SlideShare a Scribd company logo
NTAMBI MUSA
Objectives
Definition
Indications
Contraindications
Procedure
Mainly a recap of yesterday’s lecture
WHAT IS IVU?
 It is the radiographic examination of the urinary
tract including the renal parenchyma, calyces,
pelvis, ureters and the urinary bladder after the
intravenous injection of the contrast media.
 A series of plain films of the renal system, taken
after administration of an intravenous injection of
water-soluble iodine-containing contrast medium
Terminology
Urogram: Visualization of kidney parenchyma,
calyces, pelvis, ureters resulting from IV injection of
contrast.
Pyelogram: Describesretrograde studies visualizing
only the collecting system.
So, IVP is misnomer, should be IVU
INDICATIONS for IVU
1. Persistent flank pain
2. Haematuria
3. Renal and ureteric calculi
4. Ureteric fistulas and stricutures
5. Complex urinary tract infection
6. Demonstration of renal collecting
system and ureters.
Contraindications for IVU
1. Renal failure (raised serum creatinine level >1.5 mg/dL)
2. Hepatorenal syndrome
3. Previous allergy to the contrast agent/iodine
4. Generalized allergic conditions
5. Multiple myeloma
6. Pregnancy
7. Infancy
8. Thyrotoxicosis
9. Diabetes
Note: There is no absolute contraindication
Advantages of IVU
1. Clear outline of the entire urinary system so can see
even mild hydronephrosis.
2. Easier to pick out obstructing stone when there are
multiple pelvic calcifications.
3. Can show non-opaque stones as filling defects.
4. Demonstrate renal function and allow for verification
that the opposite kidney is functioning normally.
5. Cheap in comparison to modern modalities
Disadvantages of IVU
1. The need for IV contrast material
2. May provoke an allergic response
3. Multiple delayed films (In case of blockages, can take
hours as contrast passes quite slowly into the blocked
renal unit and/or ureter.)
4. May not have sufficient opacification to define the
anatomy and point of obstruction.
5. Requires a significant amount of radiation exposure
and is not be ideal for young children or pregnant
women
Contrast media
Iodine is the main element that imparts the radiopacity
Types:
Ionic; e.g: Urografin, Angiografin, Urovision and Triovideo
conary etc… They are cheap but they dissociate in solution
(ionise).
Nonionic; e.g: Iopamiro aka Iopamidol, Iohexal aka Omnipaque,
Iopromide aka Ultravist etc.
Merit: these LOCM do not dissociate in the body.
Demerit: More expensive than Ionic variants.
Dimers… Latest modification. Iso-osmolar
Patient Preparation
 Complete urine and blood examination to
assess the renal function.
 The patient is given mild laxatives(1-2 oz castor
oil) about twelve to twenty four hours before the
examination. (A night before the urographic
examination). Eliminates fecal material and
reduces amount of gas in bowel.
 The patient is kept nil by mouth over night and
is dehydrated by stopping the fluid intake.
Patient Preparation Cont.
 Most uroradiologist believe that with modern
contrast media over hydration should be
avoided and… Actually, dehydration is
unnecessary with modern CM.
 In practice pt. are advised to omit fluids after
11pm, omit breakfast which decreases chance
of vomiting and produce slight dehydration.
Patient Preparation Cont.
 The dehydration helps in better concentration of
the contrast and clearer x- ray pictures.
 The patient should not be dehydrated if
suffering from renal failure as it may lead to
severe fluid and electrolyte imbalance.
 Sensitivity to the dye (Hypaque or Urographin)
should be checked.
Preparations on day of
Procedure
 Evaluate the request form
 Greet the patient
 Take History again
 Previous reaction to contrast media
 Diabetes mellitus, myeloma, hyperuricemia,
sickle-cell disease
 Glomerular Function
 Assess if patient can excrete the dye
Patient Preparation Cont.
And what is pertinent Hx?
5. Remove jewelry, check attire, snaps, pins, NG tubes, etc.
6. Explain the exam in simple language (layman’s terms)
7. Questions?
urinary tract infection,
Renal mass, oliguria,
renovascular hypertension,
Renal calculi,
DM,
elevated creatinine or BUN,
haematuria,
bladder CA, prostate
enlargement, polycystic kidney,
8. Set technique before positioning
4. Have the patient void
Shielding
Shield gonads, keeping the shield below the superior
margin of the symphysis pubis.
Patient Position
Situate patient supine, with pillow for head, arms at sides away
from body, and support under knees to relieve back strain.
Part Position
• Align midsagittal plane to center line of table and to CR.
• Ensure no rotation of trunk or pelvis.
• Include symphysis pubis on bottom of IR without cutting off
upper kidneys. (A second smaller IR for bladder area may be
necessary on hypersthenic patients.)
Material / Equipment
High powered X-Ray generator set-up, typical 40-60 kW.
contrast (amount dependent on body weight, typically around
100cc)
Syringes, Cannula and alcohol wipes
tourniquet
emesis basin, towels, emergency drugs/crash cart, Emergency
drugs and equipment
lead marker set (anatomical and time)
compression device
10” x 12” & 14” x 17” cassettes
gonadal shields
positioning sponges
Abdominal compression equipment.
Pads and immobilisation aids
Venipuncture
Reaction
supplies
Filming
IVU scout and series.
Central Ray
• CR is perpendicular to IR.
• Center CR and IR to level of iliac crest and to midsagittal
plane.
• Minimum SID is 40 inches (100 cm).
Collimation
Collimate to IR or smaller if possible.
Respiration
Suspend respiration on expiration and expose.
SCOUT / PRELIMINARY
FILM
 Supine, full length AP of
abdomen in inspiration.
 The lower border of cassette is
at the level of symphysis
pubis and the x-ray beam is
centred in the midline at the
level of iliac crests.
 To demonstrate bowel
preparation, check exposure
factors and location of any
radiopaque material or
artefacts
Rationale of the scout film
Demonstrate:
 Calculus
 Skeletal abnormality
 Intestinal gaspattern
 Calcifications
 Abdominal masses
 Foreign bodies
If necessary the position of overlying opacities may be
further demonstrated by:.
 Supine AP of renal areas, in expiration. The x-ray beam is
centred in the mid-line at the level of lower costal
margin
 The examination should not proceed until these films are
reviewed and confirmed satisfactory.
Contrast media injection
 Low osmolar contrast media (LOCM)- 300- 600mgI/ml
 Adult dose : 50-100ml
 Paediatric dose : 1ml/kg
Informed Consent
Technique
 Venous access via the median antecubital vein
is the preferred injection site.
 The gauge of the cannula/needle should allow
the injection to be given rapidly as bolus to
maximize the density of nephrogram.
