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Radiographic Positioning > Contrast Media and Urinary System > Flashcards

Contrast Media and Urinary System Flashcards

1
Q

The tissue density and composition of the organs in the abdomen are very ________ as well as the thickness of these organs.

A

similar

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2
Q

The liver, pancreas, spleen, stomach, kidneys, and bowel will display a low amount of

A

subject contrast

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3
Q

is the radiographic contrast caused by the difference in the composition of the patient’s body tissues.

A

Subject contrast

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4
Q

The organs of the digestive system, urinary system and cerebrovascular system have similar densities and atomic numbers and will therefore absorb nearly the same amount of radiation and therefore have

A

Low subject contrast

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5
Q

Are diagnostic agents that are introduced into the body orifices or injected into the vascular system, joints, and ducts to enhance subject contrast in anatomic areas where low subject contrast exists

A

Contrast media

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6
Q

The ability of the contrast media used in radiographic procedures to enhance subject contrast depends greatly on

A

The atomic number of the element used in a particular medium and
The concentration of atoms of the element per volume of the medium

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7
Q

Contrast media are generally classified as

A

negative or positive contrast agents.

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8
Q

Negative contrast agents are (radiolucent or radiopaque?)

A

radiolucent

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9
Q

Positive contrast agents are (radiolucent or radiopaque?)

A

radiopaque

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10
Q

The specialty contrast agent for MRI is:

A

IV contrast agent gadolinium diethylenetriaminepentaacetic acid (gadolinium-DTPA).
Metalic and magnetic agent that affects signal intensity.

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11
Q

The specialty contrast agent for Ultrasound is:

A

Gas-filled microbubbles that affect the sound wave to enhance ultrasound contrast

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12
Q

Physical properties of negative contrast agents:

A 
Composed of elements with low atomic numbers
Administered as:
     Gas (air)
     Carbon dioxide 
     Tablets, crystals, soda water
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13
Q

Why is oxygen rarely used alone as a contrast agent?

A

Cells absorb oxygen quickly.

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14
Q

What is the most common negative contrast agent?

A

Room air.

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15
Q

A negative contrast agent may be combined with a positive contrast agent to produce a

A

double contrast effect.

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16
Q

In a double contrast barium enema, barium is the ______ contrast agent and air is the ______ contrast agent.

A

positive, negative.

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17
Q

An example of a discontinued exam using negative contrast media is:

A

Pneumoencephalography

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18
Q

The uses of negative contrast media are limited because

A

they may not provide sufficient contrast of a structure when used alone.

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19
Q

Why must negative contrast agents never be injected intravenously?

A

serious or fatal consequences can result

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20
Q

Three characteristics of positive contrast agents:

A

Are radiopaque
Composed of elements with high atomic numbers
Absorbs more x-rays and appears bright on a radiograph

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21
Q

Positive contrast agents absorbs about ___ times more x-rays than bone and ___ times more x-rays as soft tissues.

A

3 and 5.

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22
Q

Two examples of positive contrast agents:

A
  1. Barium (Z# 56)
  2. Iodine (Z#53)
    Each of these elements has a much higher atomic number and mass density than does soft tissue (Z# 7.4)
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23
Q

What is the atomic number of Gadolinium?

A

64

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24
Q

Two popular types of positive contrast media:

A
  1. Barium Sulfate

2. Iodinated Compounds:

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25
Q

Barium sulfate is a heavy metal element with the atomic number:

A

56

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26
Q

Barium sulfate is an inert powder composed of crystals that is used for

A

examination of the digestive system

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27
Q

What is barium sulfate comprised of?

A

The element barium is combined with oxygen and sulfate to form the inert compound barium sulfate.

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28
Q

What is the chemical formula of barium sulfate?

A

BaSO4

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29
Q

Barium sulfate is commonly referred to as:

A

Barium

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30
Q

A mixture of barium sulfate and water forms a

A

colloidal suspension, NOT a solution.

Barium sulfate never dissolves in water.

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31
Q

Depending on the environment of the barium sulfate, such as acid within the stomach, the powder has a tendency to clump and come out of suspension. This is called

A

FLOCCULATION

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32
Q

Stabilizing agents, such as _____ or _____ are used to prevent flocculation.

A

sodium carbonate, sodium citrate.

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33
Q

Barium flocculates in the presence of _____, producing fine flocculation in the proximal loops where _________

A

mucus, the pH is low.

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34
Q

Definition of enteral:

A

within, or by way of, the intestine or gastrointestinal tract.

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35
Q

Barium sulfate is used for examination of the entire ________ ________, and can be a relatively thin or thick mixture.

A

alimentary canal.

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36
Q

What are some forms barium sulfate comes in?

A

Barium sulfate can come in paste, liquid, powder and tablet form & can be purchased in premixed liquid form or in powder form.

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37
Q

Because of its inability to be absorbed by the body, barium sulfate cannot be used

A

intravascularly or intrathecally.

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38
Q

Definition of Intrathecal:

A

– introduced into or occurring in the space under the arachnoid membrane of the spinal cord or brain.

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39
Q

When is barium contraindicated?

A

in the case of a suspected perforation in the alimentary canal (organs of digestion) as barium is not absorbed naturally by the body.

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40
Q

What contrast agent must be used when patient presents with a history of suspected perforation?

A

a water-soluble iodine contrast agent is recommended (brand name examples: Gastrografin, Gastroview or Hypaque)

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41
Q

If barium enters the peritoneal or pelvic cavity, it can cause

A

peritonitis and must be surgically removed.

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42
Q

What are the adverse reactions to barium sulfate?

A 
Obstruction/constipation 
Extravasation
Vaginal Rupture
Hypervolemia
Allergic Reactions
aspiration of barium by sedated or mentally handicapped patients
Barium in appendix
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43
Q

Why should patients be instructed to drink plenty of fluids after receiving barium sulfate?

A

All barium transits the colon. One function of the colon is to absorb water from waste. Barium sulfate residue in the colon can dry and cause patient to become constipated.

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44
Q

Extravasation definition:

A

leakage from a vessel into the tissue.

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45
Q

A complication related to administration of barium during a BE is

A

perforation of the colon with extravasation into the abdominal cavity

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46
Q

Extravasation can lead to

A

peritonitis.

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47
Q

Who are at increased risk of a colon perforation during a BE?

A

Elderly patients or those receiving long term steroid medication are at increased risk for colon perforation because of atrophic tissue. Also at risk are patients with diverticulitis or ulcerative colitis. These diseases result in inflammation and degradation of the intestine.

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48
Q

Patients who have had a recent biopsy of the colon should not have a BE until

A

the area heals.

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49
Q

Barium tip or retention catheter can be a source of colon perforation. How can this risk be reduced?

A

The balloon should not be overinflated.

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50
Q

Vaginal Rupture- is a rare complication of barium sulfate administration. It is due to

A

misplacement of the catheter before lower GI examinations.

