24 Questions
What is the main indication for using plain film radiography in the urinary tract?
To evaluate renal tract calcifications
What has largely replaced intravenous excretion urography (IVU) as an imaging modality?
Ultrasound (US), CT or MRI or a combination
What is a contraindication for intravenous excretion urography (IVU)?
General contraindications to intravenous watersoluble contrast media
What is recommended for patients with impaired renal function undergoing IVU?
Alternative imaging modality such as ultrasound or MR
What is the sensitivity of plain films in detecting renal tract calcifications?
60%
What is an alternative imaging modality in patients with contrast medium allergies?
Ultrasound or MR
What is an indication for using IVU?
All of the above
What is the technique for plain film radiography similar to?
Excretion urography
What is a contraindication for compression?
After recent abdominal surgery
What is the purpose of the release film?
To show the ureters
What is the purpose of the after micturition film?
To assess bladder emptying and demonstrate drainage of the upper tracts
Why is tomography performed?
If renal outlines are not well seen
What is the purpose of a 35° posterior oblique of the kidneys, ureters or bladder?
For equivocal collecting system lesions or localization of calculi
When is compression released?
When satisfactory demonstration of the pelvicalyceal system has been achieved
What is the purpose of delayed films?
In renal obstruction, to show level and cause of obstruction
Why is a prone abdomen film taken?
To improve visualization of distal ureters
What is the typical dosage of low osmolar contrast material for an adult?
50–100 mL
Why is dehydration not necessary before the examination?
It does not improve image quality
What is the purpose of the preliminary image?
To review the images before proceeding with the examination
What is the approximate time between the injection of contrast material and the immediate film?
10–14 s
What is the purpose of the 5-min film?
To evaluate the presence or absence of obstruction
Why is a compression band applied after the 5-min film?
To produce pelvicalyceal distension
What is the typical location of the x-ray beam for the preliminary image?
At the level of the iliac crests
What is the purpose of the 35° posterior oblique views?
To evaluate the renal outline or possible masses
Study Notes
Methods of Imaging the Urinary Tract
- Plain radiography: used to evaluate renal tract calcifications
- Excretion urography (intravenous urogram [IVU]): less frequently used, replaced by US, CT, or MRI
- Ultrasound (US): used for imaging the urinary tract
- Computed tomography (CT): used for urological diagnosis and cancer staging, characterization of renal lesions, and CT urography
- Magnetic resonance imaging (MRI): used for characterization of renal lesions, prostate imaging, bladder imaging, and MR urography
- Micturating cystography and cystourethrography: used for imaging the urinary tract
- Ascending urethrography: used for imaging the urinary tract
- Retrograde pyeloureterography: used for imaging the urinary tract
- Percutaneous renal procedures: include biopsy, cyst puncture, antegrade pyelography, nephrostomy, and percutaneous nephrolithotomy
- Arteriography: used for imaging the urinary tract
- Venography: used for imaging the urinary tract
- Conduitogram: used for imaging the urinary tract
- Radionuclide imaging: used for static renography, dynamic renography, and radionuclide cystography
Plain Film Radiography
- Indications: evaluating renal tract calcifications
- Technique: as for preliminary films for excretion urography
Intravenous Excretion Urography (IVU or IVP)
- Indications: haematuria, renal colic, recurrent urinary tract infection, loins pain, and suspected urinary tract pathology
- Contraindications: general contraindications to intravenous watersoluble contrast media and ionizing radiation
- Contrast medium: low osmolar contrast material (LOCM) 300–370 mg I mL−1
- Patient preparation:
- No food for 5 hours prior to the examination
- Dehydration is not necessary and does not improve image quality
- No routine administration of bowel preparation
- Preliminary image: supine, full-length anterior posterior (AP) of the abdomen, in inspiration
- Technique:
- Venous access is established
- The gauge of the cannula/needle should allow the injection to be given rapidly as a bolus
- Images are taken at 10–14 seconds, 5 minutes, 10 minutes, and after micturition
- Compression is applied midway between the anterior superior iliac spines
- Compression is contraindicated in certain cases, such as after recent abdominal surgery or renal trauma
Learn about the different methods of imaging the urinary tract, including plain radiography, excretion urography, ultrasound, computed tomography, and magnetic resonance imaging.
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