 Upper arm or shoulder pain may be due to
stasis of contrast in vein which may be relieved
by abduction of the arm.
Administration of CM
 Dose of 200mg of iodine per pound body wt-
dose of 20-30g.
 Injection completed within 60 sec-rapidly
injecting as bolus with 50 ml syringes.
 Slow injections decrease side effects but
provides less dense nephrogram
 Another method –drip infusion technique,
infusion kit with 40-50g iodine delivered in 250-
400ml fluid.
What to
watch for
Reactions can
develop quickly,
and patients
should not be
left alone.
From Patient Care in Radiography,
5th edition. pg.271.
Potential Contrast Reactions (and treatments for)
Though the incidence is lessened, reactions to nonionic contrast injections are
the same as for ionic agents. Most reactions occur within 5 minutes of injection.
Staying calm and reassuring is imperative to the patient’s well being.
Mild: metallic taste dizziness
flushing (slow, deep breathing) diaphoresis
nausea chills (blanket warmer)
vomiting (emesis basin) vasovagal (fear of needles)
Moderate: urticaria (benadryl) swelling of parotids
facial edema transient bronchospasm
transient hypotension delayed skin reaction (keep patients 20 min)
headache tachycardia
Severe: prolonged hypotension/circulatory collapse (Adrenaline [epinephrine]
improves cardiac output and relaxes bronchial smooth muscles).
pulmonary edema arrhythmias (Inderal)
angina (nitroglycerine) convulsions
severe bronchospasm (adrenaline) coma
cardiac arrest (sodium bicarbonate) paralysis
death
Physiology of excretion of
CM
 CM reaches renal artery in 15 sec.
Vascular nephrogram: Last btn a few seconds to 1
min, & coexists with the diffusion of CM
Total body opacification phase: CM is freely
filtered by the glomeruli
Tubular phase: Last for 1 min. CM is in proximal
and distal Convulated tubules
Pyelographic phase: CM in convulated system
reaches the calyces btn 2-3 min.
Radiographic Anatomy
of the urinary system
catheter
IVU Tomogram
Right Renal Arteriogram
Circulation of iodine contrast
before the nephron phase
(first appearance) of kidney in
an IVU
cortex
renal pelvis
nephron
“blush”
renal a.
Ureter major calyx
minor calyces
Ureteropelvic junction
(infundibulum)
Anatomy
Review
Film
Sequence
Routines are determined by department protocol, but a typical
sequence is:
 1-3 minutes Antero-posterior- film coned to the renal area
 5 minutes Antero-posterior-film coned to the renal area
 Apply ureteral compression
 10 minutes Antero-posterior
 Release compression
 “Flush”, “X” or “Release view”- - full length view at 20 minutes
 Upright post void Antero-posterior
Film
Sequence
Immediate film. AP of the renal areas.
Taken ~ 10–14 s after the injection (approximate ‘arm-to-
kidney’ time).
Aims to show the nephrogram at its most dense - i.e. the
renal parenchyma opacified by contrast medium in the
renal tubules.
Tomography may assist in evaluation of the renal outline or
possible masses (or ultrasound if readily available).
5-min film. AP of the renal areas. Gives an initial
assessment of pathology—specifically the presence or
absence of obstruction before administering compression.
Film
Sequence
A compression band is then applied, positioned midway
between the ASIS - i.e. over the ureters as they cross the pelvic
brim.
Aim is to produce pelvicalyceal distension.
10-min film. AP of the renal areas. There is usually adequate
distension of the pelvicalyceal systems with opaque urine by this
time.
Compression is, contraindicated if:
(a) after recent abdominal surgery
(b) after renal trauma
(c) there is a large abdominal mass or aortic aneurysm
(d) when the 5-min film shows already distended calyces
indicative of obstruction
Compression is released when satisfactory demonstration of
the pelvicalyceal system has been achieved.
If the compression film is inadequate, the compression
should be checked and repositioned if necessary and a
further 50 mL of contrast medium administered and a
repeat film taken after 5 min.
Release film. Supine AP abdomen taken immediately after
the release of compression. Taken to show the ureters.
If film is satisfactory, the patient is asked to empty the
bladder.
cortex
Rt iliac
crest
Hilum *
medulla
Lower pole
rt. kidney
Upper pole
rt. kidney
* In middle of medial border,
superimposed on psoas m.
IVU Tomogram, late nephron
phase, collecting system
beginning to visualize
Release film with full bladder
Lateral
border
After Micturition (Post void) film. Full-length Erect or supine
AP abdomen.
Aimed at assessing bladder emptying, to demonstrate
drainage of the upper tracts, to aid the diagnosis of bladder
tumours, to confirm ureterovesical junction calculi, and
(though uncommonly), to demonstrate a urethral
diverticulum in females.
Additional Images.
1. 35° posterior oblique of the kidneys, ureters or bladder—for
equivocal collecting system lesions or localization of calculi
2. Tomography - if renal outlines are not well seen
3. Prone abdomen following the release film—may improve
visualization of distal ureters
4. Delayed films at increasing (doubling of time intervals) up to 24 h
after injection in renal obstruction
Variation
Renal colic—a limited study may be performed: preliminary films;
20-min full length (no compression); postmicturition full length;
delayed films up to 24 h as required to show level and cause of
obstruction.
RPO AND LPO POSITIONS: INTRAVENOUS (EXCRETORY)
UROGRAPHY
Pathology Demonstrated
Signs of infection, trauma, and obstruction of the elevated kidney are
shown. Also demonstrates trauma or obstruction of the downside ureter.
RPO
Summary of the Procedure
Scout Film
Injection of Contrast
Immediate Film
5-minute Film
10-minute Film
Release Film
Post-void Film
Radiographic Critique
Structures Shown: • Entire urinary system is
visualized from upper renal shadows to distal urinary
bladder.
The symphysis pubis should be included on lower
margin of the IR.
After injection, only a portion of the urinary system
may be opacified on a specific radiograph in the
series.
Position: • No rotation as evidenced by symmetry of
iliac wings and ribcage.
Radiographic Critique
Collimation and CR:
• Collimation borders to IR margins on top and bottom to
prevent cutoff of essential anatomy.
• Complete arch of symphysis pubis visible on bottom
margin of radiograph, with center of image at level of iliac
crest.
Exposure Criteria and Markers:
• No motion due to respiration or movement.
• Appropriate technique with short-scale contrast
demonstrating the urinary system.
• Minute markers and anatomical (R or L) markers visible on
all series radiographs.
IVU contrasted studies - lecture....pptx
IVU contrasted studies - lecture....pptx