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51
Q

How can vaginal rupture be avoided?

A

Female patients should be asked whether they feel the enema tip in the rectum.

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52
Q

Hypervolemia definition:

A

a blood disorder consisting of an increase in the volume of circulating blood

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53
Q

Hypervolemia can occur when:

A

water from the cleansing enema or barium enema is shifted from the colon into the circulatory system with a resulting increase in blood volume

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54
Q

Consequences of hypervolemia are:

A

pulmonary edema, seizures, coma or even death.

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55
Q

Table salt is an ingredient that is added to the barium sulfate solution by the manufacturer to:

A

reduce the possibility of hypervolemia.

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56
Q

Allergic reactions to barium sulfate are possible but are usually due to:

A

the preservatives in the barium sulfate preparation OR to the latex in the barium enema catheters.

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57
Q

Why should sedated patients not undergo an upper GI exam?

A

Swallowing reflex diminished; increases chances of aspiration resulting in barium pneumonia
Mentally handicapped and persons with altered mental status due to age or disease is also at risk for aspiration

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58
Q

What type of complications can occur from barium in the appendix?

A

No directly related complications have resulted from this occurrence.

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59
Q

What are the two types of iodinated compounds?

A

Oil based and water-soluble.

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60
Q

Iodine’s atomic number is:

A

53

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61
Q

Iodine is almost as radiopaque as:

A

barium.

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62
Q

Advances in imaging techniques and improvement in contrast agent technology have rendered oil-based contrast agents nearly obsolete. They may still be used infrequently for

A

lymphangiograms and bronchograms

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63
Q

Use of oil based contrast media in radiography is relatively

A

limited.

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64
Q

In the past, oil-based iodinated contrast media were routinely used for myelograms, bronchograms, hysterosalpingograms, sialograms, and dacryocystograms, but have been replaced by

A

water-soluble iodinated contrast media

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65
Q

Because oil-based contrast media are not miscible with blood,

A

it should NEVER be injected intravenously or intraarterially.

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66
Q

Oil based contrast media are made from

A

fatty acids

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67
Q

An ethyl group takes the place of the alcohol chemical group usually found in fatty acids. These chemical manipulations change the fatty acids into

A

esters.

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68
Q

Iodine atoms are added at certain areas of the ester molecules. The result is

A

iodinated ethyl esters of fatty acids

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69
Q

When the esters are exposed to light, heat, or air,

A

they decompose.

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70
Q

Any oil based contrast media that has darkened in color from the original pale amber color:

A

should not be used. The dark color indicates that the media has decomposed.

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71
Q

Plastic syringes should not be used for injection of oil-based iodine contrast media because

A

toxic substances from the plastic can dissolve into the media.

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72
Q

The main disadvantage of oil-based iodine contrast media is

A

that they persist in the body because they are insoluble in water

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73
Q

Adverse Reactions to oil-based iodinated contrast media:

A

Any iodine-containing contrast agent may provoke an anaphylactoid (allergic-like) reaction although this is rare.

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74
Q

Anaphylactic shock (anaphylaxis) is

A

the result of an exaggerated hypersensitivity reaction (allergic reaction) to an antigen that was previously encountered by the body’s immune system.

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75
Q

When Anaphylactic shock occurs:

A

histamine and bradykinin are released, causing widespread vasodilation, which results in peripheral pooling of blood.
This response is accompanied by contraction of nonvascular smooth muscles, particularly the smooth muscles of the respiratory tract.

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76
Q

Anaphylactic shock can cause:

A

shock, respiratory failure, and death within minutes after exposure to the allergen.

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77
Q

Usually, the more abrupt the onset of anaphylaxis,

A

the more severe the reaction.

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78
Q

The most common causes of anaphylaxis are __________________. The path of entry may be ___________________.

A

medications, iodinated contrast agents, and insect venoms. through the skin, respiratory tract, or gastrointestinal tract, or through injection.

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79
Q

Water soluble contrast media may be described as either

A

Ionic iodinated contrast media or nonionic iodinated contrast media

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80
Q

Water soluble contrast media has relatively low

A

toxicity.

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81
Q

Water soluble contrast media generally absorbed by the body and excreted by the kidneys within:

A

24 hours of intravascular administration

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82
Q

Intrathecal versus intravenous:

A

Intrathecal is introduced into or occurring in the space under the arachnoid membrane of the spinal cord or brain. Intravenous is introduced within a vein.

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83
Q

The labels of “ionic” or “nonionic” refer to

A

the structural composition of the molecules contained in the contrast agent not whether or not it has iodine in it.

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84
Q

The primary difference between the ionic and nonionic solutions rests with

A

the physiologic interaction within the body.

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85
Q

Ionic media dissociate into two molecular particles in

A

water or blood plasma.

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86
Q

IONIC Iodine Contrast Media are ionic because:

A

one particle has a negative charge called an anion, and the other particle has a positive charge called a cation.

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87
Q

The anion part of the ionic iodine contrast media molecule begins with a six-carbon bonded hexagon called a

A

benzene ring.

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88
Q

A carbon atom occupies each corner of the benzene ring but is not usually drawn because

A

the molecular diagram would look cluttered.

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89
Q

Every other carbon bond site of the benzene ring is bonded to an

A

iodine atom, which makes the contrast medium tri-iodinated.

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90
Q

There are 3 remaining carbon bond sites that are not bonded to an iodine atom.
Of those 3 remaining sites, one is occupied by

A

a negatively charged acid group.

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91
Q

It is at this acid group site in the molecule of ionic iodine contrast media that

A

the anion and cation separate on injection

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92
Q

The 2 carbon bond sites on the ionic iodine contrast molecule—R2 and R3—are occupied by

A

chemical structures that increase the solubility or the excretion rate of the contrast by the body

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93
Q

It is the two carbon bond sites (R2 and R3) that result in the different result in the different classes of ionic media:

A

Diatrizoate—with the trade name hypaque
Metrizoate—with the trade name isopaque
Iothalamate—with the trade name conray

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94
Q

The CATION (positively charged) part of the ionic iodine contrast molecule are salts. The salts most commonly used are

A

derivatives of sodium, calcium, and meglumine (methylglucamine)

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95
Q

Once injected, the CATION will dissociate or separate from the parent ANION and

A

create 2 separate ions in the blood.

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96
Q

The separation of the cation from the anion creates an increase in the blood plasma osmolality called

A

a hypertonic condition

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97
Q

Osmolality definition:

A

refers to the concentration or number of particles (anions and cations) in the solution per kilogram of water and is directly related to the occurrence of adverse reactions.

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98
Q

A contrast agent with high osmolality has

A

an increased number of particles and more osmoles in the solution.

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99
Q

An increase in osmolality can cause

A

vein spasm, pain at the injection site and fluid retention.

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100
Q

Most importantly, ionic contrast agents may increase the probability that a patient will

A

experience a contrast media reaction.

