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Questions and Answers
What is the main difference between Urology and Nephrology?
Which procedure is NOT typically performed using X-ray technology in Urologic and Nephrologic Imaging?
What is the primary patient preparation required for a KUB procedure?
Which of the following is listed as a PRO of KUB imaging?
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What is the main CONTRAINDICATION mentioned in the text for undergoing KUB imaging?
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What is the main indication for performing an Intravenous Pyelography (IVP)?
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Which of the following is a contraindication for Intravenous Pyelography (IVP)?
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What is the primary benefit of a Voiding Cystourethrogram (VCUG) compared to other imaging tests?
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Which procedure requires anesthesia and involves the use of cystoscopy and ureteral catheters?
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What is the main disadvantage associated with Retrograde Pyelogram (RGP)?
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Which of the following is NOT an indication for a Voiding Cystourethrogram (VCUG)?
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What is a common limitation of renal ultrasound according to the text?
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What is a key benefit of scrotal ultrasound highlighted in the text?
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What is a notable contraindication for CT without contrast according to the text?
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Why is CT with IV contrast preferred over CT without contrast according to the text?
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What is a common drawback of CT without contrast highlighted in the text?
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What is the main advantage of the delayed phase in a CT Urogram?
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Which of the following is not an indication for a CT Urogram?
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What is the preferred imaging modality to diagnose renal artery stenosis according to the text?
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In a CT Urogram, why is IV contrast administered more slowly than in other CT scans?
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What is the main drawback (CON) mentioned for a CT Urogram in the text?
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What is the best method to evaluate the renal vasculature and diagnose renal artery stenosis as per the text?
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What does a Captopril renogram help determine?
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Which type of scintigraphy is used for the diagnosis of primary aldosteronism?
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What is the main indication for performing a Lasix scan?
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What is one advantage of renal scintigraphy mentioned in the text?
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Why is renal scintigraphy considered safe for kids?
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What is not a contraindication for renal scintigraphy?
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What is the main indication for a KUB?
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What can easily block views on a KUB
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Intravenous pyleography cannot be used if:
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What patient education is not true in regards to a VCUG
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What is the best and ONLY test for urinary reflux?
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Series of X-rays and fluoroscopy used to watch dye illuminate the renal artery, is completed by:
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IV contrast can temporarily decrease renal function
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PATIENT DOES NOT NEED ANY RISK FACTORS TO HAVE A CONTRAST INDUCED NEPHROPATHY
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Metformin needs to be held for 12h post contrast regardless of Creatinine
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When is a renal ultrasound NOT the test of choice
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A CT without contrast is indicated in the setting of suspected:
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What is the test of choice to determine obstructive v. nonobstructive hydronephrosis
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Study Notes
CT Urogram
- Delayed phase of CT Urogram illuminates the entire urinary tract and allows for 3D reconstruction
- Excellent specificity for renal, ureteral, bladder, or adrenal malignancy
- Non-contrasted portion of CT Urogram helps detect stones
- Contraindications are the same as CT with IV contrast
CT Urogram Indications
- Gross hematuria
- Asymptomatic hematuria + smoker
- Suspected pyelonephritis
- Renal masses
- Renal pelvic tumors
- Bladder malignancy
- Recurrent UTIs
CT Angiogram
- Technique: Similar to other CTs with IV contrast, but IV contrast is administered more slowly to allow for illumination of arteries
