1.
IVP-PROCEDURE AND
INTERPRETATION
MODERATOR-DR.BHAGYALAKSHMI M.D.R.D.
PRESENTER-DR.JAYA ADITYA

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

6.
CONTRAST MEDIA-DOSES

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

18.
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.

19.
Initial treatment
• Elevation of affected extremity Ice packs
• Close observation for 2-4 hours
• Local injection of hyaluronidase

20.
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

21.
THANK YOU