Radiographic Contrast Studies of the Urinary System
Summary
TLDRThis 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
📚 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.
Mindmap
Keywords
💡Radiographic examination
💡Contrast medium
💡Antegrade and Retrograde
💡Nonionic media
💡Bowel preparation
💡Hydration
💡Excretory urography
💡Retrograde urography
💡Compression
💡Scout KUB
💡Venipuncture supplies
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.
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