Radiographic Procedures 2 > Urology > Flashcards

Urology Flashcards

(55 cards)

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1
Q

Intravenous urography

A

IVU/IVP
- antegrade procedure

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2
Q

Retrograde urography

A

retrograde procedure

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3
Q

urinary system procedures

A
  • Intravenous urography (IVU/IVP)
  • Retrograde urography
  • Cystography
  • Voiding Cystograms
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4
Q

voiding cystograms

A
  • cystourethrography
  • male and female
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5
Q

imaging techniques

A
  • Organs produce a faint shadow on radiograph
  • To demonstrate the structure and functionality of the urinary system contrast material must be used - administered intravenously
  • Imaging by either x-ray or computed tomography (CT)
  • Two filling techniques
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6
Q

what are the filling techniques for urology?

A
  • antegrade - IV injection
  • retrograde - urinary catheterization
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7
Q

Slide 4

A

know which technique is used

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8
Q

Purpose of excretory Urograph (IVU)

A
  1. visualize the anatomy of the collecting portion of the urinary system
  2. asses the functional ability of the kidneys (timed procedure)
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9
Q

Patient assessment

A

must occur before contrast is administered
- Current medications
- History of allergies
- Surgical procedures
- Past and current disease processes
- Laboratory values for GFR and Creatinine - Glomerular filtration rate (eGFR) = best overall indicator of kidney function

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10
Q

past and current disease processes to determine contraindication to IVU or appropriate amount of contrast

A
  • Polycythemia (thick blood disease)
  • Multiple myeloma (bone cancer) – can cause kidney failure
  • Pheocromocytoma – adrenal tumor(increase levels of iron in liver) - may precipitate a hypertensive crisis
  • Sickle Cell Anemia – renal infarcts
  • Diabetic on METFORMIN – Glucophage
  • Previous contrast reaction or seafood allergy
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11
Q

contraindications

A

high-risk patients may be evaluated with other modalities replacing many IVU procedures
- ultrasound
- CT abdomen/pelvis

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12
Q

equipment for IVU

A
  • Preferably tilting radiographic x-ray table with tomographic capabilities
  • Arm board support for IV injection
  • Ureteric compression device
  • Emergency drug tray – oxygen tank and mask
  • IVU tray
  • Markers, time markers, body position markers
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13
Q

ureteric compression

A
  • a method to enhance filling of pelicalyceal system
    placed at the level of the ASIS
  • promote complete filling of the renal pelvis, calyces and upper ureters
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14
Q

IVU imaging routine

A
  • note time at beginning of injection
    1. Immediate nephrogram or nephrotomography collimated to kidneys only
    2. 5 min AP supine Kidneys only
    after this varies person to person
  • Post void (prone or erect) - last
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15
Q

purpose of scout radiograph?

A
  • localize patient anatomy - increase SID to get kidneys and bladder on 1 image
  • assess proper bowel prep
  • assess technical factors
  • assess for any obvious stones or pathologies
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16
Q

nephrogram or nephrotomogram

A

radiographs taken early in study to demonstrate the renal parenchyma or the functional portion of the kidney
- Timing critical
- Demonstrates “blush” outline of kidneys

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17
Q

what is a nephrogram?

A

single radiograph immediately or at 1 minute

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18
Q

kidney view collimation?

A

xiphoid to iliac crest

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19
Q

nephrotomogram

A

series of tomograms starting at 1 min

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20
Q

setting the fulcrum for the neprotomogram?

A

measure abdomen from anterior to posterior
divide the number into a 3rd
- if abdomen is 30 inches - centre at 10 inches

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21
Q

IVU - posterior obliques

A
  • CP - level of iliac crest for full length
  • CP - between xiphoid and crest if collimated to kidneys only
  • suspend respiration
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22
Q

