Podcast
Questions and Answers
In the context of intravenous urography, what is the most critical physiological parameter to continuously monitor in a patient with known stage 3 chronic kidney disease (CKD) to mitigate the risk of contrast-induced nephropathy (CIN), beyond standard hydration protocols and dose adjustments?
In the context of intravenous urography, what is the most critical physiological parameter to continuously monitor in a patient with known stage 3 chronic kidney disease (CKD) to mitigate the risk of contrast-induced nephropathy (CIN), beyond standard hydration protocols and dose adjustments?
- Central venous pressure (CVP), maintained within a narrow range (8-12 mmHg) to optimize renal perfusion pressure without exacerbating fluid overload.
- Serum creatinine levels, measured every 30 minutes, to detect early signs of renal dysfunction and guide immediate intervention with diuretics.
- Fractional excretion of sodium (FeNa), calculated before and after contrast administration, to differentiate between prerenal azotemia and acute tubular necrosis. (correct)
- Urine output, aiming for a minimum of 300 mL/hour, facilitated by prophylactic administration of loop diuretics like furosemide.
During a retrograde pyeloureterography, an unforeseen allergic reaction to the iodinated contrast media manifests as severe bronchospasm and precipitous drop in blood pressure. Beyond the immediate administration of epinephrine and oxygen, what advanced intervention should be prioritized to stabilize the patient and prevent potential hypoxic brain injury?
During a retrograde pyeloureterography, an unforeseen allergic reaction to the iodinated contrast media manifests as severe bronchospasm and precipitous drop in blood pressure. Beyond the immediate administration of epinephrine and oxygen, what advanced intervention should be prioritized to stabilize the patient and prevent potential hypoxic brain injury?
- Immediate insertion of a laryngeal mask airway (LMA) to secure the airway, followed by administration of intravenous corticosteroids to reduce airway inflammation.
- Bolus administration of intravenous crystalloids (e.g., normal saline) to counteract hypotension, supplemented by antihistamines (e.g., diphenhydramine) to block histamine receptors.
- Urgent endotracheal intubation with cricoid pressure to prevent aspiration, coupled with vasopressor support (e.g., norepinephrine) to maintain adequate cerebral perfusion pressure. (correct)
- Application of continuous positive airway pressure (CPAP) via a tight-fitting mask to improve oxygenation, combined with inhaled bronchodilators (e.g., albuterol) to alleviate bronchospasm.
In the context of ascending urethrography for a patient with suspected urethral stricture post-trauma, what imaging protocol modification would be most prudent to minimize radiation exposure while maximizing diagnostic yield, assuming a high likelihood of significant anatomical distortion?
In the context of ascending urethrography for a patient with suspected urethral stricture post-trauma, what imaging protocol modification would be most prudent to minimize radiation exposure while maximizing diagnostic yield, assuming a high likelihood of significant anatomical distortion?
- Increase the tube voltage (kVp) to enhance contrast penetration through dense tissues, thereby requiring less radiation dose per image.
- Employ pulsed fluoroscopy at the lowest achievable frame rate (e.g., 1 frame per second) with maximal collimation and virtual grid technology to reduce scatter radiation. (correct)
- Acquire a single, high-dose, anteroposterior (AP) radiograph after contrast injection to provide a comprehensive overview of the entire urethra at once.
- Utilize digital subtraction angiography (DSA) to eliminate bone and soft tissue artifacts, allowing for lower contrast doses and reduced imaging time.
During a micturating cystourethrogram (MCUG) on a pediatric patient with a history of recurrent urinary tract infections and suspected vesicoureteral reflux (VUR), which advanced fluoroscopic technique would offer the most sensitive detection of subtle, intermittent VUR while minimizing radiation exposure?
During a micturating cystourethrogram (MCUG) on a pediatric patient with a history of recurrent urinary tract infections and suspected vesicoureteral reflux (VUR), which advanced fluoroscopic technique would offer the most sensitive detection of subtle, intermittent VUR while minimizing radiation exposure?
A patient undergoing an intravenous urography experiences acute flank pain during the compression phase of the examination. Assuming proper compression technique, what rare underlying pathology should be immediately suspected, and what imaging modality would be most appropriate to confirm the diagnosis?
A patient undergoing an intravenous urography experiences acute flank pain during the compression phase of the examination. Assuming proper compression technique, what rare underlying pathology should be immediately suspected, and what imaging modality would be most appropriate to confirm the diagnosis?
