Renal System Imaging- Modality of choice, (IVP & DTPA scan). From x ray imaging to nuclear scan.

1. Renal System
Modality of choice
for Imaging
Nasir Mohiuddin
MSc Nuclear Medicine

2. Modality
of choice
?
Intravenous
Pyelogram(IVP)
DTPA Scan

3. Intravenous
Pyelogram
(IVP)
It's the radiographic
examination of the urinary tract
including renal parenchyma,
calyces, and pelvis after IV
injection of contrast media.
An IVP shows the anatomical
position of the urinary tract, and
it can evaluate collecting system
of kidneys.

4. Patient preparation
Equipment's
• Computed Radiography/
Fluoroscopy
• X Ray table, Binder
• Syringe(50ml), IV scalp vein,
Contrast Media (Non Ionic).
Bowel
Preparation–
Laxatives
(Dulcolax)
History of DM/renal
disease, allergy to
drugs & CM
Fasting(4-6 Hr.) &
Hydrated
Verify the patient,
LMP(f) & KFT
consent, explain the
Procedure.

5. Procedure
Patient is placed in the supine
position on the X ray table or under
fluoroscopy.
• A scout KUB film is taken.
• CM is given IV in a bolus, test
inj.(1ml)
• Adequate Collimation should be
used.
• Low KV(70-90) high MA(600-
1000) & short exposure
technique is used.

6. Standard Filming
KUB.
1-min
5-min
10-min
15-min
35-min
Special films

7. Contraindications
• Pregnancy
• Iodine Sensitivity
• Several history of Anaphylaxis
• Allergy to drugs
• Compression is contraindicated (Abdominal trauma,
surgery, aneurysm & mass).

8. Renal Scintigraphy
Tc99m- DTPA
Diethylenetriaminepentaaceticacid
Radionuclide- Tc-99m tagged with
Radiopharmaceutical-DTPA
Half life- 6hrs. Type- generator
produced Gamma ray emission, Energy- 140Kev
It's used to assess renal function after injecting the
Radiopharmaceutical.
Dynamic Scan, Mechanism of Action....(100%
filtration)

9. Indications
Evaluation for Renal artery stenosis, obstruction, & trauma,
Evaluation of renal tubular function and perfusion (GFR) for blood flow, Split
function.
Evaluation of renal obstructive nephropathy(HDN study),
Evaluation of unexplained renal dysfunction,
Detection of acute tubular necrosis,
Evaluation of a kidney transplant.
Contraindication. Pregnancy, lactating mother

10. Patient
Preparation
• Patient- Well hydrated
• History of patient
• Check- Height & Weight of patient
• Frequent voiding of bladder
• Catheterization & PCN Clamping.

11. Preparation of
Radiopharmaceutical,
Procedure
• Count the syringe activity
before and after injection
under gamma camera or dose
calibrator.
• Place patient in supine
position,
• Position patient include FOV.
• Bolus IV-injection,
• Start the scan.

12. Equipment
• Gamma Camera
• Collimator(LEHR),
• Computer Set-Up:
Flow
1sec/frame(120se
c), 20-
60sec/frame

13. Protocol
Posterior view(routine),
Anterior view
(transplant
evaluation),
Diuretic protocol.
Image Acquisition
(P1, perfusion)
Dynamic uptake and
excretion images
(P2 diuretic). Delayed
static images
I​mage Processing
Draw ROI's, Generate
TAC, Differential Renal
function GFR/ERPF
Calculation.

18. • Hydronephrotic left kidney
showing impaired perfusion
and cortical uptake (denoting
impaired function),
• Uprising renogram curve (red
curve) s/o left obstructive
drainage.
• Rt kidney shows normal
function & non obstructive
drainage (green curve).

19. Comparision of Radiation dose,
Effective Dose !
IVP Imaging : 2-5 mSv (01hr)
DTPA Scan : 0.01-0.05 mSv(30min)

20. Conclusion
IVP imaging
• Radiolgical procedure,
• X –Rays are used.
• Radiations are given to patient.
• Evaluation to see disorders that
affect urinary tract & calculi
• Patient is given preparation
• More Contraindications
• Radiation dose > ^
• Modality of Choice.
DTPA-Scan
• Nuclear Scan
• Gamma Rays are used.
• Patient is emitting the radiations
• Functional study of kidneys, GFR
calculation, split function.
• No patient preparation.
• No such contraindication.
• Very less radiation dose × ✓
• Best Choice to evaluate Renal
System.

21. ThankYou