Radiographic Contrast Studies of the Urinary System

Summary

This presentation outlines key indicators and contraindications for urinary system radiographic examinations using contrast. It discusses the necessity of contrast medium for effective visualization via x-ray or CT, detailing antegrade and retrograde filling techniques. The importance of patient preparation, hydration, and bowel clearance is emphasized, alongside specific procedural recommendations for different conditions. The summary also covers emergency preparedness, the use of compression in excretory urography, and the significance of preliminary KUB imaging for accurate diagnosis.

Takeaways

• 📚 Contrast Studies of the urinary system are conducted to visualize the renal parenchyma using x-ray or CT imaging after the administration of a contrast medium.
• 🔍 Two primary filling techniques are used: Antegrade and Retrograde, with lower concentrations for bladder studies and higher concentrations for excretory urography.
• 🌟 Nonionic contrast media are preferred due to their reduced likelihood of causing adverse reactions compared to ionic contrast media.
• 🍽 Pre-exam preparation is crucial, with the intestinal tract needing to be free of gas and fecal material, and bowel preparation varies by patient age and condition.
• 🥗 For adults, a low-residue diet and a light evening meal the day before, along with hydration, are recommended to ensure clear demonstration of the urinary system.
• 💧 Hydration is especially important for patients with conditions like Diabetes, Multiple myeloma, and high uric acid levels to mitigate the risk of contrast-induced renal failure.
• 💉 For retrograde urography, patients should drink 4 to 5 cups of water several hours before the examination to facilitate the procedure.
• 🏥 A standard radiographic room setup is typically sufficient for most urinary system studies, but specific procedures may require additional equipment like a cystoscopic and radiographic unit or a tomography unit.
• 🚑 Emergency preparedness is vital, with an emergency cart stocked and easily accessible in case of a contrast reaction.
• 🔨 Compression may be used in excretory urography to ensure filling of renal pelves and calyces, but it is contraindicated in patients with certain conditions like urinary stones or abdominal mass.
• 📝 A preliminary Scout KUB examination is essential to define soft tissues, kidney borders, and to check for opaque calculi, as well as to assess GI tract preparation and exposure factors.

Q & A

What is the primary purpose of performing contrast studies of the urinary system?

The primary purpose of performing contrast studies of the urinary system is to demonstrate the renal parenchyma effectively using contrast medium followed by imaging techniques such as x-ray or computed tomography.

What are the two filling techniques utilized to visualize the urinary system in contrast studies?

The two filling techniques utilized to visualize the urinary system are Antegrade and Retrograde.

Why are lower concentrations of contrast medium required for bladder studies?

Lower concentrations are required for bladder studies because a large amount is needed to fill the bladder.

What type of contrast media is less likely to cause an adverse reaction?

Nonionic contrast media is less likely to cause an adverse reaction compared to ionic contrast media.

What is the importance of bowel preparation in the examination of the urinary system?

Bowel preparation is important to ensure a clear demonstration of the urinary system by keeping the intestinal tract free of gas and fecal material.

How does adult preparation for a urinary system examination differ from that of infants and children?

Adult preparation depends on the patient's condition and may include a low-residue diet, a light evening meal, and a non-gas-forming laxative when indicated. In contrast, bowel preparation is not attempted in infants and children.

Why is hydration particularly important for patients with certain conditions before a urinary system examination?

Hydration is particularly important for patients with Diabetes, Multiple myeloma, and high uric acid levels because these conditions put them at an increased risk for contrast medium-induced renal failure if dehydrated.

What specific preparation is required for patients undergoing retrograde urography?

For retrograde urography, patients should drink 4 to 5 cups of water several hours before the examination.

What equipment is necessary for retrograde urographic procedures that require cystography?

A combination of a cystoscopic and radiographic unit is needed for retrograde urographic procedures that require cystography.

Why is compression sometimes applied during excretory urography and where is it typically centered?

Compression is applied to disrupt the flow of opacified urine into the bladder, ensuring filling of renal pelves and calyces. It is typically centered over the level of the anterior superior iliac spine (ASIS).

What should be included in a preliminary examination for excretory urography?

A preliminary examination should include a Scout KUB to define the soft tissues of the kidneys, the lower border of the liver, and the lateral margin of the psoas muscles, and to check gastrointestinal tract preparation and exposure factors.

Why is it important to inform patients about the sensations they may experience during contrast injection?

It is important to inform patients about the sensations they may experience, such as a warm flush feeling and a taste of copper in the mouth, to ensure they know these sensations are normal and to be expected during the contrast injection.

Why should exposures be made at the end of expiration during a urinary system examination?

Exposures should be made at the end of expiration to differentiate kidneys from other shadows by making exposure on different phases of respiration due to kidney excursion during respiration.