Radiographic Technique II PDF

Radiographic Technique II AMRR 221 Dr. Elbagir Hamza Manssor, Ph.D. Ass. Professor Department of Applied Radiological Sciences College of Applied Medical Sciences Jeddah University. Lec (7) Urinary tract Plain radiography of the abdominal and pelvic cavity is carried out to visualize: Psoas musc...

Radiographic Technique II AMRR 221 Dr. Elbagir Hamza Manssor, Ph.D. Ass. Professor Department of Applied Radiological Sciences College of Applied Medical Sciences Jeddah University. Lec (7) Urinary tract Plain radiography of the abdominal and pelvic cavity is carried out to visualize: Psoas muscle 1. Outline of the kidneys, surrounded by their perirenal fat. 2. The lateral border of the psoas muscle. 3. Opaque stones in the kidney area, in the line of the ureters and in the region of the bladder. 4. Calcifications within the kidney or in the bladder wall. 5. The presence of gas within the urinary tract. :‫ﻄﻦ واﻟﺤﻮض ﻟﺘﺼﻮر‬7‫ﻒ اﻟ‬9:‫ﺮ اﻟﺸﻌﺎﻋﻲ اﻟﻌﺎدي ﻟﺘﺠ‬9:‫ﻳﺘﻢ إﺟﺮاء اﻟﺘﺼ‬ .‫ﻄﺔ ﺑﻬﺎ‬L‫ﺪﻫﻮﻧﻬﺎ اﻟﻤﺤ‬Q ‫ ﻣﺤﺎﻃﺔ‬،‫ﻠﻰ‬W‫ﻣﺨﻄﻂ ﻟﻠ‬ .psoas ‫ﺔ ﻟﻌﻀﻠﺔ‬L_‫اﻟﺤﺪود اﻟﺠﺎﻧ‬ .‫ وﻓﻲ ﺧﻂ اﻟﺤﺎﻟﺐ وﻓﻲ ﻣﻨﻄﻘﺔ اﻟﻤﺜﺎﻧﺔ‬،‫ﻠﻰ‬W‫ﺣﺼﻮات ﻣﺒﻬﻤﺔ ﻓﻲ ﻣﻨﻄﻘﺔ اﻟ‬ .‫ﻠﻰ أو ﻓﻲ ﺟﺪار اﻟﻤﺜﺎﻧﺔ‬W‫ﻠﺲ داﺧﻞ اﻟ‬l‫اﻟﺘ‬ .‫ﺔ‬L‫وﺟﻮد ﻏﺎز داﺧﻞ اﻟﻤﺴﺎﻟﻚ اﻟﺒﻮﻟ‬ AP supine plain showing a left lower pole renal calculus and a calculus in the upper right ureter Radiation protection: • The pregnancy rule should be observed unless permission has been given in case of emergency. • If the whole of the renal tract including bladder is to be visualized, then no gonad shielding is possible for females for males, a small lead sheet can protect the testes. • If the bladder and lower ureters are not to be included on the image, then females can also be given gonad protection by placing a lead-rubber sheet over the lower abdomen to protect the ovaries. :‫ﺔ ﻣﻦ اﻹﺷﻌﺎع‬Q‫اﻟﺤﻤﺎ‬ .‫ﺠﺐ ﻣﺮاﻋﺎة ﻗﺎﻋﺪة اﻟﺤﻤﻞ ﻣﺎ ﻟﻢ ﻳﺘﻢ ﻣﻨﺢ اﻹذن ﻓﻲ ﺣﺎﻟﺔ اﻟﻄﻮارئ‬Q .‫ﺘﻴﻦ‬l‫ﺔ اﻟﺨﺼ‬Q‫ﻤﻜﻦ ﻟﻮرﻗﺔ اﻟﺮﺻﺎص اﻟﺼﻐﻴﺮة ﺣﻤﺎ‬s‫ و‬،‫ـ ــﻊ اﻟﻐﺪد اﻟﺘﻨﺎﺳﻠ|ﺔ ﻟﻺﻧﺎث ﻟﻠﺬﻛﻮر‬s‫ﻤﻜﻦ اﻟﺘﺪر‬Q ‫ ﻓﻼ‬،‫ﻠﻮي „ﺄ†ﻤﻠﻪ „ﻤﺎ ﻓﻲ ذﻟﻚ اﻟﻤﺜﺎﻧﺔ‬‰‫ﺎن ﻣﻦ اﻟﻤﻘﺮر ﺗﺼﻮر اﻟﺠﻬﺎز اﻟ‬Ž ‫إذا‬ .