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PROCEDURES COMBINED WITH
RADIOLOGICAL TECHNIQUES
Au.: MD Van Scri – VN
2023

OUTLINE
USUALLY COMBINES 3 AREAS:
- CLINICAL.
- SUBCLINICAL.
- IMAGE ANALYSATION
+ ULTRASOUND. + UIV.
+UPR. + UCP.
+CT. + RENAL ANGIOGRAPHY.

SUPERSONIC
DIAGNOSTIC TOOLS ARE VERY COMMON.
OBSERVE THE KIDNEYS, RENAL PELVIS, AND KIDNEYS. RENAL FUNCTION
COULD NOT BE ASSESSED.
1. TECHNICAL.
- PATIENTS DO NOT NEED TO PREPARE.
- PATIENT HOLDS URINE IF POSSIBLE.
- USEFUL IN CHILDREN AND UNCOOPERATIVE PATIENTS.
- PORTABLE SA CAN BE USED AT BED.

SUPERSONIC
2. INDICATION.
- IN UROLOGICAL DISEASES.
+ KIDNEY CYSTS, KIDNEY TUMORS.
+ KIDNEY HYDRONEPHROSIS, KIDNEY ASSESSMENT.
- URINARY STONES.
- OF LITTLE VALUE: RENAL CALYX-PYELOPATHY, PERIRENAL TISSUE,
ADRENAL, KIDNEY DISEASE, IN TRAUMA.

SUPERSONIC
A. IN KIDNEY TRANSPLANT.
- IS AN EXCEPTION.
- USE SA DOPPLER TO OBSERVE:
PELVIC ARTERY, RENAL ARTERY, INTERLOBAR ARTERY.
- INDICATES WHETHER THE TRANSPLANTED KIDNEY HAS FAILED OR BEEN REJECTED.

SUPERSONIC
B. SCROTUM, PENIS.
- TESTICLES: INFLAMMATION, TUMORS, HYDROCELE. CYSTS, TUMORS, INFLAMMATION,
EPIDIDYMIS.
- ASSESS DV: TUNICA ALBUGINEA, CORPUS CAVERNOSUM, CORPUS SPONGIOSUM, DV BLOOD
VESSELS.
- DILATES SPERM VEINS.

SUPERSONIC
3. THROUGH THE RECTUM.
A. POINT.
- INCREASED PSA, TUMORS, PROSTATE INFLAMMATION, OBSERVATION OF
SEMINAL VESICLES, EJACULATORY DUCTS.
- BIOPSY AND DRAINAGE OF PROSTATE ABSCESS
B. TECHNIQUE.
- RINSE THE INTESTINES AND URINATE BEFORE SA. KS IF ST.
- T TILT OR OBSTETRICS AND GYNECOLOGY.
- ST 6 SAMPLES WITH 18 GAUGE NEEDLE.

SUPERSONIC
Normal kidney SA image

SUPERSONIC
Images of SA BQ
Normal BQ citadel is ruined

SUPERSONIC
Normal
Testicular Epididymis

UIV (IVU)
1. TECHNICAL.
- PATIENTS FAST FOR AT LEAST 6 HOURS BEFORE THE SCAN.
- CLEANSES THE COLON.
- COMPLETELY URINATE BEFORE TAKING THE SCAN. THE PATIENT LIES ON HIS BACK.
- BLOOD UREA < 0.8G/L.
- HOW TO MAKE A UIV MOVIE.
+ KUB EXAMINES THE ABDOMEN.
+ PRESS YOUR ABDOMEN WHEN TAKING THE PHOTO.

UIV (IVU)
2. INDICATION.
- CHECK RENAL PELVIS, NQ, SUSPECTED UROTHELIAL TUMOR. SUSPECTED CONGENITAL
ABNORMALITY OF THE URINARY SYSTEM.
- AFTER BT-NQ AND NQ-BQ JUNCTION SURGERY.
- KIDNEY STONES, NQ, DISTENDED KIDNEYS.
- URINARY TRACT OBSTRUCTION.
- TRAUMA, HEMATURIA, KIDNEY DISEASE,...
- SUSPECTED COMPLICATIONS AND URINARY COMPLICATIONS AFTER SURGERY.

