Exams, projections and so forth
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| IVU demonstrates (2) | structure and function of urinary tract
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| Structures visualized in IVU | they are visualized as the contrast follows the excretion route of the urine
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| Functions demonstrated in IVU | by the ability of the kidneys to filter contrast from the blood and concentrate it with the urine
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| Reasons for IVU (9) | 1.Abdominal masses 2.renal cysts 3.renal tumors 4.kidney stones 5.pyelonephritis 6.hydronephrosis 7.pre op 8.renal hypertension 9.trauma
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| Pyelonephritis | Infection of upper tract
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| Hydronephrosis | abnormal dialation of the pelvicalyceal system
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| Prep for IVU | Low residue diet to prevent gas formation. NPO after midnight. Laxatives. Pt should not be dehydrated (pt with certain diseases could go into renal failure)
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| OVGH prep and prep time IVU | Laxatives, suppositories, and dietary restrictions. Routine- 48 hours. Children and elderly- 24 hours. Diabetic- 18 hours
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| Why is prep necessary for IVU | b/c colon is anterior to the urinary tract. no prep is usually needed for lower urinary tract
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| Pre exam procedure for kids IVU | Newborn-2 ounces of an aerated drink. 7-8 12 ounces of an aeated drink. a highly concentrated contrast should be used
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| Contraindications for IVU/IVP | Poor kidney function. Allergic to iodine
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| Candiates for non-ionic contrast 9 | Elderly, asthma, elevated creatinine, sickle cell, DM, multiple myeloma, children, circulatory or cardiovascular disease
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| Contrast administration in children depends on | The type and amount depends on age weight and medical history
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| Contrast media used for IVP's | contrast with iodine concentrations of 50-70%
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| Contrast media for cystography | Contrast with iodine in concentrations of 30% or less bc it is less irritation on the bladder. Reaction to contrast for cystography isnt a concern cuz its introduced into bladder via catheter and doesnt flow through the blood system
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| 3 ways to administer contrast media | Direct injection-percutaneous antegrade urography 2.Catheter 3.IV
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| Types of IV injection | Bolus and infusion
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| Bolus injection | the preference of amount of contrast for an adult to be administered is 30-100mL of an average size adult
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| Infusion injection | Contrast is hung, elongates nephrogram or blush phase, allows nephrons to be visualized longer during filming.
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| Minutes contrast shows up | Appears in pelvicalyceal system within 2-8 mn. Greatest concentrations at 15-20min.
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| Pts most likley to react to contrast media 11 | Previous reaction-3x as likley; Severe allergies-2x; Asthma-3x Age-50+; BP; heart disease; alcoholism; DM; CHF; certain meds; recent MI
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| Reactions to contrast media happen within | 5 minutes of being administered
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| Normal contrast media symptoms | Warmth in chest or in bladder, funny tase in mouth, flushing
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| Mild reactions 9 | Require no meds for relief of symptoms. Nausea; Hives (uticaria); Itching; sneezing; vasovagal response; extravasation; pain; burning; numbness
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| Vasovagal response | caused by fear; weakness, diziness, sweating, feeling of passing out
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| Extravasation | some of the contrast media leaks around injection site into surrounding tissue
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| Moderate recations to contrast 3 | Excessive/giant hives, tachycardia, excessive vomitting. requires treatment of symptoms and treatment to pt
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| Severe reactions to contrast media 13 | Very low BP; cardiac/respiratory arrest; LOC; Convulsions; Laryngeal Edema; Cyanosis; Dyspneal Shock
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| OVGH projections for IVU | Ap survey, AP tomo survey, 1,3,5 min nephrotomograms, 10 min RPO LPO, 15 min AP, 15 min PA, post void
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| AP Survey IVU | 14x17. CR Crest. This checks GI tract prep and to see if theres external lesions that are causing symptoms so the test may be unnessecary
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| AP Tomo survey IVU | 10x12CW. CR-level of 10th rib, midway b/t xiphoid and crest
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| To choose depth for tomo slices | Measure pt through kidney area using calipers; Divide measurement in half, then subtract 2. This is 1st tomo slice
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| If cut is too posterior | No kidney is seen, too much of transverse process of spine is seen
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| If cut is to anterior | No transverse processes are seen, unable to see vertebral body in cuboid space
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| Nephrotomogram | a tomo that captures the nephrons very early in the filtrate phase. Kidneys have blushing appearance
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| Nephrogram | A regular film, no tomo slice, that captures nephrons early. hasnt entered collecting systems
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| 10 Min RPO LPO IVU | 14x17 LW. Oblique pt 30 degrees; CR cest 2" lateral to midline on the pts elevated side
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| Evaluation criteria for 10 Min RPO, LPO IVU | Elevated kidney will be parallel with film. Dependant kidney will be perpendicular to film. Best visualizes ureter side down. Elevated ureter is seen but will be over spine
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| 15 min AP IVU when supine | Same as AP Survey. The upper calyces fill with contrast better bc the upper poles of the kidneys are more then the inferior poles
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| 15 min AP Trendelberg IVU | lower head 15-20 degrees, will show distal ureter. fundus of bladder becomes filled with urine and moves superiorly. This provides an unobstructed view of distal ureter and ureteral orifices
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| 15 min PA IVU | 14x17LW. CR Crest. Demo ureteropelvic region. If pt has hydronephrosis, obstructed ureter will fill better
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| Ureteral compression | doc sometimes may want this. applied over distal ends of ureters. Retards flow of opacified urine, ensures visualization of proximal urinary system. must be released slowly to avoid sudden pressure or rupture, used less often cuz of improved contrastmedia
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| Contraindications for compression for IVU 6 | Stones, abdominal aneurysm or mass, colostomy, suprapubic catheter, traumatic injury, recent abdominal surgery
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| Post Void IVU | 14x17 LW; if dont erect, remember the kidneys normally drop 2" center slightly below crest
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| Post Void shows 5 | Residual urine in bladder, small tumors, enlargement of prostate, erect view demo mobility of kidneys and nephroptosis
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| Non-routine IVU Projection | Lateral, Dorsal Decub
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| Lateral proj IVU | 14x17 LW, Pt lateral recumbent. CR Perp at crest. midway b/w coronal plane and crest.