‫ﺔ اﻟﻤﺒ|ﻀﻴﻦ‬Q‫ﻖ وﺿﻊ ورﻗﺔ ﻣﻄﺎﻃ|ﺔ ﻣﻦ اﻟﺮﺻﺎص ﻓﻮق أﺳﻔﻞ اﻟ’ﻄﻦ ﻟﺤﻤﺎ‬s™‫ﺔ اﻟﻐﺪد اﻟﺘﻨﺎﺳﻠ|ﺔ ﻋﻦ ﻃ‬Q‫ﻀﺎ إﻋﻄﺎء اﻹﻧﺎث ﺣﻤﺎ‬Q‫ ﻓ|ﻤﻜﻦ أ‬،‫إذا ﻟﻢ ﻳﺘﻢ ﺗﻀﻤﻴﻦ اﻟﻤﺜﺎﻧﺔ واﻟﺤﺎﻟﺐ اﻟﺴﻔﻠ|ﺔ ﻓﻲ اﻟﺼﻮرة‬ Preparation of the patient 1.If possible, the patient should have a low-residue diet and laxatives during the 48 hours prior to the examination to clear the bowel of gas and faecal matter that might overlie the renal tract. 2.In the case of emergency radiography, no bowel preparation is possible. 3.The patient wears a clean hospital gown. ‫ﺾ ﻟﻠﻤﺮض‬s™‫إﻋﺪاد اﻟﻤ‬ .‫ﻠﻮي‬‰‫ ﺳﺎﻋﺔ ﻗ’ﻞ اﻟﻔﺤﺺ ﻟﺘﻄﻬﻴﺮ اﻷﻣﻌﺎء ﻣﻦ اﻟﻐﺎز واﻟﺒﺮاز اﻟﺘﻲ ﻗﺪ ﺗﻄﻐﻰ ﻋﻠﻰ اﻟﺠﻬﺎز اﻟ‬48 ‫ﺎ وﻣﺴﻬﻼت ﺧﻼل‬Q‫ﺾ ﻧﻈﺎﻣﺎ ﻏﺬاﺋ|ﺎ ﻣﻨﺨﻔﺾ اﻟ’ﻘﺎ‬s™‫ﺠﺐ أن ﻳ«ﺒﻊ اﻟﻤ‬Q ،‫ﺎن ذﻟﻚ ﻣﻤﻜﻨﺎ‬Ž ‫إذا‬ .‫ﻤﻜﻦ ﺗﺤﻀﻴﺮ اﻷﻣﻌﺎء‬Q ‫ ﻻ‬،‫ﺮ اﻟﺸﻌﺎﻋﻲ ﻓﻲ ﺣﺎﻻت اﻟﻄﻮارئ‬s®‫ﻓﻲ ﺣﺎﻟﺔ اﻟﺘﺼ‬ .‫ﺾ ﺛﻮب ﻣﺴ«ﺸﻔﻰ ﻧﻈ|ﻔﺎ‬s™‫ﻳﺮﺗﺪي اﻟﻤ‬ Antero-posterior(Plain Abd+ Pelv) • The patient lies supine, with the MSP of the body at right-angles to and in the midline of the table. • Cassette used should be large enough to cover the region from above the upper poles of the kidneys to the symphysis pubis (35*43 cm cassette). • The center of the cassette will be at the level of a point located 1 cm below the line joining the iliac crests. • A wide immobilization band is applied to the patient’s abdomen and, depending on the patient’s condition, compression is applied. (‫ ﺑ|ﻠﻒ‬+ -) ‫أﻣﺎﻣﻲ ﺧﻠﻔﻲ‬ .‫ﺎ اﻟ|ﻤﻨﻰ إﻟﻰ ﺧﻂ اﻟﻮﺳﻂ ﻣﻦ اﻟﺠﺪول وﻓ|ﻪ‬Q‫ ﻓﻲ اﻟﺠﺴﻢ ﻓﻲ اﻟﺰوا‬MSP ‫ ﻣﻊ وﺟﻮد‬،‫ﺾ ﻣﺴﺘﻠﻘ|ﺎ‬s™‫ﺴﺘﻠﻘﻲ اﻟﻤ‬º .(‫ ﺳﻢ‬43 * 35 ‫ﺎﺳ¿ﺖ‬Ž) - ‫ﻠﻰ إﻟﻰ‬‰‫ﻴﻦ ﻟﻠ‬s®‫ﻜﻔﻲ ﻟﺘﻐﻄ|ﺔ اﻟﻤﻨﻄﻘﺔ ﻣﻦ ﻓﻮق اﻟﻘﻄﺒﻴﻦ اﻟﻌﻠ‬Q ‫ﺎﺳ¿ﺖ اﻟﻤﺴﺘﺨﺪﻣﺔ ﻛﺒﻴﺮة „ﻤﺎ‬‰‫ﺠﺐ أن ﺗﻜﻮن اﻟ‬Q .‫ ﺳﻢ أﺳﻔﻞ اﻟﺨﻂ اﻟﺬي ﻳﻨﻀﻢ إﻟﻰ ﻗﻤﻢ اﻟﺤﺮﻗﻔﻲ‬1 ‫ﺎﺳ¿ﺖ ﻋﻠﻰ ﻣﺴﺘﻮى ﻧﻘﻄﺔ ﺗﻘﻊ ﻋﻠﻰ ﻋﻤﻖ‬‰‫ﺳ|ﻜﻮن ﻣﺮﻛﺰ اﻟ‬ .‫ ﻳﺘﻢ ﺗﻄﺒﻴﻖ اﻟﻀﻐﻂ‬،‫ﺾ‬s™‫ واﻋﺘﻤﺎدا ﻋﻠﻰ ﺣﺎﻟﺔ اﻟﻤ‬،‫ﺾ‬s™‫ﻂ ﺷﻞ ﺣﺮﻛﺔ واﺳﻊ ﻋﻠﻰ „ﻄﻦ اﻟﻤ‬s‫ﻳﺘﻢ ﺗﻄﺒﻴﻖ ﺷﺮ‬ Direction and centering of the X-ray beam: • The vertical central ray is directed to the center of the cassette, which is in the midline about the level of the low costal margin. ST • The X-ray beam is collimated to just within the margins of the cassette. • Using a high mA and a short exposure time, the exposure is made on arrested respiration after full expiration. :‫ﻨ|ﺔ وﺗﻮﺳ|ﻄﻪ‬l‫اﺗﺠﺎە ﺷﻌﺎع اﻷﺷﻌﺔ اﻟﺴ‬ ‫ﺲ‬º‫ اﻟﻘﺪ‬.