Indications, Contraindications, and Patient Preparation

Indications

• Abdominal or pelvic masses.
• Urolithiasis (renal or ureteral stones).
• Kidney trauma.
• Hematuria (blood in urine).
• Hypertension related to renal function.
• Renal failure (evaluate cause).
• Recurrent urinary tract infections.

Contraindications

• Hypersensitivity to iodinated contrast.
• Anuria (no urine production).
• Severe renal disease or failure (high BUN/creatinine).
• Diabetes, especially on metformin (Glucophage) → risk of lactic acidosis; discontinue 48 hrs post-exam.
• Multiple myeloma.
• Pheochromocytoma (rare adrenal tumor).
• Relative: pregnancy (use ultrasound instead if possible).

Patient Preparation

• Bowel cleansing: low-residue diet 1–2 days prior, laxative afternoon before exam.
• NPO: nothing after midnight before exam.
• Laxative contraindications: do not give if patient has gross bleeding, severe diarrhea, obstruction, or acute appendicitis.
• Voiding: patient empties bladder prior to procedure.

Contrast Media & Safety

• Iodinated contrast: ionic (higher reaction risk) or non-ionic (preferred for safety).
• Screening questions: allergies, asthma, prior reactions, iodine/seafood sensitivity, diabetes, meds (esp. metformin).
• Common side effects: metallic taste, flushing → not dangerous, warn patients ahead of time.
• Potential severe reactions: hives, hypotension, respiratory distress → call physician, initiate code if needed.
• Renal function: check BUN & creatinine before injection.
• Catheterized patients: clamp foley prior to injection so bladder fills.

✅ Patient Screening Checklist for IVU

🔑 Key Points for Technologists:

• Document all answers before contrast injection.
• Notify radiologist of any yes answers that suggest risk.
• Never proceed without physician clearance if contraindications are present.

⚠️ Contrast Reaction Safety Quick Reference

🔑 Key Points for Technologists:

• Always stay with the patient during injection and first minutes after.
• Never leave a symptomatic patient alone — call for help.
• Know where the emergency cart and code button are located.
• Document reaction details: onset, symptoms, treatment given, patient outcome.

Projections

Absolutely—here’s the Intravenous Urography (IVU) projections section rewritten to match your standard outline precisely. I’ve kept your content, added the missing fields, and folded in the helpful details from your notes.

Intravenous Urography (IVU) — Projections

KUB (Pre-contrast Scout & Timed Post-contrast)

CR Location & Positioning

• SID: 40 inches
• Patient Position: Supine, MSP centered to table
• Adjustments: Arms out of field; support under knees for comfort; center IR at iliac crests (L4–L5)
• CR: Perpendicular to IR, centered at iliac crests
• Pt. Instructions: Suspend respiration on end-expiration; hold still
• Exposure: Collimate to 14×17 in (35×43 cm) lengthwise; routine abdomen (urography) technique

Evaluation Criteria

• Coverage: Entire urinary system is included—diaphragms through symphysis pubis (or add a dedicated bladder image if not included).
• Rotation check: AP lumbar spine appearance (spinous processes midline), iliac wings symmetrical, sacrum aligned with pubic symphysis.
• Technique: Psoas margins, lower liver border, and renal outlines visible; contrast levels appropriate to show subsequent opacification.
• Motion: Sharp cortical outlines; bowel gas margins crisp.
• Labeling: Visible time marker (for timed films), side and position markers.

Nephrotomograms (3–4 levels, immediately post-injection)

CR Location & Positioning

• SID: 40 inches
• Patient Position: Supine
• Adjustments: Center midway between xiphoid and iliac crests (kidney level); set tomo fulcrum per protocol
• CR: Center to kidney level; tomography per dept. protocol (nephrogram phase)
• Pt. Instructions: Suspend respiration; hold still
• Exposure: Collimate to upper abdomen (kidney field); tomo parameters per protocol

Evaluation Criteria

• Coverage: Both kidneys entirely within tomo sweep; calyces and pelvis included.
• Leveling: At least 3 focal levels show cortex–medulla detail and calyceal definition (nephrogram → nephrotomographic phase).
• Rotation/Motion: Kidney margins sharp with no layer-motion blur; vertebral bodies remain crisp.
• Technique: Adequate penetration for parenchymal detail without washing out collecting system.

5–15 Minute KUBs (Supine and Prone)

CR Location & Positioning

• SID: 40 inches
• Patient Position: Supine (routine) and prone (to improve ureter filling)
• Adjustments: Center IR at iliac crests; arms out of field
• CR: Perpendicular at iliac crests
• Pt. Instructions: Suspend respiration; hold still
• Exposure: Collimate to 14×17 in; add visible time marker on each film

Evaluation Criteria

• Coverage: Diaphragms through symphysis pubis (or add bladder film if needed).
• Physiology: Progressive filling—minor/major calyces → renal pelvis → ureters → bladder across the time series.
• Prone benefit: Ureters outlined more completely; mid-ureter less obscured by spine.
• Rotation/Motion: AP lumbar spine true; iliac wings symmetrical; sharp renal edges.
• Technique/Labels: Contrast density sufficient to track collecting system; time marker present on each film.

