Introduction

Hysterosalpingography (HSG) is the radiographic evaluation of the uterus and fallopian tubes and is used predominantly in the evaluation of infertility.

The primary role of HSG is in the evaluation of the fallopian tubes.

Ultrasonography (US) is currently used for evaluation of the endometrium (ie, abnormal uterine bleeding, polyps) and pregnancy, whereas magnetic resonance (MR) imaging is used more in the evaluation of the uterine myometrium (ie, uterine contour, myomas) and the ovaries. Continue reading »

Micturating cystourethrogram (MCUG), is a technique for watching a person’s urethra and urinary bladder while the person urinates . The technique consists of catheterizing the person in order to fill the bladder with a radiopaque liquid. Under fluoroscopy (real time x-rays) the radiologist watches the contrast enter the bladder and looks at the anatomy of the patient. If the contrast moves into the ureters and back into the kidneys, the radiologist makes the diagnosis of vesicoureteral reflux, and gives the degree of severity a score. The exam ends when the person voids on the table while the radiologist is watching under fluoroscopy. Consumption of fluid promotes exertion of contrast media after the procedure. It is important to watch the contrast during voiding, because this is when the bladder has the most pressure, and it is most likely this is when reflux will occur.

Indications :

1) vesicoureteric reflux.

2) study of urethra during micturition. ( fistula or stricture )

3) abnormalities of the bladder.

4) stress incontinence.

Contraindications : acute urinary tract infection.

Contrast medium : HOCM or LOCM 150.

(Low strength (approx 25% weight/volume) contrast agent i.e. Hypaque 25% urografin 150.)

Preparation of contrast :

The estimated volume of contrast medium to be given during the examination is deter­mined mainly by the age of the child except for children less than one year of age in whom it is determined by weight:

1. Children –>

Less than one year,
Weight (kg) × 7 = capacity (ml)

Less than two years,
(2 × age in years + 2) × 30 = capacity (ml)

More than two years,
(Age in years/2 + 6) × 30 = capacity (ml)

2. Adult à 150ml contrast + 300 NS = 450 ml.

Contrast medium is given by hand injection slowly to prevent transmucosal absorption and consequent contrast reactions. It should be noted that contrast maybe also given via the gravity drip method.

Eqiupment :

1. Fluoroscopy unit with spot film device and tilting table.

2. Video recorder.

3. Catheterisation pack – and aseptic procedure pack.

4. Sterile towels.

5. Skin prep./ wash.

6. Sterile lubricant.

7. Foley catheters 5 -7 gauge French in infants larger in adults.

8. Selection of Drip stand.

Patient prep : The patient micturates prior to the examination.

Prelim film : Coned view of the bladder using the undercouch tube.

Technique :

1. The indication is almost exclusively confined to children.

2. The patient lies supine on the x-ray table.

3. Catheterise patient if patient still not catheterized.

4. The contrast media warmed to body temperature is slowly infused through the catheter using a “giving set” into the bladder.

5. Intermittent pulsed fluoroscopy is used to check the filling and for reflux up the ureters.

6. Older children and adults are given a urine receiver but smaller children should be allowed to micturate onto absorbent pads.

7. Adults will find it easier to micturate while standing erect.

An alternative to spot films is to video tape the fluoroscopy.

1) Spot films are taken of the bladder, kidneys and ureters to record the normal or abnormal anatomy.

2) When the bladder is considered full or the contrast leaks round the catheter the balloon is deflated and the catheter withdrawn. Depending on the age,the patient is asked to micturate into a receiver either erect or supine.

3) Spot films are taken during micturition and any reflux recorded.
a)      The patient is rotated into the 30 degree left and right anterior obliques to demonstrate the bladder ureteric junctions.

b)      To demonstrate the male urethra the left anterior oblique position is adopted with flexion of the right hip and knee to visualise the whole of the male urethra.

4) A final full length abdominal film is taken to visualise the kidneys.

Variations

For stress incontinence the film series is taken to include , at rest, straining and micturating in the lateral position, some centres have special sitting fluoro arrangements.

For fistulae and bladder tract abnormalities a series of films in AP. lateral and oblique positions may be required.

Complications :

A) Due to catheterization :

1.Temporary dysuria, frequency of micturition and acute urinary retention which occur within 24H. These effects can be minimized by encouraging the child to take more fluids and to micturate in a warm bath.

2.Transient hematuria.

3. Bladder perforation is rare.

B) Acute urinary tract infection–> can be covered by antibiotics.

C) Adverse reaction of contrast.

Evaluation of the Image
1)ID and anatomical markers must be present and correct in the appropriate area of the  film.

2)Optimal exposure should penetrate all the bone structures and contrast should be low enough to visualise fully the bone and soft tissue structures.

3) Images should be marked with contrast volume and indications of voiding or straining.

Additional modalities:

Ultrasound is a useful adjunct.

Reference :

1. A Guide to Radiological Procedures, Stephen Chapman, Richard Nakielny.
2. http://www.e-radiography.net/technique/technique1.htm
3. 

For those who want to join radiology-related courses in UMMC through out the year 2010, you can go to  cbie ummc website or read the planner below.

For more information regarding the courses, you can contact Mr Abd. Qayyum and Mr Hairunnizam. ( the contact number available in the planner )

Indications :

1. Strictures.

2. Urethral tears.

3. Congenital abnormalities.

4. Periurethral or prostatic abscess.

5. Fistulae or false passages.

6. Foreign body urethra.

7. Neoplastic lesions of urethra.

8. Stone urethra.

9. Pelvic fracture and suspected urethral injury.

Continue reading »

About the book

In spite of the advent of digital imaging modalities, the importance of interpreting conventional radiographs has not diminished. As with the first edition, this book presents radiographic anatomy as it appears in all commonly performed radiographic examinations. The visible anatomic structures are keyed to schematic drawings on the opposing page, thus aiding identification and interpretation. For the the new edition, many studies have been replaced with better quality radiographs and drawings.

Annotation

Incl. standard radiographs for 170 radiographic examinations & their different projections.

Booknews

With no textual accompaniment, this pocket atlas is a strictly visual depiction of normal radiographic anatomy for 170 examinations. Each radiographic image, organized by anatomical structures, such as the skeletal system, chest and lung, and circulatory system, is accompanied by a labeled line drawing of the anatomy allowing for easy identification. Annotation c. Book News, Inc., Portland, OR (booknews.com)

This book is good for reading x-rays and for x-ray reporting…..You can download the e-book here :

http://www.mediafire.com/?5k0ydydz5o1

Enjoy!