Systems-Urinary Flashcards
(100 cards)
1
Q
What are the 3 main Urinary System Procedures that can be done on patients?
A
- Intravenous urography (IVU/IVP)
- Retrograde urography
- Cystography
2
Q
What are 2 types of Cystograms?
A
- Voiding Cystograms
- Cystourethrography
3
Q
Where is contrast adminsitered for examination fo the urinary system?
A
Anterograde:Intravenously
Retrograde:Urinary catheter
4
Q
What are the 2 modalities used for examination of the urinary system?
A
X-ray or computed tomography (CT)
5
Q
Is Intravenous urography (IVU/IVP) retrograde or antegrade?
A
Antegrade procedure
6
Q
What proceedure has been done here?
A
IVU
7
Q
What proceedure has been done here?
A
Retrograde Urogram
8
Q
What is the purpose of an excretory urography— IVU proceedure?
A
- Visualize the anatomy of the collecting portion of the urinary system
- Assess the functional ability of the kidneys
STRUCTURE AND FUNCTION
9
Q
What must you acess and document on prior to an excretory urography— IVU proceedure?
A
- Current medications
- History of allergies
- Surgical procedures
- Past and current disease processes
- Laboratory values for GFR and Creatinine
10
Q
What are these contraindications for?
- Polycythemia
- Multiple myeloma
- Pheocromocytoma
- Sickle Cell Anemia
- Diabetic on METFORMIN –
- Glucophage
- Previous contrast reaction or seafood allergy
A
Excretory Urography— IVU proceedure
11
Q
What are 2 modailites that can replace an excretory Urography— IVU proceedure if contraindications are presesnt?
A
- Ultrasound
- CT Abdomen/Pelvis
12
Q
Give three examples of equipment that must be present for an IVU:
A
- Arm board support for IV injection
- Ureteric compression device
- Emergency drug tray – oxygen tank and mask
13
Q
What proceedure are these markers for?
A
IVU proceedures
14
Q
Where is Ureteric Compression placed for IVU proceedures?
A
Placed at the level of the ASIS
15
Q
T/F
The purpose of ureteric compression is for image quality.
A
False; The compression is NOT TO IMPROVE IMAGE QUALITY. It is to promote complete filling of the renal pelvis, calyces, and upper ureters.
16
Q
What is being shown here?
A
Devices inflated over ureters at level of ASIS
17
Q
What is being shown here?
A
Compression device is attached to the table
18
Q
Where must you center for a collimated view for the IVU scout images?
A
Center midway between xiphi and iliac crest for collimated view
19
Q
Where must you center for a full length view for the IVU scout images?
A
For full length, center at iliac crest
20
Q
What does a basic general routine look like for an IVU proceedure?
A
- Scout radiograph
- Injection
- Nephogram or nephrotomography
- Different positions based off of radiologist (i,e. AP, supine, ect.)
- Post void (prone or erect)
21
Q
What are the purposes of a scout radiograph or a KUB prior to the IVU proceedure?
A
- Localize patient anatomy
- Assess proper bowel prep
- Assess technical factors
- Assess for any obvious stones or pathologies
22
Q
What is one major contraindication that immedietly cancels all IVU proceedures?
A
Any residual barium in patient from other proceedure, IVU is canceled
23
Q
T/F
A Nephrogram or Nephrotomogram Demonstrates “blush” outline of kidneys.
A
True
24
Q
What is the purpose of a Nephrogram or Nephrotomogram?
A
Radiographs taken early in study to demonstrate the renal parenchyma or the functional portion of the kidney
25
What is a nephrogram and when is it taken?
-Single radiograph taken immediately or at 1 min after contrast injection
26
What is a Nephrotomogram and when is it taken?
Series of tomograms starting at 1 min after contrast injection
27
What proceedure is being shown here?
A nephrotomogram
28
Is blush filling demonstrated here?
Yes
29
Is blush filling being demonstrated here?
No
30
Is this done with or without compression? Why can't we see the middle of the ureters?
-Done without compression
-The middle of the ureters are the most anterior and the patient is supine so we cannot see it
31
Is this done with or without compression?
Without compression
32
Is this done with or without compression?
With compression
## Footnote
Note the difference in filling of the calyces, renal pelvis, and upper ureters from the previous image
33
# T/F
An IVU proceedure is done on suspended expiration.
True
34
What side is being demonstrated in the Posterior Oblique IVU positions?
The downside
35
What is the centering point for the posterior oblique IVUs?
Center 2 inches above symphysis and 2 inches medial from the raised ASIS
36
# T/F
In the posterior oblique IVU proceedures, the elevated kidney is parallel to plane of IR.
True; however it is superimposed by the spine
37
What UP junction is best demonstrated in an RPO?
Right UP junction best demonstrated
38
What position is this and what is this demonstrating?
RPO demonstrating the right UP juntion
39
How do you best demonstrate the Left UV junction?
RPO 45° oblique
40
What is the CP for the Post Void Erect?
Iliac crests
41
What is the projection of a post void erect?
AP or PA
42
# T/F
Post void erect images demonstrate nephroptosis very well.
True
43
What body type exhibits the most nephroptosis and when?
Asthenic patients exhibit greater “dropping” of the kidneys when standing
44
What are the reasons for doing a post void erect image?
1. Detect small masses or enlargement of prostate
2. Prolapse of the bladder
3. Demonstrate nephroptosis
45
What is the best position to demonstrate the distal ureters?
Trandelenberg position
46
What position can be done in place of compression for the IVU proceedures? Why?