More Related Content

Similar to IVU contrasted studies - lecture....pptx

Intravenous urography (IVU)- Avinesh Shrestha
Intravenous urography (IVU)- Avinesh ShresthaIntravenous urography (IVU)- Avinesh Shrestha
Intravenous urography (IVU)- Avinesh Shrestha
Avinesh Shrestha
 
Radiological importance of intravenous pyelography
Radiological importance of intravenous pyelographyRadiological importance of intravenous pyelography
Radiological importance of intravenous pyelography
Praful9764
 
Intravenous Urography
Intravenous UrographyIntravenous Urography
Intravenous Urography
Youttam Laudari
 
Ivu
IvuIvu
Intravenous Urography lecture detai.pptx
Intravenous Urography lecture detai.pptxIntravenous Urography lecture detai.pptx
Intravenous Urography lecture detai.pptx
ssuser504dda
 
Endoscopic management in pancreatic diseases
Endoscopic management in pancreatic diseasesEndoscopic management in pancreatic diseases
Endoscopic management in pancreatic diseases
NKP Salve Institute of Medical Sciences & Research Centre, Nagpur
 
Radiological procedure questions and answers2 converted
Radiological procedure questions and answers2 convertedRadiological procedure questions and answers2 converted
Radiological procedure questions and answers2 converted
Ganesan Yogananthem
 
Intravenous urography and its modifications.pptx 01
Intravenous urography and its modifications.pptx 01Intravenous urography and its modifications.pptx 01
Intravenous urography and its modifications.pptx 01
SUJAN KARKI
 
Renal biopsy
Renal biopsyRenal biopsy
Renal biopsy
FarragBahbah
 
CUT.docx
CUT.docxCUT.docx
CUT.docx
haileab2
 
Special contract X-ray methods of examination
Special contract X-ray methods of examinationSpecial contract X-ray methods of examination
Special contract X-ray methods of examination
Eneutron
 
RGU (Retrograde urethrogram), MCU (Micturating cystourethrogram) and its inte...
RGU (Retrograde urethrogram), MCU (Micturating cystourethrogram) and its inte...RGU (Retrograde urethrogram), MCU (Micturating cystourethrogram) and its inte...
RGU (Retrograde urethrogram), MCU (Micturating cystourethrogram) and its inte...
Milan Silwal
 
solitary kidney with a stone, Ivu cas study
solitary kidney with a stone, Ivu cas studysolitary kidney with a stone, Ivu cas study
solitary kidney with a stone, Ivu cas study
Shatha M
 