In the context of intravenous urography (IVU), what is the most critical rationale for omitting abdominal compression following recent abdominal surgery?
In the context of intravenous urography (IVU), what is the most critical rationale for omitting abdominal compression following recent abdominal surgery?
Imagine a patient undergoing IVU presents with significantly distended calyces on the 5-minute film. What immediate modification to the standard IVU protocol is MOST warranted?
Imagine a patient undergoing IVU presents with significantly distended calyces on the 5-minute film. What immediate modification to the standard IVU protocol is MOST warranted?
Following a standard IVU series, the post-micturition film reveals persistent bladder asymmetry and incomplete emptying. Which secondary imaging modality would offer the MOST comprehensive evaluation of these findings?
Following a standard IVU series, the post-micturition film reveals persistent bladder asymmetry and incomplete emptying. Which secondary imaging modality would offer the MOST comprehensive evaluation of these findings?
In the context of IVU, what is the PRIMARY diagnostic utility of employing AP oblique projections?
In the context of IVU, what is the PRIMARY diagnostic utility of employing AP oblique projections?
For a patient undergoing IVU to investigate suspected pelviureteric junction obstruction, what is the MOST significant rationale for incorporating prone imaging into the protocol?
For a patient undergoing IVU to investigate suspected pelviureteric junction obstruction, what is the MOST significant rationale for incorporating prone imaging into the protocol?
Delayed films, extending up to 24 hours post-contrast injection, are deemed MOST critical in which of the following clinical scenarios during IVU?
Delayed films, extending up to 24 hours post-contrast injection, are deemed MOST critical in which of the following clinical scenarios during IVU?
What is the MOST compelling rationale for modifying the standard adult IVU protocol when imaging infants?
What is the MOST compelling rationale for modifying the standard adult IVU protocol when imaging infants?
Given that infants typically exhibit more rapid urinary drainage post-infancy compared to adults, what is the MOST appropriate adjustment to the IVU imaging timeline for an infant older than one month being assessed for possible hydronephrosis?
Given that infants typically exhibit more rapid urinary drainage post-infancy compared to adults, what is the MOST appropriate adjustment to the IVU imaging timeline for an infant older than one month being assessed for possible hydronephrosis?
In the context of ascending urography, which statement BEST characterizes the technique's functional assessment capabilities and the typical extent of contrast media (CM) insertion?
In the context of ascending urography, which statement BEST characterizes the technique's functional assessment capabilities and the typical extent of contrast media (CM) insertion?
A patient presents with a suspected ureteral stricture and a history of equivocal findings on intravenous urography (IVU). Which of the subsequent conditions would MOST warrant proceeding with ascending urography, rather than alternative imaging modalities, to delineate the stricture?
A patient presents with a suspected ureteral stricture and a history of equivocal findings on intravenous urography (IVU). Which of the subsequent conditions would MOST warrant proceeding with ascending urography, rather than alternative imaging modalities, to delineate the stricture?
During an ascending urography procedure, the interureteric ridge is visualized. Edema in this region would raise suspicion for which of the following conditions?
During an ascending urography procedure, the interureteric ridge is visualized. Edema in this region would raise suspicion for which of the following conditions?
Following an ascending urography, a patient reports lower abdominal pain that is disproportionate to the procedure's invasiveness. Which complication is MOST likely, and what immediate action is MOST appropriate?
Following an ascending urography, a patient reports lower abdominal pain that is disproportionate to the procedure's invasiveness. Which complication is MOST likely, and what immediate action is MOST appropriate?
A patient with a known allergy to iodinated contrast media requires ascending urography due to suspected ureteral obstruction. Which prophylactic strategy would MOST effectively mitigate the risk of an allergic reaction while ensuring diagnostic image quality?
A patient with a known allergy to iodinated contrast media requires ascending urography due to suspected ureteral obstruction. Which prophylactic strategy would MOST effectively mitigate the risk of an allergic reaction while ensuring diagnostic image quality?
Which of the following findings observed during ascending urography would MOST strongly suggest the presence of a ureteral fistula?
Which of the following findings observed during ascending urography would MOST strongly suggest the presence of a ureteral fistula?
In the context of ascending urography, what is the MOST critical consideration regarding the use of abdominal compression, and what potential adverse effect should clinicians vigilantly monitor?
In the context of ascending urography, what is the MOST critical consideration regarding the use of abdominal compression, and what potential adverse effect should clinicians vigilantly monitor?
