I would wish to discourse approximately endovenous Urography in this paper. Intravenous Urography or merely known as IVU is a process to analyze the urinary system by utilizing contrast media. It had been start utilizing in twelvemonth 1930 to analyze the upsets of urinary system. It is performed to diagnosed nephritic map and investigates the anatomy of the kidneys, ureters and urinary vesica. The indicants for executing a IVU scrutiny are suspected urinary piece of land pathology, repeated harm, haematuria, injury and probe of hypotension in immature grownup. Urography may besides utilize to execute the pre- or post-therapeutic evalution of rock disease. The urography imaging sequence is design to supply diagnostic. The contrast media is brought to the kidneys through blood circulation, filtered in the glomeruli and concentrated in the nephritic tubules. Then the contrast media will delivered to the pelvic girdle, ureter and vesica where radio-opaque show on X-ray movies. Normally this scrutiny will be performed by the physician to avoid unfortunate incidences. The intent of IVU is the primary probe for urinary disease such as urinary rock, urinary rednesss, urinary injury and obstructor, assorted and contraindications.
Some necessary safeguards are taken to avoid the allergic reactions. This safeguards include ask whether patient is allergic to any medical specialty or nutrient, is patient ( adult females ) pregnant or have any opportunity to pregnancy within a hebdomad and any diseases that may do patient to hold anaphylactic daze during scrutiny.
Equipments that are needed during Intravenous Urography are exigency cart to the full equipped and handily placed, instrument for injection is arranged on a little, movable tabular array or on a tray, often used unfertile points must be readily available, disposable acerate leafs and panpipes are widely used in this process, nonsterile points such as compression bandage, little waste bin, vomit basin, disposable rub, contrast media that is required, and dressing for puncture site must be required. Besides that, a pillow or folded tower that can be place under patient ‘s cubitus during the injection of contrast media to diminish force per unit area. The equipment for endovenous disposal equipment are 50ml syringe, make fulling needle, skin homework, gluey tape, choice of acerate leafs, straight/’Butterfly ‘ 16,19,21,23 gage and compression bandage or blood force per unit area turnup. Emergency drugs and equipment such as steroid injection, adrenaline injection, antihistamine injection, endovenous dextrose trickle and O for inspiration must be checked every twenty-four hours and easy to get during IVU scrutiny.
Basically, we are utilizing 3 types of contrast media during IVU scrutiny. They are Niopam 300, Omnipaque 350 and Urograffin 370. Doses of contrast media that injected into a 70 kilogram, normal blood urea grownup are 50 milliliters through endovenous. Before injected the contrast media to patient, the contrast media must be warmed to personify temperature. To shoot the contrast media into the vena, a 19 gage acerate leaf must be punctured into the average cubital vena. Then the contrast media that been warmed to about 36-37 grade Celsius will be injected. This process is ever performed by the Radiologists or physician. Then movies are taken at intervals will show whole nephritic system.
At the twenty-four hours of scrutiny, patient is necessitating to alter to hospital gown. Make certain patient had emptying the vesica to forestall dilution of contrast media with urine. Patient is placed on the tabular array with supine place in the X-ray room, the MSP of the patient perpendicular to the midplane of the grid. Support patient ‘s articulatio genus by utilizing a pillow to cut down dipped curvature of lumbar spinal column. This can supply a more comfy place to patient. Compression devices must be prepared before the scrutiny, so that it will be ready to application in a specific clip. Obtain a preliminary radiogram of the venters. Then fix for the first post-injection before the contrast medium is injected. A cassette with movie is placed in the bucky tabular array, place the cassette and set on markers on the cassette. Changes are made on focus and exposure factors based on the prelim movie. Contrast media for injection intent is prepared utilizing sterile technique. Administration of contrast media into patient ‘s organic structure is normally done by the physician harmonizing to the patient ‘s organic structure size, ages and weight. Several radiogram will be taken at specified intervals get downing from the clip the contrast media is wholly emits into patient ‘s organic structure. In approximately 2 to 8 proceedingss the contrast media will get down to look in the pelvicaliceal system. Patient demand to empty their vesica as the scrutiny is over and a radiogram will be taken to guarantee that contrast media is wholly removed from the organic structure.