RGU MCU and its interpretation in pathology of Urinary Bladder & Urethra
RGU MCU and its interpretation in pathology of Urinary Bladder & UrethraRGU MCU and its interpretation in pathology of Urinary Bladder & Urethra
RGU MCU and its interpretation in pathology of Urinary Bladder & Urethra
dbc9427
 
Renal Diagnostic Tests OR Investigations
Renal Diagnostic Tests OR InvestigationsRenal Diagnostic Tests OR Investigations
Renal Diagnostic Tests OR Investigations
Chandima007
 
Liver biopsy
Liver biopsyLiver biopsy
Liver biopsy
Appy Akshay Agarwal
 
Intravenous urography
Intravenous urographyIntravenous urography
Intravenous urography
RamanGhimire3
 
Intravenous urography
Intravenous urographyIntravenous urography
Intravenous urography
rajen ray
 
Retroperitoneal tumours.pptx
Retroperitoneal tumours.pptxRetroperitoneal tumours.pptx
Retroperitoneal tumours.pptx
Pradeep Pande
 
Turp
TurpTurp

Similar to IVU contrasted studies - lecture....pptx (20)

Intravenous urography (IVU)- Avinesh Shrestha
Intravenous urography (IVU)- Avinesh ShresthaIntravenous urography (IVU)- Avinesh Shrestha
Intravenous urography (IVU)- Avinesh Shrestha
 
Radiological importance of intravenous pyelography
Radiological importance of intravenous pyelographyRadiological importance of intravenous pyelography
Radiological importance of intravenous pyelography
 
Intravenous Urography
Intravenous UrographyIntravenous Urography
Intravenous Urography
 
Ivu
IvuIvu
Ivu
 
Intravenous Urography lecture detai.pptx
Intravenous Urography lecture detai.pptxIntravenous Urography lecture detai.pptx
Intravenous Urography lecture detai.pptx
 
Endoscopic management in pancreatic diseases
Endoscopic management in pancreatic diseasesEndoscopic management in pancreatic diseases
Endoscopic management in pancreatic diseases
 
Radiological procedure questions and answers2 converted
Radiological procedure questions and answers2 convertedRadiological procedure questions and answers2 converted
Radiological procedure questions and answers2 converted
 
Intravenous urography and its modifications.pptx 01
Intravenous urography and its modifications.pptx 01Intravenous urography and its modifications.pptx 01
Intravenous urography and its modifications.pptx 01
 
Renal biopsy
Renal biopsyRenal biopsy
Renal biopsy
 
CUT.docx
CUT.docxCUT.docx
CUT.docx
 
Special contract X-ray methods of examination
Special contract X-ray methods of examinationSpecial contract X-ray methods of examination
Special contract X-ray methods of examination
 
RGU (Retrograde urethrogram), MCU (Micturating cystourethrogram) and its inte...
RGU (Retrograde urethrogram), MCU (Micturating cystourethrogram) and its inte...RGU (Retrograde urethrogram), MCU (Micturating cystourethrogram) and its inte...
RGU (Retrograde urethrogram), MCU (Micturating cystourethrogram) and its inte...
 
solitary kidney with a stone, Ivu cas study
solitary kidney with a stone, Ivu cas studysolitary kidney with a stone, Ivu cas study
solitary kidney with a stone, Ivu cas study
 
RGU MCU and its interpretation in pathology of Urinary Bladder & Urethra
RGU MCU and its interpretation in pathology of Urinary Bladder & UrethraRGU MCU and its interpretation in pathology of Urinary Bladder & Urethra
RGU MCU and its interpretation in pathology of Urinary Bladder & Urethra
 
Renal Diagnostic Tests OR Investigations
Renal Diagnostic Tests OR InvestigationsRenal Diagnostic Tests OR Investigations
Renal Diagnostic Tests OR Investigations
 
Liver biopsy
Liver biopsyLiver biopsy
Liver biopsy
 
Intravenous urography
Intravenous urographyIntravenous urography
Intravenous urography
 
Intravenous urography
Intravenous urographyIntravenous urography
Intravenous urography
 
Retroperitoneal tumours.pptx
Retroperitoneal tumours.pptxRetroperitoneal tumours.pptx
Retroperitoneal tumours.pptx
 
Turp
TurpTurp
Turp
 

More from ssuser504dda

Palliative care presentation slide4.pptx
Palliative care presentation slide4.pptxPalliative care presentation slide4.pptx
Palliative care presentation slide4.pptx
ssuser504dda
 
Palliative class presentation slid3.pptx
Palliative class presentation slid3.pptxPalliative class presentation slid3.pptx
Palliative class presentation slid3.pptx
ssuser504dda
 
Palliative care presentation slide2.pptx
Palliative care presentation slide2.pptxPalliative care presentation slide2.pptx
Palliative care presentation slide2.pptx
ssuser504dda
 
Palliative care presentation slides.pptx
Palliative care presentation slides.pptxPalliative care presentation slides.pptx
Palliative care presentation slides.pptx
ssuser504dda
 
Development studies - presentation .pptx
Development studies - presentation .pptxDevelopment studies - presentation .pptx
Development studies - presentation .pptx
ssuser504dda
 
Group Reproductice health Coursework.ppt
Group Reproductice health Coursework.pptGroup Reproductice health Coursework.ppt
Group Reproductice health Coursework.ppt
ssuser504dda
 
Mortality Audit presentation - slid.pptx
Mortality Audit presentation - slid.pptxMortality Audit presentation - slid.pptx
Mortality Audit presentation - slid.pptx
ssuser504dda
 
Examinating the Resipiratory System.pptx
Examinating the Resipiratory System.pptxExaminating the Resipiratory System.pptx
Examinating the Resipiratory System.pptx
ssuser504dda
 
crush-injury-and-crush-syndrome-191.pptx
crush-injury-and-crush-syndrome-191.pptxcrush-injury-and-crush-syndrome-191.pptx
crush-injury-and-crush-syndrome-191.pptx
ssuser504dda
 
Male Reproductive System ......... .pptx
Male Reproductive System ......... .pptxMale Reproductive System ......... .pptx
Male Reproductive System ......... .pptx
ssuser504dda
 
Antenatal Care -REPRODUCTIVE HEALTH.pptx
Antenatal Care -REPRODUCTIVE HEALTH.pptxAntenatal Care -REPRODUCTIVE HEALTH.pptx
Antenatal Care -REPRODUCTIVE HEALTH.pptx
ssuser504dda
 
Student Academic - PLACEMENT REPORT.pptx
Student Academic - PLACEMENT REPORT.pptxStudent Academic - PLACEMENT REPORT.pptx
Student Academic - PLACEMENT REPORT.pptx
ssuser504dda
 
Cranial nerves - esson presentation.pptx
Cranial nerves - esson presentation.pptxCranial nerves - esson presentation.pptx
Cranial nerves - esson presentation.pptx
ssuser504dda
 
HEPATITIS IN Children a case study.pptx
HEPATITIS IN Children  a case study.pptxHEPATITIS IN Children  a case study.pptx
HEPATITIS IN Children a case study.pptx
ssuser504dda
 
children. palliative care.pptx
children.     palliative       care.pptxchildren.     palliative       care.pptx
children. palliative care.pptx
ssuser504dda
 
PALLIATIVE CARE (GROUP2) BME3 2023.pptx
PALLIATIVE CARE (GROUP2)  BME3 2023.pptxPALLIATIVE CARE (GROUP2)  BME3 2023.pptx
PALLIATIVE CARE (GROUP2) BME3 2023.pptx
ssuser504dda
 