A patient undergoes ascending urography revealing a long, filiform stricture in the proximal ureter. Post-procedure, the patient develops acute flank pain and fever. What is the MOST appropriate next step in management?
A patient undergoes ascending urography revealing a long, filiform stricture in the proximal ureter. Post-procedure, the patient develops acute flank pain and fever. What is the MOST appropriate next step in management?
During a retrograde pyelogram for suspected PUJ obstruction, after initial contrast media (CM) injection and aspiration, under what specific circumstance should the procedure be immediately terminated, irrespective of the volume injected?
During a retrograde pyelogram for suspected PUJ obstruction, after initial contrast media (CM) injection and aspiration, under what specific circumstance should the procedure be immediately terminated, irrespective of the volume injected?
Following the withdrawal of the ureteric catheter in a retrograde pyelogram, what is the rationale for injecting 2ml of contrast media (CM) at two specific locations, and where are these locations precisely situated?
Following the withdrawal of the ureteric catheter in a retrograde pyelogram, what is the rationale for injecting 2ml of contrast media (CM) at two specific locations, and where are these locations precisely situated?
In the context of retrograde pyelography, what specific finding, visualized fluoroscopically, would most strongly suggest a diagnosis of diffuse transitional cell carcinoma?
In the context of retrograde pyelography, what specific finding, visualized fluoroscopically, would most strongly suggest a diagnosis of diffuse transitional cell carcinoma?
What are the most critical technique-related complications that a urologist must be vigilant for during a retrograde pyelogram, ensuring prompt intervention?
What are the most critical technique-related complications that a urologist must be vigilant for during a retrograde pyelogram, ensuring prompt intervention?
In the immediate post-procedure period following a retrograde pyelogram, assuming prophylactic antibiotics were not administered, what specific patient instruction is paramount to ensure early detection of potential complications, and why?
In the immediate post-procedure period following a retrograde pyelogram, assuming prophylactic antibiotics were not administered, what specific patient instruction is paramount to ensure early detection of potential complications, and why?
During a retrograde pyelogram, extravasation of contrast media (CM) due to overdistension of the renal pelvis constitutes a notable risk. What specific physiological consequence arises directly from this extravasation, demanding immediate clinical attention?
During a retrograde pyelogram, extravasation of contrast media (CM) due to overdistension of the renal pelvis constitutes a notable risk. What specific physiological consequence arises directly from this extravasation, demanding immediate clinical attention?
Post-retrograde pyelogram, what is the most compelling rationale for considering the administration of prophylactic antibiotics even in the absence of overt signs of infection, considering the inherent risks of the procedure?
Post-retrograde pyelogram, what is the most compelling rationale for considering the administration of prophylactic antibiotics even in the absence of overt signs of infection, considering the inherent risks of the procedure?
What is the definition of ascending urethrography?
What is the definition of ascending urethrography?
In the context of intravenous urography (IVU) for a patient with a known allergy to contrast media (CM), what is the MOST critical rationale for administering methylprednisolone 12 and 2 hours before the examination, considering the potential for severe adverse reactions and the need for diagnostic image quality?
In the context of intravenous urography (IVU) for a patient with a known allergy to contrast media (CM), what is the MOST critical rationale for administering methylprednisolone 12 and 2 hours before the examination, considering the potential for severe adverse reactions and the need for diagnostic image quality?
During the preparatory phase of an IVU, what is the PRIMARY physiological justification for instructing the patient to void (go to the toilet) immediately before the procedure, considering its impact on image interpretation and patient comfort?
During the preparatory phase of an IVU, what is the PRIMARY physiological justification for instructing the patient to void (go to the toilet) immediately before the procedure, considering its impact on image interpretation and patient comfort?
In the context of IVU imaging, what is the most compelling reason for meticulously documenting the patient's current drug therapy prior to the procedure, considering the potential for pharmacological interactions and their impact on renal function and contrast media excretion?
In the context of IVU imaging, what is the most compelling reason for meticulously documenting the patient's current drug therapy prior to the procedure, considering the potential for pharmacological interactions and their impact on renal function and contrast media excretion?
In a retrograde pyelogram, considering the necessity for optimal visualization of subtle urothelial abnormalities while minimizing patient risk, which characteristic of Low Osmolar Contrast Media (LOCM) is most crucial to modulate, and why?
