Contrast Media and Urinary System Flashcards Preview

Radiographic Positioning > Contrast Media and Urinary System > Flashcards

Flashcards in Contrast Media and Urinary System Deck (381):
1

The tissue density and composition of the organs in the abdomen are very ________ as well as the thickness of these organs.

similar

2

The liver, pancreas, spleen, stomach, kidneys, and bowel will display a low amount of

subject contrast

3

is the radiographic contrast caused by the difference in the composition of the patient’s body tissues.

Subject contrast

4

The organs of the digestive system, urinary system and cerebrovascular system have similar densities and atomic numbers and will therefore absorb nearly the same amount of radiation and therefore have

Low subject contrast

5

Are diagnostic agents that are introduced into the body orifices or injected into the vascular system, joints, and ducts to enhance subject contrast in anatomic areas where low subject contrast exists

Contrast media

6

The ability of the contrast media used in radiographic procedures to enhance subject contrast depends greatly on

The atomic number of the element used in a particular medium and
The concentration of atoms of the element per volume of the medium

7

Contrast media are generally classified as

negative or positive contrast agents.

8

Negative contrast agents are (radiolucent or radiopaque?)

radiolucent

9

Positive contrast agents are (radiolucent or radiopaque?)

radiopaque

10

The specialty contrast agent for MRI is:

IV contrast agent gadolinium diethylenetriaminepentaacetic acid (gadolinium-DTPA).
Metalic and magnetic agent that affects signal intensity.

11

The specialty contrast agent for Ultrasound is:

Gas-filled microbubbles that affect the sound wave to enhance ultrasound contrast

12

Physical properties of negative contrast agents:

Composed of elements with low atomic numbers
Administered as:
Gas (air)
Carbon dioxide
Tablets, crystals, soda water

13

Why is oxygen rarely used alone as a contrast agent?

Cells absorb oxygen quickly.

14

What is the most common negative contrast agent?

Room air.

15

A negative contrast agent may be combined with a positive contrast agent to produce a

double contrast effect.

16

In a double contrast barium enema, barium is the ______ contrast agent and air is the ______ contrast agent.

positive, negative.

17

An example of a discontinued exam using negative contrast media is:

Pneumoencephalography

18

The uses of negative contrast media are limited because

they may not provide sufficient contrast of a structure when used alone.

19

Why must negative contrast agents never be injected intravenously?

serious or fatal consequences can result

20

Three characteristics of positive contrast agents:

Are radiopaque
Composed of elements with high atomic numbers
Absorbs more x-rays and appears bright on a radiograph

21

Positive contrast agents absorbs about ___ times more x-rays than bone and ___ times more x-rays as soft tissues.

3 and 5.

22

Two examples of positive contrast agents:

1. Barium (Z# 56)
2. Iodine (Z#53)
Each of these elements has a much higher atomic number and mass density than does soft tissue (Z# 7.4)

23

What is the atomic number of Gadolinium?

64

24

Two popular types of positive contrast media:

1. Barium Sulfate
2. Iodinated Compounds:

25

Barium sulfate is a heavy metal element with the atomic number:

56

26

Barium sulfate is an inert powder composed of crystals that is used for

examination of the digestive system

27

What is barium sulfate comprised of?

The element barium is combined with oxygen and sulfate to form the inert compound barium sulfate.

28

What is the chemical formula of barium sulfate?

BaSO4

29

Barium sulfate is commonly referred to as:

Barium

30

A mixture of barium sulfate and water forms a

colloidal suspension, NOT a solution.
Barium sulfate never dissolves in water.

31

Depending on the environment of the barium sulfate, such as acid within the stomach, the powder has a tendency to clump and come out of suspension. This is called

FLOCCULATION

32

Stabilizing agents, such as _____ or _____ are used to prevent flocculation.

sodium carbonate, sodium citrate.

33

Barium flocculates in the presence of _____, producing fine flocculation in the proximal loops where _________

mucus, the pH is low.

34

Definition of enteral:

within, or by way of, the intestine or gastrointestinal tract.

35

Barium sulfate is used for examination of the entire ________ ________, and can be a relatively thin or thick mixture.

alimentary canal.

36

What are some forms barium sulfate comes in?

Barium sulfate can come in paste, liquid, powder and tablet form & can be purchased in premixed liquid form or in powder form.

37

Because of its inability to be absorbed by the body, barium sulfate cannot be used

intravascularly or intrathecally.

38

Definition of Intrathecal:

– introduced into or occurring in the space under the arachnoid membrane of the spinal cord or brain.

39

When is barium contraindicated?

in the case of a suspected perforation in the alimentary canal (organs of digestion) as barium is not absorbed naturally by the body.

40

What contrast agent must be used when patient presents with a history of suspected perforation?

a water-soluble iodine contrast agent is recommended (brand name examples: Gastrografin, Gastroview or Hypaque)

41

If barium enters the peritoneal or pelvic cavity, it can cause

peritonitis and must be surgically removed.

42

What are the adverse reactions to barium sulfate?

Obstruction/constipation
Extravasation
Vaginal Rupture
Hypervolemia
Allergic Reactions
aspiration of barium by sedated or mentally handicapped patients
Barium in appendix

43

Why should patients be instructed to drink plenty of fluids after receiving barium sulfate?

All barium transits the colon. One function of the colon is to absorb water from waste. Barium sulfate residue in the colon can dry and cause patient to become constipated.

44

Extravasation definition:

leakage from a vessel into the tissue.

45

A complication related to administration of barium during a BE is

perforation of the colon with extravasation into the abdominal cavity

46

Extravasation can lead to

peritonitis.

47

Who are at increased risk of a colon perforation during a BE?

Elderly patients or those receiving long term steroid medication are at increased risk for colon perforation because of atrophic tissue. Also at risk are patients with diverticulitis or ulcerative colitis. These diseases result in inflammation and degradation of the intestine.

48

Patients who have had a recent biopsy of the colon should not have a BE until

the area heals.

49

Barium tip or retention catheter can be a source of colon perforation. How can this risk be reduced?

The balloon should not be overinflated.

50

Vaginal Rupture- is a rare complication of barium sulfate administration. It is due to

misplacement of the catheter before lower GI examinations.

51

How can vaginal rupture be avoided?