‫ﻠﻔﺔ‬Ã‫ﻘﻊ ﻓﻲ ﺧﻂ اﻟﻮﺳﻂ ﺣﻮل ﻣﺴﺘﻮى اﻟﻬﺎﻣﺶ ﻣﻨﺨﻔﺾ اﻟﺘ‬Q ‫ اﻟﺬي‬،‫ﺎﺳ¿ﺖ‬‰‫ﻳﺘﻢ ﺗﻮﺟ|ﻪ اﻟﺸﻌﺎع اﻟﻤﺮﻛﺰي اﻟﻌﻤﻮدي إﻟﻰ وﺳﻂ اﻟ‬ .‫ﺎﺳ¿ﺖ ﻣ’ﺎﺷﺮة‬‰‫ﻨ|ﺔ داﺧﻞ ﻫﻮاﻣﺶ اﻟ‬l‫ﺗﺘﻢ ﻣﻮازاة ﺷﻌﺎع اﻷﺷﻌﺔ اﻟﺴ‬ .‫ﺎﻣﻞ‬‰‫ ﻳﺘﻢ اﻟﺘﻌﺮض ﻟﻠﺘﻨﻔﺲ اﻟﻤﻮﻗﻮف „ﻌﺪ اﻧﺘﻬﺎء اﻟﺼﻼﺣ|ﺔ اﻟ‬،‫„ﺎﺳﺘﺨﺪام ﻣﻠﻠﻲ أﻣﺒﻴﺮ ﻣﺮﺗﻔﻊ ووﻗﺖ ﺗﻌﺮض ﻗﺼﻴﺮ‬ Additional information may be obtained with posterior oblique projections: • The right posterior oblique projection shows the right kidney and collecting system in profile and the left kidney. • Similarly, the left posterior oblique projection shows the left kidney in profile and the right kidney. • A lateral projection may be necessary to confirm the presence of opacities anterior or posterior to the renal tract, which will be seen superimposed on the AP projection. Right posterior oblique :‫ﻤﻜﻦ اﻟﺤﺼﻮل ﻋﻠﻰ ﻣﻌﻠﻮﻣﺎت إﺿﺎﻓ|ﺔ ﻣﻊ اﻟﺘﻮﻗﻌﺎت اﻟﻤﺎﺋﻠﺔ اﻟﺨﻠﻔ|ﺔ‬Q .‫ﻠﻰ اﻟ¿ﺴﺮى‬‰‫ﻠﻰ اﻟ|ﻤﻨﻰ وﻧﻈﺎم اﻟﺘﺠﻤﻴﻊ ﻓﻲ اﻟﻤﻠﻒ اﻟﺸﺨﺼﻲ واﻟ‬‰‫ﻤﻦ اﻟ‬Q‫ﻈﻬﺮ اﻹﺳﻘﺎط اﻟﻤﺎﺋﻞ اﻟﺨﻠﻔﻲ اﻷ‬Q .‫ﻠﻰ اﻟ|ﻤﻨﻰ‬‰‫ﻠﻰ اﻟ¿ﺴﺮى ﻓﻲ اﻟﻤﻠﻒ اﻟﺸﺨﺼﻲ واﻟ‬‰‫ﺴﺮ اﻟ‬º‫ﻈﻬﺮ اﻹﺳﻘﺎط اﻟﻤﺎﺋﻞ اﻟﺨﻠﻔﻲ اﻷ‬Q ،‫ﺎﻟﻤﺜﻞ‬É‫و‬ .AP ‫’ﺎ ﻋﻠﻰ إﺳﻘﺎط‬Ê‫ واﻟﺬي ﺳ|ﻈﻬﺮ ﻣﺘﺮا‬،‫ﻠﻮي‬‰‫|ﺪ وﺟﻮد ﺗﻌﺘ|ﻢ أﻣﺎﻣﻲ أو ﺧﻠﻔﻲ ﻟﻠﺠﻬﺎز اﻟ‬Ê‫ﺎ ﻟﺘﺄ‬s‫ﻜﻮن اﻹﺳﻘﺎط اﻟﺠﺎﻧﺒﻲ ﺿﺮور‬Q ‫ﻗﺪ‬ Lateral Urinary bladder (‫اﻟﻤﺜﺎﻧﺔ اﻟﺒﻮﻟ|ﺔ )اﻟﺒﻮل‬ • Calculi (stone) within the urinary bladder can move freely, particularly if the bladder is full, whereas calcification and calculi outside the bladder, e.g. prostatic calculi, are immobile. • Antero-posterior and oblique projections can be taken to show change in the relative position of calculi and bladder. ،‫ﺔ‬s™‫ﺎﻣﻞ )اﻟﺤﺠﺮ( داﺧﻞ اﻟﻤﺜﺎﻧﺔ اﻟﺒﻮﻟ|ﺔ „ﺤ‬Ã‫ﻤﻜﻦ أن ﺗﺘﺤﺮك ﺣﺴﺎب اﻟﺘﻔﺎﺿﻞ واﻟﺘ‬Q ‫ﺎﻣﻞ‬Ã‫ﻠﺲ وﺣﺴﺎب اﻟﺘﻔﺎﺿﻞ واﻟﺘ‬Ã‫ ﻓﻲ ﺣﻴﻦ أن اﻟﺘ‬،‫ﺎﻧﺖ اﻟﻤﺜﺎﻧﺔ ﻣﻤﺘﻠﺌﺔ‬Ž ‫ﺧﺎﺻﺔ إذا‬ .‫ﺎن‬Ž‫ ﻏﻴﺮ ﻣﺘﺤﺮ‬،‫ﺎﻣﻞ اﻟﺒﺮوﺳﺘﺎﺗﺎ‬Ã‫ ﻣﺜﻞ ﺣﺴﺎب اﻟﺘﻔﺎﺿﻞ واﻟﺘ‬،‫ﺧﺎرج اﻟﻤﺜﺎﻧﺔ‬ ‫ﺴﺒﻲ‬Î‫ﻤﻜﻦ أﺧﺬ اﻹﺳﻘﺎﻃﺎت اﻷﻣﺎﻣ|ﺔ اﻟﺨﻠﻔ|ﺔ واﻟﻤﺎﺋﻠﺔ ﻹﻇﻬﺎر اﻟﺘﻐﻴﺮ ﻓﻲ اﻟﻮﺿﻊ اﻟ‬Q .‫ﺎﻣﻞ واﻟﻤﺜﺎﻧﺔ‬Ã‫ﻟﺤﺴﺎب اﻟﺘﻔﺎﺿﻞ واﻟﺘ‬ • Caudal angulation is required to allow for the shape of pelvis and to project the symphysis below the bladder. .