Posterior Obliques (RPO & LPO) — typically 10–15 min

CR Location & Positioning

• SID: 40 inches
• Patient Position: Supine, oblique
• Adjustments: Rotate body 30°; flex knee of elevated side; spine centered to grid; arms clear of anatomy
• CR: Perpendicular at iliac crests, entering ~2 in (5 cm) lateral to MSP on elevated side
• Pt. Instructions: Suspend respiration at end-expiration; Coughing prior to suspending respiration may better fill ureters with contrast
• Exposure: Collimate to 14×17 in lengthwise

Evaluation Criteria

• Kidney orientation: Elevated kidney parallel to IR (elongated, full profile); down-side kidney perpendicular (foreshortened as expected).
• Ureter visibility: Down-side ureter free of vertebral superimposition; UVJ region demonstrated when included.
• Rotation accuracy: About 30°—assessed by degree of kidney elongation and pelvic brim opening.
• Coverage/Technique: Kidneys, ureters, and bladder on 14×17 if body habitus allows; adequate contrast to show collecting system; time marker visible.
• Motion: No breathing or patient motion (sharp renal and pedicle margins).

AP Bladder (Timed)

CR Location & Positioning

• SID: 40 inches
• Patient Position: Supine; MSP aligned to IR
• Adjustments: If patient is tall, obtain separate bladder film; may add mild caudad angle to clear symphysis if requested
• CR: Perpendicular, centered 2 in (5 cm) above pubic symphysis
• Pt. Instructions: Suspend respiration
• Exposure: Collimate to 10×12 in (24×30 cm) crosswise or lengthwise per habitus

Evaluation Criteria

• Coverage: Entire bladder; distal ureters entering bladder visible when possible.
• Pubic clearance: Bladder neck & proximal urethra free of pubic bone superimposition (use slight caudad angle if needed).
• Rotation/Motion: Pelvis not rotated (symmetric obturator foramina; aligned coccyx and symphysis); sharp bladder wall margins.
• Technique: Contrast density adequate to show bladder contour and intraluminal defects.

Post-Void KUB

CR Location & Positioning

• SID: 40 inches
• Patient Position: Upright or supine (upright preferred to assess nephroptosis/residual)
• Adjustments: IR centered at iliac crests
• CR: Perpendicular at iliac crests
• Pt. Instructions: Suspend respiration
• Exposure: Collimate to 14×17 in; label POST-VOID

Evaluation Criteria

• Coverage: Kidneys through symphysis pubis; bladder region clearly included.
• Clinical aim: Residual contrast in bladder evaluated; ureteral drainage symmetry noted.
• Rotation/Motion: AP lumbar spine true; iliac wings symmetrical; sharp outlines.
• Labeling: Clearly marked POST-VOID with time marker if required.

Optional: Lateral (R or L)

CR Location & Positioning

• SID: 40 inches
• Patient Position: Lateral recumbent (R or L)
• Adjustments: Knees slightly flexed; MCP centered; supports between knees/ankles; arms up and out of field
• CR: Perpendicular to MCP at level of iliac crests
• Pt. Instructions: Suspend respiration at end-expiration
• Exposure: Collimate to 14×17 in lengthwise

Evaluation Criteria

• Coverage: Entire urinary system in profile—kidneys, ureters (as possible), and bladder.
• Rotation check: Hips and femurs superimposed; posterior bladder wall single line (not double).
• Use case: Demonstrates anterior/posterior displacement of kidney/ureter; localizes calcifications or masses.
• Technique/Motion: Sufficient penetration through pelvis; crisp soft-tissue margins; no motion blur.

Optional: Lateral Decubitus (Dorsal or Ventral)

CR Location & Positioning

• SID: 40 inches
• Patient Position: Supine on cart (dorsal decubitus) or prone (ventral), side against vertical grid; wheels locked
• Adjustments: MCP centered; level of iliac crests to IR; arms away from abdomen; no rotation
• CR: Horizontal and perpendicular to MCP at iliac crests
• Pt. Instructions: Suspend respiration at end-expiration
• Exposure: Collimate to 14×17 in lengthwise

Evaluation Criteria

• Coverage: Entire urinary system; horizontal-beam demonstration of fluid levels or displacement.
• Rotation check: Thoracolumbar spine vertical; pelvis not rotated (iliac wings symmetric relative to detector edge).
• Use case: UPJ/ hydronephrosis, anterior displacement of ureters/kidneys, extraperitoneal vs intraperitoneal localization.
• Technique/Motion: Adequate penetration across abdomen; sharp margins; visible position marker (e.g., Dorsal Decub).

Technique / Workflow Notes (quick recap)

• Time-stamped films from injection completion (e.g., 3, 5, 10, 15, 20 min)
• Nephrogram/nephrotomography during early parenchymal phase if protocolled
• Prone image may substitute for ureteral compression (compression contraindicated with stones, trauma, aneurysm, mass, colostomy, suprapubic catheter, recent surgery)
• Shield when it won’t obscure anatomy; precise collimation to reduce dose
• Label body position (supine/prone/upright/Trendelenburg) when used

Procedure Adaptation

• Poor renal function: reduce or avoid contrast; consider ultrasound or non-contrast CT.
• Pediatric patients: reduce contrast dose, use immobilization aids if needed.
• Hypertensive patients: take multiple timed images to assess renal excretion.
• Patients with suspected stones: prone images help visualize ureters.
• Post-surgical or trauma patients: gentle positioning; avoid compression if contraindicated.

Exposure Factors & Technical Considerations

• kVp: 75–85 (sufficient for abdominal penetration while preserving contrast).
• SID: 40 inches.
• Contrast Dose: Adult typically 50–100 mL iodinated contrast IV; adjust for pediatric/renal impairment.
• Timing: Note exact injection time → all overheads labeled with elapsed minutes.
• Radiation Protection: Gonadal shielding should not be used as it will obscure urinary tract.
• Compression: May be applied to delay contrast emptying from kidneys (contraindicated with stones, trauma, aneurysm, or abdominal mass).

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