In a retrograde pyelogram, considering the necessity for optimal visualization of subtle urothelial abnormalities while minimizing patient risk, which characteristic of Low Osmolar Contrast Media (LOCM) is most crucial to modulate, and why?
Given the necessity of a control film in IVU, what nuanced aspect of machine status is being evaluated that transcends basic functionality, and how does this evaluation critically inform subsequent imaging parameters?
Given the necessity of a control film in IVU, what nuanced aspect of machine status is being evaluated that transcends basic functionality, and how does this evaluation critically inform subsequent imaging parameters?
Given a patient with a known history of severe contrast-induced nephropathy (CIN) undergoing a retrograde pyelogram for suspected ureteral stricture, which prophylactic measure demonstrates the most nuanced understanding of renal physiology and CIN pathophysiology?
Given a patient with a known history of severe contrast-induced nephropathy (CIN) undergoing a retrograde pyelogram for suspected ureteral stricture, which prophylactic measure demonstrates the most nuanced understanding of renal physiology and CIN pathophysiology?
What is the MOST critical technical consideration when selecting the gauge and insertion technique for an intravenous (IV) catheter during IVU, aiming to optimize contrast media delivery while minimizing the risk of extravasation and maintaining patient vascular integrity?
What is the MOST critical technical consideration when selecting the gauge and insertion technique for an intravenous (IV) catheter during IVU, aiming to optimize contrast media delivery while minimizing the risk of extravasation and maintaining patient vascular integrity?
In the context of retrograde pyelography, what is the most critical rationale for ensuring the patient has fasted for at least 4-6 hours prior to the examination, considering both patient safety and procedural efficacy?
In the context of retrograde pyelography, what is the most critical rationale for ensuring the patient has fasted for at least 4-6 hours prior to the examination, considering both patient safety and procedural efficacy?
Beyond mere visualization, what is the principal diagnostic value of the immediate film (acquired 10-14 seconds post-contrast administration) in IVU, considering its role in evaluating early-phase renal perfusion and identifying subtle parenchymal abnormalities?
Beyond mere visualization, what is the principal diagnostic value of the immediate film (acquired 10-14 seconds post-contrast administration) in IVU, considering its role in evaluating early-phase renal perfusion and identifying subtle parenchymal abnormalities?
During a retrograde pyelogram, if extravasation of contrast media is observed, what is the MOST appropriate immediate next step, considering potential complications and diagnostic objectives?
During a retrograde pyelogram, if extravasation of contrast media is observed, what is the MOST appropriate immediate next step, considering potential complications and diagnostic objectives?
What is the MOST insightful interpretation of delayed or absent excretion on the 5-minute film during IVU, considering a patient with known hypertension and a history of recurrent urinary tract infections, and how does this inform subsequent diagnostic and therapeutic decisions?
What is the MOST insightful interpretation of delayed or absent excretion on the 5-minute film during IVU, considering a patient with known hypertension and a history of recurrent urinary tract infections, and how does this inform subsequent diagnostic and therapeutic decisions?
Which of the following represents the MOST sophisticated rationale for employing compression during IVU, extending beyond simple ureteric distention to enhance visualization, and how does this rationale influence the technical execution of the compression maneuver?
Which of the following represents the MOST sophisticated rationale for employing compression during IVU, extending beyond simple ureteric distention to enhance visualization, and how does this rationale influence the technical execution of the compression maneuver?
What is the primary purpose of performing preliminary films, specifically a full-length supine AP abdomen radiograph, prior to initiating the contrast injection during a retrograde pyelogram performed in the X-ray department?
What is the primary purpose of performing preliminary films, specifically a full-length supine AP abdomen radiograph, prior to initiating the contrast injection during a retrograde pyelogram performed in the X-ray department?
If, during a retrograde pyelogram, a patient with a known allergy to iodinated contrast media experiences acute bronchospasm and hypotension despite premedication with antihistamines and corticosteroids, which intervention should be prioritized?
If, during a retrograde pyelogram, a patient with a known allergy to iodinated contrast media experiences acute bronchospasm and hypotension despite premedication with antihistamines and corticosteroids, which intervention should be prioritized?
Following a retrograde pyelogram, a patient reports persistent flank pain and develops a fever of 38.5°C (101.3°F) 48 hours post-procedure. Urinalysis reveals significant pyuria and bacteriuria. Which management strategy addresses the most critical concern?