‫ﺑﺮاز اﻻرﺗﻔﺎق ﺗﺤﺖ اﻟﻤﺜﺎﻧﺔ‬Ð‫ﻞ اﻟﺤﻮض و‬Ã‫ﺸ‬Ñ ‫ﻣﻄﻠﻮب اﻟﺘﺰاﺟﻴﺞ اﻟﻘ’ﻠﻲ ﻟﻠﺴﻤﺎح‬ Antero-posterior 15 degrees caudal Antero-posterior 15 degrees caudal Antero-posterior 15 degrees (Bladder) caudal • The patient lies supine, with the MSP at right-angles to and in the midline of the table. (‫ درﺟﺔ )اﻟﺠﻠﺪ‬15 ‫ﻠ|ﺔ اﻷﻣﺎﻣ|ﺔ اﻟﺨﻠﻔ|ﺔ‬Q‫اﻟﺬ‬ • An 18 * 24-cm cassette is commonly used, placed longitudinally with its lower border 5 cm below the symphysis pubis. • The central ray is directed 15 degrees caudally and centred in the midline 5 cm above the upper border of the symphysis pubis. Antero-posterior 15 degrees caudal .‫ﺎ اﻟ|ﻤﻨﻰ إﻟﻰ ﺧﻂ اﻟﻮﺳﻂ ﻣﻦ اﻟﺠﺪول وﻓ|ﻪ‬Q‫ ﻓﻲ اﻟﺰوا‬MSP ‫ ﻣﻊ‬،‫ﺾ ﻣﺴﺘﻠﻘ|ﺎ‬s™‫ﺴﺘﻠﻘﻲ اﻟﻤ‬º .‫ﺎﺋ|ﺔ‬sÔ‫ ﺳﻢ أﺳﻔﻞ اﻟﻌﺎﻧﺔ اﻟﻮدﻳ‬5 ‫ﺘﻢ وﺿﻌﻪ ﻃﻮﻟ|ﺎ ﻣﻊ ﺣﺪودە اﻟﺴﻔﻠ|ﺔ‬s‫ و‬،‫ ﺳﻢ‬24 * 18 ‫ﺎﺳ¿ﺖ‬Ž ‫ﺸﻴﻊ اﺳﺘﺨﺪام‬º .‫ ﺳﻢ ﻓﻮق اﻟﺤﺪ اﻟﻌﻠﻮي ﻟﻠﺜﻮاج اﻟﻌﺎﻧﺔ‬5 ‫ﺘﻤﺤﻮر ﻓﻲ ﺧﻂ اﻟﻮﺳﻂ‬s‫ درﺟﺔ ﻃﻮﻟ|ﺎ و‬15 ‫ﻳﺘﻢ ﺗﻮﺟ|ﻪ اﻟﺸﻌﺎع اﻟﻤﺮﻛﺰي‬ Oblique Bladder •From the supine position, one side is raised so that the MSP is rotated through 35 degrees. •The knee in contact with the table is flexed and the raised side supported using a non-opaque pad. •The patient’s position is adjusted so that the midpoint between the symphysis pubis and the ASIS on the raised side is over the midline of the table. •A 30*24-cm cassette is placed longitudinally in the tray with its upper border at the level of the ASIS. ‫اﻟﻤﺜﺎﻧﺔ اﻟﻤﺎﺋﻠﺔ‬ .‫ درﺟﺔ‬35 ‫ ﻣﻦ ﺧﻼل‬MSP ‫ﺮ‬s‫ ﻳﺘﻢ رﻓﻊ ﺟﺎﻧﺐ واﺣﺪ „ﺤ|ﺚ ﻳﺘﻢ ﺗﺪو‬،‫ﻣﻦ وﺿﻊ اﻻﺳﺘﻤﺎﻟﺔ‬ .‫ﺪﻋﻢ اﻟﺠﺎﻧﺐ اﻟﻤﺮﺗﻔﻊ „ﺎﺳﺘﺨﺪام وﺳﺎدة ﻏﻴﺮ ﻣﺒﻬﻤﺔ‬s‫ﻳﺘﻢ ﺛﻨﻲ اﻟﺮﻛ’ﺔ اﻟﺘﻲ ﺗﺘﻼﻣﺲ ﻣﻊ اﻟﻄﺎوﻟﺔ و‬ .‫ ﻋﻠﻰ اﻟﺠﺎﻧﺐ اﻟﻤﺮﺗﻔﻊ ﻓﻮق ﺧﻂ اﻟﻮﺳﻂ ﻣﻦ اﻟﺠﺪول‬ASIS ‫ﺾ „ﺤ|ﺚ ﺗﻜﻮن ﻧﻘﻄﺔ اﻟﻮﺳﻂ ﺑﻴﻦ اﻟﻌﺎﻧﺔ اﻻرﺗﻔﺎﻗ|ﺔ و‬s™‫ﻳﺘﻢ ﺿ’ﻂ ﻣﻮﺿﻊ اﻟﻤ‬ .ASIS ‫ ﺳﻢ ﻃﻮﻟ|ﺎ ﻓﻲ اﻟﺪرج ﻣﻊ ﺣﺪودە اﻟﻌﻠ|ﺎ ﻋﻠﻰ ﻣﺴﺘﻮى‬24 * 30 ‫ﺎﺳ¿ﺖ‬Ž ‫ﻳﺘﻢ وﺿﻊ‬ • The vertical central (Basic) ray is directed to a point 2.5 cm above the symphysis pubis. • Alternatively, a caudal angulation of 15 degrees can be used with a higher centering point and the cassette displaced downwards to accommodate the angulation. .‫ﻘﻲ‬9–‫ ﺳﻢ ﻓﻮق اﻟﻌﺎﻧﺔ اﻟﻮدﻳ‬2.5 ‫ﺔ( إﻟﻰ ﻧﻘﻄﺔ‬L‫ﺔ )اﻷﺳﺎﺳ‬š‫ﺔ اﻟﻌﻤﻮد‬9–‫ﻪ اﻷﺷﻌﺔ اﻟﻤﺮﻛ‬L‫• ﻳﺘﻢ ﺗﻮﺟ‬ .