Conventional radiology remains useful in urology for preoperative diagnosis and postoperative evaluation. It includes techniques like intravenous urography to visualize the kidneys and ureters, retrograde pyelography to evaluate the ureters and collecting systems, and retrograde urethrography to assess the urethra. These techniques use iodine-based contrast agents, though complications can occur in 1-5% of cases. The physics of x-rays and factors like radiation dose are also discussed.

1. Conventional
Radiology In Urology
Presentation By: Dr. Rabi Bhushan Pandit
Moderator: Dr. Prakash Chhetri

2. Objectives
• Principles of X-ray

3. Introduction
• Imaging has indespensible role in diagnosis
and management
• Because urologic conditions cannot assessed
in physical examination, it has become the
major tool for diagnosis and management

4. Conventional Radiolography
• Remains useful in preoperative diagnosis and
post operative evaluation of variety of conditions
• Includes:
- Plane abdominal radiography
- Intravenous excretory
- Retrograde pyelography
- Retrograde urethrography
- cystography

5. Physics

6. Physics
• stream of photons is emitted from an x-ray
source
• photons travel through the air and strike
tissue, imparting energy to that tissue
• Some of the photons emerge from the patient
with varying amounts of energy attenuation
• strike an image recorder such as a film
cassette

7. • The current unit of radiation exposure is
measured in coulombs (C)/kg
• Absorbed dose is the energy absorbed from
the radiation exposure and is measured in
units called gray (Gy).

8. RADIATION TRADITIONAL
UNIT
SI UNIT QUANTITY
CONVERSION
CLINICAL
RELEVANCE
Exposure roentgen (R) coulomb
(C)/kg
1 C/kg = 3876 R Charge per unit
mass
Absorbed dose rad gray
(Gy)
1 Gy = 100 rad Energy
absorbed by
tissue
Equivalent
dose
rem sievert
(Sv)
1 Sv = 100 rem Absorbed
energy
based on tissue
type
Effective dose rem sievert Biologic risk
(Sv) associated
with
absorbed
energy

9. Contrast Media
• Iodine is most commonly used contrast media
• Other agents are added in contrast is to
- increase the water solubility
- decrease toxicity by preventing entry to cell

10. Types of contrast agents

12. Complication of contrast agent
• 1-5% complication rate

14. Management

16. Plain radioiograph
• Indication:
- As preliminary film to anticipate contrast
administration
- To see urinary calculus before and after
treatment
- To assess the presence of residual contrast
medium after other procedure
- To accertain the position of drains and stents

18. limitations

19. Intravenous Urogram
Indication
• Demonstrate the renal collecting systems and ureters.
• Investigate the level of ureteral obstruction in renal
units displaying delayed function
• Demonstrate intraoperative opacification of collecting
system during ESWL or Per-cutaneous access to the
collecting system.
• Demonstrate renal function during emergent
evaluation of unstable patients.
• Demonstrate renal and ureteral anatomy in special
circumstances

20. Contraindications
• Renal insufficiency for worsening of their renal function (contrast induced
nephrotoxicity).
• Multiple consecutive contrast studies - less than 48 hours (increased
possibility for CIN)
• Documented allergic reaction to contrast such as urticaria, angioedema,
laryngeal edema, bronchospasm, and hypotension with tachycardia.
• cardiac disease as contrast administration can cause worsening of
congestive hear t failure, due to the osmotic load.
• Patients who are on metformin must stop the drug 48 hours before
contrast injection as it can cause lactic acidosis which may be fatal.

21. Technique
• Bowel prep may help to visualize the entire ureters and upper
collecting systems (role proven only in chronic constipation)
• A KUB to allow determination of adequate bowel preparation,
confirms correct positioning, and exposes kidney stones or bladder
stones.
• Contrast is administered IV as a rapid bolus injection; slow, steady
injection; or drip infusion.
• Contrast dose is 1 mL contrast per pound of | body weight, to a
maximum of 150 ml.
• A film is taken at 5 minutes and then additional films are taken at .
intervals (individulized to each case).
• Postvoiding films are obtained to evaluate the presence of outlet
obstruction, prostate enlargement, and bladder filling defects
including stones and urothelial cancers.

23. Scout film
• Calculus
• Skeletal abnormality
• Intestinal gaspattern
• Calcifications
• Abdominal masses
• Foreign bodies

24. Nephrogram
• Size, shape, position and axis
of kidneys External cortex and
inner medulla Calyceal system
• Renal pelvis and ureteropelvic
junction
• Ureter
• Uretero-vesical junction
• Urinary bladder
• Relation of ureter to spine and
psoas muscle

25. Retrograrde pyelogram
Indication
• Evaluation of congenital & acquired ureteral obstruction.
• Elucidation of filling defects and deformities of the ureters
or intrarenal collecting systems.
• Opacification or distention of collecting system to assist
percutaneous access.
• In conjunction with ureteroscopy or stent placement.
• Evaluation of hematuria.
• Surveillance of transitional cell carcinoma.
• In the evaluation of traumatic or iatrogenic injury to the
ureter or collecting system

26. Technique
• Usually done in the dorsal lithotomy position.
• A KUB film is taken to confirm correct positioning,
and exposes kidney stones or bladder stones.
• Cystoscopy is performed and a catheter is
inserted in the ureteral orifice through which the
contrast medium is injected
• Documentary still images or “spot films” may be
saved for evaluation during peristalsis & for
future comparison

27. Retrograde urethrography
• indications

28. Retrograde urethrography
Technique:
• The patient is usually positioned slightly obliquely
(45°) and dependent
• A KUB film is taken to confirm correct positioning, and
exposes kidney _ stones or bladder stones.
• The penis is placed on slight tension.
• A small catheter may be inserted into the fossa
navicularis with the balloon inflated to 1-2 mL.
• Contrast is then introduced via catheter-tipped syringe.
Alternatively, a penile clamp may be used to occlude
the urethra around the catheter.

29. • Urethrography
• cystourethrography

30. Urethral truma

33. Voiding cystourethrography

34. Loopogram

35. References
• Principle and practice of urelogy, 2nd edition
• Campbell-Walsh-Wein Urology,12th edition
• American society of radiology, guidelines on
contrast imaging,2010
•

36. Thank you