Group pharmacology uuuuu. .pptx
Group pharmacology   uuuuu.        .pptxGroup pharmacology   uuuuu.        .pptx
Group pharmacology uuuuu. .pptx
ssuser504dda
 
Group 5_ Year 3 Pharmacology 2023.pptx
Group 5_   Year 3 Pharmacology 2023.pptxGroup 5_   Year 3 Pharmacology 2023.pptx
Group 5_ Year 3 Pharmacology 2023.pptx
ssuser504dda
 
STEP Session 10b. - Networking.ppt
STEP Session 10b.       - Networking.pptSTEP Session 10b.       - Networking.ppt
STEP Session 10b. - Networking.ppt
ssuser504dda
 
Inter-relgious cooperation -Kiyimba.pptx
Inter-relgious cooperation -Kiyimba.pptxInter-relgious cooperation -Kiyimba.pptx
Inter-relgious cooperation -Kiyimba.pptx
ssuser504dda
 

More from ssuser504dda (20)

Palliative care presentation slide4.pptx
Palliative care presentation slide4.pptxPalliative care presentation slide4.pptx
Palliative care presentation slide4.pptx
 
Palliative class presentation slid3.pptx
Palliative class presentation slid3.pptxPalliative class presentation slid3.pptx
Palliative class presentation slid3.pptx
 
Palliative care presentation slide2.pptx
Palliative care presentation slide2.pptxPalliative care presentation slide2.pptx
Palliative care presentation slide2.pptx
 
Palliative care presentation slides.pptx
Palliative care presentation slides.pptxPalliative care presentation slides.pptx
Palliative care presentation slides.pptx
 
Development studies - presentation .pptx
Development studies - presentation .pptxDevelopment studies - presentation .pptx
Development studies - presentation .pptx
 
Group Reproductice health Coursework.ppt
Group Reproductice health Coursework.pptGroup Reproductice health Coursework.ppt
Group Reproductice health Coursework.ppt
 
Mortality Audit presentation - slid.pptx
Mortality Audit presentation - slid.pptxMortality Audit presentation - slid.pptx
Mortality Audit presentation - slid.pptx
 
Examinating the Resipiratory System.pptx
Examinating the Resipiratory System.pptxExaminating the Resipiratory System.pptx
Examinating the Resipiratory System.pptx
 
crush-injury-and-crush-syndrome-191.pptx
crush-injury-and-crush-syndrome-191.pptxcrush-injury-and-crush-syndrome-191.pptx
crush-injury-and-crush-syndrome-191.pptx
 
Male Reproductive System ......... .pptx
Male Reproductive System ......... .pptxMale Reproductive System ......... .pptx
Male Reproductive System ......... .pptx
 
Antenatal Care -REPRODUCTIVE HEALTH.pptx
Antenatal Care -REPRODUCTIVE HEALTH.pptxAntenatal Care -REPRODUCTIVE HEALTH.pptx
Antenatal Care -REPRODUCTIVE HEALTH.pptx
 
Student Academic - PLACEMENT REPORT.pptx
Student Academic - PLACEMENT REPORT.pptxStudent Academic - PLACEMENT REPORT.pptx
Student Academic - PLACEMENT REPORT.pptx
 
Cranial nerves - esson presentation.pptx
Cranial nerves - esson presentation.pptxCranial nerves - esson presentation.pptx
Cranial nerves - esson presentation.pptx
 
HEPATITIS IN Children a case study.pptx
HEPATITIS IN Children  a case study.pptxHEPATITIS IN Children  a case study.pptx
HEPATITIS IN Children a case study.pptx
 
children. palliative care.pptx
children.     palliative       care.pptxchildren.     palliative       care.pptx
children. palliative care.pptx
 
PALLIATIVE CARE (GROUP2) BME3 2023.pptx
PALLIATIVE CARE (GROUP2)  BME3 2023.pptxPALLIATIVE CARE (GROUP2)  BME3 2023.pptx
PALLIATIVE CARE (GROUP2) BME3 2023.pptx
 
Group pharmacology uuuuu. .pptx
Group pharmacology   uuuuu.        .pptxGroup pharmacology   uuuuu.        .pptx
Group pharmacology uuuuu. .pptx
 
Group 5_ Year 3 Pharmacology 2023.pptx
Group 5_   Year 3 Pharmacology 2023.pptxGroup 5_   Year 3 Pharmacology 2023.pptx
Group 5_ Year 3 Pharmacology 2023.pptx
 
STEP Session 10b. - Networking.ppt
STEP Session 10b.       - Networking.pptSTEP Session 10b.       - Networking.ppt
STEP Session 10b. - Networking.ppt
 
Inter-relgious cooperation -Kiyimba.pptx
Inter-relgious cooperation -Kiyimba.pptxInter-relgious cooperation -Kiyimba.pptx
Inter-relgious cooperation -Kiyimba.pptx
 

Recently uploaded

Cardiac Assessment for B.sc Nursing Student.pdf
Cardiac Assessment for B.sc Nursing Student.pdfCardiac Assessment for B.sc Nursing Student.pdf
Cardiac Assessment for B.sc Nursing Student.pdf
shivalingatalekar1
 
Chapter 11 Nutrition and Chronic Diseases.pptx
Chapter 11 Nutrition and Chronic Diseases.pptxChapter 11 Nutrition and Chronic Diseases.pptx
Chapter 11 Nutrition and Chronic Diseases.pptx
Earlene McNair
 
Diabetic nephropathy diagnosis treatment
Diabetic nephropathy diagnosis treatmentDiabetic nephropathy diagnosis treatment
Diabetic nephropathy diagnosis treatment
arahmanzai5
 
CHEMOTHERAPY_RDP_CHAPTER 3_ANTIFUNGAL AGENT.pdf
CHEMOTHERAPY_RDP_CHAPTER 3_ANTIFUNGAL AGENT.pdfCHEMOTHERAPY_RDP_CHAPTER 3_ANTIFUNGAL AGENT.pdf
CHEMOTHERAPY_RDP_CHAPTER 3_ANTIFUNGAL AGENT.pdf
rishi2789
 
REGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptx
REGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptxREGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptx
REGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptx
LaniyaNasrink
 
CHEMOTHERAPY_RDP_CHAPTER 2 _LEPROSY.pdf1
CHEMOTHERAPY_RDP_CHAPTER 2 _LEPROSY.pdf1CHEMOTHERAPY_RDP_CHAPTER 2 _LEPROSY.pdf1
CHEMOTHERAPY_RDP_CHAPTER 2 _LEPROSY.pdf1
rishi2789
 
Abortion PG Seminar Power point presentation
Abortion PG Seminar Power point presentationAbortion PG Seminar Power point presentation
Abortion PG Seminar Power point presentation
AksshayaRajanbabu
 
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotes
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPromoting Wellbeing - Applied Social Psychology - Psychology SuperNotes
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotes
PsychoTech Services
 
Adhd Medication Shortage Uk - trinexpharmacy.com
Adhd Medication Shortage Uk - trinexpharmacy.comAdhd Medication Shortage Uk - trinexpharmacy.com
Adhd Medication Shortage Uk - trinexpharmacy.com
reignlana06
 
Tests for analysis of different pharmaceutical.pptx
Tests for analysis of different pharmaceutical.pptxTests for analysis of different pharmaceutical.pptx
Tests for analysis of different pharmaceutical.pptx
taiba qazi
 
Vestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptx
Vestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptxVestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptx
Vestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptx
Dr. Rabia Inam Gandapore
 
Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptx
Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptxEar and its clinical correlations By Dr. Rabia Inam Gandapore.pptx
Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptx
Dr. Rabia Inam Gandapore
 
A Classical Text Review on Basavarajeeyam
A Classical Text Review on BasavarajeeyamA Classical Text Review on Basavarajeeyam
A Classical Text Review on Basavarajeeyam
Dr. Jyothirmai Paindla
 
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx
Holistified Wellness
 
Does Over-Masturbation Contribute to Chronic Prostatitis.pptx
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxDoes Over-Masturbation Contribute to Chronic Prostatitis.pptx
Does Over-Masturbation Contribute to Chronic Prostatitis.pptx
walterHu5
 
Top Effective Soaps for Fungal Skin Infections in India
Top Effective Soaps for Fungal Skin Infections in IndiaTop Effective Soaps for Fungal Skin Infections in India
Top Effective Soaps for Fungal Skin Infections in India
SwisschemDerma
 
The Best Ayurvedic Antacid Tablets in India
The Best Ayurvedic Antacid Tablets in IndiaThe Best Ayurvedic Antacid Tablets in India
The Best Ayurvedic Antacid Tablets in India
Swastik Ayurveda
 
CHEMOTHERAPY_RDP_CHAPTER 1_ANTI TB DRUGS.pdf
CHEMOTHERAPY_RDP_CHAPTER 1_ANTI TB DRUGS.pdfCHEMOTHERAPY_RDP_CHAPTER 1_ANTI TB DRUGS.pdf
CHEMOTHERAPY_RDP_CHAPTER 1_ANTI TB DRUGS.pdf
rishi2789
 
Netter's Atlas of Human Anatomy 7.ed.pdf
Netter's Atlas of Human Anatomy 7.ed.pdfNetter's Atlas of Human Anatomy 7.ed.pdf
Netter's Atlas of Human Anatomy 7.ed.pdf
BrissaOrtiz3
 
THERAPEUTIC ANTISENSE MOLECULES .pptx
THERAPEUTIC ANTISENSE MOLECULES    .pptxTHERAPEUTIC ANTISENSE MOLECULES    .pptx
THERAPEUTIC ANTISENSE MOLECULES .pptx
70KRISHPATEL
 

Recently uploaded (20)

Cardiac Assessment for B.sc Nursing Student.pdf
Cardiac Assessment for B.sc Nursing Student.pdfCardiac Assessment for B.sc Nursing Student.pdf
Cardiac Assessment for B.sc Nursing Student.pdf
 
Chapter 11 Nutrition and Chronic Diseases.pptx
Chapter 11 Nutrition and Chronic Diseases.pptxChapter 11 Nutrition and Chronic Diseases.pptx
Chapter 11 Nutrition and Chronic Diseases.pptx
 
Diabetic nephropathy diagnosis treatment
Diabetic nephropathy diagnosis treatmentDiabetic nephropathy diagnosis treatment
Diabetic nephropathy diagnosis treatment
 
CHEMOTHERAPY_RDP_CHAPTER 3_ANTIFUNGAL AGENT.pdf
CHEMOTHERAPY_RDP_CHAPTER 3_ANTIFUNGAL AGENT.pdfCHEMOTHERAPY_RDP_CHAPTER 3_ANTIFUNGAL AGENT.pdf
CHEMOTHERAPY_RDP_CHAPTER 3_ANTIFUNGAL AGENT.pdf
 
REGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptx
REGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptxREGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptx
REGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptx
 
CHEMOTHERAPY_RDP_CHAPTER 2 _LEPROSY.pdf1
CHEMOTHERAPY_RDP_CHAPTER 2 _LEPROSY.pdf1CHEMOTHERAPY_RDP_CHAPTER 2 _LEPROSY.pdf1
CHEMOTHERAPY_RDP_CHAPTER 2 _LEPROSY.pdf1
 
Abortion PG Seminar Power point presentation
Abortion PG Seminar Power point presentationAbortion PG Seminar Power point presentation
Abortion PG Seminar Power point presentation
 
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotes
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPromoting Wellbeing - Applied Social Psychology - Psychology SuperNotes
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotes
 
Adhd Medication Shortage Uk - trinexpharmacy.com
Adhd Medication Shortage Uk - trinexpharmacy.comAdhd Medication Shortage Uk - trinexpharmacy.com
Adhd Medication Shortage Uk - trinexpharmacy.com
 
Tests for analysis of different pharmaceutical.pptx
Tests for analysis of different pharmaceutical.pptxTests for analysis of different pharmaceutical.pptx
Tests for analysis of different pharmaceutical.pptx
 
Vestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptx
Vestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptxVestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptx
Vestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptx
 
Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptx
Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptxEar and its clinical correlations By Dr. Rabia Inam Gandapore.pptx
Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptx
 
A Classical Text Review on Basavarajeeyam
A Classical Text Review on BasavarajeeyamA Classical Text Review on Basavarajeeyam
A Classical Text Review on Basavarajeeyam
 
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx
 
Does Over-Masturbation Contribute to Chronic Prostatitis.pptx
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxDoes Over-Masturbation Contribute to Chronic Prostatitis.pptx
Does Over-Masturbation Contribute to Chronic Prostatitis.pptx
 
Top Effective Soaps for Fungal Skin Infections in India
Top Effective Soaps for Fungal Skin Infections in IndiaTop Effective Soaps for Fungal Skin Infections in India
Top Effective Soaps for Fungal Skin Infections in India
 
The Best Ayurvedic Antacid Tablets in India
The Best Ayurvedic Antacid Tablets in IndiaThe Best Ayurvedic Antacid Tablets in India
The Best Ayurvedic Antacid Tablets in India
 
CHEMOTHERAPY_RDP_CHAPTER 1_ANTI TB DRUGS.pdf
CHEMOTHERAPY_RDP_CHAPTER 1_ANTI TB DRUGS.pdfCHEMOTHERAPY_RDP_CHAPTER 1_ANTI TB DRUGS.pdf
CHEMOTHERAPY_RDP_CHAPTER 1_ANTI TB DRUGS.pdf
 
Netter's Atlas of Human Anatomy 7.ed.pdf
Netter's Atlas of Human Anatomy 7.ed.pdfNetter's Atlas of Human Anatomy 7.ed.pdf
Netter's Atlas of Human Anatomy 7.ed.pdf
 
THERAPEUTIC ANTISENSE MOLECULES .pptx
THERAPEUTIC ANTISENSE MOLECULES    .pptxTHERAPEUTIC ANTISENSE MOLECULES    .pptx
THERAPEUTIC ANTISENSE MOLECULES .pptx
 

