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Radiographic anatomy
Positioning of:
AP cone down bladder
Oblique cone down bladder
Lateral cone down bladder
Voiding cystourethrogram (VCUG)
female
male
Injection urethrogram
Retrograde pyelogram
Film Critique
Exposure Factors
Radiographic
Pathology
What in the World?
Miscellaneous, but significant,
odds and ends
Cystography
Cystograms are obtained in two basic ways.
1. As part of an excretory IVU. The three cone down views
may be incorporated in an IVU routine, or may be done on
request.
* When a patient having an IVU has a foley catheter in place,
drain the bladder before the injection, then clamp it.
* When working with a catheterized patient, do not raise the
bag above the level of the bladder.
2. As a retrograde cystogram. Contrast is instilled via a urinary
catheter. Unless there is reflux into the ureters, no other
urinary structures are seen.
Retrograde cystography
AP position
1. Supine
2. 100-150 caudad angle
3. CR 2 superior to pubic
symphysis, midline
Oblique positions
1. RPO & LPO: 450-600
2. CR perpendicular
3. CR 2 superior to pubic
symphysis, and 2 medial
to the ASIS of the side up
Suprapubic
catheter
Used when
a urethral
catheter
cannot be
inserted.
2. In this RPO position the rami on the
right are superimposed, while the
obturator on the left is seen in profile.
3. Also an RPO:
the left SI joint is
demonstrated, and
the left ala is
foreshortened
ASIS
Distance to bladder
is much greater than
2 in a shallow oblique
Lateral position
1. True lateral position
2. CR perpendicular
3. CR 2 superior and 2
posterior to pubic
symphysis.
AP position
1. Supine
2. CR perpendicular
3. CR to pubic symphysis
RPO
All of the bladder is included.
The entire urethra is seen
during micturition (micturate)
1. 300 RPO
2. CR perpendicular
3. CR to pubic symphysis
4. Superimpose urethra on
thigh to act as filter
Extravasation of
contrast from
ruptured bladder.
Extravasate = escape out of, vs.
Infiltrate = passing, or forced into.
ureteral
catheter
Scout
0900
cystoscope
#1
0907
3 to 5 cc of contrast is
injected by the urologist.
A scout film is taken to
A film demonstrating the
check the technique,
position, and placement renal pelvis and calyces
of the ureteral catheters. is taken
#2
0912
These three films are a typical routine, though more may be taken at the urologists
discretion. All films must be marked by the technologist: order and time.
Exposure Factors
75 kVp for optimal visualization of iodine contrast
All other technique computations are the same as
for the abdomen
1. 40-60% increase for oblique positions
2. 2x kVp (15% rule) and 2x mAs for lateral.
3. 25% increase of mAs when using 10x12 for cone down views
Significant Pathologies
of the kidneys and bladder
and their
Radiographic Appearances
Calcified prostate
Bladder stones
Cystocele
Renal calculi
Hydronephrosis
Bladder Stones
Prior to the 20th century, bladder stones were a common malady that
were so painful, due to obstructions, people subjected themselves to
a procedure called cutting for stones, that was performed without
anesthesia, antibiotics, or aseptic techniques.
Cystocele
A hernia of the bladder, into
the vagina, caused by a
weakening of the vesicovaginal
fascia during delivery.
Causes urinary frequency,
urgency, and dysuria.
The cystocele on this upright
postvoid is completely below the
superior rim of the pelvic bones,
and would have been missed
with routine centering.
Renal calculi
Kidney stones are formed in the parenchyma, calyces, pelvis of the
kidneys. They may remain in place and be asymptomatic, or they come
loose and travel down the ureter.
Though often small, renal calculi
are sharp and jagged. They cut
the inside of the ureters which
are rich in sensory nerves,
causing intense pain. Hematuria
may be a sign of passing stones.
Lithotripsy is an alternative to
surgery that pulverizes stones
by using shock waves.
An obstructed ureter caused by a kidney
stone shows dilation of the ureter above
the obstruction, tapering to the lodged
calculus.
Renal calculi
Calculi in
parenchyma
Hydronephrosis
When a ureter is obstucted from
calculi or other causes, urine (or
contrast) causes the renal pelvis
and calyces to dilate as long as the
kidney is functioning.
A build up of fluid in the collecting
system is hydronephrosis.