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Histerosalpingogram

Histerosalpingography

QuestionAnswer
What is hysterosalpingography? it is the study of part of the female reproductive system, specifically the uterus & uterine (fallopian) tubes.
What is the procedure done by radiography in hysterosalpingography called? It is called a hysterosalpingogram or (HSG) for short.
What does the exam entail? Contrast media is injected into the uterus & fallopian tubes/tube, under fluoroscopic guidance by a radiologist, or other physician, and images are obtained.
Why is hysterosalpingography done? the purpose is to investigate symptoms such as abnormal uterine bleeding & pelvic pain.
What other reasons may an HSG be done? post surgical evaluation of tubal ligation , to diagnose pelvic masses, and to identify congenital defects are some other reasons.
What may be demonstrated on an HSG? things such as endometrial polyps, fistulas, adhesions, and uterine fibroids may be evident on HSGs.
The MOST COMMON reason in todays imaging for HSGs is the assessment of female infertility through investigation of functional and/or structural defects in the uterus and uterine tubes.
What is a primary reason for female infertility? A blockage of one or both fallopian tubes.
What other modality has largely replaced HSG for general evaluation of the female productive tract. Sonography
Hysterosalpingography is still done on patients for a few reasons including patients where ultrasound is inconclusive, & for those patients needing evaluation for infertility.
What is the reason that HSGs are done therapeutically today? The injection of contrast media and or insertion of small catheters & wires during the exam may dilate or straighten a narrowed, tortuous, or blocked uterine tube.
Equipment needed for HSGs includes a radiographic room with a fluoroscopic imaging system. The xray table must be able to tilt into a trendelenburg position. Ideally the table should be able to accommodate gynecological stirrups.
A sterile HSG tray typically contains these items -sterile gloves -cotton balls -antiseptic solution -forceps -drapes -vaginal speculum -basin or medicine cup -gauze sponges
These items are also included on an HSG tray -KY jelly or lubricant -Balloon catheter -plastic connecting tubing (2) 10ml syringes (inflate catheter/inject contrast) -tenaculum -hypodermic needles
What type of contrast is used for an HSG? Iodinated water-soluble media
What is the normal preparation for an HSG? A patient consent form is required, patient must be questioned regarding any iodine allergy.
When would an HSG be scheduled typically? 7-10 days after the onset of menstruation to avoid any chance of pregnancy.
What medication is given to the patient prior to the procedure a mild pain reliver may be prescribed prior to the procedure to help eliminate the possibilty of cramping, also a mild laxative or supposity may be given to eliminate feces.
The patient will be instructed to do this before the procedure begins. Empty the bladder, then prior to climbing the exam table, the patient should don a gown and remove any clothing below the waist.
An AP scout should be taken, with the patient positioned supine. CR is centered 2" superior to the symphysis pubis. Field size 10x12
What steps should the procedure follow? Place the patient supine on the xray table, in the lithotomy position with feet externally rotated. (knees may be bent and legs extended laterally, or stirrups may be used).
After positioning the patient what steps should follow? Don gloves and drape the patients pelvic area. Insert the speculum after applying lubricant, the vagnial walls and cervix should be cleaned with betadine-soaked cotton balls held by forceps.
After cleansing the cervix and vaginal walls what should be put in place (with the tenaculum if necessary)? The balloon catheter.
Once the catheter is in place it should be inflated with 1-3 cc of air. Once a tight seal is achievedremove the speculum/tenaculum and attach the syringe filled with contrast to the catheter
The patient should then be positioned slightly trendelenburg
What should be injected into the catheter? 10ml of contrast media should slowly be injected under fluoroscopic guidance.
Once all the contrast has been pushed, the balloon should be deflated, the catheter should be removed, and residual contrast should be allowed to flow out into a catch basin.
What images may be obtained during the procedure? Under fluoroscopy, the radiologist may take digital spot images
Some various positions the images may be done in include AP, RPO & LPO CR centered 2" to the pubic symphysis (10x12 field size)
What position may the radiologist want a post image done of after the procedure? an AP image may be done to show post evacuation of the contrast
What anatomy will be demonstrated on images done during an HSG Uterine cavity, & uterine fallopian tubes.
If the uterine tubes are patent, or functioning normally what should be seen? contrast will be visualized spilling into the peritoneum
Created by: ABIGAILDRAKE1984