What are the contraindications of an IVU?
hypersensitivity to contrast media
pregnancy
renal failure
all other diseases discussed during patient hx
What questions must you ask the pt prior to a contrast injection?
LMP?
allerigies to food, drugs or iodine (esp shellfish)?
hay fever, asthma or hives?
ever had contrast injection before?
weight?
diabetic? taking glucophage/glucovance?
do you have: hypertension, heart disease, hepatic/renal disease, pheochromocytoma, multiple myeloma, sickle cell anemia, or anuria?
What are the names of the drugs that diabetics may be concerned with taking?
glucophage/glucovance/metformin
Whats the difference between ionic and non ionic contrast? Are the both iodinated?
Both iodinated
Ionic=higher osmolality, less expensive, brand name is hypaque
Nonionic=low osmolality, more expensive, brand name omnipaque, less likely to cause a reaction
What is the basic routine for an IVU?
AP scout Nephrotomogram 1min after injection 5 min AP supine 10-15 min AP supine 20 min RPO/LPO AP post void recumbent or erect *special view: AP ureteric compression
What are the indications for an IVU?
abdominal/pelvic mass renal or urethral calculi kidney trauma flank pain hematuria hypertension renal failure UTI
What is the basic routine for a retrograde urography?
- a catheter is inserted through one or both ureters w/ tip at the renal pelvis.
- scout is taken to check placement of catheter
- next radiograph is called the pyelogram, when the dr inject 3-5 cc’s of contrast into one or both renal pelvis’s.
- final radiograph is called the ureterogram, dr withdraws catheters and simultaneously injects contrast into one or both ureters.
What is the basic routine a retrograde cystogram?
AP w/ 15 degree caudal angle
both 45-60 degree obliques
When does the timing sequence for the IVU begin?
at the start time of the injection
What is a cystogram? Why is it performed?
- A nonfunctional radiographic exam of the bladder after instilation of contrast via urethral catheter.
- Performed to rule out trauma, calculi, tumor, and inflammatory disease of the bladder
Describe the cystogram procedure:
- Catheterization is performed under aseptic conditions and bladder is drained of residual urine
- Bladder is filled with diluted contrast which flows in by gravity
- once bladder is full fluoro and/or overheads may be done
What is a cystourethrogram? Why is it performed? Describe the cystourethrogram procedure:
- functional study of the bladder and urethra
- performed for incontinence or trauma after a routine cystogram
- the catheter is gently removed and the pt is imaged while voiding.
- females in AP position
- males in 30 degree RPO
What are the mild symptoms of a contrast reaction? What should the technologist do?
nausea/ vomiting hives, itching, sneezing extravasation weakness, sweatiness, dizziness -comfort/reassure pt, tell them to breath slow and deeply, alert nurse if hives start
What are the moderate symptoms of a contrast reaction? What should the technologist do?
excessive hives, excessive vomiting, tachycardia
-tech should call for medical assistance
What are the severe symptoms of a contrast reaction? What should the technologist do?
very low BP cardiac/respiratory arrest loss of consciousness convulsions laryngeal edema cyanosis dyspnea profound shock -tech should declare medical emergency
What is ureteric compression? How is it performed and what position will demonstrate the same thing?
- used to enhance filling of the pelvicalyceal system and proximal ureters
- two paddles are placed over the outer pelvic brim, once contrast is injected the paddles are inflated and remain in place.
- prolongs nephron phase of IVU to 5 min
- when air pressure is released from paddles, a post release 14x17 supine film is taken
Which studies are functional? Nonfunctional? Antegrade? Retrograde?
Functional=IVU (antegrade) and voiding cystourethrogram
Non=retrograde urography and retrograde cystogram
What are the ureteric points of constriction?
- ureteropelvic junction=where renal pelvis narrows at proximal ureter
- brim of pelvis=where iliac blood vessels cross over ureters
- ureterovesical junction=where ureters meet bladder *most common point of restriction
What do the BUN and creatinine measure? What is the importance of them? What does BUN stand for?
-they measure kidney function
-high levels may indicate renal failure or tumor and also increase chances of an adverse reaction to contrast.
-blood urea nitrogen normal level: 8-25mg/100mL
creatinine normal level: 0.6 to 1.5 mg/dl
What anatomy is best demonstrated on an IVU oblique?
the upside kidney and the downside ureter
How should the IVU be scheduled?
can be done same day as BE but IVU must be done first
Why is tomography used? How does it work?
- to demonstrate a specific layer of tissue or an object that is superimposed by other tissues or objects.
- the X-ray tube and IR move about a fulcrum point to demonstrate a clear image of an object lying in the focal plane and blurring the structures above and below it
What is a fixed fulcrum? Variable fulcrum?
- fixed=pt and table are moved up or down (SID) to image desired plane
- variable=patient position (SID) is fixed
How are the tomo cuts determined for the IVU?
- requires thicker cuts
- circular tube motion is prefered
- usually taken immediately following bolus injection
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