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.

Outlines

00:00

📚 Urinary System Contrast Studies Overview

This paragraph introduces the purpose of contrast studies in the urinary system, which are conducted to visualize the renal parenchyma using x-ray or computed tomography. It explains the necessity of contrast medium and the two main filling techniques: Antegrade and Retrograde. The paragraph also touches on the concentration requirements for different studies and the preference for nonionic media to reduce adverse reactions. It emphasizes the importance of preparation to ensure a clear demonstration of the urinary system, including bowel preparation and hydration, especially for patients with certain health conditions that increase the risk of contrast-induced renal failure.

Keywords

💡Radiographic examination

Radiographic examination refers to the use of X-rays to visualize the internal structures of the body, such as bones and organs. In the context of the video, it specifically pertains to the urinary system and the use of contrast to enhance the visibility of its structures. The script mentions that 'Contrast Studies of the urinary system are performed to demonstrate the renal parenchyma', highlighting the importance of this technique in medical diagnostics.

💡Contrast medium

Contrast medium is a substance used in radiographic examinations to improve the visibility of internal structures by increasing the contrast between different tissues. The script explains its necessity for 'effectively' demonstrating the renal parenchyma through imaging techniques like x-ray or computed tomography, emphasizing its role in enhancing the diagnostic process.

💡Antegrade and Retrograde

These terms describe two filling techniques used in radiographic studies of the urinary system. Antegrade refers to the natural flow of contrast medium from the kidneys to the bladder, while retrograde involves injecting the contrast medium into the urinary system from the urethra. The script mentions these techniques to 'visualize the urinary system', indicating their importance in different diagnostic scenarios.

💡Nonionic media

Nonionic media are types of contrast agents that are less likely to cause adverse reactions compared to ionic contrast media. The script points out that 'Nonionic media less likely to cause an adverse reaction compared to ionic contrast media', which is crucial for patient safety during radiographic examinations.

💡Bowel preparation

Bowel preparation involves clearing the intestinal tract of gas and fecal material to ensure a clear demonstration of the urinary system during radiographic examinations. The script notes that 'Preparation should allow for clear demonstration of urinary system, and requires intestinal tract to be free of gas and fecal material', indicating the preparatory steps necessary for accurate imaging.

💡Hydration

Hydration is the process of drinking sufficient water to maintain adequate fluid levels in the body. The script emphasizes its importance, especially for patients with certain conditions like 'Diabetes, Multiple myeloma, and High uric acid levels', as dehydration can increase the risk of contrast medium-induced renal failure.

💡Excretory urography

Excretory urography is a specific type of radiographic examination that involves the use of contrast medium to visualize the urinary tract as it is excreted by the kidneys. The script mentions 'Higher concentrations are used for excretory urography', indicating the need for a stronger contrast to capture the urinary flow effectively.

💡Retrograde urography

Retrograde urography is a procedure where contrast is injected through a cannula into the bladder and ureter, allowing for the visualization of the urinary system from the inside out. The script describes this process as 'where contrast is injected via cannula inserted through the urethra, into the bladder, and into the distal end of the ureter', illustrating a method used for detailed examination of the urinary tract.

💡Compression

Compression in the context of radiographic examinations refers to the application of pressure to disrupt the flow of contrast medium, ensuring the filling of certain areas like the renal pelves and calyces. The script explains that 'Compression is sometimes applied over the distal ends of the ureters' and should be applied and removed slowly to minimize patient discomfort.

💡Scout KUB

A Scout KUB is an initial radiographic image taken before the administration of contrast, which helps in identifying the position and contour of the kidneys and other structures. The script states that 'Preliminary examination should include a Scout KUB', which sets the foundation for further detailed imaging with contrast.

💡Venipuncture supplies

Venipuncture supplies are the tools and materials used for drawing blood, which in the context of the video, may be necessary for emergency situations such as a contrast reaction. The script advises to 'Make sure you have all of your venipuncture supplies available', highlighting the preparedness required for potential medical emergencies during the procedure.

Highlights

Radiographic examination of the urinary system with contrast is used to demonstrate the renal parenchyma.

Contrast medium is essential for effective visualization of the urinary system through x-ray or computed tomography.

Two filling techniques for urinary system visualization are Antegrade and Retrograde.

Lower concentrations of contrast are needed for bladder studies due to the larger volume required.

Higher concentrations are utilized for excretory urography.

Nonionic contrast media are less likely to cause adverse reactions compared to ionic media.

Preparation for urinary system examination requires a clear demonstration with a gas and fecal-free intestinal tract.

