PROFESSIONAL SKILLS 1 3RD YEAR SEMESTER 6 RADIOGRAPHY. THE URINARY SYSTEM Uz. Fatema shmus aldeen Tel

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1 PROFESSIONAL SKILLS 1 3RD YEAR SEMESTER 6 RADIOGRAPHY THE URINARY SYSTEM Uz. Fatema shmus aldeen Tel

2 Professional skills-2 THE URINARY SYSTEM

3 The urinary system (review anatomy and physiology) The urinary system consist of :- 1\ two kidneys. 2\ two ureters. 3\ urinary bladder. 4\ urethra.

4 The kidneys perform the essential function of removing waste products from the blood and regulating the water fluid levels. The diagram below shows the basic structure of the kidney.

5 ureter is a small tube, about 25 cm long carries urine from the renal pelvis to the urinary bladder where it is stored and from which is periodically voided being discharged through the urethra,which is the final passageway for the flow of urine. The anatomy of the kidney, ureter, bladder is best displayed by using diagnostic U\S and IVU.

6 Urinary Disorders Common indications Trauma Spontaneous renal hemorrhage Obstructing ureteral Hematuria congenital abnormalities such as absent kidney. Cyst & abcess loss of renal function (uremia) Neoplasm (kidney, ureter, bladder, urethra 1-Plain KUB This will reveal opaque renal calculi. It may also be used to check, abdominal preparation and to determine position. 2- I.V.U Most sensitive examination to determine physiological function 3. Computed tomography- Most sensitive single examination for calculi and renal neoplasms. 4. Ultrasound Relatively efficient for detecting renal masses or ureteral obstruction Useful when there is a need to avoid ionizingradiation, such as in examining pregnant women and children 6

7 Ultrasound is less sensitive than CT for the detection of renal masses. but it is Ultrasound-Imaging procedure of choice for renal failure

9 1-Procedure of I.V.U Pt preparation :- -Allergy Check Fasting for 6-8 hours before the procedure. WHY?? This ensures that your intestines are empty of faces. -laxatives taken to clear the intestines.

10 sequences of the I.V.U Procedure 1- plain film (KUB): A.P. supine To adjusted the patient preparation, the position,t he exposure factors and if there any radio opaque stone.

11 2-5 min film (nephrogram ) : A.P. of the renal areas shows outline of the kidneys. 5min. Nephrogram

12 3-15 min film :Compression applied to distend the pelvicalyceal systems to demonstrate any filling defects 15min.

13 4-25 min (release ): *Structure best shown :All urinary system Kidneys, ureters and urinary bladder. 25min(release )

14 5- full bladder.

15 6- after maturation.

16 2- Ascending urethrogram ( retrograde urethrography) Is a radiological contrast examination of the male urethra. Indication :- 1- urethral stricture. 2- trauma. 3- perforation. 4- false passage. Contra indication :- acute urethritis. Contrast media :- media. diluted water soluble contrast

17 Full length of male urethra

18 3-Cystogram radiological contrast examination of urinary bladder. Indication :- 1- trauma. 2-fistula. 3- diverticulum. Contra indication :- acute urethritis. Procedure :- fill the bladder by 3 ways : 1- by using catheter through urethra. 2- direct suprapupic puncture. 3- after IVU ( full bladder). Projections : AP, Lat and Oblique of the bladder.

19 Cystogram

20 4-Micturation cystourethrogram Is radiological contrast examination of bladder and urethra during micturation. Indication :- 1- vasico ureteric reflux. 2- PUV( posterior urethral valve ). 3-urethral stricture. 4-control of micturition. Contra indication :- acute urethritis.

22 Full length voiding film showing reflux into the right kidney

23 Urethral stricture :

24 5-Selective renal angiography Is radiological contrast examination of the renal artery. Indication :- renal artery obstruction due to: 1\ mass. 2\ thrombus 3\ lymph nodes.

