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IVP-PROCEDURE AND
INTERPRETATION
MODERATOR-DR.BHAGYALAKSHMI M.D.R.D.
PRESENTER-DR.JAYA ADITYA
• Radiographic examination of urinary tract including renal
parenchyma, calyces and pelvis after intravenous injection of contrast
media.
INDICATIONS
• IN ADULTS
• Screening of entire urinary tract
• Diseases of renal collecting system
• Abnormalities of the ureter
• Obstructive uropathy
• Calculus disease
• Suspected renal injury
• Prior to surgery of urinary tract
• Renal colic
• IN CHILDREN
• VATER anomalies
• Polycystic disease, PUJ obstruction
• Urinary tract infection
• Malformation of genitalia
• Ectopically inserted ureter in girls
• Anorectal anomalies
• history of
• Recurrent urinary tract infection
CONTRAINDICATIONS
• Iodine sensitivity.
• Pregnancy
• Severe history of anaphylaxis previously
RISK FACTORS
• Cardiac failure
• Dehydration
• Diabetes with Azotemia
• Previous allergic reaction
• History of Pheochromocytoma
CONTRAST MEDIA-DOSES
Mode of injection
• IV. bolus injection
• Within 30-60 sec.
• Density of the nephrogram is directly proportional to the plasma
concentration of contrast media.
• Large doses of contrast media increase diuresis distends the
collecting system increasing the diagnostic information from the urogram
PREPARATION-
For Adults
• Fasting for 4 hours
• Do not dehydrate
• Bowel preparation: Low residue diet
• Bowel wash is given till bowel is clear of faecal
• matter
Laxative is recommended
For Children-
• Dehydration is strictly prohibited in children.
• Colon should be empty-Suppositories are better than laxatives
• must not have a full stomach-to avoid vomiting
PROCEDURE
• Patient is placed in supine position-pelvis at cathode side
• Reduce lordotic curvature of lumbosacral spine
• A scout film is taken
• Test injection of 1ml of contrast is given and patient is observed for 1 min
to look for any contrast reactions.
• Rest of the contrast is rapidly injected within 30-60 seconds.
• All films are taken in full expiratory phase only.
• Cortical nephrogram is seen within 20 seconds.
• The nephrogram is made up of 2 phases-
1) Cortical phase- Vascular filling
2) tubular phase- Contrast within the lumen of renal tubule
• The appearance of pyelogram is seen 2 minutes.
• In children-
• In neonates- concentrating ability of the kidney is not fully developed
• First film is taken 15 min after
• Minimum number of films should be taken.
• Gonadal protective shields should be used.
• Bowel gas paddle compression technique should be used or
prone position.
FILMING TECHNIQUE
• Low KV (65-75) high mA (600-1000).
• Plain X-ray KUB /Scout film-
• Calculus
• Intestinal abnormalities
• Intestinal gas pattern
• Calcification
• Abdominal mass
• Foreign body
• After the scout film, 1minute, 5, 10, 15, 35 and post void films are
taken.
• 1 minute film shows nephrogram.
• 5 minute film shows nephrogram, renal pelvis, upper part of ureter.
• Compression band is now applied balloon is positioned on anterior
superior iliac spine where ureters cross pelvic brim.
Better pelvicalyceal distension
• After compresson is applied, 10 minute film is taken.
• demonstrate distended collecting system and proximal ureters.
• 15 minute film- prone position,for better visualisation of ureter.
• 35 minute film: kidney, ureter, bladder.
• Post void film: 1. Residual urine;
• 2. Bladder mucosa! lesions;
• 3. Diverticula;
• 4. Bladder tumour;
• 5. Outlet obstruction;
• 6. VUR.
• Delayed films- taken 1-24 hours after injection
• Taken at 1 hr, 3hrs, 6 hrs, 12 hrs and 24 hrs.
• Used in-
1) Obstruction- Early nephrogram is seen but collecting system is not
seen.
2)Long standing hydronephrosis- renal parenchyma is seen but
collecting system.
• 3) Congenital lesions- Non-visualised upper calyceal system with
ectopic
Filming in Children
• Films are taken at 2min. (supine) and 7 min. (prone) after contrast
administration.
• Carbonated beverage- Improve visualisation of left kidney.
• 15-20 degree caudal tilt- Right kidney can be well seen through the
liver
• In neonates- Excretion of contrast media is delayed
COMPLICATIONS
• Due to Contrast
• IMMEDIATE- Minor reactions
• Intermediate reactions
• Severe reactions
• Due to Technique
• Upper arm or shoulder pain.
• Extravasation of contrast at the injection site.
Initial treatment
• Elevation of affected extremity Ice packs
• Close observation for 2-4 hours
• Local injection of hyaluronidase
AFTER CARE
• Observation for 6 hours.
• Watch for late contrast reactions.
• Prevention of dehydration.
• In high risk patients-renal function tests should be done to watch for
deterioration
THANK YOU

