Intravenous Urography IVU

Question 1

What is IVU/IVP(Intravenous Pyelogram)

Answer 1

It is a specialized X-Ray examination of the kidneys, Ureters and Bladder (Urinary System), following the injection of a contrast media

Question 2

What does IVU demonstrates on the radiograph?

Answer 2

Renal Calyces
Renal Pelvis
Ureters
Bladder

Question 3

What is the purpose of doing an IVU?

Answer 3

To visualise the collecting portion of the urinary system
To assess functional ability of the kidneys
To evaluate the urinary system for pathology or anatomic abnomalities

Question 4

Where do the kidneys lie in the body?

Answer 4

Retroperitoneal Space

Question 5

What are the fatty tissues surrounding the kidneys called?

Answer 5

Perirenal Fats

Question 6

Which kidney lie more inferiorly than the other?

Answer 6

Right Kidney

Question 7

How much angulation and the positioning type used for IVU?

Answer 7

30 degrees rotation, Posterior Oblique to place kidney parallel to IR.

Question 8

Where do the ureters lie?

Answer 8

Anterior to kidneys

Question 9

What is the capacity of the bladder?

Answer 9

350 - 500mls

Question 10

Which anatomical structure surrounds the proximal urethra, inferiorly to the bladder?

Answer 10

Prostate Gland

Question 11

Define Polycystic kidney?

Answer 11

Polycystic kidney disease (PKD) is a genetic disorder that causes many fluid-filled cysts to grow in your kidneys. PKD cysts can change the shape of your kidneys, including making them much larger.

Question 12

Define Ureterocele

Answer 12

A ureterocele is a congenital abnormality that involves a swelling or ballooning at the lower end of one or both ureters, which are the tubes that carry urine from the kidneys to the bladder. This condition typically affects the portion of the ureter where it enters the bladder.

Question 13

Define Glomerulonephritis

Answer 13

Glomerulonephritis refers to a group of diseases that affect the glomeruli. Inflammation of the glomeruli occurs, leading to impaired kidney function.

Question 14

Define Vesicoureteral reflux

Answer 14

Vesicoureteral reflux (VUR) is a condition where urine flows backward from the bladder into one or both of the ureters and, in some cases, may reach the kidneys.

Question 15

Define Cystitis

Answer 15

Inflammation of the Bladder.

Question 16

Define Intravenous extravasation

Answer 16

Intravenous extravasation refers to the unintentional leakage of fluid or medication from a vein into the surrounding tissues instead of flowing into the bloodstream as intended.

Question 17

What are the 3 constriction points?

Answer 17

Ureteropelvic Junction
Brim of Pelvis
Ureterovesical Junction (UV Junction)

Question 18

What is the name of the junction between the distal ureters and urinary bladder?

Answer 18

Ureterovesical Junction

Question 19

What is the medical term for involuntary urination?

Answer 19

Urinary Incontinence

Question 20

A common bacterium that may lead to a Urinary Tract Infection (UTI)?

Answer 20

Escherichia Coli

Question 21

What are some IVP contra-indications?

Answer 21

Pregnancy
Hypersensitivity to Iodinated contrast media
Diabetes Mellitus (compromised renal function)
Acute or chronic renal failure
Congestive Heart Failure
Elevated Creatine Level (>200mls) - contrast cannot be excreted.

Question 22

Can patients on anti-diabetic medications undergo IVP?

Answer 22

Depends on Dr’s assessment. Patients on Metformin MUST WITHOLD for 48 hours following iodinated contrast media adminstration to prevent drug-drug interactions.

Question 23

Name FOUR(4) pieces of equipment which should be present in an IVU room that are not usually found in a general x-ray room.

Answer 23

Emesis basin
Lead markers - anatomical, minute markers
Ureteric compression band
Oxygen supply

Question 24

Explain the reasons for patients to fast at least 8 hours before the intravenous urography procedure.

Answer 24

Clear Visualization of Abdominal Structures:
Minimize Bowel Gas Interference
Reduce Potential Complications
Patient Comfort and Cooperation - reduce nausea and vomiting.

Question 25

State TWO(2) situations where fasting is not required for IVU.

Answer 25

Pediatric cases/ Emergency Adult cases/ Frail elderlies

Question 26

Explain the reason(s) patients are told to empty their bladder before the IVU procedure

Answer 26

A full bladder could rupture if compression is applied. Urine present in the bladder will dilute the contrast medium.

Question 27

List FOUR(4) conditions that, if present, may place the patient at a greater risk of contrast media reactions.

Answer 27

Diabetes Mellitus (due to compromised renal function)
Hypersensitivity to iodinated contrast media (including other things such as seafood)
Asthma
Acute or Chronic kidney Disease
Congestive heart failure

Question 28

What are some examples of contrast media reactions?

Answer 28

Extravasation
Phlebitis
Anaphylactic reaction
Urticaria
Hives

Question 29

List the sequence of radiographs taken for a routine IVU procedure.

Answer 29

1. Inject CM
2. Wait for 1 minute
3. Do 1 minute nephrogram or nephrotomogram (place the 1 min marker)
4. Apply compression band immediately
5. Wait until the 10th minute, then do a 10min cone-down kidney projection (place the 10 min marker)
6. Release compression after 20mins
7. Do a 20mins full KUB immediately after releasing compression (place the 20mins marker)
8. Instruct patient to empty his/her bladder
9. Do a post-micturition KUB after voiding (place the POST VOID marker) - can be done errect, supine or prone.

Extra: Bladder view may be added just before (Scouting) or after the patient has emptied his/her bladder, depending on hospital’s protocol.

Question 30

State TWO(2) situations where the routine sequence has to be changed and describe the primary differences.

Answer 30

Routine sequence has to be changed when:
1. Compression is contra-indicated
2. Extended imaging time (slower) in patients with compromised renal function (can happen when ureteric calculi is present - resulting in slow filling of the ureter).

Primary differences are in the timing of the sequence - 1, 3, 5mins, post-micturition.

Question 31

Why is Ureteric Compression necessary in IVU?

Answer 31

Ureteric compression may be employed to delay the passage of contrast material through the ureters, allowing for better visualization of the anatomical structures in the urinary system.

Question 32

State the precautions a radiographer needs to take before applying the compression.

Answer 32

Make sure the patient has no contra-indications (e.g. any recent abdominal surgery, pregnancy, any abdominal pains)

No radio-opaque objects.

Make sure the compression band is free of any contrast media.

Question 33

State FOUR(4) situations when compression is contra-indicated.

Answer 33

Recent abdominal surgery (<3 - 4 months ago)/Abdominal mass/Severe abdominal pain/Acute abdominal trauma/Pregnancy

Question 34

Where should the tourniquet be placed?

Answer 34

The tourniquet should be placed 5 cm proximal to the site of a venipuncture.

Question 35

If IVU and barium enema are both scheduled, state and explain which procedure should be performed first?

Answer 35

IVU should be done first. Although the contrast used for both procedures are different, its clearance rate varies. Hence, the residual CM can interfere with visualization of the anatomical structures of interest.

Question 36

State and explain what the radiographer has to do for a patient who has a urinary catheter and bag before IVU.

Answer 36

Ensure that urinary catheter tubing is clamped before procedure to prevent the flow of CM into the urinary bag.

Question 37

State with reasons the kVp range recommended for IVU.

Answer 37

75kVp.
Maximises contrast enhancement by CM for better visualization of anatomical regions.

Question 38

The renal parenchyma is best seen at which stage of an IVU?

Answer 38

Arterial

Question 39

kidneys received about ______% of the total cardiac output.

Answer 39

20 - 25%