‫ﻌﺎب اﻟﺰ ﺎة‬L£‫ﺎﺳ§ﺖ ﻷﺳﻔﻞ ﻻﺳ‬W‫ﺪ اﻟ‬9‫ درﺟﺔ ﻣﻊ ﻧﻘﻄﺔ ﺗﻤﺮﻛﺰ أﻋﻠﻰ و¨ﺸﺮ‬15 ‫ﺎﻟﻎ‬7‫ﻠﻲ اﻟ‬š‫ﻖ اﻟﺬ‬9:‫ﻤﻜﻦ اﺳﺘﺨﺪام اﻟﺘﻄ‬š ،‫ﺪﻻ ﻣﻦ ذﻟﻚ‬Q • Right or left posterior oblique Intravenous Pyelography • General term used to radiographically investigate the renal collecting system. •There are two methods to fill the urinary canal with contrast media : •Antegrade: With the normal flow. blood+urine •Reterograde: Against the normal flow. urine • C.M introduced to the renal system through: 1.percutaneous antegrade urography, in certain pts the C.M introduced directly to the renal pelvis. 2. Intravenus or excretory urography. I.V.U IVP .‫ﻠﻰ‬W‫ﺎ ﻓﻲ ﻧﻈﺎم ﺟﻤﻊ اﻟ‬L‫•اﻟﻤﺼﻄﻠﺢ اﻟﻌﺎم اﻟﻤﺴﺘﺨﺪم ﻟﻠﺘﺤﻘﻴﻖ إﺷﻌﺎﻋ‬ :‫ﺎﻳﻦ‬7‫ﺔ ﺑﻮﺳﺎﺋﻂ اﻟﺘ‬L‫ﻘﺘﺎن ﻟﻤﻞء اﻟﻘﻨﺎة اﻟﺒﻮﻟ‬9µ‫•ﻫﻨﺎك ﻃ‬ ‫ اﻟ·ﺮن‬+ ‫ اﻟﺪم‬.‫ﻌﻲ‬L‫ ﻣﻊ اﻟﺘﺪﻓﻖ اﻟﻄﺒ‬:Antegrade • ‫ اﻟﺒﻮل‬.‫ﻌﻲ‬L‫ ﺿﺪ اﻟﺘﺪﻓﻖ اﻟﻄﺒ‬:Reterograde• 3- In Retrograde the CM is introduced against the normal flow through a urethral catheter. • Cystoscope is used to localize the opening for the passage of the catheter. • The function of the kidney cannot be assessed as in this I.V.U. :‫ﻠﻮي ﻣﻦ ﺧﻼل‬N‫ إﻟﻰ اﻟﺠﻬﺎز اﻟ‬M.C ‫•ﺗﻢ إدﺧﺎل‬ ‫ﻌﻲ ﻣﻦ ﺧﻼل‬k‫ ﺿﺪ اﻟﺘﺪﻓﻖ اﻟﻄﺒ‬CM ‫ ﻳﺘﻢ إدﺧﺎل‬،‫ ﻓﻲ اﻟﺘﺮاﺟﻊ‬-3 .‫ﻗﺴﻄﺮة ﻣﺠﺮى اﻟﺒﻮل‬ ‫ ﻓﻲ‬،‫ﻖ اﻟﺠﻠﺪ‬ab‫ﻞ اﻟﺼﻒ ﻋﻦ ﻃ‬h‫ﺔ ﻗ‬k‫ﺮ اﻟﻤﺴﺎﻟﻚ اﻟﺒﻮﻟ‬aq‫•ﺗﺼ‬ .‫ﻠﻮي‬N‫ﺎﺷﺮة إﻟﻰ اﻟﺤﻮض اﻟ‬h‫ ﻣ‬M.C ‫|ﻌﺾ اﻟﻨﻘﺎط ﻗﺪم‬ .‫“ﺴﺘﺨﺪم ﻣﻨﻈﺎر اﻟﻤﺜﺎﻧﺔ ﻟﺘﻮﻃﻴﻦ اﻟﻔﺘﺤﺔ ﻟﻤﺮور اﻟﻘﺴﻄﺮة‬ U.V.I .‫ﺪ أو اﻹﺧﺮاج‬a‫ﺔ داﺧﻞ اﻟﻮر‬k‫ﺮ اﻟﻤﺴﺎﻟﻚ اﻟﺒﻮﻟ‬aq‫•ﺗﺼ‬ ‫ﻠﻰ —ﻤﺎ ﻫﻮ اﻟﺤﺎل ﻓﻲ وﺣﺪة اﻟﻌﻨﺎ”ﺔ‬N‫ﻔﺔ اﻟ‬k‫ﻢ وﻇ‬k‫ﻻ ”ﻤﻜﻦ ﺗﻘﻴ‬ ‫اﻟﻤﺮﻛﺰة ﻫﺬە‬ • Examination of the lower urinary system (lower ureters, bladder and urethra is usually made by retrograde urography. ‫ﻞ‬L‫ﺔ واﻟﻤﺜﺎﻧﺔ واﻹﺣﻠ‬L‫•ﻋﺎدة ﻣﺎ ﻳﺘﻢ ﻓﺤﺺ اﻟﺠﻬﺎز اﻟﺒﻮﻟﻲ اﻟﺴﻔﻠﻲ )اﻟﺤﺎﻟﺐ اﻟﺴﻔﻠ‬ .‫ﺔ إﻟﻰ اﻟﻮراء‬L‫ﺮ اﻟﻤﺴﺎﻟﻚ اﻟﺒﻮﻟ‬9:‫ﻖ ﺗﺼ‬9µ‫ﻋﻦ ﻃ‬ ‫ﺎﻳﻦ‬%‫ردود اﻟﻔﻌﻞ ﻋﻠﻰ اﻟﺘ‬ ‫ﺎﻟﺪفء‬6 ‫• اﻟﺸﻌﻮر‬ ‫ﺎﻟﺮش‬6 ‫• اﻟﺘﻨﻈ=ﻒ‬ ‫ﺎ اﻟﻨﺤﻞ‬A‫• ﺧﻼ‬ ‫• اﻟﻐﺜ=ﺎن‬ ‫• اﻟﻘﻲء‬ ‫• وذﻣﺔ اﻷﻏﺸ=ﺔ اﻟﻤﺨﺎﻃ=ﺔ اﻟﺘﻨﻔﺴ=ﺔ‬ Cystogram AP Cystourethrogram Cystourethrogram C.M : 1.Ionic Iodienated. 2.Non ionic Iodinated. :‫ﺳﻲ إم‬ .Ionic Iodienated .‫ﻏﻴﺮ أﻳﻮﻧﻲ „ﺎﻟﻴﻮد‬ Preparation: 1.Posible laxatives. 