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101
Q

Increasing the number of ions in the plasma can

A

disrupt homeostasis and create a reaction

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102
Q

There is LESS chance of interruption of homeostasis if osmolality of the injected contrast

A

closely resembles that of BLOOD PLASMA which is about 300 osmol/kg.

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103
Q

On average, the osmolality of ionic iodinated contrast agents ranges from

A

1000 to 2400 osmol/kg

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104
Q

The osmolality of nonionic iodinated contrast agents is around

A

750 osmol/kg which is much closer to blood plasma.

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105
Q

most water based ionic iodinated contrast media are referred to as

A

high osmolality contrast media or HOCM

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106
Q

Water based iodinated nonionic contrast media are referred to as

A

low osmolality contrast media (LOCM) and are better tolerated by the body

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107
Q

Research indicates that patients are less likely to have contrast media reactions OR more likely to have less severe reactions or side effects when ________ are used.

A

nonionic contrast agents

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108
Q

LOCM are __ times more expensive than HOCM.

A

20

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109
Q

Why was nonionic iodinated contrast media developed?

A

to reduce the side effects of the ionic iodine contrast media.

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110
Q

Nonionic iodinated contrast media molecules ____________ so that hypertonicity is avoided.

A

molecules do not dissociate or separate in solution

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111
Q

The molecular structure of NONIONIC Iodine Contrast Media is a tri-iodinated benzene ring that

A

does not carry an acid group.

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112
Q

NONIONIC Iodine Contrast Media (LOCM):

Many __________ surround the benzene rings

A

oxygen-hydrogen hydroxyl groups

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113
Q

The hydroxyl groups in nonionic iodine contrast media increase

A

the solubility of the media in blood plasma

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114
Q

Both ionic and nonionic iodine media have physiologic effects on the body, but IONIC agents are _________ and therefore have shown greater effects and adverse reactions.

A

higher osmolality contrast agents

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115
Q

Viscosity of water based iodinated contrast media is influenced by

A

the concentration and size of the molecule and affects the injectability of the media.

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116
Q

Heating the media to body temperature reduces _______ and facilitates the ability for rapid injection.

A

viscosity

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117
Q

When plasma water is displaced by contrast particles, water from body cells

A

move into the vascular system (through osmosis)

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118
Q

Water from body cells moving into the vascular system results in:

A

in hypervolemia and blood vessel dilation, with pain and discomfort

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119
Q

hypervolemia definition:

A

a blood disorder consisting of an increase in the volume of circulating blood

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120
Q

With the use of water soluble iodinated contrast media:

Blood pressure may decrease because of ________, or it may increase because of _________

A

vessel dilation, hypervolemia and the effects of hormones in the kidneys.

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121
Q

Allergic reactions to water-soluble iodinated contrast media resemble allergic reactions to

A

foreign substances, such as pollen grains.

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122
Q

Concerning water soluble iodinated contrast media, reactions of typical allergic patients may be:

A

minor such as urticaria (hives)

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123
Q

Reactions such as wheezing and edema in the throat and lungs with accompanying bronchospasm and nausea and vomitting are thought to be caused by

A

the release of histamine from certain cells found in the lungs, stomach, and lining of blood vessels.*

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124
Q

Sometimes pre-medication with steroids and antihistamines can reduce or eliminate

A

allergic effects of water soluble iodinated contrast media.

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125
Q

Injection of contrast media results in dilation and then constriction of the renal arteries. The end result is

A

diminished blood supply to the kidneys.

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126
Q

Osmotic effects are also presumed to cause an increase in the amount of

A

molecular substances that cannot be reabsorbed by the renal tubules.
This results in an increased secretion of urine with dehydration.

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127
Q

BUN (blood urea nitrogen) and creatinine (waste product of metabolism) levels are indicators of kidney function and is a good indicator for

A

possible contrast media-induced renal effects.

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128
Q

Normal creatinine levels for the adult are

A

0.6 to 1.5 mg/dl (mg/100ml)

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129
Q

BUN levels should range between

A

8 to 25 mg/100 ml

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130
Q

Blood urea nitrogen (BUN) – This lab test checks

A

the metabolic function of the liver and excretory function of the kidneys.

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131
Q

Abnormal BUN values may indicate

A

CHF, renal disease, renal failure, myocardial infarction, dehydration

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132
Q

Serum creatinine—This lab test checks

A

renal excretory function.

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133
Q

Abnormal values of serum creatinine may indicate

A

dysfunction of the kidneys and/or dehydration.

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134
Q

IV fluid given before and during procedures can

A

reduce the severity of renal effects in those with renal disease or diabetes and older patients.

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135
Q

The urinary system eliminates _______ and maintains ________ .

A

organic wastes, the water and electrolyte balance of the body.

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136
Q

The urinary system consists of:

A

2 kidneys
2 ureters
1 urinary bladder
1 urethra

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137
Q

Kidneys and ureters are ______ structures.

A

retroperitoneal

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138
Q

Kidneys lie

A

on either side of the vertebral column in the most posterior part of the abdominal cavity

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139
Q

The latin designation for kidney is ____ and renal is a common adjective referring to ______.

A

ren, kidney.

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140
Q

Right kidney is more inferior than the left kidney because of

A

the liver.

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141
Q

On the upper medial border of each kidney is the

A

suprarenal (adrenal) gland

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142
Q

The suprarenal glands (adrenal glands) are part of the ______ system and have no functional relationship with the kidneys

A

endocrine

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143
Q

Each kidney connects to the urinary bladder by a

A

ureter

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144
Q

The bladder _______ until it can be eliminated.

A

stores urine

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145
Q

Urine is eliminated from the body via

A

the urethra

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146
Q

Most of each ureter lies ______ to its respective kidney

A

anterior

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147
Q

The ureters follow the natural curve of

A

the vertebral column curving forward following the lumbar lordotic curve and then curves backward on entering the pelvis.

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148
Q

The ureters enter the _______ aspect of the bladder.

A

posterolateral

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149
Q

The urethra is

A

the connection of the bladder to the exterior

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150
Q

The urethra exits from the body inferior to

A

the pubic symphysis

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151
Q

Retroperitoneal structures of the urinary system:

A

Kidneys and ureters

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152
Q

Infraperitoneal structures of the urinary system:

A

Distal ureters
Urinary bladder
Urethra

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153
Q

Each kidney is arbitrarily divided into an upper part and a lower part—called

A

the “upper pole” and the “lower pole”

154
Q

Dimensions of the average kidney:

A

4-5 inches long, 2-3 inches wide, 1 inch thick. About the size of a bar of soap.

155
Q

The angle of the psoas muscles causes the longitudinal plane of the kidneys to form a vertical angle of about ___ degrees with the MSP where the ____ POLE is closer to the vertebral column than its ____ POLE

A

20, upper, lower.

156
Q

The kidneys are rotated ___ degrees from the coronal plane with the lateral border ______ to the medial border

A

30, posterior.

157
Q

A 30º LPO will position the _____ kidney parallel to the IR.

A 30º RPO will position the _____ kidney parallel to the IR.

A

Right, left.

158
Q

Most abdominal radiographs are performed on (breathing instruction) with patient _____.
This allows kidneys to lie ________________.

A

expiration, supine. High in the abdominal cavity.

159
Q

The kidneys are somewhat higher in individuals of _______ habitus and somewhat lower in those of ______ habitus.

A

hypersthenic, asthenic.

160
Q

Kidneys normally lie about halfway between

A

xiphoid process and iliac crest.

161
Q

Top of left kidney is usually at level of

A

T11-T12.

162
Q

Bottom of right kidney most often level with upper part of

A

L3

163
Q

When one inhales deeply or stands upright, the kidneys will drop about

A

one lumbar vertebrae, or 5 cm (2 inches).

164
Q

If the kidneys tend to drop more than 2 inches from the supine to upright position than a condition termed _______ exists.

A

nephroptosis

165
Q

Sometimes in very thin patients and in older patients, the kidneys could drop dramatically and end up within the pelvis which could create problems from

A

a “kinking” or twisting of the ureters.

166
Q

During the production of urine, the kidneys:

A

(1) Remove waste products from the blood
(2) Regulates water levels in the body
(3) Regulate acid-base balance and electrolyte levels of the blood

167
Q

Nitrogenous waste products (urea and creatinine) are formed during the normal metabolism of proteins.
Build up of nitrogenous wastes in blood results in

A

uremia and may indicate renal dysfunction

168
Q

uremia:

A

the presence of excessive amounts of urea and other nitrogenous waste products in the blood, as occurs in renal failure.

169
Q

How much of blood pumped from the heart with each beat passes through the kidneys?

A

25%

170
Q

The average water intake for humans during each 24-hour period is about

A

2.5 L, which eventually ends up in the bloodstream. The kidneys are the filters for the circulatory system.

171
Q

At rest, more than ____ of blood flows through the kidneys every minute.

A

1 L

172
Q

From the large amount of blood flowing through the kidneys daily, the kidneys normally excrete about ____ of urine per day

A

1.5 L

173
Q

renal cortex

A

the outer, smooth-textured reddish area

174
Q

renal medulla

A

the deep, reddish-brown region that consists of 8-18 cone shaped renal pyramids.

175
Q

The apex of the renal pyramids are also known as:

A

renal papilla.

176
Q

The portions of the renal cortex that extend between the renal pyramids are called

A

renal columns.

177
Q

Together, the renal cortex and renal pyramids of the renal medulla make up the

A

functional portion or parenchyma of the kidney

178
Q

The term renal parenchyma is a general term used to describe _______________, such as those visualized during an early phase of an IVU procedure.

A

the total functional portion of the kidneys,

179
Q

The essential microscopic components of the parenchyma of the kidney are called

A

nephrons.

180
Q

Each kidney has about _____ nephrons.

A

1 million

181
Q

Urine formed by the nephrons drain into large ________ which extend through the renal papillae of the pyramids

A

papillary ducts

182
Q

Nephrons are involved in 3 basic processes:

A
  1. Filtering blood
  2. Returning useful substances to the blood so they aren’t lost from the body
  3. Removing substances from the blood that aren’t needed
183
Q

The individual nephron is composed of

A

renal corpuscle and a renal tubule

184
Q

The renal corpuscle consists of a double-walled membranous cup called the ____________ and a cluster of blood capillaries called the ___________.

A 
glomerular capsule (Bowman’s capsule),
glomerulus (=little ball)
185
Q

The vessel entering the glomerular capsule (Bowman’s capsule) is called the ____________.

A

afferent arteriole

186
Q

The vessel leaving the glomerular (Bowman’s) capsule is the

A

efferent arteriole.

187
Q

After exiting the glomerular capsule, the efferent arteriole ultimately reunite and continue on to communicate with the

A

renal vein.

188
Q

The glomerulus serves as a filter for the blood, permitting water and finely dissolved substances to:

A

pass through the walls of the capillaries into the capsule.

189
Q

From the glomerular (Bowman’s) capsule the filtered fluid from the plasma passes into the second part of the nephron, the

A

renal tubule.

190
Q

Each renal tubule contines from a glomerular capsule in the _____ of the kidney and then travels in a circuitous path through the _____________________.

A

cortex, cortical and medullary substances.

191
Q

The renal tubule consists of three parts:

A

the proximal convoluted tubule, the nephron loop (loop of Henle) and the distal convoluted tubule

192
Q

The renal pyramids within the medulla are primarily a collection of

A

collecting ducts (tubules).

193
Q

The filtrate is termed urine by the time it reaches the

A

minor calyx.

194
Q

Between the glomerular capsule and minor calyces, more than of the filtrate is reabsorbed into the kidney’s venous system.

A

99%

195
Q

Part of the renal pelvis, the calyces, and branches of the renal blood vessels and nerves lie in a cavity within the kidney called the

A

renal sinus.

196
Q

The ureters vary in diameter from _____to_____.

A

1 mm to almost 1 cm.

197
Q

Each ureter is _____ long

A

10 to 12 inches

198
Q

Each ureter descends behind the _________ and in front of the _________________.

A

peritoneum, psoas muscle and the transverse processes of the lumbar vertebrae

199
Q

The ureters enter the __________ portion of the bladder.

A

posterolateral

200
Q

As the urinary bladder fills with urine, pressure within it compresses:

A

the openings into the ureters and prevents the reflux. (backflow of urine into the kidney)

201
Q

Normally, 3 constricted points exists along the course of each ureter, which are:

A

1) the ureteropelvic junction or UPJ. This is the point the renal pelvis funnels down into the small ureter
2) where the ureters join the bladder. where the iliac blood vessels cross over the ureters
3) where the ureters join the bladder. This is called the ureterovesical junction or UVJ.

202
Q

ureterovesical junction or UVJ.

A

where the ureters join the bladder.

203
Q

Ureteropelvic junction or UPJ:

A

the point where the renal pelvis funnels down into the small ureter.

204
Q

Most kidney stones passing down ureter tend to hang up at the:

A

UVJ.

205
Q

When the volume of urine reaches about 250 mL,

A

the desire for micturition occurs

206
Q

The total capacity of the bladder varies from

A

350 to 500 mL

207
Q

As the bladder becomes more and more full, the desire to void becomes more and more urgent.
If the internal bladder pressure rises too high,

A

involuntary micturition occurs.

208
Q

Dysuria =

A

pain during urination.

