Week 11- genito-urinary system Flashcards
what anatomy is covered when imaging the genito-urinary system?
abdominal aorta
Renal V
IVC
Kidneys
Ureters
Testicular/ Ovarian A + V
Superior mesenteric A
Inferior Mesenteric A
Bladder
What is it called when you image the following:
1- Kidneys & Ureters
2- Urinary bladder
3- Urethra
- Urography
- Cystography
- Urethrography
what urography procedures are there?
IV urography
Antegrade urography
Retrograde urography
what cystography procedures are there?
retrograde cystography
Voiding cystography
what is the path of IV contrast urography
Cubital fossa Basilla Vein Axillary vein Subclavian Vein Brachiocephalic Vein SVC R atrium R ventricle Pulmonary trunk Lungs Pulmonary veins L atrium L ventricle Aorta L/R renal arteries
Indications for IVPs
- Kidney Stones
- Tumours in the Kidney, ureter and/or bladder
- Scarring from UTI
- Post-surgery
- Congenital abnormalities
- Obstruction in kidney or ureter
- Hydronephrosis
- Mass/Cyst in Kidney
- Pyelonephritis
- Glomerulonephritis
- Haematuria
Contraindications for IVP
- Renal Failure
- Previous Allergy to iodine
- Generalized allergic reactions
- Multiple Myeloma
- Pregnancy
- Thyrotoxicosis
- Diabetes
- Sickle Cell Anaemia
- Pheocromocytoma
- Severe decreased Liver Function
- Metformin
- Interleukin 2 Chemotherapy
IVP imaging procedure
- Control imaging
- Pressure is applied to the bladder area, with a strap and sponge
- Once the nephrogram images have been obtained a “Full ureter filling image is attempted
- RPO and LPO Renal images are taken
- RPO and LPO images are taken of the bladder area to show the VUJ in the bladder
- If an obstruction becomes evident, then delayed images need to be take to see how the obstructed kidney is performing.
Tomographic principles
The X-ray tube takes a plain X-ray image by moving
The focal plane remains clear and all other structures are blurred above and below the focal plane
4 steps to setting up a tomogram
Set up the patient as per a normal X-ray
Move the X-ray tube to its caudal extent, and do a test run
Once the fulcrum position is determined, the x-ray tube is set to the start position
What consists of a antegrade contrast urography
- Contrast is injected into the kidneys
- Patient is usually lying prone on the x-ray table or fluoro table
This procedure is often done in the OR
Usually 50MI of 370 iodinated contrast is used
370 is a high osmolarity. Why is this okay in an antegrade urography?
Contrast is being injected straight into the ureters to be eliminated: it bypasses the kidney and is not filtered, therefore, does not affect the kidneys
indications for antegrade uropgraphy
- Kidney Stones
- Tumours in the Kidney, ureter and/or bladder
- Scarring from UTI
- Post-surgery
- Congenital abnormalities
- Obstruction in kidney or ureter
- Hydronephrosis
- Mass/Cyst in Kidney
- Pyelonephritis
- Glomerulonephritis
- Haematuria
Contraindications for antegrade urography
- Renal Failure
- Previous Allergy to iodine
- Generalized allergic reactions
- Multiple Myeloma
- Pregnancy
- Thyrotoxicosis
- Diabetes
- Sickle Cell Anaemia
- Pheocromocytoma
- Severe decreased Liver Function
- Metformin
- Interleukin 2 Chemotherapy
why would we put a needle directly into the patients kidney and inject contrast rather than an intra-venous?
this procedure is used to insert a “Nephrostomy Tube” that then is taped and secured to the back of the patient so that the kidney drain externally, as there is an obstruction in the ureter.
What technique is used to put the Nephrostomy tube into the Kidney?
Seldinger
ureteric catheter insertion procedure with antegrade urography
- Use Seldinger technique to locate a wire into the Kidney
- The wire is then advanced down the Ureter under the guidance of contrast and fluoroscopy
- When the wire reaches the bladder, the Ureteric Stent is placed over the wire
- The wire is withdrawn
- Removal of the catheter is done by an Antegrade approach and a clamp is introduced into the Kidney
what is retrograde contrast urography used for?