Female patients should be asked whether they feel the enema tip in the rectum.

52

Hypervolemia definition:

a blood disorder consisting of an increase in the volume of circulating blood

53

Hypervolemia can occur when:

water from the cleansing enema or barium enema is shifted from the colon into the circulatory system with a resulting increase in blood volume

54

Consequences of hypervolemia are:

pulmonary edema, seizures, coma or even death.

55

Table salt is an ingredient that is added to the barium sulfate solution by the manufacturer to:

reduce the possibility of hypervolemia.

56

Allergic reactions to barium sulfate are possible but are usually due to:

the preservatives in the barium sulfate preparation OR to the latex in the barium enema catheters.

57

Why should sedated patients not undergo an upper GI exam?

Swallowing reflex diminished; increases chances of aspiration resulting in barium pneumonia
Mentally handicapped and persons with altered mental status due to age or disease is also at risk for aspiration

58

What type of complications can occur from barium in the appendix?

No directly related complications have resulted from this occurrence.

59

What are the two types of iodinated compounds?

Oil based and water-soluble.

60

Iodine's atomic number is:

53

61

Iodine is almost as radiopaque as:

barium.

62

Advances in imaging techniques and improvement in contrast agent technology have rendered oil-based contrast agents nearly obsolete. They may still be used infrequently for

lymphangiograms and bronchograms

63

Use of oil based contrast media in radiography is relatively

limited.

64

In the past, oil-based iodinated contrast media were routinely used for myelograms, bronchograms, hysterosalpingograms, sialograms, and dacryocystograms, but have been replaced by

water-soluble iodinated contrast media

65

Because oil-based contrast media are not miscible with blood,

it should NEVER be injected intravenously or intraarterially.

66

Oil based contrast media are made from

fatty acids

67

An ethyl group takes the place of the alcohol chemical group usually found in fatty acids. These chemical manipulations change the fatty acids into

esters.

68

Iodine atoms are added at certain areas of the ester molecules. The result is

iodinated ethyl esters of fatty acids

69

When the esters are exposed to light, heat, or air,

they decompose.

70

Any oil based contrast media that has darkened in color from the original pale amber color:

should not be used. The dark color indicates that the media has decomposed.

71

Plastic syringes should not be used for injection of oil-based iodine contrast media because

toxic substances from the plastic can dissolve into the media.

72

The main disadvantage of oil-based iodine contrast media is

that they persist in the body because they are insoluble in water

73

Adverse Reactions to oil-based iodinated contrast media:

Any iodine-containing contrast agent may provoke an anaphylactoid (allergic-like) reaction although this is rare.

74

Anaphylactic shock (anaphylaxis) is

the result of an exaggerated hypersensitivity reaction (allergic reaction) to an antigen that was previously encountered by the body’s immune system.

75

When Anaphylactic shock occurs:

histamine and bradykinin are released, causing widespread vasodilation, which results in peripheral pooling of blood.
This response is accompanied by contraction of nonvascular smooth muscles, particularly the smooth muscles of the respiratory tract.

76

Anaphylactic shock can cause:

shock, respiratory failure, and death within minutes after exposure to the allergen.

77

Usually, the more abrupt the onset of anaphylaxis,

the more severe the reaction.

78

The most common causes of anaphylaxis are __________________. The path of entry may be ___________________.

medications, iodinated contrast agents, and insect venoms. through the skin, respiratory tract, or gastrointestinal tract, or through injection.

79

Water soluble contrast media may be described as either

Ionic iodinated contrast media or nonionic iodinated contrast media

80

Water soluble contrast media has relatively low

toxicity.

81

Water soluble contrast media generally absorbed by the body and excreted by the kidneys within:

24 hours of intravascular administration

82

Intrathecal versus intravenous:

Intrathecal is introduced into or occurring in the space under the arachnoid membrane of the spinal cord or brain. Intravenous is introduced within a vein.

83

The labels of “ionic” or “nonionic” refer to

the structural composition of the molecules contained in the contrast agent not whether or not it has iodine in it.

84

The primary difference between the ionic and nonionic solutions rests with

the physiologic interaction within the body.

85

Ionic media dissociate into two molecular particles in

water or blood plasma.

86

IONIC Iodine Contrast Media are ionic because:

one particle has a negative charge called an anion, and the other particle has a positive charge called a cation.

87

The anion part of the ionic iodine contrast media molecule begins with a six-carbon bonded hexagon called a

benzene ring.

88

A carbon atom occupies each corner of the benzene ring but is not usually drawn because

the molecular diagram would look cluttered.

89

Every other carbon bond site of the benzene ring is bonded to an

iodine atom, which makes the contrast medium tri-iodinated.

90

There are 3 remaining carbon bond sites that are not bonded to an iodine atom.
Of those 3 remaining sites, one is occupied by

a negatively charged acid group.

91

It is at this acid group site in the molecule of ionic iodine contrast media that

the anion and cation separate on injection

92

The 2 carbon bond sites on the ionic iodine contrast molecule—R2 and R3—are occupied by

chemical structures that increase the solubility or the excretion rate of the contrast by the body

93

It is the two carbon bond sites (R2 and R3) that result in the different result in the different classes of ionic media:

Diatrizoate—with the trade name hypaque
Metrizoate—with the trade name isopaque
Iothalamate—with the trade name conray

94

The CATION (positively charged) part of the ionic iodine contrast molecule are salts. The salts most commonly used are

derivatives of sodium, calcium, and meglumine (methylglucamine)

95

Once injected, the CATION will dissociate or separate from the parent ANION and

create 2 separate ions in the blood.

96

The separation of the cation from the anion creates an increase in the blood plasma osmolality called

a hypertonic condition

97

Osmolality definition:

refers to the concentration or number of particles (anions and cations) in the solution per kilogram of water and is directly related to the occurrence of adverse reactions.

98

A contrast agent with high osmolality has

an increased number of particles and more osmoles in the solution.

99

An increase in osmolality can cause

vein spasm, pain at the injection site and fluid retention.

100

Most importantly, ionic contrast agents may increase the probability that a patient will

experience a contrast media reaction.