209
Q

Anuria =

A

absence of urine formation

210
Q

Polyuria =

A

Passage of large volume of urine in relation to fluid intake during a given period; common symptom of diabetes

211
Q

Diuresis =

A

increased excretion of urine

212
Q

The urethra is

A

a narrow, musculomembranous tube with a sphincter type of muscle at the neck of the bladder and extends about 1 ½ inches in the female and 7 to 8 inches in the male

213
Q

The male urethra extends from the bladder to the end of the penis and is divided into _______________ portions.

A

prostatic, membranous, and spongy

214
Q

The male urethra is about The male urethra is about _____ in length

A

7” to 8”

215
Q

Prostatic portion of the male urethra:

A

about 1 inch in length, reaches from the bladder to the floor of the pelvis and is completely surrounded by the prostate

216
Q

Membranous portion of male urethra:

A

passes through the urogenital diaphragm and is about ½ inch long

217
Q

Spongy portion of urethra

A

passes through shaft of penis, extending from floor of pelvis to external urethra orifice.

218
Q

The length of the male urethra acts as a natural barrier to external bacteria and the urine remains

A

sterile

219
Q

The prostate is

A

a small glandular body surrounding the proximal part of the male urethra and is situated just posterior to the inferior portion of the pubic symphysis.

220
Q

True or false: The renal veins are anterior to the renal arteries.

A

True

221
Q 
Which of the following structures is most anterior in the female pelvis?
Rectum
 Urinary bladder
 Uterus
 Ovaries
A

Urinary bladder

222
Q

The urinary bladder is located in the _______ compartment of the peritoneum.

Infraperitoneal
Retroperitoneal
Intraperitoneal
Rectouterine

A

Infraperitoneal

223
Q

Radiographic examination of the urinary system in general is termed

A

urography

224
Q

Contrast may be ______ into the bloodstream by an ___________ or some sort of __________ may be required so that the contrast medium can be delivered directly into structure being studied.

A

injected, intravenous injection, catheterization

225
Q

Venipuncture and contrast media injection are considered

A

delegated medical arts

226
Q

Radiographers must be certified competent in venipuncture after:

A

attending an organized training program.

Annual recertification is required.

227
Q

Before withdrawing contents from any vial or bottle confirm:

A

Correct contents of container
Route of administration
Amount to be administered
Expiration date

228
Q

Iodinated contrast agents may be administered by either:

A

bolus injection or drip infusion

229
Q

Bolus injections:

A

provide a rapid introduction of contrast agent into the venous system at one time. This method is typical for maximum contrast enhancement

230
Q

The rate of bolus injection is controlled by:

A 
Gauge of needle or connecting tubing
Amount of contrast agent injected
Viscosity of contrast agent
Stability of vein
Force applied by individual performing injection
231
Q

Drip Infusion

A

Method where contrast media is introduced into venous system by connective tubing attached to IV site.

232
Q

Rate of drip infusion:

A

May be gradual or rapid depending on study

Controlled by clamp

233
Q

The radiographer must have all necessary materials ready before injecting contrast media. Room must be prepared, including

A

emergency cart stocked with epinephrine or Benadryl in event of adverse contrast reaction

234
Q

Equipment and Materials for Injection

A 
Sharps container
Tourniquets
Alcohol pads
Cotton balls or gauze
Tape or Tegaderm
Gloves
Contrast media
Various sizes of butterfly and over-the-needle catheter
Syringes
IV tubing
Arm board
235
Q

Why is a consent form required when injections of contrast media are made?

A

Venipuncture is an invasive procedure and carries the risk of complication when contrast agents are injected

236
Q

Whose responsibility is it to make sure the consent form for contrast injection is signed?

A

It is the radiographers responsibility to ensure the patient is aware of potential risks and that the informed consent form is signed.
If patient is child, procedure needs to be explained to child and parent or guardian and the parent/guardian signs the informed consent form

237
Q

For most IVUs, veins in the __________ are recommended and include:

A

antecubital fossa (“in front of the elbow”)
Median cubital
Cephalic
basilic

238
Q

Veins in this region are generally large, easy to access, and durable enough to withstand a bolus injection of contrast agents without extravasation

A

the antecubital fossa

239
Q

Other veins that may be selected for injection of contrast include

A

cephalic vein of lateral wrist and veins on posterior hand or lower forearm such as cephalic or basilic

240
Q

DO NOT inject contrast media directly into

A

a shunt, central line, or vascular catheter unless it has been manufactured for contrast injections or under direction of a physician

241
Q

What size needle is most commonly used for bolus injections of 50 to 100 mL (cc) of contrast solution on adults?

A

an 18- to 20- gauge butterfly needle. For pediatric patients a smaller 23- to 25 gauge needle is often used.

242
Q

It is recommended that IV access be maintained until

A

imaging procedure is completed in the event that treatment for an adverse contrast reaction becomes necessary

243
Q

Expected outcome (typical feelings during injection) of injected contrast media:

A

Temporary hot flash
Metallic taste in mouth
Usually pass quickly
Discussing these with patient reduces anxiety and prepares patient psychologically.

244
Q

Questions to ask patient when taking patient’s history:

A
  1. Are you allergic to anything?
  2. Have you ever had hay fever asthma, or hives
  3. Are you allergic to any drugs or medications?
  4. Are you allergic to iodine?
  5. Are you allergic to any foods
  6. Are you currently taking metformin, Glucophage, Glucovance, Avandamet, Fortamet, Riomet, Actosplus, Met, Diabex, or Metaglip?
  7. Have you ever had an x-ray exam that required an injection into an artery or vein?
245
Q

Normal Creatinine level (adult)

A

0.6 to 1.5 mg/dl

246
Q

Normal BUN levels (adult)

A

8 to 25 mg/100 ml

247
Q

Elevated levels of either creatinine or BUN levels may indicate

A

indicate acute or chronic renal failure, tumor, or other conditions of the urinary system.

248
Q

Patients with elevated blood levels have a greater chance of

A

experiencing adverse contrast media reaction

249
Q

Combination of iodinated contrast media and metformin may increase risk for

A

contrast media-induced acute renal failure and/or lactic acidosis

250
Q

ACR recommends that metformin be withheld

A

for 48 hours after the procedure and resumed only if kidney function is determined to be within normal limits.

251
Q

Radiographer must review chart and ask the patient whether he/she is taking metformin. If patient says yes – inform radiologist before injection. Why?

A

Current kidney function must be verified

Referring physician is notified to check kidney function 48 hours after procedure before medication is resumed

252
Q

When preparing for an injection of contrast media, what should be done with the empty container of contrast?

A

Empty container should be shown to radiologist or person who is making actual injection. Empty contrast container should be kept in exam room until procedure is complete and patient dismissed

253
Q

Who is responsible for ensuring emergency cart is stocked and available in room during injection procedures?

A

the radiographer.

254
Q

Patients who have a history of hay fever, asthma, food allergies, or previous contrast media reaction may be candidates for the pre-medication procedure. What is one common pre-medication protocol?

A

Give combination of Benadryl and prednisone over a period of 12 or more hours before the procedure.

