with barbiturates may be considered in patients with evidence of inadvertent intracranial entry of a large bolus of the contrast medium．
Patient management
1．Precare and premedication
If the patient needs a sedative，diazepam may be used．In patients with severe pain，it may be necessary to give analgesics．
Ensure good hydration up to procedure．
2．Aftercare and postmedication
After myelography patients should preferably be confined to bed with head elevated for at least 6 hours and remain passive for 24 hours．
Patients with suspected lowered seizure threshold should be closely observed．If an epileptic seizure should occur，antiepileptic treatment must be given immediately，for instance diazepam 10 mg by slow intravenous injection．Recurrence may be prevented by e．g．intramuscularly administered phenobarbitone 200 mg 20-30 minutes after the seizure has ceased．
Encourage oral fluids and food as tolerated．
If persistent nausea or vomiting should occur prompt fluid replacement by intravenous infusion is recommended．If necessary，antiemetics may be given．
3．Alternative aftercare
Recent evidence suggests that maintaining the patients in an upright position in a wheelchair after myelography may minimize certain adverse effects．The upright position may help to delay up-ward dispersion of the medium and to maximize the lumbar arachnoid absorption．Ensure strict information to the patient never to bend down during the first 24 hours．The patient should also be instructed to keep relatively passive to minimize CSF-leakage．
Adverse reactions
Headache，nausea and vomiting are the adverse reactions most frequently observed in myelography．The incidence of headache after myelography with Omnipaque is found to be lower than after myelography with metrizamide．Severe headache lasting for some days may occasionally occur．
Other minor adverse reactions observed have been transient dizziness，pain or increased pain in the back，neck or extremities and paraesthesias．Non-specific transient changes(slow waves)in the EEG-recordings have been registered in a few patients．
Following myelography with water-soluble contrast media aseptic meningitis has been observed．After myelography with Omnipaque mild and short-lasting episodes have been reported．
The frequency of severe reactions is very low and the majority of the adverse reactions are mild，resembling those occurring after lumbar puncture alone．
Dosage and administration
The dosage and concentration of Omnipaque will depend on type of examination，the technique used and the size of the subarachnoid space．
Injection is normally made via the lumbar route，L3／L4 puncture，(lumbar and cervical myelography)or by the lateral cervical puncture，C1／C2，(cervical myelography)．
When cervical myelography by lumbar puncture is performed，utmost care must be exercised when tilting the patients to avoid intracranial entry of a large and concentrated bolus of contrast medium．
Slow injection over 1-2 minutes is recommended to minimize mixing with CSF．(Specific gravity of Omnipaque is higher than CSF at all actual concentrations)．
Recommended Dosage
Table 22
To minimize possible adverse reactions a total dose of 3 g iodine should not be exceeded．
Part Ⅲ Use in body cavities
Clinical studies
Omnipaque has been used for a variety of body cavity examinations including oral use．
No serious or long-lasting patient reactions occurred．The patient tolerance of Omnipaque was similar to that observed with the comparable media．
Good or excellent visualization was obtained in the majority of cases，and Omnipaque was found to be well studied for the various examinations．
Indications
Arthrograghy，endoscopic retrograde pancreatography(ERP)，endoscopic retrograde cholangiopancreatography(ERCP)，hemiography，hysterosalpingography，sialography and studies of the gastrointestinal tract using oral water-soluble contrast medium．
Precautions
Iodinated contrast media may provoke anaphylactoid or other allergy-like manifestations．Although the risk of severe reactions in connection with use of Omnipaque is regarded as very minor，a course of action should be planned in advance for immediate treatment，should a serious reaction occur．
A positive history of allergy，asthma or untoward reaction at previous similar investiga tions indicates a need for special caution．Premedication with corticosteroids and possibly antihistamines may be considered in these cases．
Adverse reactions
In body cavities the frequency and intensity of adverse reactions with Omnipaque is similar to that observed with the comparable media．
Dosage
The dosage depends on the type of investigations and the technique used．Usually the same iodine concentration and volume is used as for other intravascular contrast media in current use．
The following dosages may serve as a guide：
Table 23
Storage
Room temperature，protected from light．
A vial of Omnipaque is intended for one patient only．Discard any surplus portion．
Presentation
1．140mg Ⅰ／ml 10 bottles of 50 ml；6 bottles of 200 ml。
2．180mg Ⅰ／ml 10 bottles of 10 ml；10 bottles of 15 ml；10 bottles of 50 ml。
3．240mg Ⅰ／ml 10 bottles of 10 ml；6 bottles of 20 ml；25 bottles of 20 ml；10 bottles of 100 ml。
4．300mg Ⅰ／ml 10 bottles of 10 ml；6 bottles of 20 ml；25 bottles of 20 ml；6 bottles of200ml。
5．350mg I／ml 6 bottles of 20ml；25 bottles of 20ml；10 bottles of 100ml。
Please note
In certain countries some of the indications may not be approved by the health authorities，and some of the concentrations and package sizes may not be available．
300mg I／ml×10ml
300mg I／ml×20ml
300mg I／ml×50ml
300mg I／ml×100ml
300mg I／ml×20ml
300mg I／ml×50ml
Manufacturer
Nycomed Imaging AS，Norway