101

Increasing the number of ions in the plasma can

disrupt homeostasis and create a reaction

102

There is LESS chance of interruption of homeostasis if osmolality of the injected contrast

closely resembles that of BLOOD PLASMA which is about 300 osmol/kg.

103

On average, the osmolality of ionic iodinated contrast agents ranges from

1000 to 2400 osmol/kg

104

The osmolality of nonionic iodinated contrast agents is around

750 osmol/kg which is much closer to blood plasma.

105

most water based ionic iodinated contrast media are referred to as

high osmolality contrast media or HOCM

106

Water based iodinated nonionic contrast media are referred to as

low osmolality contrast media (LOCM) and are better tolerated by the body

107

Research indicates that patients are less likely to have contrast media reactions OR more likely to have less severe reactions or side effects when ________ are used.

nonionic contrast agents

108

LOCM are __ times more expensive than HOCM.

20

109

Why was nonionic iodinated contrast media developed?

to reduce the side effects of the ionic iodine contrast media.

110

Nonionic iodinated contrast media molecules ____________ so that hypertonicity is avoided.

molecules do not dissociate or separate in solution

111

The molecular structure of NONIONIC Iodine Contrast Media is a tri-iodinated benzene ring that

does not carry an acid group.

112

NONIONIC Iodine Contrast Media (LOCM):
Many __________ surround the benzene rings

oxygen-hydrogen hydroxyl groups

113

The hydroxyl groups in nonionic iodine contrast media increase

the solubility of the media in blood plasma

114

Both ionic and nonionic iodine media have physiologic effects on the body, but IONIC agents are _________ and therefore have shown greater effects and adverse reactions.

higher osmolality contrast agents

115

Viscosity of water based iodinated contrast media is influenced by

the concentration and size of the molecule and affects the injectability of the media.

116

Heating the media to body temperature reduces _______ and facilitates the ability for rapid injection.

viscosity

117

When plasma water is displaced by contrast particles, water from body cells

move into the vascular system (through osmosis)

118

Water from body cells moving into the vascular system results in:

in hypervolemia and blood vessel dilation, with pain and discomfort

119

hypervolemia definition:

a blood disorder consisting of an increase in the volume of circulating blood

120

With the use of water soluble iodinated contrast media:
Blood pressure may decrease because of ________, or it may increase because of _________

vessel dilation, hypervolemia and the effects of hormones in the kidneys.

121

Allergic reactions to water-soluble iodinated contrast media resemble allergic reactions to

foreign substances, such as pollen grains.

122

Concerning water soluble iodinated contrast media, reactions of typical allergic patients may be:

minor such as urticaria (hives)

123

Reactions such as wheezing and edema in the throat and lungs with accompanying bronchospasm and nausea and vomitting are thought to be caused by

the release of histamine from certain cells found in the lungs, stomach, and lining of blood vessels.*

124

Sometimes pre-medication with steroids and antihistamines can reduce or eliminate

allergic effects of water soluble iodinated contrast media.

125

Injection of contrast media results in dilation and then constriction of the renal arteries. The end result is

diminished blood supply to the kidneys.

126

Osmotic effects are also presumed to cause an increase in the amount of

molecular substances that cannot be reabsorbed by the renal tubules.
This results in an increased secretion of urine with dehydration.

127

BUN (blood urea nitrogen) and creatinine (waste product of metabolism) levels are indicators of kidney function and is a good indicator for

possible contrast media-induced renal effects.

128

Normal creatinine levels for the adult are

0.6 to 1.5 mg/dl (mg/100ml)

129

BUN levels should range between

8 to 25 mg/100 ml

130

Blood urea nitrogen (BUN) – This lab test checks

the metabolic function of the liver and excretory function of the kidneys.

131

Abnormal BUN values may indicate

CHF, renal disease, renal failure, myocardial infarction, dehydration

132

Serum creatinine—This lab test checks

renal excretory function.

133

Abnormal values of serum creatinine may indicate

dysfunction of the kidneys and/or dehydration.

134

IV fluid given before and during procedures can

reduce the severity of renal effects in those with renal disease or diabetes and older patients.

135

The urinary system eliminates _______ and maintains ________ .

organic wastes, the water and electrolyte balance of the body.

136

The urinary system consists of:

2 kidneys
2 ureters
1 urinary bladder
1 urethra

137

Kidneys and ureters are ______ structures.

retroperitoneal

138

Kidneys lie

on either side of the vertebral column in the most posterior part of the abdominal cavity

139

The latin designation for kidney is ____ and renal is a common adjective referring to ______.

ren, kidney.

140

Right kidney is more inferior than the left kidney because of

the liver.

141

On the upper medial border of each kidney is the

suprarenal (adrenal) gland

142

The suprarenal glands (adrenal glands) are part of the ______ system and have no functional relationship with the kidneys

endocrine

143

Each kidney connects to the urinary bladder by a

ureter

144

The bladder _______ until it can be eliminated.

stores urine

145

Urine is eliminated from the body via

the urethra

146

Most of each ureter lies ______ to its respective kidney

anterior

147

The ureters follow the natural curve of

the vertebral column curving forward following the lumbar lordotic curve and then curves backward on entering the pelvis.

148

The ureters enter the _______ aspect of the bladder.

posterolateral

149

The urethra is

the connection of the bladder to the exterior

150

The urethra exits from the body inferior to

the pubic symphysis

151

Retroperitoneal structures of the urinary system:

Kidneys and ureters

152

Infraperitoneal structures of the urinary system:

Distal ureters
Urinary bladder
Urethra

153

Each kidney is arbitrarily divided into an upper part and a lower part—called

the “upper pole” and the “lower pole”

154

Dimensions of the average kidney:

4-5 inches long, 2-3 inches wide, 1 inch thick. About the size of a bar of soap.

155

The angle of the psoas muscles causes the longitudinal plane of the kidneys to form a vertical angle of about ___ degrees with the MSP where the ____ POLE is closer to the vertebral column than its ____ POLE

20, upper, lower.

156

The kidneys are rotated ___ degrees from the coronal plane with the lateral border ______ to the medial border

30, posterior.

157

A 30º LPO will position the _____ kidney parallel to the IR.
A 30º RPO will position the _____ kidney parallel to the IR.

Right, left.