255
Q

Categories of Contrast Media Reactions

A
  1. Mild
  2. Moderate
  3. Severe
  4. Organ specific
256
Q

Mild reactions to contrast media:

A

Nonallergic reaction does not typically require drug intervention or medical assistance.

257
Q

Treatment of mild reactions to contrast media:

A

includes having patient breath slowly, providing cool cloth, reassuring patient. Continue to observe and monitor to ensure that symptoms do not advance into more serious condition

258
Q

Symptoms of mild reaction to contrast media:

A 
Anxiety
Light-headedness
Nausea
Vomiting
Metallic taste (common side effect)
Mild erythema
Warm, flush sensation during injection (common side effect)
Itching
259
Q

Moderate reaction to contrast media:

A

A true allergic reaction (anaphylactic reaction)

260
Q

Symptoms of a moderate reaction to contrast media:

A 
Urticaria (moderate to severe hives)
Possible laryngeal swelling
Bronchospasm
Tachycardia (100 beats per minute)
Bradycardia (60 beats per minute)
Angioedema
Hypotension
261
Q

Treatment for moderate reaction to contrast media:

A

Moderate reaction may lead to life-threatening, medical assistance must be provided without delay. Treatment: often drug intervention to counter effects of reaction

262
Q

Severe reaction to contrast media:

A

Life-threatening reaction known as vasovagal reaction. (From the book) Introduction of contrast media stimulates the vagus nerve, which may cause heart rate to drop and blood pressure to fall dangerously low. Fast and prompt response from medical team is required.

263
Q

Symptoms of severe reaction to contrast media:

A 
Hypotension (systolic blood pressure 80 mm Hg)
Bradycardia (50 beats/min)
Cardiac arrhythmias 
Laryngeal swelling
Possible convulsions
Loss of consciousness
Cardiac arrest
Respiratory arrest
No detectable pulse
264
Q

Treatment of severe reaction to contrast media:

A

Medical emergency must be declared immediately
Emergency cart available with oxygen and suction apparatus
Hospitalization is eminent

265
Q

Organ-specific reaction to contrast media:

A

Specific organs are affected by the contrast media injection.

266
Q

Organ specific symptoms of reaction to contrast media include:

A

Cardiac system—pulseless electrical activity
Respiratory system—pulmonary edema
Vascular system—venous thrombosis
Nervous system—seizure induction
Renal system—temporary failure or complete shutdown
Extravasation—leakage of contrast media outside of the vessel into the surrounding soft tissues

267
Q

Organ specific reaction follows contrast media injection and may not be identifiable for up to ___ hours after the study has been completed.

A

48

268
Q

Treatment of organ specific reactions includes:

A

monitoring, possible hydration, administration of Lasix (diuretic), interventional cardiac medications, antiseizure medications, and renal dialysis

269
Q

Because reaction type occurs after urographic procedure has been completed patient should be instructed to

A

alert the physician of any difficulties producing urine or other unusual symptoms.

270
Q

Suggested treatment of extravasation:

A

Notify department nurse and/or physician.
Elevate affected extremity above heart to decrease capillary pressure and promote reabsorption of extravasated contrast media.
Use cold compress followed by warm compresses first to relieve pain and then to improve resorption of contrast media.
Document the incident.

271
Q

Excretory or intravenous urography (IVU) :

A

Common radiologic exam of the urinary system.

Often referred to as an IVP or intravenous pyelogram.

272
Q

Pyelo refers only to

A

the renal pelves. Excretory or intravenous urogram normally visualizes more anatomy than just the renal pelvis so the term IVP is not accurate.

273
Q

The IVU visualizes:

A

the minor and major calyces, renal pelves, ureters, and urinary bladder after injection of a contrast medium.

274
Q

The IVU is a functional test because

A

contrast medium molecules are removed from the bloodstream and excreted completely by the normal kidneys.

275
Q

Purpose of IVU:

A
  1. Visualize the collecting portion of the urinary system
  2. Evaluate kidney function
  3. Evaluate urinary system for pathology or anatomic anomalies
276
Q

Contraindications to IVU:

A 
Hypersensitivity to iodinated contrast media
Anuria
Multiple myeloma
Diabetes
Severe hepatic or renal disease
Congestive Heart Failure
Pheochromocytoma
277
Q

Pheochromocytoma

A

Usually benign tumor of the adrenal medulla. Over-secretion of epinephrine and/or norepinephrine by the tumor cells is associated with hypertension.

278
Q

Diuretic-

A

An agent that increases excretion of urine

279
Q

Lasix

A

Brand name for a diuretic

280
Q

Lithotripsy

A

Therapeutic technique that uses acoustic (sound) waves to shatter large kidney stones into small particles that can be passed

281
Q

Oliguria

A

excretion of a diminished amount of urine in relation to fluid intake (hypouresis or oliouresis

282
Q

Urinary reflux

A

backward or return flow of urine from bladder into ureter and kidney; also called vesicoureteral reflux; common cause of pyelonephritis, in which backflow of urine may carry bacteria that can produce infection in the kidney

283
Q

Urinary Tract Infection (UTI):

A

infection caused by bacteria, viruses, fungi, or certain parasites; commonly caused by urinary reflux

284
Q

Patient Preparation for an IVU

A

Light evening meal prior to the procedure
Bowel-cleansing laxative
NPO after midnight (minimum of 8 hours)-not dehydrated
Enema on the morning of the examination
Voiding prior to procedure.

285
Q

Why is voiding prior to an IVU important?

A

Bladder that is too full could rupture

Urine present in bladder dilutes contrast media

286
Q

Pregnancy precautions for IVU:

A

IVUs may be performed to rule out urinary obstruction
Radiologist determines routine to reduce # of radiographs
Higher kV with lower mAs reduces patient exposure

287
Q

Bowel preparation is not attempted in infants and children getting an IVU. What is recommended instead?

A

It has been recommended by some that infants and children be given a carbonated soft drink to distend the stomach with gas.

288
Q

How does distending the stomach with gas help see the urinary system during a pediatric IVU?

A

the gas-containing intestinal loops are usually pushed inferiorly and the upper urinary tracts, particularly those on the left side of the body, are then clearly visualized through the outline of the gas-filled stomach.

289
Q

To fully inflate the stomach of a child undergoing an IVU, at least __ ounces of a carbonated soft drink should be given to a newborn infant, and _____ ounces are required for a child 7 or 8 years old.

A

2, a full 12

290
Q

Supplies needed for an IVU

A 
Correct type and amount of contrast
Empty container of contrast media
Selection of needles
Alcohol wipes
Procedure gloves
Tourniquet
Support for elbow
Sharps container
Male gonadal shield
Emesis basin
Epinephrine or benadryl
Ureteric compression (if used)
Cold towel (or warm towel)
Operational and accessible oxygen and suction devices
291
Q

Ureteric Compression:

A

Enhances filling of pelvicalyceal system and proximal ureters
Allows renal collecting system to retain contrast longer

292
Q

Where are the paddles of the ureteric compression device placed?