2.Light evening meal. 3.NPO .after midnight. • The pts with multiple myloma, diabitus and high uric acid level will not dehydrated, because of contrast induced renal failure. :‫اﻟﺘﺤﻀﻴﺮ‬ .‫ﻣﻠﻴﻨﺎت اﺣﺘﻤﺎﻟ|ﺔ‬ .‫وﺟ’ﺔ ﻣﺴﺎﺋ|ﺔ ﺧﻔ|ﻔﺔ‬ .‫ „ﻌﺪ ﻣﻨﺘﺼﻒ اﻟﻠ|ﻞ‬.NPO ‫ﺘﻮس وارﺗﻔﺎع ﻣﺴﺘﻮى‬l‫ﺎﺑ‬Q‫ ﻣﻊ اﻟﻤ|ﻠﻮﻣﺎ اﻟﻤﺘﻌﺪدة واﻟﺪ‬pts ‫ﺠﻒ‬Q ‫ﻟﻦ‬ .‫ﻠﻮي اﻟﻨﺎﺟﻢ ﻋﻦ اﻟﺘ’ﺎﻳﻦ‬‰‫ﺐ اﻟﻔﺸﻞ اﻟ‬ß‫ﺴ‬Ñ ،‫ﻚ‬s‫ﺣﻤﺾ اﻟﻴﻮر‬ Compression: :‫اﻟﻀﻐﻂ‬ It is applied at the distal end of ureters, 2 inches above the superior boarder of symphisis pubis with immbolization band. ( in the median ) ‫ ﻋﻠﻰ „ﻌﺪ‬،‫ﻳﺘﻢ ﺗﻄﺒ|ﻘﻪ ﻓﻲ اﻟﻄﺮف اﻟ’ﻌ|ﺪ ﻟﻠﺤﺎﻟﺐ‬ ‫ﺑﻮﺻﺘﻴﻦ ﻓﻮق اﻟﺤﺪود اﻟﻤﺘﻔﻮﻗﺔ ﻣﻦ ﺳ|ﻤﻔ¿ﺴ¿ﺲ‬ .‫ﻂ اﺳﺘﻘﻼب‬s‫اﻟﻌﺎﻧﺔ ﻣﻊ ﺷﺮ‬ Compression Contraindicated when: 1.Urinary stone. 2.Abdominal mass or aneurysm. 3.Colostomy. 4.Suprapubic catheter. trauma 5.Traumatic injury. :‫ﻫﻮ „ﻄﻼن اﻟﻀﻐﻂ ﻋﻨﺪﻣﺎ‬ .‫ﺣﺠﺮ اﻟﺒﻮل‬ .‫ﺔ‬s®‫ﻛﺘﻠﺔ اﻟ’ﻄﻦ أو ﺗﻤﺪد اﻷوﻋ|ﺔ اﻟﺪﻣ‬ .‫اﺳ«ﺌﺼﺎل اﻟﻘﻮﻟﻮن‬ ‫ ﺻﺪﻣﺔ‬.‫ﺐ‬ß‫ﺴ‬Ñ ‫ﻗﺴﻄﺮة‬ .‫إﺻﺎ„ﺔ ﻣﺆﻟﻤﺔ‬ Plain: 1.Can catch extrarenal pathology, so no IVU. 2.Contour of the kidney. outlines 3.Stone and calcification. 4.Check for preparation. 5.Exposure factors. Radiation Protection: 1.Shield men under the S.P. 2.For female shield the pelvis when for kidneys only :‫ﻋﺎدي‬ .IVU ‫ ﻟﺬﻟﻚ ﻻ ﻳﻮﺟﺪ‬،‫ﺤﻞ‬W‫ﻤﻜﻦ اﻟﺘﻘﺎط اﻷﻣﺮاض ﺧﺎرج اﻟ‬f ‫ﻀﺔ‬ij‫ اﻟﺨﻄﻮط اﻟﻌ‬.‫ﻠﻰ‬p‫ﻂ اﻟ‬r‫ﻣﺤ‬ .‫ﻠﺲ‬t‫اﻟﺤﺠﺮ واﻟﺘ‬ .‫ﺗﺤﻘﻖ ﻣﻦ اﻹﻋﺪاد‬ .‫ﻋﻮاﻣﻞ اﻟﺘﻌﺮض‬ :‫ﺔ ﻣﻦ اﻹﺷﻌﺎع‬f‫اﻟﺤﻤﺎ‬ .‫رﺟﺎل اﻟﺪرع ﺗﺤﺖ اﻟﺤﺰب اﻟﺠﻤﻬﻮري‬ .‫ﻠﻰ ﻓﻘﻂ‬p‫ﻜﻮن ﻟﻠ‬f ‫ﺔ اﻟﺤﻮض ﻋﻨﺪﻣﺎ‬f‫ ﻗﻢ „ﺤﻤﺎ‬،‫ﺔ ﻟﻺﻧﺎث‬Š‫ﺴ‬Œ‫„ﺎﻟ‬ ‫ﻣﻮاﻧﻊ ﻟﺘﺼ‪XY‬ﺮ اﻟﻤ‪%‬ﺬﻳﻦ اﻟﻮر‪X‬ﺪي‬ ‫• اﻟﻔﺸﻞ اﻟ[ﻠﻮي‬ ‫• أﻧﻮر‪X‬ﺎ‬ ‫• اﻟ‪wx‬ﻮ‬ ‫• رد ﻓﻌﻞ وﺳﺎﺋﻂ اﻟﺘ‪%‬ﺎﻳﻦ اﻟﺴﺎ‪6‬ﻘﺔ‬ ‫• أﻣﺮاض اﻟﺪورة اﻟﺪﻣ‪XY‬ﺔ أو أﻣﺮاض‬ ‫اﻟﻘﻠﺐ واﻷوﻋ=ﺔ اﻟﺪﻣ‪XY‬ﺔ‬ ‫• ارﺗﻔﺎع ﻣﺴﺘﻮى اﻟ•‪Xx‬ﺎﺗ~ﻨﻴﻦ‬ ‫• ﻣﺮض اﻟﺨﻼ‪A‬ﺎ اﻟﻤﻨﺠﻠ=ﺔ‬ ‫• داء اﻟﺴﻜﺮي‬ ‫• اﻟﻤﺎ‪A‬ﻠﻮﻣﺎ اﻟﻤﺘﻌﺪدة‬ ‫اﻹﺟﺮاء‪:‬‬ ‫اﻃﻠﺐ ﻣﻦ ‪ pt‬إﻓﺮاغ اﻟﻤﺜﺎﻧﺔ وارﺗﺪاء ﺛﻮب اﻟﻤﺴ=ﺸﻔﻰ‪.‬‬ ‫ﺗﻤﺖ ﻣﺮاﺟﻌﺔ ﺗﺎر‪X‬ـ ــﺦ ‪ Pt‬ﻟﻠﺤﺴﺎﺳ‪U‬ﺔ واﻟﺘﺎر‪X‬ـ ــﺦ اﻟﺴﺮ‪X‬ﺮي وﻣﺴﺘ‪XY‬ﺎت ﻛ‪U‬ﻤ‪U‬ﺎء اﻟﺪم‪.‬‬ ‫‪ Pt‬ﺳ‪oY‬ﻴﻦ ﻣﻊ ‪ MSP‬ﻣﻦ اﻟﺠﺴﻢ ﻋﻤﻮدي و‪X‬ﺘﺪاﺧﻞ ﻣﻊ ﺧﻂ اﻟﻄﺎوﻟﺔ اﻷوﺳﻂ‪.‬‬ ‫اﻟﻀﻐﻂ ﺟﺎﻫﺰ‪.‬‬ ‫‪€‬ﺠﺐ أن ‪€‬ﻜﻮن ﻓ‪U‬ﻠﻢ ﻣﺎ }ﻌﺪ اﻟﺤﻘﻦ ﻓﻲ ﺻ‪z‬ﻨ‪U‬ﺔ اﻟ‪x‬ﺎﺳ‪w‬ﺖ ﻗ‪u‬ﻞ اﻟﺤﻘﻦ‪.‬‬ ‫ﻋﻼﻣﺔ اﻟﻮﻗﺖ ﺟﺎﻫﺰة‪.