Following a retrograde pyelogram, a patient reports persistent flank pain and develops a fever of 38.5°C (101.3°F) 48 hours post-procedure. Urinalysis reveals significant pyuria and bacteriuria. Which management strategy addresses the most critical concern?
When adapting retrograde pyelography for pediatric patients, what is the most critical adjustment in technique to minimize radiation exposure while maintaining diagnostic image quality, assuming all ALARA principles are meticulously followed?
When adapting retrograde pyelography for pediatric patients, what is the most critical adjustment in technique to minimize radiation exposure while maintaining diagnostic image quality, assuming all ALARA principles are meticulously followed?
Flashcards
Urinary System Anatomy
Urinary System Anatomy
The structure of organs involved in urine production and excretion, including kidneys, ureters, bladder, and urethra.
Intravenous Urography
Intravenous Urography
A radiographic procedure that uses contrast media injected into the bloodstream to visualize the urinary tract.
Retrograde Pyeloureterography
Retrograde Pyeloureterography
An imaging technique where contrast is injected reverse through the ureters to visualize the kidneys and ureters.
Micturating Cystourethrography (MCUG)
Micturating Cystourethrography (MCUG)
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Special Considerations in Radiography
Special Considerations in Radiography
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KUB Radiograph Compression
KUB Radiograph Compression
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5-Minute Film Purpose
5-Minute Film Purpose
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15-Minute Film Role
15-Minute Film Role
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Release Film Importance
Release Film Importance
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Post-Micturation Film Usage
Post-Micturation Film Usage
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Additional Films Types
Additional Films Types
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IVU Series for Infants
IVU Series for Infants
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Delayed Films Purpose
Delayed Films Purpose
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Methyle Prednisolone Administration
Methyle Prednisolone Administration
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Control Film Purpose
Control Film Purpose
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IV Line Setup
IV Line Setup
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Timing in IVU Procedure
Timing in IVU Procedure
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Immediate Film Exposure
Immediate Film Exposure
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Pre-procedure Checklist
Pre-procedure Checklist
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Film Sequence in IVU
Film Sequence in IVU
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Edema in Interureteric Ridge
Edema in Interureteric Ridge
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Complications of CM
Complications of CM
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Aftercare Instructions
Aftercare Instructions
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Ascending Urography Definition
Ascending Urography Definition
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Indications for Urography
Indications for Urography
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Contraindications for Urography
Contraindications for Urography
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Equipment for Urography
Equipment for Urography
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Extravasation Definition
Extravasation Definition
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Leg Stirrups
Leg Stirrups
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Sterile Tray/Set
Sterile Tray/Set
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Normal Saline Purpose
Normal Saline Purpose
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LOCM
LOCM
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Patient Preparation
Patient Preparation
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Cystoscope Use
Cystoscope Use
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Catheterization Technique
Catheterization Technique
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X-ray Department Role
X-ray Department Role
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Ureteric Catheter Procedure
Ureteric Catheter Procedure
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Contrast Media (CM) Usage
Contrast Media (CM) Usage
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PUJ Obstruction Indicators
PUJ Obstruction Indicators
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Withdrawn Catheter Step
Withdrawn Catheter Step
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Retrograde Pyelogram
Retrograde Pyelogram
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Possible Complications
Possible Complications
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Post-Procedure Care
Post-Procedure Care
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Ascending Urethrography Definition
Ascending Urethrography Definition
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Study Notes
Urinary System Overview
- Students should be able to describe the anatomy and physiology of the urinary system at the end of the session.
- They should also describe common procedures, technical factors, contrast media, and procedure-related drugs.
- Special considerations within the urinary system should also be covered.
- Demonstrating ethics and professionalism in role-play is necessary while performing radiographic positioning.
- Teamwork skills are also essential during radiographic positioning, with attention to technical parameters and considerations specific to the urinary system.
Urinary System Procedures
- Intravenous (Descending) Urography, Ascending Urography, Retrograde Pyeloureterography, Ascending Urethrography, and Micturating Cystourethography (MCUG) are procedures included in the urinary system.
Urinary System Introductions
- The examination covers the kidney, ureter, urinary bladder, and urethra.
- Contrast media is used to visualize the urinary tract adequately.
- Water-soluble contrast is administered intravenously.
- Antegrade filling provides a physiologic study of the system.
- Retrograde filling is done via catheter or sound, but does not provide a physiologic study.
- Sterile technique is required for retrograde filling.