A

Should be positioned over the point where the ureters cross the psoas muscles

293
Q

Once contrast media is introduced with ureteric compression device in place,

A

the paddles are inflated and remain in place until post-compression images are ready to be obtained.

294
Q

Contraindications to Ureteric Compression

A 
Possible ureteric stones
Abdominal mass
Abdominal aortic aneurysm
Recent abdominal surgery
Severe abdominal pain
Acute abdominal trauma
295
Q

Alternative to ureteric compression:

A

Position the pt trandelenburg. Head end of the table is lowered 15 degrees.

296
Q

Purpose of the scout film for an IVU:

A

Verifies patient prep
Determines acceptable exposure factors
Verifies positioning
Detects abnormal calcifications

297
Q

What is usually the first thing done when performing an IVU?

A

Patient history taken.

298
Q

When does the radiologist see the scout film for an IVU?

A

Prior to injection.

299
Q

If the pt is catheterized for the IVU:

A

clamp before injection.

300
Q

Timing for entire IVU series is based on

A

start of injection. Exact time and length of injection should be noted

301
Q

Injection usually takes

A

between 30 seconds and 1 minute

302
Q

Most reactions (for IVU)occur within first __ minutes following injection—though delayed reactions occur

A

5.

303
Q

Patient is observed for signs and symptoms indicating a reaction to the contrast during an IVU. What should be noted?

A

Chart the amount and type of contrast given to patient

304
Q

According to the preference of the radiologist, ______ of contrast agent is used for adults

A

30 to 100 ml

305
Q

The dosage administered to infants and children is regulated according to

A

age and weight.

306
Q

After full injection at start of IVU procedure:

A

radiographs are taken at specific time intervals. Each image marked with lead numbers to indicated time interval when radiograph was taken

307
Q

The initial contrast “blush” of the kidney is termed the

A

nephron phase

308
Q

After the nephron phase, as kidneys continue to filter and concentrate the contrast medium, it is directed to the

A

pelvicalyceal system.

309
Q

During an IVU, depending on patient’s hydration status and the speed of the injection, the contrast agent normally begins to appear in the pelvicalyceal system within

A

2-8 minutes.

310
Q

The greatest concentration of contrast medium in the kidneys, during an IVU, normally occurs

A

15 to 20 minutes after injection.

311
Q

Common basic IVU routine:

A
  1. Nephrogram or Nephrotomogram
  2. 5-Minute image
  3. 10- to 15- Minute image
  4. 20-Minute obliques
  5. Postvoid
312
Q

Nephrogram or Nephrotomogram

A

Taken immediately after injection (or 1 min. after start of injection)
Captures early stages of entry of contrast media into collecting system

313
Q

5-Minute image & 10- to 15- Minute image

A 
Full KUB to include entire urinary system
Usually supine (AP)
314
Q

20-Minute obliques

A

LPO and RPO-Upside kidney parallel to IR and projects downside ureter away from spine

315
Q

Postvoid

A

AP, PA or erect AP

316
Q

What is a Postrelease or “Spill” Procedure with Ureteric Compression?

A

Full size radiograph taken after compression has been released
Used to assess for asymmetric renal function

317
Q

How is a Postrelease or “Spill” Procedure with Ureteric Compression performed?

A

Compression applied immediately after 5 minute radiograph

Removed immediately before 15-minute radiograph

318
Q

Erect Position for Bladder: For what exam is it taken and why?

A

Radiograph taken before voiding during an IVU: Prolapse of bladder
Enlarged prostate

319
Q

Delayed Radiographs: for what reason would they be taken?

A

Filling of involved ureter is often slow in patients with urinary calculi
Patient may be brought back to department on a 1 to 2 hour basis

320
Q

Why would Prone Radiographs be taken?

A

May be recommended for demonstration of the ureteropelvic region and for filling the obstructed ureter in patients with hydronephrosis.
The ureters fill better in the prone position because it reverses the curve of their inferior course

321
Q

Hydronephrosis

A

distention of the renal pelvis and calyces of the kidneys as a result of some obstruction of the ureters or renal pelvis.

322
Q

Causes of hydronephrosis:

A

It may be present in both kidneys in a female when the ureters are compressed by the fetus.
Other more common causes are calculi (stones) in the renal pelvis or ureter, tumors, and structural or congenital abnormalities.

323
Q

The supine position allows the more ______ placed upper calyces to fill more readily and the ____________________ fill more in the prone position.

A

posteriorly, anterior and inferior parts of the pelvicalyceal system

324
Q

Why would 14x17 Upright Radiographs be taken?

A

Demonstrates mobility of the kidneys and determines if the kidney’s mobility is beyond normal limits. (also provides information as described in erect position of bladder)

325
Q

Nephron phase is

A

a blush of the entire kidney substance.

Blush results from contrast throughout nephrons

326
Q

When is a Nephrogram image obtained?

A

1 minute after start of injection. Ureteric compression can prolong nephron phase to as long as 5 minutes in the normal kidney

327
Q

If the nephrogram is taken with tomography it is called a

A

nephrotomogram. 3 tomograms and 3 focal levels
Centering and IR size confined to kidneys
Usually midway between iliac crest and xiphoid

328
Q

One method to determine initial fulcrum level for nephrotomogram:

A

measure thickness of mid-abdomen with calipers and then divide that number by 3.
A 24 cm abdomen would require an 8 cm cut a 7 cm cut and a 6 cm cut

329
Q

Timing during an IVU is critical, so exposure must be made exactly ________ after start of injection

A

60 seconds.
Table, IR and control panel must be set before injection is begun
Injection sometimes takes nearly 60 seconds to complete

330
Q

Examinations of Urinary System:

A
  1. Intravenous Urography (Excretory Urography)
  2. Hypertensive Intravenous Urography
  3. Retrograde Urography
  4. Retrograde Cystography
  5. Voiding Cystourethrography
  6. Retrograde Urethrography
331
Q

Purpose of a Hypertensive IVU

A

IVU for patients with high blood pressure

Determines whether kidneys are cause of hypertension

332
Q

Suggested protocol for a hypertensive IVU:

A

Radiographs taken every minute for up to 5 minutes
After 5-minute IR, standard IVU routine
Check with radiologist to determine additional images to be taken.

333
Q

True or false: Hypertensive IVU’s are a common procedure today.

A

False

334
Q

Retrograde Urography: Indications and contraindications:

A

The retrograde urogram is indicated for evaluation of the collecting system in patients who have renal insufficiency or who are allergic to iodinated contrast media.

335
Q

Under what conditions is a retrograde urography performed?

A

Performed in surgery-patient sedated or anesthesized

STERILE. Contrast media delivered to pelvicalyceal system retrograde through catheter by urologist

336
Q

What is a retrograde urography and what is its purpose?

