ivu, retrograde urography and cystography Flashcards
What kind of procedure is intravenous urography
antegrade procedure
what kind of procedure is retrograde urography
retrograde procedure
What is happening in these 3 images
A. non contrast
B. antegrade IV
C retrograde
2 purposes of IVU
- visualize the anatomy of the collecting portion of the urinary system
- assess the functional ability of the kidneys (timed procedure)
Patient assessment before IVU
- current medications
- history of allergies
- surgical procedures
- past and current disease processes
- labs for eGFR and creatinine
Contraindications for IVU
high risk patients may be evaluated with other modalities replacing many IVU procedures
1. IVU
2. CT abdomen/pelvis
Equipment used for IVU
- tilting table
- arm board for IV injection
- ureteric compression device
- emergency drug tray
- IVU tray
- Markers, time, body position etc
Where is ureteric compression placed
- placed at the level of the ASIS
IVU basic routine
- scout KUB
- injection
- 1 immediate nephrogram
- 5 min AP supine Kidneys only
- 10-15min AP supine full KUB
- 20 min posterior obliques collimated or full length
- post void (prone or erect)
Purpose of Scout Radiograph
- localize patient anatomy
- assess proper bowel prep
- assess technical factors
- assess for obvious stones or pathologies
What is a nephrogram/nephrotomogram
- demonstrates blush of kidneys
- single radiograph done immediately or 1min after injection
- neprhotomogram starts at 1 min
How to determine fulcrum position
1/3 of distance from ant to posterior of pateint abdomen d/ 1/3
How to demonstrate the left/right UP junction
LPO 30* & RPO 30*
How to demonstrate L/R kidney in profile
LPO 30*
RPO 30*
How to demonstate L/R UV junction
RPO 45*
LPO 45*
How to demonstrate L/R kidney parallel to IR
RPO 30*
LPO 30*
What is viewed in posterior oblique of kidney
Elevated side: kidney is parallel
Downside: ureter is free from superimposition of the spine
What does trendelenburg postion best demonstrate in IVU
distal ureters
What does Prone Position Demonstrate in IVU
- middle of ureter
Respiration for IVU imaging
end of expiration
- respiratory excursion of 1”
CTU benefits
- minimal bowel prep
- non contrat images to evaluate for presence and location of renal calculi
- option for contrast provides structural and functional study
- 3D reconstruction
Ultrasound Urinary Benefits
- no harmful radiation
Where is retrograde urography performed
- OR, radiology or outpatient department
What position is retrograde urography performed in
Modified Lithotomy position
