VCUG

Question 1

Indications for VCUG

Answer 1

NOTE: techs do the vast majority of the VCUGs per radiologist protocol
If fluoro needed: usually a newborn male w/ hydronephrosis and c/f posterior urethral valves (PUV) initial exam or follow up after UV resection/ablation

Question 2

VCUG
Contrast
Machine Settings
Table/positioning

Answer 2

Contrast: cystografin or cystocontray II
Volume: ~50-100mL for neonates/infants. Do not worry about bladder calculations. Fill until full. You will not hurt the bladder when filling by gravity. Once bubble stop in the contrast bottle, bladder if full or baby is baring down

Machine Settings: 3p/s, 0.5f/s for still exposure images, 2 f/s for exposure loops

Table/positioning:
- Horizontal
- Tech will take scout and cath if needed. Cath will be done with a 5 Fr or 8 Fr feeding tube w/ NO balloon. Tech will palce tape around urethral opening and assist w/ holding the catheter in place. You will almost always get some of the tech’s hands in our pictures. They know.
- Start AP to fill bladder. Take last-image hold of early (low volume), mid-volume fill, and full bladder. Take extra last-image hold or exposures at any time you see something unusual/abnormal (VUR, ectopic ureter, etc)
-LPO last image hold vs exposure if you are seeing anything abnormal
- RPO, as above
- Voiding views: males-> oblique; females -> AP
Ideally would like cyclical voids in males (2-3 times) but not always able to do this usually because baby will pee the catheter out. DO NOT re-cath unless extremely necessary. If you get one good voiding run without the catheter in place, that’s enough.
If you get cyclical voids, allow baby to void around the catheter, save cine loop OR exposure loop set to 2 f/s; refill the bladder. Once you have 1-2 voids w/ catheter in place (usually 1 is enough) and bladder is again full, have tech pull the catheter and they will let you know when the pt starts voiding -> expose 2f/s
- tech will take post-void images.

Question 3

Notes on VCUG

Answer 3

• Many times pt will already come w/ catheter in place. Essential that we get voiding views without the catheter in placed and the ordering service knows this but ALWAYS double check that it is ok to remove and leave the catheter out (they will replace on the floor)
• if multiple techs have tried and failed to cath, reach out to urology APP (lead tech will help w/ this) b/c they might need to use the Coude catheter which we cannot use