- Removal of Calculi via dormia basket, laser, smashing (US)
- Insertion if stents
- Exploration of pathology
contraindications for retrograde urography
- Same for all Iodinated contrast media
- Operating Theatre staff will assess the patients compatibility to undergo an operation
- If there are issues the operating theatre staff will discuss them with the radiographer and determine solutions to proceed
what does the radiographer need to do during a retrograde urography in the operating theatre
- To record the times sequence of the images
- To record the sequence of pathological imaging
- To image all relevant anatomy
- Record the place (which operating Theatre), Surgeons name, Radiographers name, date and time
2. Archive the images
what is external shock wave lithotripsy (ESWL)
- Use of high energy ultrasound waves that are focused on the kidney stone
- The focused shock wave “smashes” or disintegrates the stone
- Patients are usually sedated or unconscious
what happens during ESWL
- he x-ray is used to centre over the kidney stone
- Most modern machines automatically centre the ultrasound device in the process
- The stone can move as it breaks up. We go chasing the fragments to break each piece up
what is a risk of ESWL
kidney rupture can occur Extreme pain (stone breaks up and irritates the kidney)
what is cystography
Specifically looking at the pathology of the bladder by using X-rays and iodinated Contrast media. This can be done via fluoroscopy or CT
indications for cystography
- Tumours
- Reflux to the ureter
- Bladder diverticula
- UTI’s
- Inflammation
- Fistula
- Foreign bodies
- Post-surgical assessment
- Bladder trauma
contraindications for cystography
- iodinated contrast contraindications
- Blockage in the urethra (unable to place ureter scope)
imaging steps of cystography
- Urinary catheter is inserted into the urethra
- A balloon is inflated so the catheter is secure and doesn’t slide out of the ureter
- Contrast is then let passively flow into the bladder, with occasional screening to see if there are any filling defects
- This procedure may be done in the operating theatre with w ureter scope, visually checking the bladder or in Radiology under fluoroscopy
- The patient may be asked to roll partially to take oblique X-rays
- If reflux occurs contrast will move up the ureter
imaging steps for micturition (voiding) cystogram
- Same set up for a Cystogram
- Same initial x-ray procedure as for Cystogram done under fluoroscopy in Radiology
- Then the patient voids under fluoroscopy to visualise how the bladder empties
- Spot imaging may be done to document the emptying of the bladder
- Residual contrast in the bladder after voiding indicates incomplete emptying. This may cause infections as the urine in the bladder can become stagnant.
causes of voiding abnormalities that lead to needing a micturition cystogram
- Infections
- Inflammation
- Mass: tumour/cysts
- Calculi
imaging sequence for micturition (voiding) cystogram
- Control image
- Filling x-ray 1st, 2nd ,3rd etc.
- RPO or LPO and Lateral
- Voiding x-ray 1st, 2nd, 3rd etc.
- Post voiding
who are urethrograms more commonly performed on and what happens during a urethrogram?
- Most often performed on males (longer urethra)
- A catheter is inserted into the urethra
- Contrast is inserted.
- Images taken are mostly laterals and obliques
urethrogram indications
- Stricture
- Trauma
- Fistula or false passage (Vesicovaginal/Vesico colic)
- Congenital
- Prostatic Abscess/mass
- Functional problems voiding
- Urethral diverticula
urethrogram contraindications
- Contrast Allergies
- Previous listed Iodinated contrast contraindications
- Acute UTI
what cant a patient do before a urethrogram and why
don’t have sex/masturbate (sperm can be caught in the Strictures/blockages etc.), making diagnosis more difficult
patient prep for a Hysterosalpingogram
- Abstain from sex/ use contraception
- Performed to coincide with the menstrual cycle.
- diagnostic complications:
- Dilution of contrast
- Filling or fluids mixing defect mimicking a pathology
- Infection
- Allergy inducing - Determine the patient is not pregnant
- Have the patient urinate before the procedure
- Control image of the pelvis
- Patient privacy is paramount!
- Relevant equipment: towels, 20 ml contrast, speculum, forceps, sterile field
indications for Hysterosalpingogram
- Infertility
- Fallopian tube patency
- Possible therapy; flush out the fallopian tubes
- Spontaneous abortions/ miscarriage (a lot of them)
- Post-surgery
- Post radiation therapy
- Assessment of caesarean suture (rare)
- Congenital abnormality assessment (rare)
contraindications for Hysterosalpingogram
- Pregnancy (possible or known)
- Acute infection
- Contrast allergy
- During menses
- Constant vaginal bleeding
- Recent surgery
- Poor kidney function
Hysterosalpingogram post procedure care
- Slight pain may occur after
- Sanitary pad
- Slight bleeding: from irritation from the equipment in the lining of the uterus
- Severe bleeding is not normal
- Possible trauma
- Cramp: mild to severe
- Contrast in the uterine veins
- Infection