‬‬ ‫ﺣﻘﻦ ‪ M.C‬ﻓﻲ ﺗﻘﻨ‪U‬ﺔ اﻟﺼﺮف اﻟﺼﺤﻲ‪.‬‬ ‫ﺣﻘﻦ ‪ 100-30‬ﺳﻢ ﻣﻜﻌﺐ ﻟﻠ‪u‬ﺎﻟﻐﻴﻦ‪ .‬ﻟﻸﻃﻔﺎل ﺣﺴﺐ اﻟﻮزن واﻟﻌﻤﺮ‪.‬‬ ‫ﻣﺆﺷﺮات ل‪:‬‬ ‫اﻟﺘﺼ‪XY‬ﺮ اﻟﻮر‪X‬ﺪي اﻟﻮر‪X‬ﺪي‬ ‫• ﺗﻘﻴ=ﻢ ﻛﺘﻞ اﻟ‪%‬ﻄﻦ واﻟ[ﻠﻰ‬ ‫اﻟﺨﺮاﺟﺎت واﻷورام اﻟ[ﻠ‪XY‬ﺔ‬ ‫• ﺗﺤﺺ ﺑﻮﻟﻲ‬ ‫• اﻟﺘﻬﺎب اﻟﺤ‪XY‬ﻀﺔ واﻟ[ﻠ=ﺔ‬ ‫• اﺳ‪h‬ﺴﻘﺎء اﻟ[ﻠ=ﺔ‬ ‫"ﺗﻘﻴ=ﻢ آﺛﺎر اﻟﺼﺪﻣﺔ‬ ‫• ارﺗﻔﺎع ﺿﻐﻂ اﻟﺪم اﻟ[ﻠﻮي‬ ‫• اﻟﺘﻘﻴ=ﻢ ﻗ‪%‬ﻞ اﻟﺠﺮاﺣﺔ‬ ‫‪Procedure:‬‬ ‫‪1. Ask the pt to empty the bladder and wear a hospital gown.‬‬ ‫‪2. Pt history of allergy, clinical history and blood chemistry levels reviewed.‬‬ ‫‪3. Pt supine with MSP of the body perpendicular and overlap the mid table line.‬‬ ‫‪4. Compression is ready.‬‬ ‫‪5.Post injection film must be in cassette tray before injection.‬‬ ‫‪6. Time marker is ready.‬‬ ‫‪7. C.M injected in a septic technique.‬‬ ‫‪8. 30 -100 cc injected for adults. For children depending on weight and age.‬‬ • Depending on if the pt is partially dehydrated or the speed of the injection contrast medium takes from 2-8 min to reach the pelvicalaceal system. ‫ ﻣﺠﻔﻔﺎ ﺟﺰﺋ=ﺎ أو أن ﺳﺮﻋﺔ‬pt ‫ﺎن‬œ ‫•اﻋﺘﻤﺎدا ﻋﻠﻰ ﻣﺎ إذا‬ ‫ دﻗﺎﺋﻖ ﻟﻠﻮﺻﻮل‬8-2 ‫ﺎﻳﻦ اﻟﺤﻘﻦ ¡ﺴﺘﻐﺮق ﻣﻦ‬%‫وﺳ=ﻂ ﺗ‬ .pelvicalaceal ‫إﻟﻰ اﻟﺠﻬﺎز‬ 2- Nephrogram immediately ‫ ﺗﺨﻄ=ﻂ اﻟ[ﻠ=ﺔ ﻋﻠﻰ اﻟﻔﻮر‬-2• 3- 5 min Pelvicalaceal Pelvicalaceal ‫ دﻗﺎﺋﻖ‬5 -3 • 4- 10 min Pelvicalaceal Pelvicalaceal ‫ دﻗﺎﺋﻖ‬10 -4• ‫•ﺿﻐﻂ‬ Compression 5- 15 min Pelvicalaceal+ upper ureters +Pelvicalaceal ‫ دﻗ=ﻘﺔ ﻣﻦ اﻟﺤﺎﻟﺐ اﻟﻌﻠﻮي‬15 -5• (‫ )ﺗﻘﺎﻃﻊ ﻣﺜﺎﻧﻲ اﻟﺤﺎﻟﺐ‬.(‫ دﻗ=ﻘﺔ )اﻹﻓﺮاج‬25 -6• 6- 25 min (Release).(vesicoureteric junction) • The most frequently recommended views are supine AP from 3- 20 min 7- The last views in IVU are bladder A- Pre voiding. Full bladder B. Post voiding. done to check the residual urine which indicate: 1.Small tumor mass. 2.Enlarged prostate gland. ‫ دﻗ=ﻘﺔ‬20 ‫ إﻟﻰ‬3 ‫ اﻻﺳﺘﺨﺎط ﻣﻦ‬AP ‫ﺜﺮ ﻣﻮﺻﻰ ﺑﻬﺎ ﻫﻲ‬³‫• اﻟﻤﺸﺎﻫﺪات اﻷ‬ ‫ ﻫﻲ اﻟﻤﺜﺎﻧﺔ‬IVU ‫ اﻵراء اﻷﺧﻴﺮة ﻓﻲ‬-7 ‫ﺎﻣﻠﺔ‬p‫ اﻟﻤﺜﺎﻧﺔ اﻟ‬.‫ﻞ اﻹﻓﺮاغ‬Š‫ ﻣﺎ ﻗ‬-‫أ‬ ‫ﻘﻲ اﻟﺬي‬Š‫ ﺗﻢ إﺟﺮاؤە ﻟﻠﺘﺤﻘﻖ ﻣﻦ اﻟﺒﻮل اﻟﻤﺘ‬.‫ „ﻌﺪ اﻹﻓﺮاغ‬.‫ب‬ :‫ﺸﻴﺮ إﻟﻰ‬œ .‫ﻛﺘﻠﺔ ورم ﺻﻐﻴﺮة‬ .