INTRAVENOUS UROGRAM

INTRAVENOUS UROGRAPHY (IVU)

MR.SHANKAR .S.PAVHANEADMIT FIRST YEARTATA MEMORIAL HOSPITALC.C.NO.455578

CONTENT

INTRODUCTION

INDICATION AND

CONTRAINDICATION

OVERVIEW OF KIDNEY ANATOMY

CONTRAST MEDIA

THE PROCEDURE

STANDARD FILM TAKEN

Introduction

What is Intravenous Urography (IVU)

It commonly used investigation for evaluation of

urinary system.

 Radiographic study of the renal parenchyma,

pelvicalyceal system, ureters and the urinary bladder.

After intravenous injection of contrast media.

Indication

In suspected obstructive uropathies like stone etc.

Congenital anomalies involving kidney.

Investigation of hypertension.

Suspected abdominal mass lesion arising from

kidney.

In Blunt injuries of abdomen with Hematuria.

Function of kidney.

Bladder pathology –diverticulum fistula.

Contraindication

Iodine sensitivity or previous reaction to

contrast media.

Intractable cardial or renal failure.

Multiple myeloma.

Renal insufficiency.

Thyrotoxicosis.

The kidneys are a pair of fist-sized organs located at the

bottom of the rib cage.

The organs of Urinary system.

-Kidneys

-Ureters

-Bladder and Urethra.

Kidney Anatomy

Kidney Anatomy

Ask the patient history diabetics renal disease or allergy

to drugs

Fasting for 4 hours.

explain the exam to patient in layman language.

Check the patient creatine level. (RFT. Normal range: 0.6-1.2mg)

Bowel Preparation Low residue diet.

Bowel wash is given till bowel is clear of feacal

matter on previous night.

Laxative Dulcolax is given 2-4 tablet at bedtime for

two day prior to exam .

Patient Preparation

Patient is placed in supine position with pelvis at

cathode side of the tube.

A scout film is taken including KUB and ureter region

on large film.

Contrast media injected intravenously into a

prominent vein in the arm.

Test injection of 1 ml contrast look for reaction and

observed 1 min.

The Procedure

Exposures are generally in the 65-75 kV range, mA of 600-1000.(Higher kV ranges reduce contrast of the renal parenchyma)

Exposures technique

Correct positioning .

supine full AP abdomen

include lower border of

symphysis pubis and

diphrams.

A KUB to allow the

determination adequate

bowel preparation.

Plain KUBPlain x ray KUB/Scout film14’’x 17’’

Contrast media is usually given as a IV bolus injection within 30-60 sec.

IONIC -Low osmolar contrast material LOCM.

-Urografin

NON IONIC -High osmolar contrast material HOCM.

-Ultravist and Omnipaque.

Adult dose

1-2 ml for each 1 kg.

Pediatric dose

-1 ml for each 1 kg.

Contrast media

Mode of Injection

1 minute film show nephrogram. Radiograph is often omitted as the renal outline are usually adequately visualize on 5 minute.(after the 1 minute film compression band is applied)

COMPRESSION BAND

Standard Film Taken1 Minute film10’’x 12’’

1MIN FILM

5 minute film show nephrogram renal pelvis upper part of ureter. compression band applied on patient abdomen.

(note if calyces and pelvis are not visualize adequately obstruction exist and band should not applied)

5 Minute film. 14’’x14’’

5MIN FILM

If compression is applied 10 minute film center on kidney to demonstrate distended collecting system and proximal ureter.

supine position.

All film taken in expiratory phase.

10 Minute film. 14’’x 14’’

10MIN FILM

Visualize the ureter in prone position as they fill better. Supine full length AP Compression is released when satisfactory Demonstration of pelvicalyceal system has been achived.

15 Minute film. 14’’x 17’’

15MIN FILM

Its give complete overview of urinary track. Bladder distention can be evaluated.

Taken immediately after voiding. its use to assess for -Residual urine -Bladder mucosal lesions - Diverticula - Bladder tumor - Outlet obstruction.

Post Void film. 8’’x 10’’

35 Minute film. 14’’x 17’’ 35MIN FILM

Special Film Taken

Oblique film: better visualize the calyaceal system. filling defect that may overlap in routine AP ViewProne film: better imaging the ureter.Upright film: Layering of contrast media is in severely hydronephrotic system.Post void film: Filling defect in bladder post wall. Diverticula.

FOR ATTENTION