Imaging the Urinary Tract

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Questions and Answers

What is the main indication for using plain film radiography in the urinary tract?

To diagnose urinary tract infections

To detect urinary tract pathology

To evaluate renal tract calcifications (correct)

To stage urological cancer

What has largely replaced intravenous excretion urography (IVU) as an imaging modality?

Ultrasound (US), CT or MRI or a combination (correct)

Micturating cystography and cystourethrography

Plain film radiography

Radionuclide imaging

What is a contraindication for intravenous excretion urography (IVU)?

Recurrent urinary tract infection

Loin pain

Haematuria

General contraindications to intravenous watersoluble contrast media (correct)

What is recommended for patients with impaired renal function undergoing IVU?

Alternative imaging modality such as ultrasound or MR Signup and view all the answers

What is the sensitivity of plain films in detecting renal tract calcifications?

60% Signup and view all the answers

What is an alternative imaging modality in patients with contrast medium allergies?

Ultrasound or MR Signup and view all the answers

What is an indication for using IVU?

All of the above Signup and view all the answers

What is the technique for plain film radiography similar to?

Excretion urography Signup and view all the answers

What is a contraindication for compression?

After recent abdominal surgery Signup and view all the answers

What is the purpose of the release film?

To show the ureters Signup and view all the answers

What is the purpose of the after micturition film?

To assess bladder emptying and demonstrate drainage of the upper tracts Signup and view all the answers

Why is tomography performed?

If renal outlines are not well seen Signup and view all the answers

What is the purpose of a 35° posterior oblique of the kidneys, ureters or bladder?

For equivocal collecting system lesions or localization of calculi Signup and view all the answers

When is compression released?

When satisfactory demonstration of the pelvicalyceal system has been achieved Signup and view all the answers

What is the purpose of delayed films?

In renal obstruction, to show level and cause of obstruction Signup and view all the answers

Why is a prone abdomen film taken?

To improve visualization of distal ureters Signup and view all the answers

What is the typical dosage of low osmolar contrast material for an adult?

50–100 mL Signup and view all the answers

Why is dehydration not necessary before the examination?

It does not improve image quality Signup and view all the answers

What is the purpose of the preliminary image?

To review the images before proceeding with the examination Signup and view all the answers

What is the approximate time between the injection of contrast material and the immediate film?

10–14 s Signup and view all the answers

What is the purpose of the 5-min film?

To evaluate the presence or absence of obstruction Signup and view all the answers

Why is a compression band applied after the 5-min film?

To produce pelvicalyceal distension Signup and view all the answers

What is the typical location of the x-ray beam for the preliminary image?

At the level of the iliac crests Signup and view all the answers

What is the purpose of the 35° posterior oblique views?

To evaluate the renal outline or possible masses Signup and view all the answers

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

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Description

Learn about the different methods of imaging the urinary tract, including plain radiography, excretion urography, ultrasound, computed tomography, and magnetic resonance imaging.