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IVP.pptx

  • 2. • Radiographic examination of urinary tract including renal parenchyma, calyces and pelvis after intravenous injection of contrast media.
  • 3. INDICATIONS • IN ADULTS • Screening of entire urinary tract • Diseases of renal collecting system • Abnormalities of the ureter • Obstructive uropathy • Calculus disease • Suspected renal injury • Prior to surgery of urinary tract • Renal colic • IN CHILDREN • VATER anomalies • Polycystic disease, PUJ obstruction • Urinary tract infection • Malformation of genitalia • Ectopically inserted ureter in girls • Anorectal anomalies • history of • Recurrent urinary tract infection
  • 4. CONTRAINDICATIONS • Iodine sensitivity. • Pregnancy • Severe history of anaphylaxis previously
  • 5. RISK FACTORS • Cardiac failure • Dehydration • Diabetes with Azotemia • Previous allergic reaction • History of Pheochromocytoma
  • 7. Mode of injection • IV. bolus injection • Within 30-60 sec. • Density of the nephrogram is directly proportional to the plasma concentration of contrast media. • Large doses of contrast media increase diuresis distends the collecting system increasing the diagnostic information from the urogram
  • 8. PREPARATION- For Adults • Fasting for 4 hours • Do not dehydrate • Bowel preparation: Low residue diet • Bowel wash is given till bowel is clear of faecal • matter Laxative is recommended
  • 9. For Children- • Dehydration is strictly prohibited in children. • Colon should be empty-Suppositories are better than laxatives • must not have a full stomach-to avoid vomiting
  • 10. PROCEDURE • Patient is placed in supine position-pelvis at cathode side • Reduce lordotic curvature of lumbosacral spine • A scout film is taken • Test injection of 1ml of contrast is given and patient is observed for 1 min to look for any contrast reactions. • Rest of the contrast is rapidly injected within 30-60 seconds. • All films are taken in full expiratory phase only.
  • 11. • Cortical nephrogram is seen within 20 seconds. • The nephrogram is made up of 2 phases- 1) Cortical phase- Vascular filling 2) tubular phase- Contrast within the lumen of renal tubule • The appearance of pyelogram is seen 2 minutes.
  • 12. • In children- • In neonates- concentrating ability of the kidney is not fully developed • First film is taken 15 min after • Minimum number of films should be taken. • Gonadal protective shields should be used. • Bowel gas paddle compression technique should be used or prone position.
  • 13. FILMING TECHNIQUE • Low KV (65-75) high mA (600-1000). • Plain X-ray KUB /Scout film- • Calculus • Intestinal abnormalities • Intestinal gas pattern • Calcification • Abdominal mass • Foreign body
  • 14. • After the scout film, 1minute, 5, 10, 15, 35 and post void films are taken. • 1 minute film shows nephrogram. • 5 minute film shows nephrogram, renal pelvis, upper part of ureter. • Compression band is now applied balloon is positioned on anterior superior iliac spine where ureters cross pelvic brim. Better pelvicalyceal distension
  • 15. • After compresson is applied, 10 minute film is taken. • demonstrate distended collecting system and proximal ureters. • 15 minute film- prone position,for better visualisation of ureter. • 35 minute film: kidney, ureter, bladder. • Post void film: 1. Residual urine; • 2. Bladder mucosa! lesions; • 3. Diverticula; • 4. Bladder tumour; • 5. Outlet obstruction; • 6. VUR.
  • 16. • Delayed films- taken 1-24 hours after injection • Taken at 1 hr, 3hrs, 6 hrs, 12 hrs and 24 hrs. • Used in- 1) Obstruction- Early nephrogram is seen but collecting system is not seen. 2)Long standing hydronephrosis- renal parenchyma is seen but collecting system. • 3) Congenital lesions- Non-visualised upper calyceal system with ectopic
  • 17. Filming in Children • Films are taken at 2min. (supine) and 7 min. (prone) after contrast administration. • Carbonated beverage- Improve visualisation of left kidney. • 15-20 degree caudal tilt- Right kidney can be well seen through the liver • In neonates- Excretion of contrast media is delayed
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  • 37. COMPLICATIONS • Due to Contrast • IMMEDIATE- Minor reactions • Intermediate reactions • Severe reactions • Due to Technique • Upper arm or shoulder pain. • Extravasation of contrast at the injection site.
  • 38. Initial treatment • Elevation of affected extremity Ice packs • Close observation for 2-4 hours • Local injection of hyaluronidase
  • 39. AFTER CARE • Observation for 6 hours. • Watch for late contrast reactions. • Prevention of dehydration. • In high risk patients-renal function tests should be done to watch for deterioration

Notas do Editor

  1. IVU is the gold standard Malformation of genitalia like bilateral cryptorchidism, III degree hypospadiasis
  2. 30% risk osimilar reaction on a subsequent occasion. The risk is lower with low osmolar contrast media.
  3. More iodine increases the density of the nephrogram.
  4. Dulcolax (Biscodyl) is given 2-4 tablets at bedtime for 2 days prior Castor oil
  5. Compliance in their administration by parents is erratic. About vomiting-child should not be given anything by mouth for 3-4 hours prior
  6. -support is placed under patient's knees -including the kidneys, ureters, bladder and urethral regions
  7. (contrast in calyces)
  8. as it displaces bowel away from the kidneys.
  9. As they fill better
  10. due to immaturity of the tissue
  11. (15-60 minute applications three times per day for 1-3 days). (if volume exceeds 5 ml).