UIV (IVU)
3. CONTRAST AGENT.
OFTEN USE DIODON, VIOSTRAST, CARDIOSTRAST...
- HAS LOW PERMEABILITY.
- HAS HIGH PERMEABILITY.
- SINGLE OR MULTIMOLECULAR GROUPS THAT CREATE IONS: TELÉBRIX-
35, HEXABRIX-32...
- NON-IONIC RADIOPAQUE GROUP: TRIENETIX-30...

UIV (IVU)
4. RESULTS.
A. NORMAL.
B. PATHOLOGICAL.
- RENAL FUNCTION
- BODY DEFORMITY.
- BLOCKAGE LOCATION.
- BLADDER.
Normal UIV 30 minutes

UPR
1. INDICATION.
- KIDNEY UIV DOES NOT ABSORB DRUGS, LEAVING THE HEART THE CAUSE OF OBSTRUCTION.
- FIND FISTULA ROUTES THROUGH THE LYMPHATIC SYSTEM.
- RARELY USED DUE TO PAIN AND UPSTREAM INFECTION.
- SPECIFY ONLY WHEN ABSOLUTELY NECESSARY.

UPR
2. PROCEDURES.
INJECT 12 – 15 ML OF CONTRAST MEDIUM. MOVIE 1 AFTER INJECTION, MOVIE 2 AFTER 5
MINUTES.
3 RESULTS.
-RENAL PELVIS, NQ LIKE UIV.
-DETERMINE THE LOCATION OF FOREIGN BODIES, STENOSIS IN THE KIDNEY OR NQ.
-FISTULA FROM KIDNEY TO LYMPHATIC SYSTEM.

RETROGRADE CYSTOGRAPHY.
1. INDICATION.
INJURY, PROLAPSE, URINARY TRACT FISTULA. POSTOPERATIVE. BQ BODY
SHAPE. EVALUATE URINE LEAKAGE.
2. TECHNICAL.
SOFT CATHETER. ADEQUATE CONTRAST AGENT.
3. RESULTS.
- BQ -NQ REFLUX. BQ -INTESTINAL PROBE.
- PROBE THE BQ -UTERUS INTO THE AD. U BQ, TLT.
- DILATION, INFLAMMATION, PROLAPSE OF THE BLADDER, BLADDER
NERVES.

RETROGRADE CYSTOGRAPHY.
BQ normal Tune BQ – TC into AD

RETROGRADE URETHROGRAPHY.
1. INDICATION.
2. TECHNICAL.
INJECT THE MEDICINE UPSTREAM FROM THE MOUTH OF THE FLUTE.
3. RESULTS.
- NORMAL.
- PATHOLOGICAL.
+ ND STENOSIS. ND–TSM, ND–RECTAL FISTULA.
+ DEFORMATION OF THE URETHRA.

RETROGRADE URETHROGRAPHY.
Straight Lean
Normal image

CT URINARY SYSTEM
1. HISTORY.
- INVENTED BY ENGINEER GODFREY NEWBOLD HOUNSFIELD AND HIS COLLEAGUES.
- 1971 THE FIRST BRAIN CT WAS BORN, CUTTING ONE LAYER TOOK 4 MINUTES.
- DEVELOPED THROUGH 4 GENERATIONS.

CT URINARY SYSTEM
2. OPERATING PRINCIPLE.
- THE MOVING X-RAY SOURCE SCANS CROSS-SECTIONAL LAYERS AT DIFFERENT DEGREES.
- BASED ON THE DENSITY OF EACH BODY PART, DIFFERENT IMAGES ARE PRODUCED.
- DIAGNOSIS BASED ON DENSITY: WHITE (BONE), BLACK (FLUID, WATER, VAPOR).

CT URINARY SYSTEM
2. OPERATING PRINCIPLE.
- HOUNSFIELD UNIT (HU) TO MEASURE DENSITY:
+ WATER IS 0HU.
+ GAS IS 1000HU.
- THERE ARE 3 LEVELS OF DENSITY:
+ CONCENTRATED COPPER.
+ INCREASE DENSITY.
+ REDUCE DENSITY.

CT URINARY SYSTEM
3. TECHNICAL.
- CUT THE LAYER ALONG THE CONVENTIONAL AXIS, THE SCANNING TABLE SLIDES STEP BY STEP
THROUGH THE SCANNER.
- SPIRAL CT IS MORE ACCURATE THAN CONVENTIONAL CT.
+ CONTINUOUS SLIDING TABLE. THE PATIENT HELD HIS BREATH ONCE.
+ PITCH = TABLE SLIDING SPEED / LAMP OPENING = 1:1, TAKING 1 KIDNEY SHOT TAKES 30
SECONDS.

CT URINARY SYSTEM
3. TECHNICAL.
- SPIRAL CT DOES NOT HAVE DEVIATIONS DUE TO MOVEMENT AND SPACE LIKE CONVENTIONAL
CT.
- CT WITH FLUOROSCOPY.
+ THE PATIENT FASTED FOR 4 HOURS BEFORE INJECTING THE DRUG.
+ INJECT 100ML OF MEDICINE, 1.5 - 4 ML/S.
- THERE ARE MANY TYPES OF DRUGS ON THE MARKET.

CT URINARY SYSTEM
3. TECHNICAL.
STAGES AFTER INJECTION:
- MM PHASE: AFTER 15 - 40 SECONDS.
- MARTIAL KIDNEY STAGE: AFTER 25 - 80 SECONDS.
- RENAL PHASE: AFTER 90 - 120 SECONDS.
- EXCRETION PHASE: AFTER 3 - 5 MINUTES.

CT URINARY SYSTEM
4. HOW TO DO IT.
A. KIDNEY STONES, NQ.
B. KIDNEY TUMOR.
C. RENAL BLOOD VESSELS.
D. URINARY TRACT INFECTION.
E. BQ AND NQ.

CT URINARY SYSTEM
Renal blood vessels

RENAL ARGIOGRAPHY
1. INDICATION.
- HEMATURIA SUSPECTED OF VASCULAR ABNORMALITIES.
- KIDNEY TUMOR: VASCULAR DISTRIBUTION.
- BEFORE SURGERY: PARTIAL NEPHRECTOMY, LARGE KIDNEY, ADRENAL, RETROPERITONEAL
TUMORS.
- RENAL VASCULAR DISEASE.
- SUSPECTED RENAL VASCULAR INJURY ON UIV OR CT IN TRAUMA.

RENAL ARGIOGRAPHY
2. PRINCIPLES.
- TAKING 2 RENAL ARTERIES TOGETHER: INJECTING MEDICINE INTO THE AORTA ABOVE THE
RENAL ARTERY.
- SCAN EACH RENAL ARTERY SEPARATELY: FROM THE AORTA, INSERT THE CATHETER INTO THE
RENAL ARTERY TO BE SCANNED AND INJECT MEDICATION.

RENAL ARGIOGRAPHY
3. PROCEED.
A. DIRECT METHOD.
- INSERT THE NEEDLE DIRECTLY INTO THE AORTA ABOVE THE RENAL
ARTERY.
B. INDIRECT METHOD.
- CATHETER FROM THE FEMORAL ARTERY UP TO THE 12TH LUMBAR AND
1ST LUMBAR VERTEBRAE. MEDICATION PUMP.
- DIRECT THE CATHETER INTO THE KIDNEY TO TAKE THE SCAN. KIDNEY
SCAN TO CHOOSE FORTUNE.