obliquity for UP junction

A

30 RPO or LPO

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23
Q

obliquity for UV junction

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A

45 LPO or RPO

24
Q

posterior oblique criteria of elevated side

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A

Kidney is parallel to plane of IR

25
posterior oblique criteria of downside
Ureter is free of superimposition from spine
26
RPO
- Rt UP junction 30˚ - Rt kidney is in profile - Lt UV junction with 45˚ Rotation - Lt kidney is parallel to IR
27
LPO
- Lt UP junction 30˚ - Lt kidney is in profile - Rt UV junction with 45˚ Rotation - Rt kidney is parallel to IR
28
Post void erect
AP or PA erect - Include symphysis pubis - CP – below iliac crests - Detect small masses or enlargement of prostate - Prolapse of the bladder - Nephroptosis - Asthenic patients exhibit greater “dropping” of the kidneys when standing - 2"
29
trendelenberg view
**Best demonstrates distal ureters - Can be used in place of compression to better demonstrate kidneys if stones are present (gravity helps with filling)
30
Prone position
**Best demonstrates the ureter (especially middle part) - Ureteropelvic junction
31
respiration
- Exposures should be made at the end of expiration, unless otherwise requested - Because of kidney excursion during respiration, it is possible to differentiate kidneys from other shadows by making exposure on different phase of respiration - Respiratory excursion – average of 1”
32
bladder
- CP - MSP - 2" above upper border of the symphysis - 2" below ASIS - CR - perpendicular - CR - 10-15 caudad if symphysis is obscurring bladder
33
what is a non-contrast CT used to demonstrate?
stones
34
what is a contrast CT used to demonstrate?
tumours and kidney structure and function
35
slide 31
be able to tell which modality is being used
36
CTU benefits
- Minimal bowel prep: Water only at least 1 hour prior to procedure * Non-contrast images to evaluate for presence and location of renal calculi * Option to use contrast media provides a structural and functional study - 3D reconstruction
37
Benefits of ultrasound
NO harmful radiation
38
Retrograde urography
- performed in OR, Radiology or outpatient department - contrast media is delivered retrograde through catheter
39
retrograde urogram
- performed by a Urologist, with the help of a nurse and a radiographer - Non functional examination of urinary system little physiologic information - provides more anatomical information than an IVU - Contrast injection into pelvicalyceal system following catheterization - Urine sampling can be done during procedure - Stents may be placed depending on findings
40
procedure for retrograde urogram
- Lithotomy or modified lithotomy position - Sedation or general anaesthetic - Insertion of cystoscope via urethra into bladder - Bladder examined then catheter/s inserted thru cystoscope into ureter/s - Contrast injected (3-5 mL)- maintain pressure - MRT runs the fluoro or takes the exposures depending on the room set up
40
contrast to maintain pressure
- Dilated ureters may require more contrast - Must make sure they do not inject any air - Would mimic a stone
41
views
- Exposures as directed by Urologist - Series of KUB’s - 14X17” IR – N/C SCOUT view first - Images must be numbered - AP’s with catheter(s) in place, with contrast in kidneys and/or ureters - May be a bilateral or unilateral study - Use of good collimation with unilateral studies - May use fluoroscopy to observe flow of contrast
42
birthing position called?
lithotomy position (hips flexed to 90) or modified lithotomy position
43
optional views for retrograde
- Trendelenburg – for pyelogram image or for prostate imaging - KUB - table elevated 10° -15° - Horizontal ray lateral – ureteropelvic region - Delayed imaging - Obliques - RPO and LPO – 30°-45°- Typically done with c-arm
44
retrograde cystography
- Contrast media delivered through catheter - Gravity flow of contrast media - 150-500cc - Fluoro - AP, posterior oblique and lateral projections - Demonstrates structure of bladder - often performed following trauma
45
where would they look to get the urethral opening?
the lateral edge of the trigone - right where the rugae starts
46
procedure
- Technologist will empty bladder into k-basin just prior to the procedure and re-clamp the catheter - Technologist will connect the contrast tubing to the catheter and unclamp the catheter to fill the bladder with contrast - Observing proper infection control practices - When bladder is full – imaging may begin
47
positioning following cystogram
AP Bladder AP trendelenburg AP obliques
48
AP bladder
collimate to bladder - CR 10-15 caudad for bladder neck - greater patient lordosis, less angle is required - CP - 2" inferior to ASIS
49
AP trendelenburg
- for distal ureters and prostate - table tilted 15-20, vertical CR
50
what is hydronephrosis
swelling of area of outflow of kidney due to blockage of flow of urine
51
AP oblique
- RPO and LPO 45 to demo posterolateral aspect of bladder and UV junctions - CR - perpendicular - CP - 2" superior to pubic symphysis and 2" medial to uppermost ASIS
52
Voiding cystogram
- Patient recumbent or erect - Receptacle (urinal) or disposable pads placed under patient - Fluoroscopy to record voiding - To show ureteric reflux and opacify urethra (functional study) - Females - AP (may angle 10º-15º caudad) - Males – RPO 30° (or LPO 30°) to place penis over soft tissue of the thigh
53
slide 50 diagram
understand what is being demonstrated
54
retrograde urethrography - male
- Retrograde approach using Brodney penile clamp with anaesthetic jelly or balloon catheter - Best demonstrates structure of the male urethra (when reflux and other pathologies are not suspected) - Structural study only - RPO 30° or LPO 30°
Radiographic Procedures 2
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