Bowel preparation is not attempted in infants and children for urinary system studies.

Adult preparation may include a low-residue diet and a light evening meal the day before the examination.

Patients should be well hydrated, especially those with diabetes, multiple myeloma, and high uric acid levels.

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

No preparation is typically required for lower urinary tract examinations.

A standard radiographic room setup is sufficient for most urinary system studies.

A combination of cystoscopic and radiographic unit is needed for specific retrograde urographic procedures.

A tomography unit is necessary for infusion nephrourography.

Time-interval and body position markers are important for accurate procedural documentation.

Emergency preparedness is crucial, with an emergency cart stocked and nearby.

Venipuncture supplies and motion control equipment should be readily available.

Compression may be applied in excretory urography to ensure filling of renal pelves and calyces.

Compression is contraindicated in patients with certain conditions like urinary stones and abdominal mass.

A preliminary Scout KUB examination is essential for defining kidney soft tissues and checking preparation.

Patients should be informed about the sensations caused by contrast injection, such as a warm flush feeling.

Exposures should be made at the end of expiration to differentiate kidneys from other shadows.

The Scout AP radiograph in the supine position is crucial for assessing kidney location, contour, and calculi.

Transcripts

In this presentation, we’re going to discuss some indicators and contraindications for

radiographic examination of the urinary system with contrast, as well as procedural and pre-exam

preparation recommendations.

Contrast Studies of the urinary system are performed to demonstrate the renal parenchyma,

and to do so effectively, contrast medium is needed, followed by imaging by either x-ray

or computed tomography.

Two filling techniques can be utilized to visualize the urinary system: Antegrade and

Retrograde.

Lower concentrations are required for bladder studies because of large large amount required

to fill bladder.

Higher concentrations are used for excretory urography.

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

Preparation should all for clear demonstration of urinary system, and requires intestinal

tract to be free of gas and fecal material.

Bowel preparation is not attempted in infants and children.

Adult preparation depends on patient condition.

When time permits, low-residue diet for 1 to 2 days before examination should be planned.

A light evening meal on the day before examination, combined with a non–gas-forming laxative,

when indicated, the day before the examination.

Nothing by mouth after midnight the day of the examination and the patient should be

well hydrated.

Hydration is particularly important for patients with Diabetes, Multiple myeloma, and High

uric acid levels.

These conditions put patient at increased risk for contrast medium−induced renal failure

if dehydrated.

For retrograde urography, where contrast is injected via cannula inserted through the

urethra, into the bladder, and into the distal end of the ureter, the patient should drink

4 to 5 cups of water several hours before examination.

No preparation is usually required for examinations of the lower urinary tract.

A standard radiographic room sufficient for excretory urography and most retrograde studies

of the bladder and urethra.

A combination of cystoscopic and radiographic unit is needed for retrograde urographic procedures

that require cystography.

A tomography unit is required for infusion nephrourography.

Time-interval and body position markers should also be used for these procedures, and a sufficient

number of properly-sized image receptors should be available.

Make sure the emergency cart is nearby, and check to make sure it has been stocked.

You should always know the location of the cart in case of a contrast reaction where

seconds could mean a lot in the administration of drugs to counteract anaphylaxis.

Make sure you have all of your venipuncture supplies available as well, as long as any

equipment you may anticipate needing for motion control such as immobilization and ureteral

compression.

In excretory urography, compression is sometimes applied over the distal ends of the ureters.

The purpose of compression is to disrupt the flow of opacified urine into the bladder to

ensure filling of renal pelves and calyces.

Compression can be centered over level of anterior superior iliac spine (ASIS).

Apply and remove slowly to reduce patient discomfort caused by changes in intraabdominal

pressure.

Compression is contraindicated in patients with Urinary stones, Abdominal mass, Aortic

aneurysm, Colostomy, Suprapubic catheter, and Traumatic injuries.

Preliminary examination should include a Scout KUB.

Contrast and density will be the same as for abdominal radiographs with soft tissues of

the kidneys, the lower border of the liver, and the lateral margin of the psoas muscles

that must be defined.

It’s extremely important to inform patient of sensations caused by contrast injection.

This usually feels like a very warm, flush feeling that goes through your entire body,

and sometimes includes the taste of copper in the mouth.

It’s normal to feel this during the contrast injection and for a few moments after.

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.

Images should be marked if exposed on phase of respiration other than expiration.

The Scout anteroposterior (AP) radiograph, supine position, demonstrates location of

kidneys, their contour, and opaque calculi, if present and also serves to check gastrointestinal

(GI) tract preparation and exposure factors.