CT UROGRAPHY / IVP IS A MEDICAL PROCEDURE TO LOOK ABNORMALITIES IN KUB.

1. MAAJID MOHI UD DIN MALIK
LECTURER COPMS ADESH UNIVERSITY
BATHGINDA,PUNJAB
CT UROGRAPHY/IVP

2. UROGRAPHYDEFINITION
Urography is a radiologic technique
used for the evaluation of the
genitourinary system: specifically,
the kidneys, ureters and bladder.

3. CONT…
Urography is an examination used to evaluate
the kidneys, ureters and bladder. Excretory
urography, also known as intravenous
Pyelogram, is performed using conventional x-
ray after the intravenous administration of
radiographic contrast material. This technique is
still performed for pediatric patients and
occasionally for younger adult patients.

4. CONT…
Computed tomography (CT) urography use CT images,
after intravenous contrast material to obtain images of
the urinary tract. CT urography (CTU) uses as primary
imaging techniques to evaluate patients with blood in the
urine (hematuria), follow patients with prior history of
cancers of the urinary collecting system and to identify
abnormalities in patients with recurrent urinary tract
infections. In addition to imaging the urinary tract, CT
can provide valuable information about other abdominal
and pelvic structures and diseases that may affect them.

5. CT SCANNER
The CT scanner is typically a large, donut-shaped
machine with a short tunnel in the center. You will lie on
a narrow examination table that slides in and out of this
short tunnel. Rotating around you, the x-ray tube and
electronic x-ray detectors are located opposite each other
in a ring, called a gantry. The computer workstation that
processes the imaging information is located in a separate
control room. This is where the technologist operates the
scanner and monitors your exam in direct visual contact.
The technologist will be able to hear and talk to you using
a speaker and microphone.

6. UROGRAPHICTECHNIQUES
 INTRAVENOUS UROGRAPHY
 COMPUTERIZED TOMOGRAPHIC
UROGRAPHY
 MAGNETIC RESONANCE UROGRAPHY

7. INDICATIONS
 Suspected urinary tract pathology.
 Repeated infections -focus, damage
 Hematuria
 Investigation of hypertension not controlled
by medication in young adults.
 Renal colic.
 Trauma.

8. CONTRA -INDICATION
Allergic to contrast agents.
Diabetes,
Thyrotoxicosis,
Pregnancy
Raised urea creatinine
Metformin therapy

9. PREPERATION
 Bowel prep.
 Basic psychological preparation with
reassurance & explanation of technique
 NBM for 5 hrs.
 Bladder emptied immediately before exam.
 Previous experience of iodinated
contrast media.
 Abdominal surgery,Allergies, drugs history.

10. CONTRAST
 Inject nonionic contrast Or LOCM as bolus, 30-
60 sec at a rate of
2-4 ml/second
Adult 50-100 ml
Pediatric 1ml/kg

11. ADVERSE REACTION OF CONTRAST
True contrast reactions are uncommon
Most commonly seen are minor side effects
Flushing
Metallic taste in mouth
Tachycardia
Usually resolve within a few minutes

12. TERMINOLOGY
Urogram
 Visualization of kidney parenchyma,
 Calyces and pelvis resulting from IV injection of
contrast
Pyelogram
 Describes retrograde studies visualizing only the
collecting system So, IVP
is misnomer, should be IVU

13. Cystography
Describes visualization of the bladder
Urethrography
Visualization of urethra
Cystouretrography
 Combined study to visualize bladder and urethra

14. CTUPROTOCOL –THREE PHASE PROTOCOL
 Unenhanced phase
 Nephrographic phase after 90-100 secs
 Pyelographic phase after 12-15 minutes
 4 Phase protocol (5 min and 7.5 min)

16. ADVANTAGESOF IVUOVER CT UROGRAPHY
 Better spatial resolution
 Lesser radiation dose
 Cheaper

17. LIMITATIONS
 A person who is very large may not fit into the opening of a
conventional CT scanner or may be over the weight limit—
usually 450 pounds—for the moving table.
 High-quality images depend on your ability to remain
perfectly still and follow breath-holding instructions while
the images are being recorded. If you are anxious, confused
or in severe pain, you may find it difficult to lie still during
imaging.
 A person who is very large may not fit into certain types of
CT machines. There are weight limits on the scanners.

18. RISKS
There is always a slight chance of cancer from
excessive exposure to radiation. However, the benefit
of an accurate diagnosis far outweighs the risk.
Because children are more sensitive to radiation, they
should have a CT exam only if it is essential for making
a diagnosis and should not have repeated CT exams
unless absolutely necessary. CT scans in children
should always be done with low-dose technique.

19. BENEFITS
 CT scanning is painless, noninvasive and accurate.
 A major advantage of CT is its ability to image bone, soft tissue
and blood vessels all at the same time.
 Unlike conventional x-rays, CT scanning provides very detailed
images of many types of tissue as well as the lungs, bones, and
blood vessels.
 CT examinations are fast and simple; in emergency cases, they
can reveal internal injuries and bleeding quickly enough to help
save lives.
 CT has been shown to be a cost-effective imaging tool for a wide
range of clinical problems.

20. CONT…
 CT can be performed if you have an implanted medical
device of any kind, unlike MRI.
 CT imaging provides real-time imaging, making it a good
tool for guiding minimally invasive procedures such
as needle biopsies and needle aspirations of many areas of
the body, particularly the lungs, abdomen, pelvis and bones.
 A diagnosis determined by CT scanning may eliminate the
need for exploratory surgery and surgical biopsy.
 No radiation remains in a patient's body after a CT
examination.
 X-rays used in CT scans should have no immediate side
effects.

21. HOW IS THE PROCEDURE PERFORMED?
 If CT urography is being performed, the technologist will begin
by positioning you on the CT examination table, usually lying flat
on your back or possibly on your side or stomach. You may be
asked to change positions during portions of the examination.
Straps and pillows may be used to help you maintain the correct
position and to hold still during the exam.
 Many scanners are fast enough that children can be scanned
without sedation. In special cases, sedation may be needed for
children who cannot hold still. Motion will cause blurring of the
images and degrade the quality of the examination the same way
that it affects photographs.

22. CONT…
 If contrast material is used, a nurse or technologist will inject the
contrast through an IV line placed in the hand or arm.
 Next, the table will move quickly through the scanner to
determine the correct starting position for the scans. Then, the
table will move slowly through the machine as the actual CT
scanning is performed. Depending on the type of CT scan, the
machine may make several passes.
 You may be asked to hold your breath during the scanning. Any
motion, including breathing and body movements, can lead
to artifacts on the images. This loss of image quality can resemble
the blurring seen on a photograph taken of a moving object.

23. CONT…
 When the exam is complete, you will be asked to wait
until the technologist verifies that the images are of
high enough quality for accurate interpretation.
 CT exams are generally painless, fast and easy. With
multidetector CT, the amount of time that the patient
needs to lie still is reduced.