ZMDA MRD450 Intravenous Urography. Introduction Terminology Patient preparation Contrast Scout films...

ZMDA MRD450

Intravenous Urography

Intravenous Urography Introduction Terminology Patient preparation Contrast Scout films Compression Tomography Routine procedure/filming sequence

LearningRadiology.com

Intravenous Urography Aka excretory urography Use decreased significantly in recent years

CT, US, MR is replacing

Remains primary modality for visualization of pelvocalyceal system and ureter

ZMDA MRD450

Terminology

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

Cystography Describes visualization of

the bladder Urethrography

Visualization of urethra Cystourethrography

Combined study to visualize bladder and urethra

One more word about terminology….

Contrast is what we give intravenously Dye is used on clothes and in cooking to

change the color of things—it is not given IV to patients!

Preparation of patients for IVU Bowel Prep

Controversial Eliminates fecal material and reduces amount of gas in

Dehydration Now thought to be unnecessary Improves degree of opacification of contrast Patients now kept NPO to decrease chance of vomiting as

well as producing slight dehydration

ZMDA MRD450

ContrastWill be covered later

ZMDA MRD450

Scout Films

Scout films for IVU Evaluate technique Look for calcifications Abnormal soft tissue Air within urinary tract Bony abnormalities Determine if a contraindication to abdominal

compression exists

Abnormal Soft Tissue Renal outlines Spleen Liver Loss of psoas margin may indicate

retroperitoneal pathology

Air Within urinary tract may indicate fistula or

gas forming infections If patient has Foley, may have been

introduced thru Foley

Bony abnormalities Osteoblastic metastases due to prostate

cancer Spine abnormalities may be associated

with neurogenic bladder

Proper scout radiograph Supine Should extend from upper renal poles to 2

cm below the inferior margin of pubic symphysis

Often difficult to fit this large area on a single radiograph, may need…. 14 x 17 of abdomen 10 x 12 of lower pelvis

Proper scout

ZMDA MRD450

Ureteral Compression films

Value of ureteral compression Normal peristalsis may leave portions of

ureters empty of contrast With compression, ureters are compressed

against pelvis and are temporarily obstructed

As a result, the proximal ureters and intrarenal collecting system are optimally distended

Contraindications to compression

Abdominal Aortic Aneurysm Ureteral obstruction

Acute abdominal/flank pain

Recent abdominal surgery Abdominal stomas

Colostomy, ileostomy, ileal conduit

Proper compression Ureters are compressed against pelvis Place belt and pneumatic balloons at

upper edge anterior superior iliac spine Paddles should nearly meet at the

midline

ZMDA MRD450

Tomograms

Scout tomograms

Tabletop is 0 cm position

Estimated midcoronal kidney level is determined as…

( Distance in cm from table top to ant abd wall / 3) +1

Example

27/3 = 9

9+1 =10cm

Anterior abd is 27 cm

Tomograms Average patient-- tomos at

8, 9, 10 cm Heavier patients– tomos at

9, 10, 11 Thinner patients– tomos at

7, 8, 9

Remember upper pole of kidney is more posterior than lower pole Think about kidney lying on

psoas muscle that gets larger more inferiorly so in average patient Upper pole best seen at 8 cm from

table top Mid kidney best seen at 9 cm from

table top Lower pole best seen at 10 cm from

table top

Tomograms May not need tomos

If study is a repeat of a study from short time ago when kidneys have been evaluated by other

modality and were shown to be normal

Value of tomograms with barium on scout

Value of tomograms to get rid of overlying bowel gas

ZMDA MRD450

Routine procedure/ filming sequence

General principles of IVU No universally accepted filming sequence Best examination is monitored by radiologist and

modified to answer clinical question However, certain views are essential to every

examination Scout Film Early Nephrogram films Excretion films

Example Preliminary scout (patient should void before study) Inject contrast Immediate tomograms at 2,3,4 minutes

10 x 12 over kidneys 5 minute film 14 x 17 Inflate compression paddles 10 minute supine film with compression 15 minute film (14 x 17) immediately after release of

compression Bladder image

Optional—delayed, oblique, prone or post-void

Additional views Oblique Views

Good for questionable ureteral lesions For differentiating extrinsic and intrinsic renal and

ureteral masses Visualization of posterolateral aspect of bladder

Value of oblique views to move ureter from spine

Delayed Views 1 hour to 48 hours- in cases of obstruction Better to CT patient for immediate diagnosis

Additional views Remember that contrast opacified urine is

heavier than nonopacified urine, so use gravity…

Prone film Helps fill ureteral areas not seen in supine position

since upper ureters more anterior than kidney

Erect film

Promotes emptying of collecting system Optimal for showing bladder hernias Shows layering of calculi in cysts Demarcates areas of ureteral obstruction better than

prone views

Example of prone view in patient whose left ureter was not filling on supine views

Postvoiding films

To determine residual urine in bladder—especially in older male patients

To look for bladder neoplasms Must be obtained immediately after voiding

Transitional cell carcinoma

Images from Normal IVU Studies…

1,3,5 minute tomo images

1 min. 3 min

Examples of compression images

10 min with compression

15 min without compression

Film with compression immediately after release of compression

Value of fluoroscopy

Normal Bladder, pre and post-void

ZMDA MRD450

The End

ZMDA MRD450 Intravenous Urography. Introduction Terminology Patient preparation Contrast Scout films...

Documents

Multi-Detector Row Computed Tomography Urography (MDCTU) … · 2015-03-11 · 2.3. Multi-Detector Computed Tomography Urography (MDCTU) Imaging Protocol Protocol of study consisted

Opportunities for filming on the Yorkshire Water Estate › media › 1277 › filming... · 2020-06-08 · Yorkshire Water | Filming Opportunities | Opportunities for filming on

Chapter 13 Intravenous Infusion & Transfusion. Section Two Intravenous Transfusion Definition: Intravenous transfusion is the intravenous administration

AUSTRALIAN PRODUCT INFORMATION UROGRAFIN (Sodium … · Retrograde urography. Because of its good tissue tolerance Urografin 30% is especially well suited for retrograde urography

Hybrid CT Urography: Paradigm Shift in CT Radiation Dose ... · urography has sufficient sensitivity in detecting upper tract urothelial lesions to replace excretory urography (EU)

Effectiveness of MR Urography in the Evaluation of Kidney which … · Opacify during Excretory Urography: Comparison with Ultrasonography Objective: The purpose of this study was

Commercial Filming and Photography · Land for commercial filming and photography levied by way of a commercial filming licence. Commercial filming means any filming or photography

Analysis of Intravenous Urography in Renal Abnormalities

Professional filming on your smartphone Me… · Professional filming on your smartphone -Filming -Storytelling -Mobile editing -Publishing ... Benefits of filming on your smartphone

INTRAVEANOUS UROGRAPHY (IVU) Enhancing Knowledge …hqe.moh.gov.my/radiologi/3. IVU.pdf · INTRAVEANOUS UROGRAPHY (IVU) Enhancing Knowledge And Skills Of Radiographers “Update in

Intravenous urography Cysto-urethography Antegrade pyelography Retrograde pyelography Hysterosalpingography IONIZING RADIATIONIONIZING RADIATION Conventional

Urinary Procedures. AP PROJECTION (SCOUT AND SERIES): INTRAVENOUS (EXCRETORY) UROGRAPHY Pathology Demonstrated Scout demonstrates abnormal calcifications

Urinary system (Imaging) Radiological anatomy. Imaging Techniques Plane urinary Tract film. Kidney, Ureters and bladder(KUB). Intravenous urography

Imaging of the urinary tract - ssregypt.com · Intravenous urography showing ectopic pelvic left kidney seen above the urinary bladder IVP and coronal reconstructed CT image showing

Excretory urography

EAU Standardised Medical Terminology for Urologic Imaging ... · examination, for example, Intravenous Urogram (IVU) was also termed Kidney, Ureter, Bladder (KUB) Urogram or Urography

ROLE OF MULTIDETECTOR CT UROGRAPHY IN EVALUATION OF …

An illustrative set of picture of IVP Intravenous ...dalelaacademy.in/Content/Pdfs/Pdf4217.pdf · Intravenous Urography All that you need to know UroHealth Research Center Lucknow

Intravenus Urography (IVU)

MR UROGRAPHY EDUARDO D CAMPUZANO BS,RT(R,MR,CT). MR UROGRAPHY MR Urography (MRU)- Have the potential to provide a comprehensive assessment of the urinary