URINARY TRACT RADIOLOGICAL AND IMAGING INVESTIGATIONS  KUB Kidney ad Urinary bladder X ray(Radiograph)  IVP Intravenous pyelography or Intravenous urography or descending pyelography  Ascending pyelography or Retrograde pyelography PLAIN RADIOGRAPH KUB  Both kidneys shadow visible  From T12 --- L3  Longitudinal Axis is parallel to the Lateral margin of Psaus Muscle  Pelvis --------- Level L 2  Ureteric line: start from L2 run down word,medial to the tip of the transverse processes of lumber vertebrae URETERIC LINE • Ureteric line: start from L2 , run down word, medial to the tip of the transverse processes of lumber vertebrae It run further down word medial to the sacroiliac joint • • It enter into the pelvc cavity medial to the ischial spine medially It than enter into the Vesico Ureteric junction in the wall of Urinary Bladder SPECIAL PROCEDURES  IVP OR IVU  Special radiological Procedure for opacifying  The Pelvi collecting system, Ureter and Urinary bladder, after injecting radio opaque contrast agent (Drug) intravenously  CONTRAST are drug. They are water soluble ionic or non ionic in nature with least side effect  When they enter into the blood stream, concentrate with nephrons, excreted out from calasis, pelvis, ureter and collected within Urinary bladder with 25 -30 minute normally CONTRAST? • • • • • • • A substance that stops the passage of x-rays and is used to outline the interior of hollow organs, such as heart chambers, blood vessels, respiratory passages, and the biliary tract in x-ray or fluoroscopic pictures. Also called radiographic contrast medium They are colorless drug. Non ionic Water soluble Ionic water soluble BaSo4 white powder tasteless. Not use for IV contrast. They are Oral Contrast Gestrografin water soluble contrast. They are also not use As IV injection They are oral contrast for GIT examination        SIDE EFFECT OF CONTRAST After IV injection: Mild Arm pain during injection Palpitation Arm burning sensation Headache Nausea Vomiting      Dizziness Bronchospasm Lyrngospasm Anaphylactic shock Cardiac arrest         • INDICATION Congenital lesion Inflammation Renal Calculus Ureteric calculus Vesicle Calculus Retro Peritoneal mass To confirm Urinary tract calculus or uretric calculus Renal Mass. Bladder Mass, Enlarge Prostate POST MICTURATING CYSTOGRAM TO EVALUATE Residual amount of Urine • • • Ultrasound now Choice of investigation for Prostate lesion RETROGRADE PYELOGRAPGY ASCENDING PYELOGRAPHY Radio opaque contrast injected by the help of catather introduce into the Ureter through uretro vescical junction. Procedure perform in theater under GA with the help of cystoscope ULTRASOUND • Ultrasound is one of the radiological modality where sound wave which are not radiation but mechanical waves are used, which have frequesn HYDRONEPHROSIS RENAL CALCULUS STAG HORN CALCULUS RENAL ANGIOGRAPHY  Renal arteriography is a special x-ray of the blood vessels of the kidneys.  Renal arteriography is also called renal angiography. PROCEDURE • • • • A small nick is made in the anaesthetised skin at groin level, usually about 8mm long (1/3 inch). The femoral artery is punctured with a needle, and a fine wire is passed through the needle up the artery into the artery in the abdomen. A flexible narrow tube (cannula) is passed along the wire and up the artery from groin level to diaphragm level (just under your ribs). You don’t feel this at all. Once the tip of the cannula is in position, the wire is temporarily removed, and contrast (dye) is injected. We can get an outline of the arteries from your diaphragm down to your feet. RENAL ARTERIOGRAPHY CT PYELOGRAPHY The examination: CT exams are painless, fast and easy. The CT scanner is a box-like machine with a short tunnel in the center and a narrow examination table that slides into and out of this tunnel. The scanners and detectors form a ring that will rotate around you. The technologist will operate the scanner and monitor your examination from a separate windowed room, but you'll be in two-way communication with the technologist the entire time PROCEDURE • • • • • • • • The technologist begins by positioning you on the CT examination table so that you can be examined If used, the contrast material will be injected through an IV or given orally Next, the correct starting position will be set for the scans The table will move through the tunnel very slowly as the scanning takes place You will hear buzzing, clicking and whirring sounds as the CT scanner revolves around you The scan takes anywhere from five to 30 minutes CT urogram. CT of the abdomen with contrast reformatted in the coronal projection shows a filling defect in the left lateral wall of the urinary bladder (red arrow) representing a papillary urothelial tumor of the bladder. Radioisotope renography is a form of kidney imaging involving radioisotopes. Different radiolabelled pharmaceuticals are used, and the most commonly used agent is 99mTc-DTPA (Diethylene Triamine Pentacaetic Acid). • • • • • • DTPA is by far the most frequently used agent. The other agents are 99mTc-labelled MAG3, EC (Ethyl Cysteine), 131-Iodine labeled OIH (Ortho Iodo Hippurate) EC use when serum cretenine is high 15 mCi of 99mTc DTPA were injected and flow phase, perfusion and excretion phases were obtained and examined. There was delayed radiotracer excretion in keeping with reduced glomerular filtration rate. The delayed images demonstrated enlarged, distorted renal collecting systems bilaterally (tracer accumulation within peri pelvic cysts) Selected axial CT image through the abdomen was also available for anatomic correlation and demonstrated severe enlargement of both kidneys due to multiple cysts THANK YOU XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX