imaging of pelvis + urinary tract

Question 1

know how to tell if its a female or male pelvis

Question 2

know how to label a sagittal MRI scan of the female pelvis system:
- rectum
- bladder
- pubic symphysis
- pouch of Douglas
-uterus

Question 3

what are the 3 layers of the uterus, what does this look like on sagittal MRI

Answer 3

• uterine cavity
• endometrium (inner layer)
• myometrium (muscle layer)

(3 layers seen in sagittal section)

Question 4

ensure to see if theres any fluid attenuation in the pouch of Douglas on sagittal scan

Question 5

be able to identify the bladder, uterus and rectum on axial MRI scan

Question 6

what is the best ultrasound views for the female pelvis

Answer 6

• internal / trans-vaginal

Question 7

what structure is used as an acoustic window during trans abdominal scnas

Answer 7

bladder

Question 8

identify what the sections of the uterus looks like on ultrasound :
fundus
body
myometrium and endometrium
cervix

Question 9

what is laparoscopy

Answer 9

a surgical procedure in which a fibre-optic instrument is inserted through the abdominal wall to view the organs in the abdomen or permit small-scale surgery

Question 10

know what different structures look like with a laparoscopy camera e.g

round ligament
ureter
uterus
suspensory ligament
uterine tube

Question 11

what is a hysterosalpingogram

Answer 11

X-ray procedure that is used to view the inside of the uterus and fallopian tubes. (uses contrast)

Question 12

recap the male pelvic organs and where they are situated e.g

ductus deferens
prostate
bladder
rectum
testes
epididymis etc

Question 13

know where the different male pelvic organs are located on a sagittal and axial MRI :

rectum
bladder
prostate
pubic symphysis
seminal vesicles

Question 14

know what the testis look like on ultrasound :

identify epididymal head and tail
scrotal skin
testis

Question 15

identify what renal structures look like on ultrasound

Question 16

what is intravenous urogram and how does it work

Answer 16

• intravenous contrast given which gets filtered by blood and drained through the ureters which highlights it
• series of plain film examinations taken
• can be taken with digital tomosyntheis (detector and xray tube moves allowing imaging from several different angles)

Question 17

what is excretory phase CT

Answer 17

injection of contrast which gets excreted by kidney into the renal pelvis and so on, highlighting the ureter

• typically CT image taken

Question 18

identify what the different structures look like on an excretory phase CT view

Question 19

what is contrast phasing

Answer 19

taking CT images at delayed timings to see the progression of the contrast movement through the kidneys etc to identify obstruction or similar

Question 20

what is MR urography

Answer 20

• contrast being excreted by kidney and highlighting ureter
• usual MRI images taken

Question 21

what is a CT KUB and why is no contrast used for this

Answer 21

CT kidney, ureter, bladder

• to avoid masking of kidney stones that could be within the ureters

Question 22

what is a CT angiogram for

Answer 22

• contrast used
• used to identify the vasculature/ blood supply going to the kidneys
• spot narrowing of vessels

Question 23

what is a MRI angiogrpahy

Answer 23

• contrast used
• MRI imaging to identify vasculature going to kidneys

Question 24

what is conventional angiography

Answer 24

• if there is a known narrowing, this technique can identify as well as treat the issue
• e.g putting a stent in
• this is why it is better than. CT and MRI angiography

Question 25

what is the negative of CT and MRI angiography

Answer 25

if u spot an abnormality, you cant do anything about it

Question 26

what is a CT cystogram

Answer 26

- imaging modality specific to bladder - contrast injected into bladder - images then taken - if theres injury to bladder wall for example, you can see contrast leaking out

Question 27

what are the 2 ways contrast can be inserted into the bladder

Answer 27

- intravenously then excreted by kidney into bladder or - catheter insertion of contrast into bladder ( this affects the time taken for imaging as u may need to wait for contrast to be reached in bladder before imaging)

Question 28

what is a retrograde urethrogram

Answer 28

- examination of urethra - contrast is injected via penis, and the contrast enters backwards into the bladder - if theres any issues with urethra you can see due to the movement of contrast through the ureter

Question 29

what tracer is used in nuclear medicine scans of renal ssytem

Answer 29

technetium based tracer or DMSA or MAG3

Question 30

how is nuclear medicinal imaging taken

Answer 30

- images taken regularly over period of time - observe passage of tracer through kidney to bladder