A

Nonfunctional exam of urinary system

Determines location of calculi or other type of obstruction

337
Q

How is the pt positioned for a retrograde urography?

A

The patient is placed on the cystoscopic table in a modified lithotomy position.

338
Q

Once the pt is positioned for a retrograde urography, what happens?

A

The patient is then sedated or anesthesized
Patient is draped appropriately
The urologist inserts a cystoscope through the urethra and into the bladder

339
Q

Retrograde Urography: After the urologist examines the bladder,

A

ureteral catheters are inserted into one or both ureters.

The tip of each ureteral catheter is placed at the level of the renal pelvis

340
Q

Retrograde Urography: What is performed After catheterization?

A

Scout film. Radiographer checks technique and positioning. Urologist checks placement of the catheter.

341
Q

Retrograde Urography: Once the Urologist checks placement of the catheter,

A

he/she then injects 3 to 5 ml of contrast through the catheter into the renal pelvis of one or both kidneys.

342
Q

What is the second radiograph of the retrograde urograph?

A

The pyelogram. Respiration is suspended after the injection. This demonstrates the renal pelvis and major and minor calyces.

343
Q

Retrograde urography: The THIRD and final radiograph is the:

A

ureterogram. The head of the table may or may not be elevated.

344
Q

Retrograde urography: After the third radiograph, the urologist withdraws the catheters and

A

simultaneously injects contrast medium in one or both ureters.

345
Q

For all radiographs taken during retrograde urography, exposure is made after:

A

anesthesist suspends respiration if the patient is under general anesthesia.

346
Q

Retrograde Urography: Who generally indicates when to make exposure?

A

The urologist.

347
Q

Retrograde Cystography: How is the contrast media delivered?

A

Catheter.

348
Q

Retrograde Cystography: How much contrast media is used?

A

150-500 cc

349
Q

Retrograde Cystography: How is the procedure viewed?

A

The gravity flow of the contrast media is viewed via fluoro with AP and AP obliques. Introducing the contrast too quickly could result in rupture of the bladder.

350
Q

Retrograde Cystography: Purpose

A

NONFUNCTIONAL radiographic exam of the urinary bladder after iodinated contrast media has been introduced by a catheter.

351
Q

The cystogram is a common procedure performed to rule out

A

trauma, calculi, tumor, and inflammatory disease of the urinary bladder

352
Q

This is or is not, a surgical procedure and is carried out in the fluoroscopy room?

A

Is NOT. Cystoscopy is not required

353
Q

Retrograde cystography: Pt prep:

A

There is no patient preparation but patient should empty bladder before catheterization.

354
Q

Retrograde Cystography: After catheterization under aseptic conditions, the bladder is:

A

drained of any residual urine.

355
Q

Retrograde Cystography: Filling the bladder may require :

A

150 to 500 cc and is filled under fluoroscopic guidance

Radiologist may take spot films

356
Q

Voiding Cystourethrography: Purpose:

A

Functional study of the bladder and urethra

Performed after routine cystogram

357
Q

Voiding Cystourethrography: Pathologic Indications:

A

Trauma or incontinence are common pathologic indications for a VCU exam.

358
Q

Voiding Cystourethrography: Procedure:

A

The voiding phase of the examination is done under fluoroscopy
Procedure is performed with patient supine.

359
Q

Voiding Cystourethrography: How is female pt viewed compared to male pt?

A

The female is examined in the AP or slight oblique position.

The male is best examined in a 30 degree AP oblique projection—RPO position

360
Q

Where to center for Voiding Cystourethrography?

A

symphysis pubis

361
Q

Retrograde Urethrography: Purpose:

A

Nonfunctional radiographic study of the male urethra

362
Q

Basics of Retrograde Urethrography:

A

Retrograde injection of contrast media
Use of Brodney clamp
Patient in 30° RPO position
Rarely performed

363
Q

Retrograde Urethrography: Pathologic Indications:

A

Trauma or obstruction of the urethra

364
Q

How is contrast media delivered for an IVU?

A

intravenous injection: antegrade flow of media through superficial vein in arm.

365
Q

How is contrast media delivered for retrograde urography?

A

retrograde injection through ureteral catheter by a urologist as a surgical procedure

366
Q

How is contrast media delivered for retrograde cystography?

A

retrograde flow into the bladder through ureteral catheter driven by gravity.

367
Q

How is contrast media delivered for VCUG?

A

retrograde flow into the bladder through ureteral catheter , followed by removal of catheter for imaging during voiding.

368
Q

How is contrast media delivered for Retrograde Urethrography on a male?

A

retrograde injection through Brodney clamp or special catheter.

369
Q

Pediatric Applications for urinary system exams:

A

Preparation for IVU for infant and young child must be monitored carefully-can’t restrict fluids for long period of time
Increased use of US for urinary conditions-no radiation

370
Q

Geriatric applications for urinary system exams:

A

May be affected negatively by change in diet and food intake before IVU
Must be carefully monitored during procedure
Many have clinical history of diabetes

371
Q

Alternative modalities and procedures for urinary system:

A

CT, MRI, Nuclear Med, Ultrasound

372
Q

Renal cysts and/or adrenal masses may be demonstrated during this phase of IVU:

A

Nephrotomogram or nephrogram

373
Q

RPO and LPO Positions: IVU: What is shown?

A

Trauma or obstruction to downside ureter

374
Q

AP Projection: IVU - Postvoid: Pathology Demonstrated:

A 
Enlarged prostate (possible BPH) or prolapse of bladder
nephroptosis
375
Q

AP Projection: IVU—Ureteric Compression: Pathology Demonstrated:

A

Pyelonephritis and other conditions involving the collecting system

376
Q

Cystography: AP/LPO and RPO and Lateral (special): Pathology demonstrated:

A 
Signs of cystitis
Obstruction 
Vesicoureteral reflux
Bladder calculi
Lateral projection will demonstrate possible fistulas between bladder and uterus or rectum
377
Q

Cystography: AP: Central Ray

A 
2 inches (5 cm) superior to pubic symphysis with 10° to 15° caudad tube angle
Projects pubic symphysis inferior to bladder
378
Q

Cystography: Posterior Obliques position:

A

45° to 60° body rotation.

Visualizes posterolateral aspect of bladder, especially UV junction

379
Q

Cystography: Posterior Obliques Central ray:

A 
2 inches (5 cm) superior to pubic symphysis and 2 inches (5 cm) medial to ASIS
To demonstrate urinary reflux, center higher at level of iliac crest
380
Q

Cystography: Lateral: Central Ray

A

Perpendicular

Center 2 inches (5 cm) superior and posterior to pubic symphysis

381
Q

Voiding Cystourethrography: Pathology demonstrated

A

Determines causes of urinary retention

Evaluates for possible vesicoureteral reflux

Radiographic Positioning (23 decks)

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