- Indications: Best method to detect renal artery stenosis or renal vein thrombus, and for patients with unexplained progressive hypertension
- Patient expectations: Similar to prior CT scans
- Contraindications: Same as CT with IV contrast
MRI Urogram
- Technique: Protons responding to magnetic field and radio wave pulses, computers transform signals into cross-sectional images
- Patient expectations: In a gown, lying flat on a table, bed slides into a narrow cylindrical tube, no soft tissue evaluation
- Patient examples: Staghorn calculus, foreign body
Intravenous Pyelogram (IVP)
- Technique: Patient supine, IV contrast bolus, series of radiographs at timed intervals
- Patient expectations: Prep may include +/- bowel prep, warm feeling, flush, itch, nausea with IV contrast, duration varies
- Indications: Hematuria, recurrent UTI, flank pain, obstructive uropathy
- Contraindications: Pregnancy, IVc allergy, iodine, shellfish, CKD, Cr > 2.0
- Pros: Minimal radiation, internal urinary tract
- Cons: Better imaging exists
Voiding Cystourethrogram (VCUG)
- Technique: Pt supine, urinary catheter in place, KUB, contrast media instilled into bladder, pt voids under fluoroscopy
- Patient expectations: Undressed, in gown, females: frog leg position, catheter placed per urethra, remain still, contrast media flows into bladder causing fullness, urinate when instructed, 30 minutes
- Indications: Young child with recurrent UTIs, known vesicoureteral reflux-monitoring or post-surgical correction
- Pros: Minimal radiation exposure compared to CT, detailed imaging of lower urinary tract, best (only) test for reflux
- Cons: Radiation exposure, catheter insertion can be uncomfortable, UTI post-procedure
Retrograde Pyelogram (RGP)
- Technique: Anesthesia required, cystoscopy, ureteral catheters, KUB, directly into ureters during fluoroscopy contrast media instilled
- Patient expectations: Prep similar to a surgery +/- bowel prep, cystoscope will be placed per urethra and small catheters in ureters
- Renal cortical imaging: detects amount of functioning renal parenchyma, 2-3 hour delay after admin of radiotracer
- Renal perfusion and functional imaging: vascular evaluation and function
- Diuretic renal images (MAG3, Lasix scan): detects obstructions by assessing images before and after administration of diuretic, test of choice to determine obstructive v.nonobstructive hydronephrosis in children
- Captopril renogram: helps determine if renovascular hypertension is present by comparing images before and after admin of Captopril (ACE-inhibitor), every 15 m x 1 hour
Renal Scintigraphy
- Indications: Captopril= renovascular HTN suspected, Lasix= ureteral obstruction suspected, test of choice to determine obstructive v.nonobstructive hydronephrosis, others not commonly used
- Contraindications: Breast feeding, pregnancy
- Pros: Very minimal radiation exposure, safe for kids, allergic reaction to radiotracer extremely rare
- Cons: Time consuming, cannot reliably evaluate for other pathology
Adrenal Scintigraphy
- Used solely for evaluation of function in the diagnosis of primary aldosteronism
- Per Up to Date: “While it has the potential advantage of correlating function with anatomic findings, it is not useful for evaluating small adrenal nodules, as tracer uptake is poor in APAs
Urology and Nephrology
- Urology: Surgical specialty, structure, surgical correction of diseases that affect function, entire urinary tract
- Nephrology: Medical specialty, function, diseases that affect function
X-ray Technology
- KUB: Technique - patient usually supine, 2-3 images, no prep work, remain clothed, remove jewelry, hold breath, quick and painless
- Indications: Abdominal pain (outpt), kidney stones, osseous abnormalities, preliminary radiograph in series
- Contraindications: Pregnancy
- Pros: Patient comfort, minimal radiation
- Cons: Vague, nonspecific, constipation is a killer!!, bowel prep?? solid v. abscess, Doppler= renal vessels, renal masses, patient satisfaction: comfortable, quick, painless, no radiation exposure, only option for pregnant patients
- Cons: Tech dependent, body habitus, cannot evaluate ureters or surrounding anatomy, if abnormality, will need CT scan
Renal Ultrasound
- Indications: Test of choice for evaluation of renal failure, test of choice for unexplained AKI, obstruction v. medical renal disease v. renal artery stenosis, pregnant female, children, suspected renal stones, renal cysts or palpable abdominal mass (Wilm’s tumor), renal masses, less specific than CT, characterization: cyst v. solid, screening test of choice for suspected PCKD, renal transplant monitoring, microhematuria, no risk factors for GU malignancy
- Contraindications: No real contraindications, caution with large body habitus, caution with gross hematuria, caution with nonspecific symptoms
- Renal ultrasound with renal mass
Scrotal Ultrasound
- Technique: Similar to renal US
- Patient expectations: Scrotum will be exposed, 30-minute exam, if already having testicular pain, pressure of the transducer can cause pain
- Indications: Testicular pain, palpable mass, scrotal edema, scrotal trauma, scrotal abscess, test of choice for testicular cancer and testicular torsion
- Contraindications: None
- Pros: Best imaging study for this area of the body, patient comfort, no radiation
- Cons: None
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Description
Test your knowledge on the tools used in urologic and nephrological imaging, including X-ray technology, KUB, IVP, VCUG, RGP, and renal angiogram. Learn about the techniques and applications of each imaging tool.
