2. INTRODUCTION
• It is most frequently performed to evaluate the
calyces and pelvis of the kidneys.
• Urters and urenary bladder when abnormalities of
these organs are suspected.
• An abdominal flat plate (kub) film is taken , an
iodinated contrast medium such as diatrisoate
sodium or diatrizoate megulumate is injected,and
then serial film is performed.
3. INDICATIONS
IN ADULTS:
• Screening of the entire urinary tract especialy in cases of haematuria or pyuria.
• Diseases of renal collecting system and renal pelvis.
• Differentiation of function of both kidneys.
• Abnormalities of the ureter.
• TB of the urinary tract.
• Calculus disease.
• Potential renal donors.
• Prior to endo urological procedures and surgery of urinary tract.
• Suspected renal injury.
1. Renal colic or blank pain.
4. IN CHILDREN
• VATER ANOMALIES: These patients have vertibral, anal,
tracheo-oesophageal, and renal anamoloes are seen in
about 90% of patients.
• Malformation of urinary tract,e.g.,polycystic disease,PUJ
obstraction etc.
• Neutrological disorders affecting urinary tract.
• Enuresis in the presence bacteriuria, abnormal urinary
sediment,adolecents,diurnal/nocturinal incontinence and
history of recurrent urinary tract infection.
• Anorectal anomalies.
5. CONTRAINDICATIONS(RELATIVE)
• Severe history of anaphylaxis previously carries
30% risk of similar reaction on a subsequent
occation. The risk is lower with low osmolar
contrast media.
• Iodine sensitivity.
• Pregnancy
6. RISK FACTOR
• Cardiac failure: For patients in cardiac
decompensation, hyperosmolar contrast should
not be used as the media intensify the
congestive cardiac failure. Low osmolar contrast
media like lohexol should be used.
7. • Dehydration: Renal shut down may be precipitated especialy in
infants,diabetics and in multiple myeloma patients as it causes
protein precipitation in renal tubules and result in anuria.
Dehydration can cause thrombosis of renal vein and renal
failure in children.
8. • Diabetes with Azotimia: These patient are prone to
nephrotoxic contrast media effects. 1in 2000
patients can develop renal shutdown.
• Previous allergic reaction: In this cases, non-ionic
agents should be used and injectable steroids
should be given 12 and 4 hours before procedure.
• History of pheochromacytoma: contrast media can
presipitate hypertensive crisis.
9. CONTRAST MEDIA
Doses:
In adults In children
Non ionic contrast media:
Iohexol-omnipaque
300 mg I/ml-40-80 ml or
350 mg I/ml 40-80 ml
240 mg I/ml
Below 7 kg 4 ml/kg
Above 7 kg 3 ml/kg
300mg I/ml
3 ml/kg
Ionic media:
300 to 600 mg Iodine
equivalent / kg body
weight. Maximum of 40
gm of Iodine.
Meglumine iothalamate or
diatrizoate 60% containing
equivalent of 280 mg I/ml
of iodine. Dose is 1-2 ml
/kg body weight.
Below 6 months :10ml
6 months-2 yrs :20ml
2-10yrs :
10. MODE OF INJECTION
• Contrast media is usualy given as a I.V. Bolus injection within
30-60 seconds.
• The density of the nephrogram is directly proportional to the
plasma concervation of contrast media.
• Mor iodine increases the density of the of the nephrogram.
• Large doses contrast media increase diuresis which distends
the collecting system these increasing the diagnostic
information from the urogram.
11. PATIENT PREPARATION
For adults:
• Ask for any history of diabates mellitus, pheochromocytoma
renal disease, or allergy to drugs and any specufic foods.
• Fasting for four hours.
• Do not dehydrate the patient.
12. BOWEL PREPARATION
• Low residue diet like dal-chapati/non-vegetation food and flenty of oral fluids.
• Bowel wash given till bowelis clear of faecal matter on the previous night.
• Laxatives is recommended to eliminate faecal matter from the colon and to
reduce ammount of gas in the bowel.
• Dulcolax (biscodyl) is given 2-4 tablets at bedtime for 2 days prior to the I.V.U
• If the dose not cause aduquate bowel cleanising then give castor oil.
• Caster oil is an oil is an effective catharis when administrated in the dose of 30-
60ml.
• Castor oil is contraindicated in case of abdominal pain of unknown cause,old and
debilitated patients.
• In older patients it is adviseable to use a suppository in the morning in addition
to oral laxatives.
13. For children:
• No paediatric patient should ever be purposely dehydrated as it ia
hazardousto do so.
• Colon should be empty for I.V.U. For this laxative to given
• Cleaning enemas are used in choldren older than 2years. A
preliminary is taken.
• If this shows unduegas are faces in this colonthe nurse can
administer a cleanising enema using saop suds.