IVU contrasted studies - lecture....pptx

  • 3. WHAT IS IVU?  It is the radiographic examination of the urinary tract including the renal parenchyma, calyces, pelvis, ureters and the urinary bladder after the intravenous injection of the contrast media.  A series of plain films of the renal system, taken after administration of an intravenous injection of water-soluble iodine-containing contrast medium
  • 4. Terminology Urogram: Visualization of kidney parenchyma, calyces, pelvis, ureters resulting from IV injection of contrast. Pyelogram: Describesretrograde studies visualizing only the collecting system. So, IVP is misnomer, should be IVU
  • 5. INDICATIONS for IVU 1. Persistent flank pain 2. Haematuria 3. Renal and ureteric calculi 4. Ureteric fistulas and stricutures 5. Complex urinary tract infection 6. Demonstration of renal collecting system and ureters.
  • 6. Contraindications for IVU 1. Renal failure (raised serum creatinine level >1.5 mg/dL) 2. Hepatorenal syndrome 3. Previous allergy to the contrast agent/iodine 4. Generalized allergic conditions 5. Multiple myeloma 6. Pregnancy 7. Infancy 8. Thyrotoxicosis 9. Diabetes Note: There is no absolute contraindication
  • 7. Advantages of IVU 1. Clear outline of the entire urinary system so can see even mild hydronephrosis. 2. Easier to pick out obstructing stone when there are multiple pelvic calcifications. 3. Can show non-opaque stones as filling defects. 4. Demonstrate renal function and allow for verification that the opposite kidney is functioning normally. 5. Cheap in comparison to modern modalities
  • 8. Disadvantages of IVU 1. The need for IV contrast material 2. May provoke an allergic response 3. Multiple delayed films (In case of blockages, can take hours as contrast passes quite slowly into the blocked renal unit and/or ureter.) 4. May not have sufficient opacification to define the anatomy and point of obstruction. 5. Requires a significant amount of radiation exposure and is not be ideal for young children or pregnant women
  • 9. Contrast media Iodine is the main element that imparts the radiopacity Types: Ionic; e.g: Urografin, Angiografin, Urovision and Triovideo conary etc… They are cheap but they dissociate in solution (ionise). Nonionic; e.g: Iopamiro aka Iopamidol, Iohexal aka Omnipaque, Iopromide aka Ultravist etc. Merit: these LOCM do not dissociate in the body. Demerit: More expensive than Ionic variants. Dimers… Latest modification. Iso-osmolar
  • 10. Patient Preparation  Complete urine and blood examination to assess the renal function.  The patient is given mild laxatives(1-2 oz castor oil) about twelve to twenty four hours before the examination. (A night before the urographic examination). Eliminates fecal material and reduces amount of gas in bowel.  The patient is kept nil by mouth over night and is dehydrated by stopping the fluid intake.
  • 11. Patient Preparation Cont.  Most uroradiologist believe that with modern contrast media over hydration should be avoided and… Actually, dehydration is unnecessary with modern CM.  In practice pt. are advised to omit fluids after 11pm, omit breakfast which decreases chance of vomiting and produce slight dehydration.
  • 12. Patient Preparation Cont.  The dehydration helps in better concentration of the contrast and clearer x- ray pictures.  The patient should not be dehydrated if suffering from renal failure as it may lead to severe fluid and electrolyte imbalance.  Sensitivity to the dye (Hypaque or Urographin) should be checked.
  • 13. Preparations on day of Procedure  Evaluate the request form  Greet the patient  Take History again  Previous reaction to contrast media  Diabetes mellitus, myeloma, hyperuricemia, sickle-cell disease  Glomerular Function  Assess if patient can excrete the dye
  • 14. Patient Preparation Cont. And what is pertinent Hx? 5. Remove jewelry, check attire, snaps, pins, NG tubes, etc. 6. Explain the exam in simple language (layman’s terms) 7. Questions? urinary tract infection, Renal mass, oliguria, renovascular hypertension, Renal calculi, DM, elevated creatinine or BUN, haematuria, bladder CA, prostate enlargement, polycystic kidney, 8. Set technique before positioning 4. Have the patient void
  • 15. Shielding Shield gonads, keeping the shield below the superior margin of the symphysis pubis. Patient Position Situate patient supine, with pillow for head, arms at sides away from body, and support under knees to relieve back strain. Part Position • Align midsagittal plane to center line of table and to CR. • Ensure no rotation of trunk or pelvis. • Include symphysis pubis on bottom of IR without cutting off upper kidneys. (A second smaller IR for bladder area may be necessary on hypersthenic patients.)
  • 16. Material / Equipment High powered X-Ray generator set-up, typical 40-60 kW. contrast (amount dependent on body weight, typically around 100cc) Syringes, Cannula and alcohol wipes tourniquet emesis basin, towels, emergency drugs/crash cart, Emergency drugs and equipment lead marker set (anatomical and time) compression device 10” x 12” & 14” x 17” cassettes gonadal shields positioning sponges Abdominal compression equipment. Pads and immobilisation aids Venipuncture Reaction supplies Filming
  • 17. IVU scout and series.
  • 18. Central Ray • CR is perpendicular to IR. • Center CR and IR to level of iliac crest and to midsagittal plane. • Minimum SID is 40 inches (100 cm). Collimation Collimate to IR or smaller if possible. Respiration Suspend respiration on expiration and expose.
  • 19. SCOUT / PRELIMINARY FILM  Supine, full length AP of abdomen in inspiration.  The lower border of cassette is at the level of symphysis pubis and the x-ray beam is centred in the midline at the level of iliac crests.  To demonstrate bowel preparation, check exposure factors and location of any radiopaque material or artefacts
  • 20. Rationale of the scout film Demonstrate:  Calculus  Skeletal abnormality  Intestinal gaspattern  Calcifications  Abdominal masses  Foreign bodies
  • 21. If necessary the position of overlying opacities may be further demonstrated by:.  Supine AP of renal areas, in expiration. The x-ray beam is centred in the mid-line at the level of lower costal margin  The examination should not proceed until these films are reviewed and confirmed satisfactory.
  • 22. Contrast media injection  Low osmolar contrast media (LOCM)- 300- 600mgI/ml  Adult dose : 50-100ml  Paediatric dose : 1ml/kg
  • 24. Technique  Venous access via the median antecubital vein is the preferred injection site.  The gauge of the cannula/needle should allow the injection to be given rapidly as bolus to maximize the density of nephrogram.  Upper arm or shoulder pain may be due to stasis of contrast in vein which may be relieved by abduction of the arm.
  • 25. Administration of CM  Dose of 200mg of iodine per pound body wt- dose of 20-30g.  Injection completed within 60 sec-rapidly injecting as bolus with 50 ml syringes.  Slow injections decrease side effects but provides less dense nephrogram  Another method –drip infusion technique, infusion kit with 40-50g iodine delivered in 250- 400ml fluid.
  • 26. What to watch for Reactions can develop quickly, and patients should not be left alone. From Patient Care in Radiography, 5th edition. pg.271.
  • 27. Potential Contrast Reactions (and treatments for) Though the incidence is lessened, reactions to nonionic contrast injections are the same as for ionic agents. Most reactions occur within 5 minutes of injection. Staying calm and reassuring is imperative to the patient’s well being. Mild: metallic taste dizziness flushing (slow, deep breathing) diaphoresis nausea chills (blanket warmer) vomiting (emesis basin) vasovagal (fear of needles) Moderate: urticaria (benadryl) swelling of parotids facial edema transient bronchospasm transient hypotension delayed skin reaction (keep patients 20 min) headache tachycardia Severe: prolonged hypotension/circulatory collapse (Adrenaline [epinephrine] improves cardiac output and relaxes bronchial smooth muscles). pulmonary edema arrhythmias (Inderal) angina (nitroglycerine) convulsions severe bronchospasm (adrenaline) coma cardiac arrest (sodium bicarbonate) paralysis death
  • 28. Physiology of excretion of CM  CM reaches renal artery in 15 sec. Vascular nephrogram: Last btn a few seconds to 1 min, & coexists with the diffusion of CM Total body opacification phase: CM is freely filtered by the glomeruli Tubular phase: Last for 1 min. CM is in proximal and distal Convulated tubules Pyelographic phase: CM in convulated system reaches the calyces btn 2-3 min.
  • 29. Radiographic Anatomy of the urinary system catheter IVU Tomogram Right Renal Arteriogram Circulation of iodine contrast before the nephron phase (first appearance) of kidney in an IVU cortex renal pelvis nephron “blush” renal a. Ureter major calyx minor calyces Ureteropelvic junction (infundibulum)
  • 31. Film Sequence Routines are determined by department protocol, but a typical sequence is:  1-3 minutes Antero-posterior- film coned to the renal area  5 minutes Antero-posterior-film coned to the renal area  Apply ureteral compression  10 minutes Antero-posterior  Release compression  “Flush”, “X” or “Release view”- - full length view at 20 minutes  Upright post void Antero-posterior
  • 32. Film Sequence Immediate film. AP of the renal areas. Taken ~ 10–14 s after the injection (approximate ‘arm-to- kidney’ time). Aims to show the nephrogram at its most dense - i.e. the renal parenchyma opacified by contrast medium in the renal tubules. Tomography may assist in evaluation of the renal outline or possible masses (or ultrasound if readily available). 5-min film. AP of the renal areas. Gives an initial assessment of pathology—specifically the presence or absence of obstruction before administering compression.
  • 33. Film Sequence A compression band is then applied, positioned midway between the ASIS - i.e. over the ureters as they cross the pelvic brim. Aim is to produce pelvicalyceal distension. 10-min film. AP of the renal areas. There is usually adequate distension of the pelvicalyceal systems with opaque urine by this time. Compression is, contraindicated if: (a) after recent abdominal surgery (b) after renal trauma (c) there is a large abdominal mass or aortic aneurysm (d) when the 5-min film shows already distended calyces indicative of obstruction
  • 34.
  • 35.
  • 36. Compression is released when satisfactory demonstration of the pelvicalyceal system has been achieved. If the compression film is inadequate, the compression should be checked and repositioned if necessary and a further 50 mL of contrast medium administered and a repeat film taken after 5 min. Release film. Supine AP abdomen taken immediately after the release of compression. Taken to show the ureters. If film is satisfactory, the patient is asked to empty the bladder.
  • 37.
  • 38. cortex Rt iliac crest Hilum * medulla Lower pole rt. kidney Upper pole rt. kidney * In middle of medial border, superimposed on psoas m. IVU Tomogram, late nephron phase, collecting system beginning to visualize Release film with full bladder Lateral border
  • 39. After Micturition (Post void) film. Full-length Erect or supine AP abdomen. Aimed at assessing bladder emptying, to demonstrate drainage of the upper tracts, to aid the diagnosis of bladder tumours, to confirm ureterovesical junction calculi, and (though uncommonly), to demonstrate a urethral diverticulum in females.
  • 40.
  • 41. Additional Images. 1. 35° posterior oblique of the kidneys, ureters or bladder—for equivocal collecting system lesions or localization of calculi 2. Tomography - if renal outlines are not well seen 3. Prone abdomen following the release film—may improve visualization of distal ureters 4. Delayed films at increasing (doubling of time intervals) up to 24 h after injection in renal obstruction Variation Renal colic—a limited study may be performed: preliminary films; 20-min full length (no compression); postmicturition full length; delayed films up to 24 h as required to show level and cause of obstruction.
  • 42. RPO AND LPO POSITIONS: INTRAVENOUS (EXCRETORY) UROGRAPHY Pathology Demonstrated Signs of infection, trauma, and obstruction of the elevated kidney are shown. Also demonstrates trauma or obstruction of the downside ureter.
  • 43. RPO
  • 44. Summary of the Procedure Scout Film Injection of Contrast Immediate Film 5-minute Film 10-minute Film Release Film Post-void Film
  • 45. Radiographic Critique Structures Shown: • Entire urinary system is visualized from upper renal shadows to distal urinary bladder. The symphysis pubis should be included on lower margin of the IR. After injection, only a portion of the urinary system may be opacified on a specific radiograph in the series. Position: • No rotation as evidenced by symmetry of iliac wings and ribcage.
  • 46. Radiographic Critique Collimation and CR: • Collimation borders to IR margins on top and bottom to prevent cutoff of essential anatomy. • Complete arch of symphysis pubis visible on bottom margin of radiograph, with center of image at level of iliac crest. Exposure Criteria and Markers: • No motion due to respiration or movement. • Appropriate technique with short-scale contrast demonstrating the urinary system. • Minute markers and anatomical (R or L) markers visible on all series radiographs.