158

Most abdominal radiographs are performed on (breathing instruction) with patient _____.
This allows kidneys to lie ________________.

expiration, supine. High in the abdominal cavity.

159

The kidneys are somewhat higher in individuals of _______ habitus and somewhat lower in those of ______ habitus.

hypersthenic, asthenic.

160

Kidneys normally lie about halfway between

xiphoid process and iliac crest.

161

Top of left kidney is usually at level of

T11-T12.

162

Bottom of right kidney most often level with upper part of

L3

163

When one inhales deeply or stands upright, the kidneys will drop about

one lumbar vertebrae, or 5 cm (2 inches).

164

If the kidneys tend to drop more than 2 inches from the supine to upright position than a condition termed _______ exists.

nephroptosis

165

Sometimes in very thin patients and in older patients, the kidneys could drop dramatically and end up within the pelvis which could create problems from

a “kinking” or twisting of the ureters.

166

During the production of urine, the kidneys:

(1) Remove waste products from the blood

(2) Regulates water levels in the body

(3) Regulate acid-base balance and electrolyte levels of the blood

167

Nitrogenous waste products (urea and creatinine) are formed during the normal metabolism of proteins.
Build up of nitrogenous wastes in blood results in

uremia and may indicate renal dysfunction

168

uremia:

the presence of excessive amounts of urea and other nitrogenous waste products in the blood, as occurs in renal failure.

169

How much of blood pumped from the heart with each beat passes through the kidneys?

25%

170

The average water intake for humans during each 24-hour period is about

2.5 L, which eventually ends up in the bloodstream. The kidneys are the filters for the circulatory system.

171

At rest, more than ____ of blood flows through the kidneys every minute.

1 L

172

From the large amount of blood flowing through the kidneys daily, the kidneys normally excrete about ____ of urine per day

1.5 L

173

renal cortex

the outer, smooth-textured reddish area

174

renal medulla

the deep, reddish-brown region that consists of 8-18 cone shaped renal pyramids.

175

The apex of the renal pyramids are also known as:

renal papilla.

176

The portions of the renal cortex that extend between the renal pyramids are called

renal columns.

177

Together, the renal cortex and renal pyramids of the renal medulla make up the

functional portion or parenchyma of the kidney

178

The term renal parenchyma is a general term used to describe _______________, such as those visualized during an early phase of an IVU procedure.

the total functional portion of the kidneys,

179

The essential microscopic components of the parenchyma of the kidney are called

nephrons.

180

Each kidney has about _____ nephrons.

1 million

181

Urine formed by the nephrons drain into large ________ which extend through the renal papillae of the pyramids

papillary ducts

182

Nephrons are involved in 3 basic processes:

1. Filtering blood
2. Returning useful substances to the blood so they aren’t lost from the body
3. Removing substances from the blood that aren’t needed

183

The individual nephron is composed of

renal corpuscle and a renal tubule

184

The renal corpuscle consists of a double-walled membranous cup called the ____________ and a cluster of blood capillaries called the ___________.

glomerular capsule (Bowman’s capsule),
glomerulus (=little ball)

185

The vessel entering the glomerular capsule (Bowman’s capsule) is called the ____________.

afferent arteriole

186

The vessel leaving the glomerular (Bowman’s) capsule is the

efferent arteriole.

187

After exiting the glomerular capsule, the efferent arteriole ultimately reunite and continue on to communicate with the

renal vein.

188

The glomerulus serves as a filter for the blood, permitting water and finely dissolved substances to:

pass through the walls of the capillaries into the capsule.

189

From the glomerular (Bowman’s) capsule the filtered fluid from the plasma passes into the second part of the nephron, the

renal tubule.

190

Each renal tubule contines from a glomerular capsule in the _____ of the kidney and then travels in a circuitous path through the _____________________.

cortex, cortical and medullary substances.

191

The renal tubule consists of three parts:

the proximal convoluted tubule, the nephron loop (loop of Henle) and the distal convoluted tubule

192

The renal pyramids within the medulla are primarily a collection of

collecting ducts (tubules).

193

The filtrate is termed urine by the time it reaches the

minor calyx.

194

Between the glomerular capsule and minor calyces, more than of the filtrate is reabsorbed into the kidney’s venous system.

99%

195

Part of the renal pelvis, the calyces, and branches of the renal blood vessels and nerves lie in a cavity within the kidney called the

renal sinus.

196

The ureters vary in diameter from _____to_____.

1 mm to almost 1 cm.

197

Each ureter is _____ long

10 to 12 inches

198

Each ureter descends behind the _________ and in front of the _________________.

peritoneum, psoas muscle and the transverse processes of the lumbar vertebrae

199

The ureters enter the __________ portion of the bladder.

posterolateral

200

As the urinary bladder fills with urine, pressure within it compresses:

the openings into the ureters and prevents the reflux. (backflow of urine into the kidney)

201

Normally, 3 constricted points exists along the course of each ureter, which are:

1) the ureteropelvic junction or UPJ. This is the point the renal pelvis funnels down into the small ureter
2)where the ureters join the bladder. where the iliac blood vessels cross over the ureters
3)where the ureters join the bladder. This is called the ureterovesical junction or UVJ.

202

ureterovesical junction or UVJ.

where the ureters join the bladder.

203

Ureteropelvic junction or UPJ:

the point where the renal pelvis funnels down into the small ureter.

204

Most kidney stones passing down ureter tend to hang up at the:

UVJ.

205

When the volume of urine reaches about 250 mL,

the desire for micturition occurs

206

The total capacity of the bladder varies from

350 to 500 mL

207

As the bladder becomes more and more full, the desire to void becomes more and more urgent.
If the internal bladder pressure rises too high,

involuntary micturition occurs.

208

Dysuria =

pain during urination.

209

Anuria =

absence of urine formation

210

Polyuria =

Passage of large volume of urine in relation to fluid intake during a given period; common symptom of diabetes

211

Diuresis =

increased excretion of urine

212

The urethra is

a narrow, musculomembranous tube with a sphincter type of muscle at the neck of the bladder and extends about 1 ½ inches in the female and 7 to 8 inches in the male

213

The male urethra extends from the bladder to the end of the penis and is divided into _______________ portions.

prostatic, membranous, and spongy

214

The male urethra is about The male urethra is about _____ in length

7" to 8"

215

Prostatic portion of the male urethra:

about 1 inch in length, reaches from the bladder to the floor of the pelvis and is completely surrounded by the prostate

216

Membranous portion of male urethra:

passes through the urogenital diaphragm and is about ½ inch long

217

Spongy portion of urethra

passes through shaft of penis, extending from floor of pelvis to external urethra orifice.