Methods of Demonstrating the Urinary System
- Plain films, Intravenous Urography (IVU), Micturating cystography, Ascending Urethrography, Retrograde pyelography, Percutaneous renal puncture, Arteriography, and venography.
- Radioisotopes, Computed Tomography (CT), and Magnetic Resonance Imaging (MRI) are imaging techniques that can be used to examine the urinary system.
Indications for Urography
- Demonstrates the physiologic function and structure of the urinary system.
- Evaluation of abdominal masses, renal cysts, and tumors.
- Urolithiasis (kidney stones), Pyelonephritis (kidney infection), Hydronephrosis (swelling of the kidney), Trauma effects, Pre-operative evaluation, and Renal hypertension are also included.
Contraindications for Urography
- Inability to filter the contrast medium from the blood.
- Allergy to contrast medium.
- Abnormal blood urea nitrogen (BUN) and creatinine levels.
General Patient Preparation
- Patients should follow a low-residue diet 1-2 days before the examination.
- A laxative is recommended the day before.
- Patients need to be NPO (nothing by mouth) after midnight.
- Well-hydrated patients with multiple myeloma, high uric acid levels, or diabetes are preferred.
- Dehydration increases the risk of renal failure.
- IVU (Intravenous Urography)
Related Anatomy
- Preliminary KUB (kidney, ureter, bladder) films are taken before an IVU.
- Abdominal views are used to help spot kidney stones.
- Post-traumatic imaging, in order to determine extent of injuries involving urinary organs.
- Technical factors: use proper positions: Supine, full length of the abdomen while in inspiration, 35 x 43 cm film, includes upper pole of kidneys & symphysis pubis, center at the level of iliac crest, and FFD 100cm
Indications for Urinary Tract Procedures
- Urinary tract pathology, renal stones, obstructions, and hydronephrosis.
Contraindications for the use of Contrast Media
- Allergy to contrast media, renal failure due to dehydration, myeloma due to dehydration, or infancy due to dehydration.
Contrast Media
- Iodine-based contrast media (LOCM/IOCM) is normally preferred, especially in infants, young children, and elderly patients.
- Renal and cardiac failure, and dehydration are also considerations for when choosing contrast.
Patient Preparation for an IVU
- The patient should follow a low residue diet for 1-2 days prior.
- A laxative to clear the bowels one day before.
- NPO (nothing by mouth) after midnight.
- Patients with conditions that require hydration prior to the procedure (such as multiple myeloma, high uric acid levels, or diabetes) should be well hydrated.
- Dehydration increases the risk of renal failure.
Urography Film Sequence-Control/Preliminary/Immediate/5 Minutes
- Control film (35x43cm): KUB, including the lower border of the symphysis pubis and diaphragm
- Immediate film (24x30cm): AP of renal areas, ideally taken under one minute.
- 5-minute film (35x43cm): to assess purpose and evaluate need for compression
Preliminary Films
- A preliminary AP abdomen, taken in supine position, is typically the first control film .
- This film assesses exposure, positioning, bowel prep/condition, initial stone localization, and overall machine status, providing a baseline for comparison in contrast studies.
Intravenous Urography Technique
- The IV line is typically placed in the antecubital vein.
- An appropriate sized needle (e.g. 19G) is used.
- The contrast medium is gently injected into the chosen vein, the flow rate can be adjusted to control the rate of contrast flow.
- Positioning should be consistent, spot films are taken and reviewed frequently.
- Appropriate compression to prevent issues with patient comfort.
Procedure Steps (IVU)
- Timing set up: Once the contrast material is administered, start the timer.
- Immediate film: taken 10-14 seconds after injecting contrast medium, to visualize the nephrogram/nephrotomogram, enhancing the renal area with contrast.
- 5-minute film: assessing excretion of the contrast material, with a focus on both kidneys.
- 15-minute film: imaging the entirety of the pelvicalyceal system; if satisfactory, compression is released.
- Release film: to demonstrate the full urinary tract (often taken after bladder drainage).
- Post-micturition film: Shows normal bladder emptying and return to normal condition.
Urography Equipment
- The equipment used during a typical examination includes an X-ray system/machine, an angulated table, foot pad, imaging device, and likely immobilization aids.
- Contrast medium and syringes will also be needed.
Patient Preparation Procedures
- Blood tests (PT, PTT, platelet count) are commonly ordered before the procedures.
- NPO (nothing by mouth) for 4-6 hours.
