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Specialized Gen Rad > IVU > Flashcards

IVU Flashcards

1
Q

IVU aka

A

intravenous pyelogram

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2
Q

what does IVU demonstrate

A

renal calyxes
renal pelvis
ureters
urinary bladder

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3
Q

what does IVU allow one to visualize

A

1) collecting portion
2) functional ability of kidneys
3) pathology / anomalies

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4
Q

where are kidneys found in

A

retroperitoneal space surrounded by fatty tissues

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5
Q

instructions for patients before IVU

A

1) light evening meal
2) laxatives night before
3) fluid restriction at least few hours before
4) suppository on morning of exam
5) Nil by mouth after midnight (minimum 8 hrs)

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6
Q

what are the 3 points of constrictions

A

1) ureteropelvic junction
2) brim of pelvis
3) ureterovesical junction

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7
Q

for patients taking metformin, what must they do

A

withhold for 48 hours following iodinated CM administration

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8
Q

what happens if patient has full bladder

A

bladder could rupture if compression applied & urine will dilute contrast media

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9
Q

local contrast media reactions

A

extravasation, phlebitis

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10
Q

systemic contrast media reactions

A

mild, moderate, severe

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11
Q

which reaction is suggestive of true allergy / anaphylactic reaction

A

moderate systemic contrast media reaction

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12
Q

patient care for mild reactions

A

1) monitor & reassure patient
2) provide warm towel for extravasation

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13
Q

patient care for moderate reactions

A

1) call for medical assistance
2) assist radiologist to administer meds

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14
Q

patient care for severe reactions

A

1) call for immediate medical assistance
2) remove any obstacles that impede medical staff
3) assist w/ treatment

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15
Q

IVU routine

A

1) clinical history taken
2) preliminary radiograph
3) inject CM
4) imaging sequence

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16
Q

preliminary radiograph AKA

A

control / scout radiograph

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17
Q

prelim radiograph positioning

A

1) patient supine w/ arms away from ROI
2) MSP perpendicular to IR midline
3) ensure SP included on lower border of IR
4) center CR 1 cm below level of iliac crests
5) expose on arrested expiration

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18
Q

image critique of prelim radiograph

A

1) entire renal outline & bladder included
2) vertebral column centered to radiograph
3) sufficient contrast to show CM in kidneys, ureters, bladder
4) no motion unsharpness

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19
Q

purpose of prelim radiograph

A

1) detect any anomalies which may obscure CM
2) adequate bowel prep

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20
Q

IVU imaging sequence

A

1) 1 min nephogram (followed by compression immediately)

2) 10 min cone down kidney projection

3) 20 min full KUB (immediate following release of compression)

4) post micturition radiograph

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21
Q

CM appears in pelvicalyceal system within ___

A

2 - 8 mins

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22
Q

purpose of nephogram is to

A

1) capture early stages of CM entering collecting system
2) assess kidney function, size, shape

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23
Q

image critique of nephogram

A

1) entire renal parenchyma seen with some filling of CM in collecting system

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24
Q

greatest concentration of CM in kidneys normally occurs ___ after injection

A

15 - 20 mins

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25
Q

why is ureteric compression applied

A

distention of renal pelvis & calyces

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26
Q

contra-indications of ureteric compression

A

any form of abdominal issues

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27
Q

purpose of 10 min coned down kidney radiograph

A

determines if
1) excretion is symmetrical
2) further injection of CM needed due to poor opacification

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28
Q

image critique of 10 min coned down kidney radiograph

A

1) both kidneys shown w/ pelvic calyceal filling
2) no rotation / motion unsharpness

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29
Q

purpose of 20 min release image radiograph

A

demonstrates filling of ureters as CM flows from kidneys to bladder

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30
Q

image critique of 20 min release image radiograph

A

1) contrast filled renal pelvis, major & minor calyces, ureters seen
2) no rotation / motion unsharpness

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31
Q

purpose of post-micturition radiograph

A

detects presence of residual urine which might indicate:
1) small tumor mass
2) enlarged prostate gland
3) renal stones

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32
Q

when should one consider prone position for post-micturition radiograph

A

to enhance visualization of pelvicalyceal & ureteral filling

33
Q

when should one consider erect position for post-micturition radiograph

A

to enhance visualization of ureters & kidney mobility, and prolapsed bladder / enlarged prostate

34
Q

when should one consider oblique position for post-micturition radiograph

A

better demonstration of ureterovesical junction

35
Q

how to position patient if patient presented with compression contra-indications

A

1) patient placed in Trendelenburg position to enhance renal pelvis & calyces filling for 1st & 2nd exposures
2) radiographs taken at 1, 3, 5 min instead of 1, 10, 20 mins

36
Q

when should one consider bladder view for post-micturition radiograph

A

better demonstrate contrast-filled
- urinary bladder & distal ureters for possible reflex
- prostate & proximal male urethra

37
Q

where will the SP be projected for bladder view

A

below bladder

38
Q

what does staghorn calculus mean

A

kidney stones that block the kidneys entirely

39
Q

where is the axis of normal kidneys closer to

A

vertebral column at upper pole

40
Q

where is the axis of horseshoe kidneys closer to

A

vertebral column at lower pole

41
Q

what is the unique shape caused due to ureterocele

A

cobra head shaped at most distal portion of ureters

42
Q

what is the unique shape caused due to benign prostatic hypertrophy

A

semilunar impression on bladder base with resultant fish hooks of distal ureters

43
Q

alternatives to IVU

A

ultrasound, CT, MRI

44
Q

sterile syringe gauges

A

18-, 20- ,22-

45
Q

fulcrum

A

pivot point between x-ray tube & IR

46
Q

fulcrum level

A

distance (cm) from tabletop to fulcrum

47
Q

objective plane / focal plane

A

plane in which target anatomy is clear & focused

48
Q

what variables control sectional thickness

A

exposure angle & x-ray tube movement

49
Q

what is the fulcrum level of patient

A

dependent on patient thickness but usually is 6 - 9 cm (adults)