Trandelenberg can be used in place of compression to better demonstrate kidneys if stones are present (gravity helps with filling)
47
What does the prone position for the IVU proceedures best demonstrate?
Best demonstrates the ureter (especially middle part) and ureteropelvic junction
48
What type of respiration should be used for all IVU proceedures
Exposures made at the end of expiration
49
What is the average respiratory exursion?
Respiratory excursion – average of 1”
50
What is the centering point for bladder imaging?
MSP - 2” above upper border of the symphysis
51
What angle would you use for the bladder and when?
CR 10º-15º caudad if symphysis is obscuring bladder
52
# T/F
Non-contrast CT is used to demonstrate stones
True
53
What does CTU stand for?
Computerized tomography (CT) urogram
54
What are the benefits of CTU?
1. Minimal bowel prep
2. Non-contrast images to evaluate for presence and location of renal calculi (kidney stones)
3. Option to use contrast media
4. 3D reconstruction
55
# T/F
CTU provides a structural and functional study
True
56
What is the benefit of ultrasound for urinary imaging?
NO harmful radiation
57
How is contrast media delivered through Retrograde Urography?
Contrast media delivered retrograde through catheter
58
# T/F
**A Retrograde Urogram is done for the structural and functional purpose of examining the urinary system.**
False; Non functional examination of urinary system, done for structural purposes
59
# T/F
A retrograde urogram
provides more anatomical information than an IVU
True
60
# T/F
In a retrograde urogram, stents may be placed depending on findings
True
61
How do they find the ureter after inserting a catheter through the bladder?
Go to the corner of the ruguae
62
What body position is a patient in for a retrograde urogram?
Lithotomy or modified lithotomy position
63
# T/F
A retrograde urogram is done under sedation or general anaesthetic
True
64
What instrument is inserted into the bladder via the urethra in a retrograde urogram?
Insertion of cystoscope via urethra into bladder
65
# T/F
Dilated ureters may require less contrast
False; Dilated ureters may require more contrast
66
# T/F
Double contrast is sometimes used a retrograde urogram.
False; air could mimick stones
67
# T/F
For a retrograde urogram, they may use fluoroscopy to observe flow of contrast
True
68
What does an imaging series look like for a retrograde urogram?
1. Scout images
2. Series of KUB’s
3. AP’s with catheter(s) in place, with contrast in kidneys and/or ureters
69
What are other optional views that can be done for a retrograde urogram?
| 5
1. Horizontal ray lateral
2. Obliques - RPO and LPO – 30°-45°
3. KUB - table elevated 10° -15°
4. Trendelenburg
5. Delayed imaging
70
What is the amount of contrast in cc given for retrograde cystography?
150-500cc
71
How is contrast media delived for a retrograde cystogram?
Contrast media delivered through catheter
72
What does a retrograde cystogram demonstrate?
Demonstrates structure of bladder
73
What modality is typically used for retrograde cystograms?
Fluoroscopy
74
What are the series of projections taken in retrograde cystograms?
AP, posterior oblique and lateral projections
75
What are the pre-imaging steps prior to performing a retrograde cystogram?
1. Technologist empty bladder into basin just prior to the procedure and re-clamp the catheter
2. Connect the contrast tubing to the catheter and unclamp the catheter to fill the bladder with contrast
3. When bladder is full – imaging may begin
76
What is the CR angle for the AP bladder?
CR-10-15° caudad
77
What is the centering point for the AP bladder?
2” inferior to ASIS
78
# T/F
Greater patient lordosis, less angle is required for the AP bladder.
True
79
What is the purpose of doing an AP trandelenberg for a retrograde cystogram?
For imaging the distal ureters and the prostate
80
What is the position of the table in the trandelenberg position for the retrograde cystogram? What is the CR angle?
Table tilted 15°-20°, vertical CR
81
What position and proceedure is this for?
-AP trandelenberg for the retrograde cystogram
82
What AP obliques are done for the retrograde cystogram and what does it demonstrate?
RPO AND LPO 45° to demo posterolateral aspect of bladder and UV Junctions
83
What is the centering point for the AP obliques for the retrograde cystogram proceedure?
2” superior to pubic symphysis and 2” medial to uppermost ASIS
84
What pathology is show here?
Rupturred bladder
85
What does VCU stand for?
Cystourethrography voiding cystogram
86
What body positions are VCU proceedures done in?
Recumbent or erect
87
What modality is used for VCU proceedures?
Floro
88
# T/F
A VCU proceedure is a functional study.
True
89
What is the purpose of a VCU proceedure
To show ureteric reflux and opacify urethra
90
# T/F
For VCU proceedures, place receptacle (urinal) or disposable pads placed under patient
True
91
What is the projection and angle used for females recieving a VCU proceedure?
AP (may angle 10º-15º caudad)
92
What is the projection and angle used for males recieving a VCU proceedure? Why?
RPO 30° (or LPO 30°) to place penis over the soft tissue of the leg
93
Is this a normal or abnormal study done on a female?
Normal
94
Is the urethra normal in this? What is the pathology?
-Normal urethra
-Prostatic enlargment
95
What pathology is being shown here?
Left ureteric reflux and an abnormal urethra
96
What is the position of the patients (males) in Retrograde Urethrography proceedures?
RPO 30° or LPO 30°
97
# T/F
A Retrograde Urethrography proceedure for males is a structural study only.
True
98
What does a Retrograde Urethrogram best demonstrate on males?
Best demonstrates structure of the male urethra
99
What type of clamp is used in Retrograde Urethrograms on males?
Brodney penile clamp
100
Is this a normal study of the urethra?
Yes
| Can visualize the clamp in this image