- Light evening meal before the procedure (2 days prior).
- Ambulatory status 2 hours prior is strongly recommended.
- Bowel cleansing (laxative or enema) in the morning of the procedure.
- Appropriate medication considerations should be discussed prior to starting the procedure.
Films sequence for IVU
- Preliminary films (35x43cm): Control film (KUB).
- Immediate film (24x30cm): AP view of kidneys.
- 5-minute film (35x43cm): further assessment.
- 15-minute film (35x43cm): assessment of the entire pelvicalyceal system.
- Release film (35x43cm): ensuring satisfactory excretion.
- Post-micturition film (35x43cm): post-voiding imaging.
Additional Films
- AP oblique projections (35x43cm) are sometimes used to locate the radiopaque shadow, determining if it is located within the ureter or elsewhere.
- Prone (35x43cm) views are useful for investigating potential pelviureteric or ureteric obstructions.
- Delayed films (35x43cm) may be necessary if additional assessment of ureteric obstruction is needed.
IVU series for Infants
- The procedure needs a reduction in radiation dose.
- Imaging involves two 2-minute films of the renal area and a 15-minute film of the abdominal region.
- No compression.
- Drainage time is faster in infants than in adults.
Related Pathology
- Various pathologies (e.g., kidney stones, ureteral obstruction, and complications affecting the ureter and renal pelvis).
Complications of Urography
- Adverse reactions to contrast media (mild to severe).
- Complications related to technique (e.g., improper compression, swelling, pain during injection, extravasation of contrast).
Aftercare for Urography
- Patients are advised to drink plenty of water.
- Allergy checks (if present) should be reassessed.
- Ensure injection site is properly secured and monitored.
Ascending Urethrography
- Uses contrast material (CM) to evaluate the bladder and urethra.
- The CM is injected into the urethra using a catheter.
- The procedure aims to diagnose any pathological conditions affecting the urethra.
Indications for Ascending Urethrography
- Strictures
- Anterior urethra disease/tear
- Trauma
- Congenital abnormalities
- Prostatic abscesses
- Fistulae/false passages
- Acute Urinary Tract Infection (UTI)
- Recent instrumentations
Equipment for Ascending Urethrography
- An X-ray system, including an angulated table and imaging device.
- A foot pad.
- A catheter for precise placement of contrast medium.
- Lubricating gel to help ensure adequate passage of the catheter.
- Contrast media (normal saline solution) to administer, and likely pre-warmed.
- A galley pot.
- Gauze pads.
Film Sequence for Ascending Urethrography
- Preliminary films (e.g., a coned PA supine view).
- During the procedure (e.g., 30-degree LAO or RAO projections with the patient in supine position and legs abducted, with knee flexed.)
Micturating Cystourethrography (MCUG)
- A voiding study analyzing the urinary bladder and urethra during urination.
- Used for assessing conditions like vesicoureteric reflux (VUR), urinary tract abnormalities, and stress incontinence (leakage of urine when there's pressure on the bladder).
Indications for MCUG
- Vesicoureteric reflux
- Functional issues of the urethra during urination
- Abnormalities in the bladder
- Stress incontinence
Related Equipment for MCUG
- X-ray system/machine equipped with an angulated table and foot pad.
- Imaging device.
- Catheter.
- Contrast media and syringe.
- Lubricating gel.
- Normal saline.
- Galley pot.
- Gauze pads.
Patient Preparation for MCUG
- Patients should urinate before the exam.
- The patient is placed in the supine position.
- Preliminary film(s) may be taken using under-couch tube technique.
Patient Prep for Urography, Ascending Urography, and MCUG
- Preparing the patient ensures a precise examination, to minimize artifacts and obtain the best possible images for diagnostic purposes.
Procedure Sequence for MCUG
- Patient positioned supine.
- Catheter insertion (with lubricating gel).
- Placing the tip of the catheter correctly (fossa navicularis of the penis).
- Inflate catheter balloon using normal saline.
- Inject CM (contrast material) under fluoroscopic guidance.
- Imaging while the patient urinates (in various positions).
Complications of Urinary Procedures (MCUG)
- Due to contrast media: Allergic reactions, cystitis.
- Due to technique: Acute UTI, catheter trauma, bladder complications, ectopic ureteral orifices, retention of the catheter.
Aftercare for MCUG
- Plenty of fluids.
- Monitor for urinary side effects as needed.
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