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| Lateral IVU demo | Rotation or pressure displacement of kidneys, and to localize calcareous areas and tumor masses
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| Dorsal decub IVU | 14x17 LW, pt supine. CR iliac crests and MCP
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| Dorsal decub Demo IVU | UPJ for pt with hydronephrosis, shows if an external tumor is inside or outside of peritoneum, shows if kidneys and ureters are abnormally displaced anteriorly
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| Retrograde Urography | Operative procedure done in cysto room, considered urologic radiologic procedure. done by urologist
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| Reasons for doing retrograde urography | Pt may have renal insufficiency (poor renal function)
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| 3 films are taken during retrograde urography | Prelim film, pyelogram film, uretrogram film
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| Preliminary film | shows catheter in place, can adjust positioning and technique
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| Pyelogram film | shows pelvicalyceal region of kidney, head of table may be lowered 10-15 degrees to keep contrast from escaping into ureters. Pt may feel pressure in their back when pelvis is full
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| Ureterogram film | done after pyelogram, head may be elevated 35-40 degress. cathers slowly pulled down to distal ureter, contrast injected to fill ureter. Demo twisting of ureters and mobility of kidneys
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| Cystogram | Shows lower urinary system
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| Reasons for doing cystograms 6 | Vesicoureteral reflux, recurrent lower UTIs, Neurogenic bladder, bladder trauma, Urethral stricture, posterior urehtral valves
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| Contraindications for cystograms | Inability to catheterize
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| AP Axial Bladder proj | 10x12 LW, pt supine, legs extended.
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| CR ap axial bladder | 10-15 caudad entering 2" above the upper border of pubic symph. when the bladder neck and prox uretera are of interest a 5 degree caudal angle is sufficient to project pubic bone below them
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| Demo ap axial bladder | Distal ureters will be visualized and will demo any ureteral reflux, prostate and proximal male urethra will be visiualized
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| PA axial bladder | 10x12Lw, CR->10-15 cephalic, entering 1" distal to tip of coccyx (exits little above superior border of the pubic symph) or 20-25 ceph, to demo prostate and project if above the pubic bones
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| LPO/RPO Bladder proj | 10x12LW. oblique pt 40-60degrees. CR-2" above upper border of pubic symph, 2"medial to upper ASIS
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| Lateral bladder | 10x12 LW, rt or lt, cr-2" above pubic symph at MCP. Demo anterior and posterior bladder walls and base of bladder
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| VCUG | voiding cystourethrogram. shows urethra
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| Reasons for doig femal VCUG | tumors, abscesses, diverticula, dialation, stricture, urinary incontience due to increased intraabdominal pressure such as coughing and and sneezing
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| Urography | investigation of the renal drainage or collection system
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| 2 types of urography | Antegrade, retrograde
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| Antegrade urography | Contrast media enters kidneys in the direction of normal blood flow.
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| methods of antergrade urography | intravenous, percutaneous
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| Percutaneous method | contrast goes directly into renal pelvis via percutaneous puncture, less common then intravenous
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| Exams for lower urinary tract only | bladder, lower ureters and urethra. Cystography, cystoureterography, cystourethrography. All done retrograde. All catherization
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| Tomography | radiographic technique that shows a single plane of tissue by blurring images of structure above and below the area of interest
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| Zonography | tomography that uses an exposure angle of 10 degrees of less
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| Nephrotomography | evaluates renal hypertensions, intestinal shadows will be removed
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| Percutaneous renal puncture | done to differentiate b/w cysts and tumors of the renal parenchyma. Direct injection into cyst under fluoro. US pretty much eliminated these exams
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