218

The length of the male urethra acts as a natural barrier to external bacteria and the urine remains

sterile

219

The prostate is

a small glandular body surrounding the proximal part of the male urethra and is situated just posterior to the inferior portion of the pubic symphysis.

220

True or false: The renal veins are anterior to the renal arteries.

True

221

Which of the following structures is most anterior in the female pelvis?
Rectum
Urinary bladder
Uterus
Ovaries

Urinary bladder

222

The urinary bladder is located in the _______ compartment of the peritoneum.

Infraperitoneal
Retroperitoneal
Intraperitoneal
Rectouterine

Infraperitoneal

223

Radiographic examination of the urinary system in general is termed

urography

224

Contrast may be ______ into the bloodstream by an ___________ or some sort of __________ may be required so that the contrast medium can be delivered directly into structure being studied.

injected, intravenous injection, catheterization

225

Venipuncture and contrast media injection are considered

delegated medical arts

226

Radiographers must be certified competent in venipuncture after:

attending an organized training program.
Annual recertification is required.

227

Before withdrawing contents from any vial or bottle confirm:

Correct contents of container
Route of administration
Amount to be administered
Expiration date

228

Iodinated contrast agents may be administered by either:

bolus injection or drip infusion

229

Bolus injections:

provide a rapid introduction of contrast agent into the venous system at one time. This method is typical for maximum contrast enhancement

230

The rate of bolus injection is controlled by:

Gauge of needle or connecting tubing
Amount of contrast agent injected
Viscosity of contrast agent
Stability of vein
Force applied by individual performing injection

231

Drip Infusion

Method where contrast media is introduced into venous system by connective tubing attached to IV site.

232

Rate of drip infusion:

May be gradual or rapid depending on study
Controlled by clamp

233

The radiographer must have all necessary materials ready before injecting contrast media. Room must be prepared, including

emergency cart stocked with epinephrine or Benadryl in event of adverse contrast reaction

234

Equipment and Materials for Injection

Sharps container
Tourniquets
Alcohol pads
Cotton balls or gauze
Tape or Tegaderm
Gloves
Contrast media
Various sizes of butterfly and over-the-needle catheter
Syringes
IV tubing
Arm board

235

Why is a consent form required when injections of contrast media are made?

Venipuncture is an invasive procedure and carries the risk of complication when contrast agents are injected

236

Whose responsibility is it to make sure the consent form for contrast injection is signed?

It is the radiographers responsibility to ensure the patient is aware of potential risks and that the informed consent form is signed.
If patient is child, procedure needs to be explained to child and parent or guardian and the parent/guardian signs the informed consent form

237

For most IVUs, veins in the __________ are recommended and include:

antecubital fossa (“in front of the elbow”)
Median cubital
Cephalic
basilic

238

Veins in this region are generally large, easy to access, and durable enough to withstand a bolus injection of contrast agents without extravasation

the antecubital fossa

239

Other veins that may be selected for injection of contrast include

cephalic vein of lateral wrist and veins on posterior hand or lower forearm such as cephalic or basilic

240

DO NOT inject contrast media directly into

a shunt, central line, or vascular catheter unless it has been manufactured for contrast injections or under direction of a physician

241

What size needle is most commonly used for bolus injections of 50 to 100 mL (cc) of contrast solution on adults?

an 18- to 20- gauge butterfly needle. For pediatric patients a smaller 23- to 25 gauge needle is often used.

242

It is recommended that IV access be maintained until

imaging procedure is completed in the event that treatment for an adverse contrast reaction becomes necessary

243

Expected outcome (typical feelings during injection) of injected contrast media:

Temporary hot flash
Metallic taste in mouth
Usually pass quickly
Discussing these with patient reduces anxiety and prepares patient psychologically.

244

Questions to ask patient when taking patient's history:

1. Are you allergic to anything?
2. Have you ever had hay fever asthma, or hives
3. Are you allergic to any drugs or medications?
4. Are you allergic to iodine?
5. Are you allergic to any foods
6. Are you currently taking metformin, Glucophage, Glucovance, Avandamet, Fortamet, Riomet, Actosplus, Met, Diabex, or Metaglip?
7. Have you ever had an x-ray exam that required an injection into an artery or vein?

245

Normal Creatinine level (adult)

0.6 to 1.5 mg/dl

246

Normal BUN levels (adult)

8 to 25 mg/100 ml

247

Elevated levels of either creatinine or BUN levels may indicate

indicate acute or chronic renal failure, tumor, or other conditions of the urinary system.

248

Patients with elevated blood levels have a greater chance of

experiencing adverse contrast media reaction

249

Combination of iodinated contrast media and metformin may increase risk for

contrast media-induced acute renal failure and/or lactic acidosis

250

ACR recommends that metformin be withheld

for 48 hours after the procedure and resumed only if kidney function is determined to be within normal limits.

251

Radiographer must review chart and ask the patient whether he/she is taking metformin. If patient says yes – inform radiologist before injection. Why?

Current kidney function must be verified
Referring physician is notified to check kidney function 48 hours after procedure before medication is resumed

252

When preparing for an injection of contrast media, what should be done with the empty container of contrast?

Empty container should be shown to radiologist or person who is making actual injection. Empty contrast container should be kept in exam room until procedure is complete and patient dismissed


253

Who is responsible for ensuring emergency cart is stocked and available in room during injection procedures?

the radiographer.

254

Patients who have a history of hay fever, asthma, food allergies, or previous contrast media reaction may be candidates for the pre-medication procedure. What is one common pre-medication protocol?

Give combination of Benadryl and prednisone over a period of 12 or more hours before the procedure.

255

Categories of Contrast Media Reactions

1. Mild
2. Moderate
3. Severe
4. Organ specific

256

Mild reactions to contrast media:

Nonallergic reaction does not typically require drug intervention or medical assistance.