‫ﺗﻀﺨﻢ ﻏﺪة اﻟﺒﺮوﺳﺘﺎﺗﺎ‬ Post procedure care: Ask the pt to take extra fluids after the procedure to flush the contrast from the body. :‫ﺔ ﻣﺎ „ﻌﺪ اﻹﺟﺮاء‬f‫رﻋﺎ‬ ‫ﺎﻳﻦ‬Š‫ﺔ ﻟﻄﺮد اﻟﺘ‬r‫ﺔ „ﻌﺪ اﻟﻌﻤﻠ‬r‫ ﺗﻨﺎول ﺳﻮاﺋﻞ إﺿﺎﻓ‬pt ‫اﻃﻠﺐ ﻣﻦ‬ .‫ﻣﻦ اﻟﺠﺴﻢ‬ Alternative projections: A- PA prone is done fore: 1.Uretral pelvic region. 2.Filling the obstructed ureters in Hydronephrosis. :‫ﻠﺔ‬€‫ﺪ‬u‫اﻟﺘﻮﻗﻌﺎت اﻟ‬ :‫ ﻓﻲ اﻟﻤﻘﺪﻣﺔ‬prone PA ‫ ﻳﺘﻢ إﺟﺮاء‬-‫أ‬ . ‫ﻣﻨﻄﻘﺔ اﻟﺤﻮض‬ .‫ﺔ‬U‫ﻠ‬x‫ﻣﻞء اﻟﺤﺎﻟﺐ اﻟﻤﺴﺪودة ﻓﻲ اﺳ=ﺴﻘﺎء اﻟ‬ B- Upright done for: 1.Opacified bladder . 2.Mobility of the kidneys. C- Trendelenburg done fore: :‫ﻢ ﻣﻦ أﺟﻞ‬Y‫ﻪ _ﺸ]ﻞ ﻣﺴﺘﻘ‬a ‫ﺎم‬Y‫ ﺗﻢ اﻟﻘ‬-‫ب‬ .‫اﻟﻤﺜﺎﻧﺔ اﻟﻤﺘﻀﺨﻤﺔ‬ 1. Lower ends of the ureters 15-20 degrees. 2. Viscal ureteral orphis. .‫ ﺣﺮﻛﺘﻬﺎ‬.‫ﻠﻰ‬u‫ﺣﺮﻛﺔ اﻟ‬ :‫ ﻓﻲ اﻟﻤﻘﺪﻣﺔ‬Trendelenburg -‫ج‬ .‫ درﺟﺔ‬20-15 ‫ﺔ ﻣﻦ اﻟﺤﺎﻟﺐ‬Y‫اﻷﻃﺮاف اﻟﺴﻔﻠ‬ .‫أورﻓ„ﺲ اﻟﺤﺎﻟﺐ ﻓ„ﺴﺎل‬ Bladder: 1- scout + 2- after contrast + 3- post voiding. • supine •C.P: 2-3 inches upper to the symphisis pubis. •15-25 caudal. .:‫اﻟﻤﺜﺎﻧﺔ‬ .‫ ﻣﺎ „ﻌﺪ اﻹﻓﺮاغ‬-3 + ‫ „ﻌﺪ اﻟﺘ’ﺎﻳﻦ‬-2 + ‫ﺸﺎﻓﺔ‬â‫ اﻟ‬-1 ‫ﻴﻦ‬É®‫ﺳ‬ .‫ ﺑﻮﺻﺎت أﻋﻠﻰ ﻣﻦ اﻟﻌﺎﻧﺔ اﻟﺴﻤﻔﻮﻧ|ﺔ‬3-2 :P.C .caudal 25-15 CR: Vertical unless: 1. 5 degrees caudal for bladder neck and proximal urethra. 2. 15-20 degrees caudal for lordosis abnormalities. 3. 20-25 degrees caudal prostate gland, above the S.P. 4. PA 10-15 cephalic bladder neck. • Suspended respiration. :‫ ﻋﻤﻮدي ﻣﺎ ﻟﻢ‬:CR .‫ﺐ‬PQ‫ﻞ اﻟﻘ‬U‫ﺔ ﻟﺮﻗ]ﺔ اﻟﻤﺜﺎﻧﺔ واﻹﺣﻠ‬U‫ درﺟﺎت اﻟﺬ`ﻠ‬5 .‫ﺸﻮﻫﺎت اﻟﻘﻌﺲ‬i‫ ﻟ‬caudal ‫ درﺟﺔ‬20-15 .P.S ‫ ﻓﻮق‬،‫ﺔ‬U‫ درﺟﺔ ﻏﺪة اﻟﺒﺮوﺳﺘﺎﺗﺎ اﻟﺬ`ﻠ‬25-20 .‫ﺔ‬U‫ رﻗ]ﺔ اﻟﻤﺜﺎﻧﺔ اﻟﺮأﺳ‬15-PA 10 . .‫اﻟﺘﻨﻔﺲ اﻟﻤﻌﻠﻖ‬ D- AP Oblique: RPO +LPO for: 1. The region of the distal end of ureters. 2.The Bladder. 3.The proximal part of the urethra. :‫ ﻣﻦ أﺟﻞ‬LPO+ RPO :AP Oblique -D .‫ﻣﻨﻄﻘﺔ اﻟﻄﺮف اﻟ’ﻌ|ﺪ ﻣﻦ اﻟﺤﺎﻟﺐ‬ ..‫اﻟﻤﺜﺎﻧﺔ‬ .‫ﺐ ﻣﻦ ﻣﺠﺮى اﻟﺒﻮل‬s™‫اﻟﺠﺰء اﻟﻘ‬ E- Lateral For: 1.The region of the distal end of ureters. 2.The Bladder. 3.The proximal part of the urethra filled with C.M. 4.The anterior and posterior bladder walls and base of the bladder. :‫ اﻟﺠﺎﻧﺒﻲ ﻣﻦ أﺟﻞ‬-E .‫ﻣﻨﻄﻘﺔ اﻟﻄﺮف اﻟ’ﻌ|ﺪ ﻣﻦ اﻟﺤﺎﻟﺐ‬ ..‫اﻟﻤﺜﺎﻧﺔ‬ .M.C ‫ﺐ ﻣﻦ ﻣﺠﺮى اﻟﺒﻮل ﻣﻤﻠﻮء ب‬s™‫اﻟﺠﺰء اﻟﻘ‬ ..‫ﺟﺪران اﻟﻤﺜﺎﻧﺔ اﻷﻣﺎﻣ|ﺔ واﻟﺨﻠﻔ|ﺔ وﻗﺎﻋﺪة اﻟﻤﺜﺎﻧﺔ‬ ureter RPO Bladder Young Female