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Histerosalpingogram
Histerosalpingography
| Question | Answer |
|---|---|
| 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
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