257

Treatment of mild reactions to contrast media:

includes having patient breath slowly, providing cool cloth, reassuring patient. Continue to observe and monitor to ensure that symptoms do not advance into more serious condition

258

Symptoms of mild reaction to contrast media:

Anxiety
Light-headedness
Nausea
Vomiting
Metallic taste (common side effect)
Mild erythema
Warm, flush sensation during injection (common side effect)
Itching

259

Moderate reaction to contrast media:

A true allergic reaction (anaphylactic reaction)

260

Symptoms of a moderate reaction to contrast media:

Urticaria (moderate to severe hives)
Possible laryngeal swelling
Bronchospasm
Tachycardia (100 beats per minute)
Bradycardia (60 beats per minute)
Angioedema
Hypotension

261

Treatment for moderate reaction to contrast media:

Moderate reaction may lead to life-threatening, medical assistance must be provided without delay. Treatment: often drug intervention to counter effects of reaction

262

Severe reaction to contrast media:

Life-threatening reaction known as vasovagal reaction. (From the book) Introduction of contrast media stimulates the vagus nerve, which may cause heart rate to drop and blood pressure to fall dangerously low. Fast and prompt response from medical team is required.

263

Symptoms of severe reaction to contrast media:

Hypotension (systolic blood pressure 80 mm Hg)
Bradycardia (50 beats/min)
Cardiac arrhythmias
Laryngeal swelling
Possible convulsions
Loss of consciousness
Cardiac arrest
Respiratory arrest
No detectable pulse

264

Treatment of severe reaction to contrast media:

Medical emergency must be declared immediately
Emergency cart available with oxygen and suction apparatus
Hospitalization is eminent

265

Organ-specific reaction to contrast media:

Specific organs are affected by the contrast media injection.

266

Organ specific symptoms of reaction to contrast media include:

Cardiac system—pulseless electrical activity
Respiratory system—pulmonary edema
Vascular system—venous thrombosis
Nervous system—seizure induction
Renal system—temporary failure or complete shutdown
Extravasation—leakage of contrast media outside of the vessel into the surrounding soft tissues

267

Organ specific reaction follows contrast media injection and may not be identifiable for up to ___ hours after the study has been completed.

48

268

Treatment of organ specific reactions includes:

monitoring, possible hydration, administration of Lasix (diuretic), interventional cardiac medications, antiseizure medications, and renal dialysis

269

Because reaction type occurs after urographic procedure has been completed patient should be instructed to

alert the physician of any difficulties producing urine or other unusual symptoms.

270

Suggested treatment of extravasation:

Notify department nurse and/or physician.
Elevate affected extremity above heart to decrease capillary pressure and promote reabsorption of extravasated contrast media.
Use cold compress followed by warm compresses first to relieve pain and then to improve resorption of contrast media.
Document the incident.

271

Excretory or intravenous urography (IVU) :

Common radiologic exam of the urinary system.
Often referred to as an IVP or intravenous pyelogram.

272

Pyelo refers only to

the renal pelves. Excretory or intravenous urogram normally visualizes more anatomy than just the renal pelvis so the term IVP is not accurate.

273

The IVU visualizes:

the minor and major calyces, renal pelves, ureters, and urinary bladder after injection of a contrast medium.

274

The IVU is a functional test because

contrast medium molecules are removed from the bloodstream and excreted completely by the normal kidneys.

275

Purpose of IVU:

1. Visualize the collecting portion of the urinary system

2. Evaluate kidney function

3. Evaluate urinary system for pathology or anatomic anomalies

276

Contraindications to IVU:

Hypersensitivity to iodinated contrast media
Anuria
Multiple myeloma
Diabetes
Severe hepatic or renal disease
Congestive Heart Failure
Pheochromocytoma

277

Pheochromocytoma

Usually benign tumor of the adrenal medulla. Over-secretion of epinephrine and/or norepinephrine by the tumor cells is associated with hypertension.

278

Diuretic-

An agent that increases excretion of urine

279

Lasix

Brand name for a diuretic

280

Lithotripsy

Therapeutic technique that uses acoustic (sound) waves to shatter large kidney stones into small particles that can be passed

281

Oliguria

excretion of a diminished amount of urine in relation to fluid intake (hypouresis or oliouresis

282

Urinary reflux

backward or return flow of urine from bladder into ureter and kidney; also called vesicoureteral reflux; common cause of pyelonephritis, in which backflow of urine may carry bacteria that can produce infection in the kidney

283

Urinary Tract Infection (UTI):

infection caused by bacteria, viruses, fungi, or certain parasites; commonly caused by urinary reflux

284

Patient Preparation for an IVU

Light evening meal prior to the procedure
Bowel-cleansing laxative
NPO after midnight (minimum of 8 hours)-not dehydrated
Enema on the morning of the examination
Voiding prior to procedure.

285

Why is voiding prior to an IVU important?

Bladder that is too full could rupture
Urine present in bladder dilutes contrast media

286

Pregnancy precautions for IVU:

IVUs may be performed to rule out urinary obstruction
Radiologist determines routine to reduce # of radiographs
Higher kV with lower mAs reduces patient exposure

287

Bowel preparation is not attempted in infants and children getting an IVU. What is recommended instead?

It has been recommended by some that infants and children be given a carbonated soft drink to distend the stomach with gas.

288

How does distending the stomach with gas help see the urinary system during a pediatric IVU?

the gas-containing intestinal loops are usually pushed inferiorly and the upper urinary tracts, particularly those on the left side of the body, are then clearly visualized through the outline of the gas-filled stomach.

289

To fully inflate the stomach of a child undergoing an IVU, at least __ ounces of a carbonated soft drink should be given to a newborn infant, and _____ ounces are required for a child 7 or 8 years old.

2, a full 12

290

Supplies needed for an IVU

Correct type and amount of contrast
Empty container of contrast media
Selection of needles
Alcohol wipes
Procedure gloves
Tourniquet
Support for elbow
Sharps container
Male gonadal shield
Emesis basin
Epinephrine or benadryl
Ureteric compression (if used)
Cold towel (or warm towel)
Operational and accessible oxygen and suction devices

291

Ureteric Compression:

Enhances filling of pelvicalyceal system and proximal ureters
Allows renal collecting system to retain contrast longer

292

Where are the paddles of the ureteric compression device placed?