50
Q

exposure angle for kidney nephrotomography

A

5 - 10 degrees for thicker slices; larger angles (45 - 60 degrees) for thinner slices

51
Q

Tomograms taken during an IVU with an exposure angle of 10 degrees or less are termed as

A

zonography

52
Q

The kidneys received ___ of the total cardiac output

A

about 20 to 25%

53
Q

A common bacterium that may lead to a Urinary Tract Infection (UTI) is

A

Escherichia coli

54
Q

Involuntary urination is termed

A

incontinence

55
Q

The total capacity for the average adult bladder is

A

350 - 500 ml

56
Q

The gland which is located just inferior to the male bladder is the

A

prostate gland

57
Q

The name of the junction between the distal ureters and urinary bladder is the

A

ureterovesical junction

58
Q

The specific name for the mass of fat that surrounds each kidney is

A

perirenal fat

59
Q

The kidneys and ureters are located in the

A

retroperitoneal space

60
Q

state FOUR situations when compression is contra-indicated

A

severe abdominal pain
abdominal mass
aortic abdominal aneurysm
recent abdominal surgery
acute abdominal trauma

61
Q

Name FOUR(4) pieces of equipment which should be present in an IVU room that are not usually found in a general x-ray room

A

backcheck valve
emesis basin
tourniquet
ureteric compression band
contrast media injector

62
Q

state the precautions a radiographer needs to take before applying the compression

A

check if patient has abdominal pain
recent abdominal surgery
pregnancy
check bladder full

63
Q

explain why ureteric compression is necessary

A

causes contrast retention in renal pelvis & calyces to improve visibility of urinary tract

64
Q

The tourniquet should be placed __ proximal to the site of a venipuncture

A

5cm

65
Q

State TWO(2) situations where the routine sequence has to be changed and describe the primary differences.

A

1) allergic reaction = take meds prior to CM administration to minimize allergic reaction
2) renal impairment = use alternative imaging agent that is less nephrotoxic / non contrasting

66
Q

Sequence of radiographs taken for routine IVU

A

1) pre contrast / scout images
2) contrast injection
3) nephrogram phase
4) corticomedullary phase
5) pyelogram phase
6) urography phase
7) post micturition images

67
Q

List FOUR (4) conditions that, if present, may place the patient at a greater risk of contrast media reactions

A

allergic reactions
cardiovascular conditions
renal conditions
thyroid disorder

68
Q

Explain the reason(s) patients are told to empty their bladder before the IVU procedure.

A
  • Clearer visualization of urinary tract
  • Minimize unnecessary pressure placed on kidneys as rupture could occur
  • Prevent overlapping structures as distended bladder can impede anatomical assessment of urinary system
  • Bladder with full urine could rupture due to compression
69
Q

Explain the reasons for patients to fast at least 8 hours before the intravenous urography procedure

A
  • Minimal gastrointestinal activity = reduces movement artifacts
  • Optimal imaging quality = presence of food might interfere with absorption & distribution of contrast media in body
  • Reduced risk of aspiration = chance of regurgitation & aspiration during IVU procedure
  • Patient safety & comfort = decreased likelihood of nausea & vomitting
70
Q

State TWO(2) situations where fasting is not required for IVU

A

emergency adult case, pediatrics case, weak elderly

71
Q

Intravenous extravasation

A

leakage of injected medication, drugs or contrast medium from blood vessels causing damage to the surrounding tissues, by intravenous (IV) poor cannula placement and puncture techniques

72
Q

Cystitis

A

Cystitis is usually caused by bacteria in the lower urinary tract. When bacteria comes into contact with the urethra, it travels to the bladder, leading to cystitis.

73
Q

Polycystic kidney

A

clusters of cysts develop primarily within your kidneys, causing your kidneys to enlarge and lose function over time

74
Q

Ureterocele

A

dilation of the area where distal end of ureters form sac-like pouches

75
Q

Glomerulonephritis

A

glomeruli inflammation which causes the glomeruli to malfunction and the kidney unable to filter waste products from the blood normally

76
Q

Vesico-ureteral reflux

A

urine flows backward from the bladder to one or both ureters and sometimes to the kidneys.

77
Q

w/ compression sequence

A

1) inject CM
2) wait 1 min
3) do 1 min nephrogram (place 1 min marker)
4) apply compression band immediately
5) wait till 10 mins
6) do 10 min cone down kidney projection (place 10 min marker)
7) release compression after 20 mins
8) do 20 min full KUB (place 20 min marker)
9) instruct patient to empty bladder
10) do post micturition KUB after voiding (place “POST-VOID” marker)

78
Q

w/o compression sequence

A

1) patient in trendelenburg position
2) inject CM
3) wait 1 min
4) do 1 min nephrogram (place 1 min marker)
5) wait till 3 mins
6) do 3 min cone down kidney projection (place 3 min marker)
7) place patient supine
8) do 5 min full KUB (place 5 min marker)
9) instruct patient to empty bladder
10) do post micturition KUB after voiding (place “POST-VOID” marker)

Specialized Gen Rad (13 decks)

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