25 RT renal artery Abdominal aorta

26 6-CT Urography is a specialized radiological examination designed to evaluate the urinary tract (kidneys, ureters and bladder) using computed tomography (CT). evaluate urinary tract with the added advantage of visualizing all of the other intaabdominal and pelvic structures as well, These examinations are best performed using Spiral CT scanners.

27 What are the indications for this study? detect kidney stones. evaluate patients with blood in their urine (hematuria). contrast injection ever necessary to evaluate kidneys stones. CT without contrast media is increasingly used to detect smaller stones with less calcium not visualised otherwise.

28 CTu 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

29 7-MRU Magnetic resonance (MR) urography comprises an evolving group of techniques with the potential for allowing optimal noninvasive evaluation of many abnormalities of the urinary tract.

30 The most common MR urographic techniques can be divided into two categories: A-static-fluid MR urography B-excretory MR urography. Static MRU is also used for the visualization of urinary tract disorders in women during pregnancy. Excretory MR urography is performed during the excretory phase of enhancement after the intravenous administration of thus, the patient must have sufficient renal function

32 8- ultrasonography is an excellent imaging modality as it is noninvasive, reliable and affordable. Usage: investigate the kidney, bladder, and prostate gland. It can also be combined with voiding providing an indication of the residual volume. This gives an indirect measure of bladder function.

33 Ultrasound can detect stones above about 3-4 mm in the kidneys or pelvis, but is, for practical purposes, insensitive regarding to stones more downstream. On the other hand, ultrasound can, in most cases, rule out any significant obstruction resulting in distension of the collecting system.

34 Suspected left ureteric calculus on ultrasound.

35 9-NUCLEAR MEDICINE This involves low amounts of radiation and provides information regarding renal perfusion, function and the contribution each kidney is making to total function.

37 CT MRI Examples of different upnormal cases By different modalities US Nuclear Medicien

38 Ectopic kidney Doublex kidney

39 Absent kidney Lead to other kidney enlarge in size called compensatory hypertrophy

40 Horse shoe kidney

41 Uretral and bladder diverticulum

42 Multiple bladder diverticula

43 Bladder transitional cell carcinoma. Bladder image shows a filling defect

44 Ca bladder

45 Urographic image demonstrates the typical "cobra head" configuration of an orthotopic ureterocele in the bladder (arrow).

46 Hydro nephrosis

47 Renal calculi

48 Preliminary( plain ) radiograph shows an 8-mm calculus in the ureter (arrow). (same previous patient

49 Calculus. This case demonstrates how a calculus can be obscured by contrast material.

50 Renal cyst

51 Simple cyst. Nephrotomogram shows build-up of normal parenchymal tissue (cortical "beaking") at the margins of an unenhanced mass in the lower pole of the left kidney (arrows). The lesion was confirmed to be a simple cyst at US.

52 CTU image shows ileal conduit (IC) after cystectomy for bladder cancer.

53 20-year-old man with ureteropelvic junction narrowing (arrow). Coronal maximum intensity projection (MIP) excretory MR urography. The renal pelvis shows typical dilatation and convex inferior border.

54 Figure 5. A 55-year-old man with left-sided ureteral stone. Coronal maximum intensity projection (MIP) excretory MR urograph shows filling defect (arrow) in left distal ureter that is causing mild pyeloureterectasis..

55 56-year-old woman with ileal loop urinary diversion. Maximum intensity projection (MIP) image from excretory MR urography shows the postoperative urinary tract anatomy. Both sides are dilated because of stenosis (arrowheads) close to the ureteroenteric implantation site.

56 . Ultrasound images reveal an echogenic focus in the dilated left upper ureter. Mild dilatation of the upper ureter also noted.

57 Bladder cyst

58 Renal function test by nuclear medicine image

R adio logical investigations of urinary system

R adio logical investigations of urinary system There are 4 main radiological Ix: 1 IVU: Intravenous urography. 2- U/S 3-CT scan 4-Radioisotope scan. Others (not frequently used): MRI, arteriography, antegrade