Should be positioned over the point where the ureters cross the psoas muscles

293

Once contrast media is introduced with ureteric compression device in place,

the paddles are inflated and remain in place until post-compression images are ready to be obtained.

294

Contraindications to Ureteric Compression

Possible ureteric stones
Abdominal mass
Abdominal aortic aneurysm
Recent abdominal surgery
Severe abdominal pain
Acute abdominal trauma

295

Alternative to ureteric compression:

Position the pt trandelenburg. Head end of the table is lowered 15 degrees.

296

Purpose of the scout film for an IVU:

Verifies patient prep
Determines acceptable exposure factors
Verifies positioning
Detects abnormal calcifications

297

What is usually the first thing done when performing an IVU?

Patient history taken.

298

When does the radiologist see the scout film for an IVU?

Prior to injection.

299

If the pt is catheterized for the IVU:

clamp before injection.

300

Timing for entire IVU series is based on

start of injection. Exact time and length of injection should be noted

301

Injection usually takes

between 30 seconds and 1 minute

302

Most reactions (for IVU)occur within first __ minutes following injection—though delayed reactions occur

5.

303

Patient is observed for signs and symptoms indicating a reaction to the contrast during an IVU. What should be noted?

Chart the amount and type of contrast given to patient

304

According to the preference of the radiologist, ______ of contrast agent is used for adults

30 to 100 ml

305

The dosage administered to infants and children is regulated according to

age and weight.

306

After full injection at start of IVU procedure:

radiographs are taken at specific time intervals. Each image marked with lead numbers to indicated time interval when radiograph was taken

307

The initial contrast “blush” of the kidney is termed the

nephron phase

308

After the nephron phase, as kidneys continue to filter and concentrate the contrast medium, it is directed to the

pelvicalyceal system.

309

During an IVU, depending on patient’s hydration status and the speed of the injection, the contrast agent normally begins to appear in the pelvicalyceal system within

2-8 minutes.

310

The greatest concentration of contrast medium in the kidneys, during an IVU, normally occurs

15 to 20 minutes after injection.

311

Common basic IVU routine:

1. Nephrogram or Nephrotomogram
2. 5-Minute image
3. 10- to 15- Minute image
4. 20-Minute obliques
5. Postvoid

312

Nephrogram or Nephrotomogram

Taken immediately after injection (or 1 min. after start of injection)
Captures early stages of entry of contrast media into collecting system

313

5-Minute image & 10- to 15- Minute image

Full KUB to include entire urinary system
Usually supine (AP)

314

20-Minute obliques

LPO and RPO-Upside kidney parallel to IR and projects downside ureter away from spine

315

Postvoid

AP, PA or erect AP

316

What is a Postrelease or “Spill” Procedure with Ureteric Compression?

Full size radiograph taken after compression has been released
Used to assess for asymmetric renal function

317

How is a Postrelease or “Spill” Procedure with Ureteric Compression performed?

Compression applied immediately after 5 minute radiograph
Removed immediately before 15-minute radiograph

318

Erect Position for Bladder: For what exam is it taken and why?

Radiograph taken before voiding during an IVU: Prolapse of bladder
Enlarged prostate

319

Delayed Radiographs: for what reason would they be taken?

Filling of involved ureter is often slow in patients with urinary calculi
Patient may be brought back to department on a 1 to 2 hour basis

320

Why would Prone Radiographs be taken?

May be recommended for demonstration of the ureteropelvic region and for filling the obstructed ureter in patients with hydronephrosis.
The ureters fill better in the prone position because it reverses the curve of their inferior course

321

Hydronephrosis

distention of the renal pelvis and calyces of the kidneys as a result of some obstruction of the ureters or renal pelvis.

322

Causes of hydronephrosis:

It may be present in both kidneys in a female when the ureters are compressed by the fetus.
Other more common causes are calculi (stones) in the renal pelvis or ureter, tumors, and structural or congenital abnormalities.

323

The supine position allows the more ______ placed upper calyces to fill more readily and the ____________________ fill more in the prone position.

posteriorly, anterior and inferior parts of the pelvicalyceal system

324

Why would 14x17 Upright Radiographs be taken?

Demonstrates mobility of the kidneys and determines if the kidney’s mobility is beyond normal limits. (also provides information as described in erect position of bladder)

325

Nephron phase is

a blush of the entire kidney substance.
Blush results from contrast throughout nephrons

326

When is a Nephrogram image obtained?

1 minute after start of injection. Ureteric compression can prolong nephron phase to as long as 5 minutes in the normal kidney

327

If the nephrogram is taken with tomography it is called a

nephrotomogram. 3 tomograms and 3 focal levels
Centering and IR size confined to kidneys
Usually midway between iliac crest and xiphoid

328

One method to determine initial fulcrum level for nephrotomogram:

measure thickness of mid-abdomen with calipers and then divide that number by 3.
A 24 cm abdomen would require an 8 cm cut a 7 cm cut and a 6 cm cut

329

Timing during an IVU is critical, so exposure must be made exactly ________ after start of injection

60 seconds.
Table, IR and control panel must be set before injection is begun
Injection sometimes takes nearly 60 seconds to complete

330

Examinations of Urinary System:

1. Intravenous Urography (Excretory Urography)
2. Hypertensive Intravenous Urography
3. Retrograde Urography
4. Retrograde Cystography
5. Voiding Cystourethrography
6. Retrograde Urethrography

331

Purpose of a Hypertensive IVU

IVU for patients with high blood pressure
Determines whether kidneys are cause of hypertension

332

Suggested protocol for a hypertensive IVU:

Radiographs taken every minute for up to 5 minutes
After 5-minute IR, standard IVU routine
Check with radiologist to determine additional images to be taken.

333

True or false: Hypertensive IVU's are a common procedure today.

False

334

Retrograde Urography: Indications and contraindications:

The retrograde urogram is indicated for evaluation of the collecting system in patients who have renal insufficiency or who are allergic to iodinated contrast media.

335

Under what conditions is a retrograde urography performed?

Performed in surgery-patient sedated or anesthesized
STERILE. Contrast media delivered to pelvicalyceal system retrograde through catheter by urologist

336

What is a retrograde urography and what is its purpose?