RENAL ARGIOGRAPHY
4.RESULTS.
A. NORMAL.
CLEARLY SEE THE DIVISION OF MM INTO EACH KIDNEY.
B. PATHOLOGICAL.
- MM PROLIFERATION IN MALIGNANT TUMOR AREAS.
- REDUCE MM IN KIDNEY CYST AREA.
- RENAL ARTERY ANEURYSM.
- RENAL ARTERY STENOSIS.

RENAL ARGIOGRAPHY
5. COMPLICATIONS.
- THROMBOSIS.
- MM PSEUDOANEURYSM.
- ARTERIAL EMBOLISM.
- DISSECTION INTO MM.
- ALLERGY OR NEPHROTOXICITY DUE TO CONTRAST DYE.

COMPARE THE VALUES OF DIAGNOSTIC IMAGING METHODS
Kidney
tissue
owner
Kidney
stones
Renal
function
Renal pelvis Ureters Bladder
KUB + + + 0 0 0 +
UIV + + + + + + + + + + + + + + +
Capture
upstream
0 + + + + + + + + + + + + +
Supersonic + + + + + + 0 + + +
0 (if not
stretched)
+ + (if
stretched)
Clearly seen
through
cystoscopy
CT without
contrast
+ + + + + 0 + + + + + + +
CT with
contrast
+ + + + + + + + + + + + + + + + + + +
MRI + + + + 0 + + + + + + + + + + +
Kidney
scintigraphy
+ + 0 + + + + + + + + + +

A. KIDNEY AND URETER STONES.
- REPLACE UIV IN RENAL COLIC.
- CONTRAST-ENHANCED CT SHOULD NOT BE USED TO MISDIAGNOSE INTESTINAL DIVERTICULA.
- CT USUALLY DOES NOT SHOW STONES OR WHEN IT IS NECESSARY TO DETERMINE KIDNEY
FUNCTION, A SLOW CONTRAST CT SCAN IS PERFORMED AFTER 10 MINUTES.

B. KIDNEY TUMOR.
-GET A PLAIN CT SCAN FIRST.
-ONE FILM 1 MINUTE AFTER DRUG INJECTION.
-AFTER 10 MINUTES, TAKE A FILM.
MANY KIDNEY TUMORS CLEARLY SHOW THE EXCRETION STAGE.
- SPIRAL CT IS DONE QUICKLY, SCANS CONTINUOUSLY, AND ALWAYS MEASURES BLOOD
VESSELS.
- SEE KIDNEY TUMOR INVADING VEINS, NUMBER OF ARTERIES.

C. RENAL BLOOD VESSELS.
- IDENTIFY RENAL MM PATHOLOGY.
- INJECT THE DRUG INTO THE ANTERIOR TIBIAL VEIN AT 3ML/S.
- TAKE A PHOTO AFTER 20 - 25 SECONDS. SLOW FILM CLEARLY SHOWS THE STRUCTURE OF
KIDNEY MM.
- 2 OR 3 DIMENSIONAL IMAGING CLEARLY SHOWS MM ABNORMALITIES.

D. URINARY TRACT INFECTION.
- USUALLY RELIES ON LS. CT TO DETECT COMPLICATIONS OR MONITOR TREATMENT.
- CT OFTEN SHOWS ABNORMAL KIDNEYS.
- CONTRAST-ENHANCED CT CLEARLY SHOWS THE LESIONS, WHEREAS CT SHOWS NO LESIONS.
- NO SIGNS IN URINARY TRACT INFECTION.

E. BQ AND NQ.
- TAKE A SHOT AFTER PUMP MEDICINE 5 - 10 MINUTES . LIE YES , YES CAN CONCLUDE
VALSALVA MATCH .
- TWISTED CT SNAIL SEE OCCLUSION BLOCKAGE AND INFLAMMATION INFECTED NQ PULSE .
- SA PRICE TREAT THAN IN DAMAGE LOVE BQ.
- CT SEES IT CLEARLY TISSUE FAT PULSE AROUND AND LYMPH NODES REGION POT .

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Urolo radiology eng procedure by Van Scri

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