The typical exposure values for IVU are 65-75kVp, 50-70mAs, 100cm of Film Focusing Distance ( FFD ) , used grid to diminish spread radiation and utilize regular film/screen.
5 X-ray movies will be taken during this scrutiny. The first X ray besides known as preliminary movie is a normal abdomen X ray. The movie should include most of the venters and pelvic girdle ( kidneys, ureters and vesica ) . If the movie is demoing unsatisfactory component such as gases and a tonss of fecal matters inside the patient venters, we might hold to prorogue the scrutiny. This is cause by the patient that did non follow the direction right. This is usually go on on the out-of-door patient. This scrutiny will be go on when patient have achieved proper readying. The 2nd movie ( immediate movie ) is after the patient is injected with the contrast media. The intent of this movie is to show AP nephritic disease by demoing nephrogram, examples the nephritic parenchyma. The 3rd movie or merely known as 5 proceedingss movie is taken to find whether farther dosage of contrast media is required or non. We might use compaction to dilate pelvicalyceal system so that it can clearly show make fulling defects in the 3rd movie ( 15 proceedingss movie ) . The Forth movie ( 25 proceedingss movie ) is taken to show the distended vesica. This can be done by concentrating 15 degree caudal angulations and the upper boundary line of the symphysis pubic bone is centered. The last movie ( station urination movie ) will show the emptying success of vesica and the antecedently distend lower terminals of ureters had been returned to normal. There are besides some extra projections required such as inspiratory, expiratory and oblique projection so that relationship of opacities and make fulling defects to the nephritic piece of land is demonstrated. Purpose of imaging is to show lineations nephritic and overcome darkening from the gastro enteric piece of land.
An immediate station injection radiogram should show the kidneys addition in denseness because of the contrast within the uriniferous tubules. Different denseness nephrograms may bespeak nephritic nephritic arteria stricture, if this is suspected a series of movies at 1, 2, and 3 proceedingss after injection can convey more accurate visual image. The kidney lineations should be smooth and does non concentrating contrast media. If it is concentrating the medium, it is likely cause by tumours.
The calyces, nephritic pelvic girdle and portion of ureter should be seeable in the 5 or 10 proceedingss movie. Both kidneys should hold the same denseness as the nephrogram is reduced. If we see 1 of the kidney denseness is lower, it might be cause by ureteric diseases such as urinary obstructor. To find site of obstructor, a delayed movie is required after 45 to 60 proceedingss after injection. 15 proceedingss movie shall demo the cause of urinary obstructor. Urinary obstructor might be caused by stne, coagulum or tumor near the ureteric opening. If the ureters are dilated, the cause is likely in the vesica or urethra. The intent of taking vesica movie is to name the unnatural size of vesica that might be cause urinary diseases. Examples of the diseases are prostate expansion, urethral obstructor, neurogenic vesica, TB, Schisotosomiasis, rocks, calcification, tumor and gas in the vesica.
It is the duty of a Radiographer to use to patient and radiographer to diminish the radiation doses that receive. Guidelines refering radiation protection are using gonad shield to patient if it does non overlap the part of involvement. Collimation need to be applied so that lone part of involvement merely will have radiation. Do non reiterate the scrutiny so that patient will non have external radiation. Male patient shall be shield for all scrutinies. Some patient might shown some symptoms such as sickness, minor urticarial roseolas, on occasion terrible laryngeal hydrops, anaphylactic daze and cardiac apprehension. As the marks of these symptoms appear on patient, injection of contrast media must be stopped instantly. Emergency drugs such as antihistamines and steroids are given to patient.
Decision is IVU is a safe scrutiny with all the set up in the X-ray room and it gives detail information to physician for diagnose intent.