Nonfunctional exam of urinary system
Determines location of calculi or other type of obstruction

337

How is the pt positioned for a retrograde urography?

The patient is placed on the cystoscopic table in a modified lithotomy position.

338

Once the pt is positioned for a retrograde urography, what happens?

The patient is then sedated or anesthesized
Patient is draped appropriately
The urologist inserts a cystoscope through the urethra and into the bladder

339

Retrograde Urography: After the urologist examines the bladder,

ureteral catheters are inserted into one or both ureters.
The tip of each ureteral catheter is placed at the level of the renal pelvis

340

Retrograde Urography: What is performed After catheterization?

Scout film. Radiographer checks technique and positioning. Urologist checks placement of the catheter.

341

Retrograde Urography: Once the Urologist checks placement of the catheter,

he/she then injects 3 to 5 ml of contrast through the catheter into the renal pelvis of one or both kidneys.

342

What is the second radiograph of the retrograde urograph?

The pyelogram. Respiration is suspended after the injection. This demonstrates the renal pelvis and major and minor calyces.

343

Retrograde urography: The THIRD and final radiograph is the:

ureterogram. The head of the table may or may not be elevated.

344

Retrograde urography: After the third radiograph, the urologist withdraws the catheters and

simultaneously injects contrast medium in one or both ureters.

345

For all radiographs taken during retrograde urography, exposure is made after:

anesthesist suspends respiration if the patient is under general anesthesia.

346

Retrograde Urography: Who generally indicates when to make exposure?

The urologist.

347

Retrograde Cystography: How is the contrast media delivered?

Catheter.

348

Retrograde Cystography: How much contrast media is used?

150-500 cc

349

Retrograde Cystography: How is the procedure viewed?

The gravity flow of the contrast media is viewed via fluoro with AP and AP obliques. Introducing the contrast too quickly could result in rupture of the bladder.

350

Retrograde Cystography: Purpose

NONFUNCTIONAL radiographic exam of the urinary bladder after iodinated contrast media has been introduced by a catheter.

351

The cystogram is a common procedure performed to rule out

trauma, calculi, tumor, and inflammatory disease of the urinary bladder

352

This is or is not, a surgical procedure and is carried out in the fluoroscopy room?

Is NOT. Cystoscopy is not required

353

Retrograde cystography: Pt prep:

There is no patient preparation but patient should empty bladder before catheterization.

354

Retrograde Cystography: After catheterization under aseptic conditions, the bladder is:

drained of any residual urine.

355

Retrograde Cystography: Filling the bladder may require :

150 to 500 cc and is filled under fluoroscopic guidance
Radiologist may take spot films

356

Voiding Cystourethrography: Purpose:

Functional study of the bladder and urethra
Performed after routine cystogram

357

Voiding Cystourethrography: Pathologic Indications:

Trauma or incontinence are common pathologic indications for a VCU exam.

358

Voiding Cystourethrography: Procedure:

The voiding phase of the examination is done under fluoroscopy
Procedure is performed with patient supine.

359

Voiding Cystourethrography: How is female pt viewed compared to male pt?

The female is examined in the AP or slight oblique position.
The male is best examined in a 30 degree AP oblique projection—RPO position

360

Where to center for Voiding Cystourethrography?

symphysis pubis

361

Retrograde Urethrography: Purpose:

Nonfunctional radiographic study of the male urethra

362

Basics of Retrograde Urethrography:

Retrograde injection of contrast media
Use of Brodney clamp
Patient in 30° RPO position
Rarely performed

363

Retrograde Urethrography: Pathologic Indications:

Trauma or obstruction of the urethra

364

How is contrast media delivered for an IVU?

intravenous injection: antegrade flow of media through superficial vein in arm.

365

How is contrast media delivered for retrograde urography?

retrograde injection through ureteral catheter by a urologist as a surgical procedure

366

How is contrast media delivered for retrograde cystography?

retrograde flow into the bladder through ureteral catheter driven by gravity.

367

How is contrast media delivered for VCUG?

retrograde flow into the bladder through ureteral catheter , followed by removal of catheter for imaging during voiding.

368

How is contrast media delivered for Retrograde Urethrography on a male?

retrograde injection through Brodney clamp or special catheter.

369

Pediatric Applications for urinary system exams:

Preparation for IVU for infant and young child must be monitored carefully-can’t restrict fluids for long period of time
Increased use of US for urinary conditions-no radiation

370

Geriatric applications for urinary system exams:

May be affected negatively by change in diet and food intake before IVU
Must be carefully monitored during procedure
Many have clinical history of diabetes

371

Alternative modalities and procedures for urinary system:

CT, MRI, Nuclear Med, Ultrasound

372

Renal cysts and/or adrenal masses may be demonstrated during this phase of IVU:

Nephrotomogram or nephrogram

373

RPO and LPO Positions: IVU: What is shown?

Trauma or obstruction to downside ureter

374

AP Projection: IVU - Postvoid: Pathology Demonstrated:

Enlarged prostate (possible BPH) or prolapse of bladder
nephroptosis

375

AP Projection: IVU—Ureteric Compression: Pathology Demonstrated:

Pyelonephritis and other conditions involving the collecting system

376

Cystography: AP/LPO and RPO and Lateral (special): Pathology demonstrated:

Signs of cystitis
Obstruction
Vesicoureteral reflux
Bladder calculi
Lateral projection will demonstrate possible fistulas between bladder and uterus or rectum

377

Cystography: AP: Central Ray

2 inches (5 cm) superior to pubic symphysis with 10° to 15° caudad tube angle
Projects pubic symphysis inferior to bladder

378

Cystography: Posterior Obliques position:

45° to 60° body rotation.
Visualizes posterolateral aspect of bladder, especially UV junction

379

Cystography: Posterior Obliques Central ray:

2 inches (5 cm) superior to pubic symphysis and 2 inches (5 cm) medial to ASIS
To demonstrate urinary reflux, center higher at level of iliac crest

380

Cystography: Lateral: Central Ray

Perpendicular
Center 2 inches (5 cm) superior and posterior to pubic symphysis

381

Voiding Cystourethrography: Pathology demonstrated

Determines causes of urinary retention
Evaluates for possible vesicoureteral reflux