Editor's Notes

  1. Actually a misnomer since pyelogram means: retrograde studies visualizing only the collecting system, while urogram means: visualization of kidney parenchyma, calyces and pelvis resulting from IV injection of contrast Therefore, it should be IVU It is the classic routine investigation of uroradiology Role is much diminished by the advent of new technology such as ultrasound and CT scan
  2. Actually a misnomer since pyelogram means: retrograde studies visualizing only the collecting system, while urogram means: visualization of kidney parenchyma, calyces and pelvis resulting from IV injection of contrast Therefore, it should be IVU It is the classic routine investigation of uroradiology Role is much diminished by the advent of new technology such as ultrasound and CT scan
  3. All these are Relative contraindications whose danger must be weighed against the benefit
  4. All these are Relative contraindications whose danger must be weighed against the benefit
  5. All these are Relative contraindications whose danger must be weighed against the benefit
  6. All these are Relative contraindications whose danger must be weighed against the benefit
  7. Controversial: regarded as generally unhelpful and unpleasant, and no trial has proven it to be of help - Nephrotoxicity: Traditionally fluid was restricted prior to the IVU in order to improve opacification of the collecting system. However, it has long been accepted that dehydration is associated with an increased risk of nephrotoxicity, which may be permanent in patients with diabetes mellitus, myeloma, hyperuricaemia, sickle-cell disease and pre-existing renal disease. The risk of irreversible damage to renal function in a previously healthy kidney due to the contrast injection is very low. This appears to be further reduced with avoidance of dehydration. Modern non-ionic contrast agents do not provoke an osmotic diuresis and the degree of opacification is unlikely to be significantly altered by dehydration. Fluid restriction should therefore he avoided and if there is a risk that the patient is dehydrated before the IVU this should be corrected first.
  8. Controversial: regarded as generally unhelpful and unpleasant, and no trial has proven it to be of help - Nephrotoxicity: Traditionally fluid was restricted prior to the IVU in order to improve opacification of the collecting system. However, it has long been accepted that dehydration is associated with an increased risk of nephrotoxicity, which may be permanent in patients with diabetes mellitus, myeloma, hyperuricaemia, sickle-cell disease and pre-existing renal disease. The risk of irreversible damage to renal function in a previously healthy kidney due to the contrast injection is very low. This appears to be further reduced with avoidance of dehydration. Modern non-ionic contrast agents do not provoke an osmotic diuresis and the degree of opacification is unlikely to be significantly altered by dehydration. Fluid restriction should therefore he avoided and if there is a risk that the patient is dehydrated before the IVU this should be corrected first.
  9. Controversial: regarded as generally unhelpful and unpleasant, and no trial has proven it to be of help - Nephrotoxicity: Traditionally fluid was restricted prior to the IVU in order to improve opacification of the collecting system. However, it has long been accepted that dehydration is associated with an increased risk of nephrotoxicity, which may be permanent in patients with diabetes mellitus, myeloma, hyperuricaemia, sickle-cell disease and pre-existing renal disease. The risk of irreversible damage to renal function in a previously healthy kidney due to the contrast injection is very low. This appears to be further reduced with avoidance of dehydration. Modern non-ionic contrast agents do not provoke an osmotic diuresis and the degree of opacification is unlikely to be significantly altered by dehydration. Fluid restriction should therefore he avoided and if there is a risk that the patient is dehydrated before the IVU this should be corrected first.
  10. - Previous reaction:
  11. Controversial: regarded as generally unhelpful and unpleasant, and no trial has proven it to be of help - Nephrotoxicity: Traditionally fluid was restricted prior to the IVU in order to improve opacification of the collecting system. However, it has long been accepted that dehydration is associated with an increased risk of nephrotoxicity, which may be permanent in patients with diabetes mellitus, myeloma, hyperuricaemia, sickle-cell disease and pre-existing renal disease. The risk of irreversible damage to renal function in a previously healthy kidney due to the contrast injection is very low. This appears to be further reduced with avoidance of dehydration. Modern non-ionic contrast agents do not provoke an osmotic diuresis and the degree of opacification is unlikely to be significantly altered by dehydration. Fluid restriction should therefore he avoided and if there is a risk that the patient is dehydrated before the IVU this should be corrected first.
  12. Controversial: regarded as generally unhelpful and unpleasant, and no trial has proven it to be of help - Nephrotoxicity: Traditionally fluid was restricted prior to the IVU in order to improve opacification of the collecting system. However, it has long been accepted that dehydration is associated with an increased risk of nephrotoxicity, which may be permanent in patients with diabetes mellitus, myeloma, hyperuricaemia, sickle-cell disease and pre-existing renal disease. The risk of irreversible damage to renal function in a previously healthy kidney due to the contrast injection is very low. This appears to be further reduced with avoidance of dehydration. Modern non-ionic contrast agents do not provoke an osmotic diuresis and the degree of opacification is unlikely to be significantly altered by dehydration. Fluid restriction should therefore he avoided and if there is a risk that the patient is dehydrated before the IVU this should be corrected first.
  13. Controversial: regarded as generally unhelpful and unpleasant, and no trial has proven it to be of help - Nephrotoxicity: Traditionally fluid was restricted prior to the IVU in order to improve opacification of the collecting system. However, it has long been accepted that dehydration is associated with an increased risk of nephrotoxicity, which may be permanent in patients with diabetes mellitus, myeloma, hyperuricaemia, sickle-cell disease and pre-existing renal disease. The risk of irreversible damage to renal function in a previously healthy kidney due to the contrast injection is very low. This appears to be further reduced with avoidance of dehydration. Modern non-ionic contrast agents do not provoke an osmotic diuresis and the degree of opacification is unlikely to be significantly altered by dehydration. Fluid restriction should therefore he avoided and if there is a risk that the patient is dehydrated before the IVU this should be corrected first.
  14. Controversial: regarded as generally unhelpful and unpleasant, and no trial has proven it to be of help - Nephrotoxicity: Traditionally fluid was restricted prior to the IVU in order to improve opacification of the collecting system. However, it has long been accepted that dehydration is associated with an increased risk of nephrotoxicity, which may be permanent in patients with diabetes mellitus, myeloma, hyperuricaemia, sickle-cell disease and pre-existing renal disease. The risk of irreversible damage to renal function in a previously healthy kidney due to the contrast injection is very low. This appears to be further reduced with avoidance of dehydration. Modern non-ionic contrast agents do not provoke an osmotic diuresis and the degree of opacification is unlikely to be significantly altered by dehydration. Fluid restriction should therefore he avoided and if there is a risk that the patient is dehydrated before the IVU this should be corrected first.
  15. Controversial: regarded as generally unhelpful and unpleasant, and no trial has proven it to be of help - Nephrotoxicity: Traditionally fluid was restricted prior to the IVU in order to improve opacification of the collecting system. However, it has long been accepted that dehydration is associated with an increased risk of nephrotoxicity, which may be permanent in patients with diabetes mellitus, myeloma, hyperuricaemia, sickle-cell disease and pre-existing renal disease. The risk of irreversible damage to renal function in a previously healthy kidney due to the contrast injection is very low. This appears to be further reduced with avoidance of dehydration. Modern non-ionic contrast agents do not provoke an osmotic diuresis and the degree of opacification is unlikely to be significantly altered by dehydration. Fluid restriction should therefore he avoided and if there is a risk that the patient is dehydrated before the IVU this should be corrected first.
  16. Controversial: regarded as generally unhelpful and unpleasant, and no trial has proven it to be of help - Nephrotoxicity: Traditionally fluid was restricted prior to the IVU in order to improve opacification of the collecting system. However, it has long been accepted that dehydration is associated with an increased risk of nephrotoxicity, which may be permanent in patients with diabetes mellitus, myeloma, hyperuricaemia, sickle-cell disease and pre-existing renal disease. The risk of irreversible damage to renal function in a previously healthy kidney due to the contrast injection is very low. This appears to be further reduced with avoidance of dehydration. Modern non-ionic contrast agents do not provoke an osmotic diuresis and the degree of opacification is unlikely to be significantly altered by dehydration. Fluid restriction should therefore he avoided and if there is a risk that the patient is dehydrated before the IVU this should be corrected first.
  17. Controversial: regarded as generally unhelpful and unpleasant, and no trial has proven it to be of help - Nephrotoxicity: Traditionally fluid was restricted prior to the IVU in order to improve opacification of the collecting system. However, it has long been accepted that dehydration is associated with an increased risk of nephrotoxicity, which may be permanent in patients with diabetes mellitus, myeloma, hyperuricaemia, sickle-cell disease and pre-existing renal disease. The risk of irreversible damage to renal function in a previously healthy kidney due to the contrast injection is very low. This appears to be further reduced with avoidance of dehydration. Modern non-ionic contrast agents do not provoke an osmotic diuresis and the degree of opacification is unlikely to be significantly altered by dehydration. Fluid restriction should therefore he avoided and if there is a risk that the patient is dehydrated before the IVU this should be corrected first.
  18. Controversial: regarded as generally unhelpful and unpleasant, and no trial has proven it to be of help - Nephrotoxicity: Traditionally fluid was restricted prior to the IVU in order to improve opacification of the collecting system. However, it has long been accepted that dehydration is associated with an increased risk of nephrotoxicity, which may be permanent in patients with diabetes mellitus, myeloma, hyperuricaemia, sickle-cell disease and pre-existing renal disease. The risk of irreversible damage to renal function in a previously healthy kidney due to the contrast injection is very low. This appears to be further reduced with avoidance of dehydration. Modern non-ionic contrast agents do not provoke an osmotic diuresis and the degree of opacification is unlikely to be significantly altered by dehydration. Fluid restriction should therefore he avoided and if there is a risk that the patient is dehydrated before the IVU this should be corrected first.
  19. 5 min film: To see if excretion is symmetrical. If poor opacification, more CM is injected.
  20. Controversial: regarded as generally unhelpful and unpleasant, and no trial has proven it to be of help - Nephrotoxicity: Traditionally fluid was restricted prior to the IVU in order to improve opacification of the collecting system. However, it has long been accepted that dehydration is associated with an increased risk of nephrotoxicity, which may be permanent in patients with diabetes mellitus, myeloma, hyperuricaemia, sickle-cell disease and pre-existing renal disease. The risk of irreversible damage to renal function in a previously healthy kidney due to the contrast injection is very low. This appears to be further reduced with avoidance of dehydration. Modern non-ionic contrast agents do not provoke an osmotic diuresis and the degree of opacification is unlikely to be significantly altered by dehydration. Fluid restriction should therefore he avoided and if there is a risk that the patient is dehydrated before the IVU this should be corrected first.
  21. Controversial: regarded as generally unhelpful and unpleasant, and no trial has proven it to be of help - Nephrotoxicity: Traditionally fluid was restricted prior to the IVU in order to improve opacification of the collecting system. However, it has long been accepted that dehydration is associated with an increased risk of nephrotoxicity, which may be permanent in patients with diabetes mellitus, myeloma, hyperuricaemia, sickle-cell disease and pre-existing renal disease. The risk of irreversible damage to renal function in a previously healthy kidney due to the contrast injection is very low. This appears to be further reduced with avoidance of dehydration. Modern non-ionic contrast agents do not provoke an osmotic diuresis and the degree of opacification is unlikely to be significantly altered by dehydration. Fluid restriction should therefore he avoided and if there is a risk that the patient is dehydrated before the IVU this should be corrected first.