Urology Flashcards
(55 cards)
1
Q
Intravenous urography
A
IVU/IVP
- antegrade procedure
2
Q
Retrograde urography
A
retrograde procedure
3
Q
urinary system procedures
A
- Intravenous urography (IVU/IVP)
- Retrograde urography
- Cystography
- Voiding Cystograms
4
Q
voiding cystograms
A
- cystourethrography
- male and female
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
6
Q
what are the filling techniques for urology?
A
- antegrade - IV injection
- retrograde - urinary catheterization
7
Q
Slide 4
A
know which technique is used
8
Q
Purpose of excretory Urograph (IVU)
A
- visualize the anatomy of the collecting portion of the urinary system
- asses the functional ability of the kidneys (timed procedure)
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
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
11
Q
contraindications
A
high-risk patients may be evaluated with other modalities replacing many IVU procedures
- ultrasound
- CT abdomen/pelvis
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
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
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
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
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
17
Q
what is a nephrogram?
A
single radiograph immediately or at 1 minute
18
Q
kidney view collimation?
A
xiphoid to iliac crest
19
Q
nephrotomogram
A
series of tomograms starting at 1 min
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
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
22
Q
obliquity for UP junction
A
30 RPO or LPO
23
Q
obliquity for UV junction
A
45 LPO or RPO
24
Q
posterior oblique criteria of elevated side
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°
