GU imaging

Question 1

common indications to image the renal tract

Question 2

categories for renal tract symptoms

Answer 2

• pain in lumbar region when micturating
• changes to urine and flow of urine
• palpable lump

Question 3

what is visible on a KUB

Answer 3

• kidney size, location and morphology
• calcifications
• potential pathologies/ incidental findings
• spinal disease
• Metastases

Question 4

common clinical indications x-ray

Answer 4

• Haematuria (macroscopic {can be seen} or microscopic [only seen under microscope})
• ? stones
• post surgery (stents)
• loin pain
• dysuria

Question 5

intravenous urogram (IVU) common indications

Answer 5

• renal colic
• haematuria
• recurrent UTI
• Suspected urinary tract pathology

Question 6

potential findings on x-ray

Answer 6

• duplex kidney

- horseshoe kidney

Question 7

benefits and uses of ultrasound

Answer 7

effective in evaluating:

• renal size
• masses
• renal obstruction
• bladder residual volumes
• function of vessels using doppler

Question 8

disadvantages of ultrasound

Answer 8

• cant be used for air related studies
• can be nonspecific - can see abnormality, but what it is may be difficult
• non replicable - images wont look the same if redone

Question 9

ultrasound common indications

Answer 9

• renal mass
• rena; cysts
• infections
• UTI
• haematuria
• obstruction

Question 10

ultrasound patient prep

Answer 10

• patient needs full bladder (1hr b4 scan start drinking water 500-1000mls
• patient shouldn’t empty the bladder b4 examination

Question 11

renal ultrasound technique - kidneys (which transducer is used?)

Answer 11

3-7 MHz curvilinear transducer - more frequency and high penetration

Question 12

Renal ultrasound technique

Answer 12

• scanned in supine longitudinally
• in oblique coronal plane
• A transverse view is included, so all aspects are visualised

Question 13

for renal ultrasound paeds are scanned…

Answer 13

in prone postion

Question 14

US guided biopsy - after care

Answer 14

• patient is advised not to drive
• no heavy lifting or strenuous exercise
• pain killers are allowed to be taken, however not aspirin
• Attend emergency department if they experience severe back pain, blood/clots in the urine or feel faint

Question 15

CT renal imaging

Answer 15

renal stone
tumours
perineal collection
loin mass
staging and follow up of renal carcinomas
CT angiography - renal arteries

Question 16

CT KUB allows detection of

Answer 16

ureteral wall oedema
perinephric oedema
hydronephrosis
renal sinus infiltration

Question 17

CT IVU Technique

Answer 17

• patient is supine
• scanogram is done
• initial scan is non-contrast
• patient is injected with 70 MLS of contrast at 2-4mls/s
• 10 minutes after contrast injection, another 30mls is injected and 1mm slices are taken from the top of the kidneys to the base of the bladder

Question 18

renal mass imaging

Answer 18

• patient is supine
• scanogram is done
• non-enhanced scan from diaphragm to lower poles of kidneys
• patient is injected with ‘low osmolar contrast’
• contrast-enhanced scan is taken. 30 second

Question 19

other renal scans

Answer 19

• scanning for trauma

- penetrating wounds

Question 20

renal trauma scan

Answer 20

• patient is supine
• ABDO-PELVIS CT
• scanogram - from diaphragm - symphysis pubis
• 100 mls of IV contrast 2-4mls/s
• 60 -70 sec delay

Question 21

CT Guided biopsy patient prep

Answer 21

bloods- eGFR, INR

• written consent
• contrast enhanced CT prior to biopsy
• site entry and trajectory is then planned using previous CT
• patient position is dependant on mass location

Question 22

CT Biopsy technique

Answer 22

• patient positioned onto table
• unenhanced scan 5-7mm slice thickness through kidneys
• the slice depicting the mass is selected
• limited scan through the mass is repeated
• needle entry point is determined

Question 23

CT biopsy technique (during)

Answer 23

• local anaesthetic is administered
• angle of approach is determined
• needle is then advanced
• sample is acquired and processed
• the sample is rolled onto a saline soaked gauze
• is then assessed for glomeruli
• then placed into formalin saline solution

Question 24

CT Biopsy patient aftercare

Answer 24

• patient needs to stay flat on back for 6 hrs

- close monitoring is done

Question 25

CT biopsy potential complications

Answer 25

- could induce further bleeding in the renal system - pain - could induce sepsis - tumour seeding (breaking up tumour - could induce it to another area if dropped in body)

Question 26

MRI in GU imaging

Answer 26

- not commonly used as 1st choice - used in prostatic and endometrial imaging - renal masses - urinary tract obstruction - congenital anomalies - visualisation of renal arteries

Question 27

MRI prep

Answer 27

- safety questionnaire - contrast check - consent

Question 28

mri technique

Answer 28

- T2 weighted sequence used ( good for fluid filled structures) e.g. renal cysts - T1 shows tumours well with gadalinium enhancement