IVP.pptx

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1. IVP-PROCEDURE AND INTERPRETATION MODERATOR - DR.BHAGYALAKSHMI M.D.R.D. PRESENTER-DR.JAYA ADITYA

2. Radiographic examination of urinary tract including renal parenchyma, calyces and pelvis after intravenous injection of contrast media.

3. INDICATIONS IN ADULTS Screening of entire urinary tract Diseases of renal collecting system Abnormalities of the ureter Obstructive uropathy Calculus disease Suspected renal injury Prior to surgery of urinary tract Renal colic IN CHILDREN VATER anomalies Polycystic disease, PUJ obstruction Urinary tract infection Malformation of genitalia Ectopically inserted ureter in girls Anorectal anomalies history of Recurrent urinary tract infection

4. CONTRAINDICATIONS Iodine sensitivity . Pregnancy Severe history of anaphylaxis previously

5. RISK FACTORS Cardiac failure Dehydration Diabetes with Azotemia Previous allergic reaction History of Pheochromocytoma

6. CONTRAST MEDIA-DOSES

7. Mode of injection IV . bolus injection Within 30-60 sec. Density of the nephrogram is directly proportional to the plasma concentration of contrast media. Large doses of contrast media increase diuresis distends the collecting system increasing the diagnostic information from the urogram

8. PREPARATION- For Adults Fasting for 4 hours Do not dehydrate Bowel preparation : Low residue diet Bowel wash is given till bowel is clear of faecal matter Laxative is recommended

9. For Children- Dehydration is strictly prohibited in children. Colon should be empty- Suppositories are better than laxatives must not have a full stomach-to avoid vomiting

10. PROCEDURE Patient is placed in supine position-pelvis at cathode side Reduce lordotic curvature of lumbosacral spine A scout film is taken Test injection of 1ml of contrast is given and patient is observed for 1 min to look for any contrast reactions. Rest of the contrast is rapidly injected within 30-60 seconds . All films are taken in full expiratory phase only.

11. Cortical nephrogram is seen within 20 seconds. The nephrogram is made up of 2 phases- Cortical phase- Vascular filling tubular phase- Contrast within the lumen of renal tubule The appearance of pyelogram is seen 2 minutes.

12. In children- In neonates- concentrating ability of the kidney is not fully developed First film is taken 15 min after Minimum number of films should be taken. Gonadal protective shields should be used . Bowel gas paddle compression technique should be used or prone position.

13. FILMING TECHNIQUE Low KV (65-75) high mA ( 600-1000). Plain X-ray KUB /Scout film- Calculus Intestinal abnormalities Intestinal gas pattern Calcification Abdominal mass Foreign body

14. After the scout film, 1minute, 5, 10, 15, 35 and post void films are taken. 1 minute film shows nephrogram . 5 minute film shows nephrogram , renal pelvis, upper part of ureter . Compression band is now applied balloon is positioned on anterior superior iliac spine where ureters cross pelvic brim. Better pelvicalyceal distension

15. After compresson is applied, 10 minute film is taken. demonstrate distended collecting system and proximal ureters . 15 minute film- prone position,for better visualisation of ureter. 35 minute film : kidney, ureter, bladder . Post void film : 1. Residual urine ; 2 . Bladder mucosa! lesions ; 3 . Diverticula ; 4. Bladder tumour; 5 . Outlet obstruction ; 6 . VUR.

16. Delayed films- taken 1-24 hours after injection Taken at 1 hr, 3hrs, 6 hrs, 12 hrs and 24 hrs . Used in- Obstruction- Early nephrogram is seen but collecting system is not seen . 2)Long standing hydronephrosis - renal parenchyma is seen but collecting system. 3) Congenital lesions- Non-visualised upper calyceal system with ectopic

17. Filming in Children Films are taken at 2min. (supine) and 7 min. (prone) after contrast administration. Carbonated beverage- Improve visualisation of left kidney. 15-20 degree caudal tilt- Right kidney can be well seen through the liver In neonates- Excretion of contrast media is delayed

18. COMPLICATIONS Due to Contrast IMMEDIATE- Minor reactions Intermediate reactions Severe reactions Due to Technique Upper arm or shoulder pain. Extravasation of contrast at the injection site.

19. Initial treatment Elevation of affected extremity Ice packs Close observation for 2-4 hours Local injection of hyaluronidase

20. AFTER CARE Observation for 6 hours . Watch for late contrast reactions. Prevention of dehydration. In high risk patients-renal function tests should be done to watch for deterioration

21. THANK YOU