• The child posted for urographymust not have a full stomach to
avoid vomitting. So the child should not be given anything by
mouth forb3-4 hours prior to the procedure.
14. PROCEDURE
• . Patient is placed in supine position with pelvis at cathode
sidevof the tube.
• A support is placed under patient’s knees to reduce lordotic
curvature of lumbosacral spine and provide comfort.
• A scout film is taken including the kidneys, bladder and
urethral regions on a large size film
15.
16. CONTRAST MEDIA
• Contrast media is injected intravenously into a prominent vein
in the arm.
• Test injection of 1ml of contrast is given and patient is
abserved for 1 min to look for any contrast reactions.
• Then the rest of the contrast is rapidly injected within 30-60
seconds.
17. • The appearance of pyelogram (contrast in calyces) is seen to
mintes after contrast injection.
• During is transit, it may be concentrated as much as 50 times
producing a dence pyelogram.
18. EQUIPMENT
• Equipment should be capable of short exposure to avoid motion blurring.
• Usually a moving grid is used.
• Source to image distance-40 inches or 1 metre.
• Contrast-non-ionic best.
• Dose 1-2 ml/kg.
• Filming : The concentrating ability of the kidney is not fully developed in
neonates, so delay is given for initial films. First film is taken 15 mints after.
Adequate colimation should be used so as to reduce total absorbed dose
and effect of scattered radiation on film quality. Fast film-screen
combinations and minimum number of films should be taken.
19. • Gonadal protective shields should be used.
• If bowl gas obscures the renal region, either
paddle compression technique should be used
or place the child in prone positionas it displaces
bowel away from the kidneys or use post
compression release technique.
20. FILMING TECHNIQUE
• Low kv (65-
75)high mA (600-
1000) and
shortvexposure
should be used to
get optimum
image contrast
21. STANDARD FILM TAKEN
• Plain X-ray KUB/scout film-14”×17”
• 1 minute film-10”×12”
• 5 minute film-10”×12”
22. INTRAVENOUS PYELOGRAM-FILM TAKEN
• 15 minute film----15”×12”
• 10 minute film----15”×12”
• 35 minute film----14”×17”
• Post void film-----10”×8”
23. Plain x-ray KUB/scout film diagnosis
• Calculus
• Intestinal
abnormalities
• Intestinal gas
pattern
• Calcification
• Abdominal mass
• Foreign body
24. 1 minute film
• 1 minute shows
nephrogram. This
radiograph is often
omittedas tge renal
outline are usually
adequately visualised on
5 minute film.
25. 5 minute film
• 5 minute shows nephrogram, renal pelvis
upper part of ureter. Compression band is
now applied on patient’s abdomen and the
balloon is positioned on anteroir superior iliac
spine where ureters cross pelvis brim.
• This is to produce better pelvicalyceal
distension.
26. COMPRESSION CONTRAINDICATED IN:
• Renal trauma
• Large abdominal mass
• Abdominal aneurysm
• After abdominal surgery
• If 5 minute film shows dilated calyces or if calyces and pelvis
are not adequately opecified,obstruction exists and
compression band should not be applied.
27. 15 MINUTE FILM
• Visualisation of ureter better in prone position
as they fill better.
• This position reverses the curve of the inferior
course of the ureters making it anti-
dependent to gravity. Another method to see
ureter is modified trendelenberg technique
with 15-20 degrees head low tilt with the
patient supine.
28. 30 MINUTE FILM
• It gives complete over view of the urinary
tract; kidney, ureter, bladder, bladder
distension can be evaluated
29. POST VOID FILM
• Taken imediately after voiding. It is used to
assess for:
• Residual urine;
• Bladder mucosal lession;
• Diverticula;
• Bladder tumour;
• Outlet obstraction;
• VUR.
31. SPECIAL FILM IN IVU
• Oblique view
• Erect view
• Prone film
• Delayed films in IVU
32.
33. OBLIQUE VIEW
• To project the ureter away from spine and to
separate overlying radio opaque shadow
mimicking calculi.
• Oblique views are also used for visualisation
of posterolateral aspects of bladder;
• Differentiation of extrinsic or intrinsic
renal,ureteral or bladder masses and for
doubtful urethral masses.
34. ERECT FILM
• Provoke of emptying in urinary tract;
• Demobtrate layering of calculi in cysts and
abscesses;
• Detect urinary tract gas not seen and other
films;
• Have optimum demonstration of renal
ptosis,bladder hernia,cystocele and areas of
obstraction ureter.
38. DELAYED FILMS
• In IVU TAKEN 1-24 hours after injection.
• Cases of obstraction where early nephrogram
is seen but collecting system is not seen.
• Long standing hydronephrosis in which renal
paranchyma is seen but collecting system is
not visualised until many houts later.
• Congenital lesions like non-visualised upper
calyceal system with ectopic or obstracted
ureter.
