Use since its introduction in early 1930, intravenous urography (also known as intravenous pyelogram) is a basic procedure for testing and radiology tests to access the kidney and urinary system. Tests and Procedures are very important to investigate any abnormalities in the organs of the excretory system (kidney, ureter, bladder and urethra) and the presence of kidney stones, Bloody urine and congenital birth defects of the urinary excretory system of children. This procedure involves the use of contrast media fluid as indicators in radiograph images. Liquid dye contrast media is injected through the vein and travels through the bloodstream. Through a blood vessel is a liquid contrast media will move to the kidneys, ureters and bladder channels. At that time, imaging tests will be done to get the best image of the status of the excretory system. The resulting image will show more clearly the image of the organ, the effects of radiopaque contrast media. Any abnormalities in the excretory system looks at the image of the radiograph. Since 1930, reforms in medical technology have found a more effective way of imaging the entire urinary system and status of the papillae and calyces. Procedures such as Computed Tomography Urography (CTU) and Magnetic Resonance Urography (MRU) to replace IVU as the basis of imaging the kidneys and urinary system overall.
If patients do not want to undergo this test, the results of the patient must be respected. notwithstanding, the privacy and rights of patients must be observed and protected by the health authorities (radiographers, doctors, etc.)
fixing the date of initial appointment and the test should be conducted to ensure that patients receive early information about the procedure for patients can be prepared in advance and radiation tests can be conducted smoothly. Make sure the patient's medical history review, identify allergies (if any) and the menstrual cycle of patients. This aims to prevent anaphylactic shock effect and facilitate the doctor and the chief x-ray contrast media are looking for, together with the patient. These measures should be taken seriously on those who are allergic to iodine. as a radiographers, is an obligation to remind the patient to fast for 8-12 hours before the procedure. If necessary, the quantity of food intake in the low and high fiber is allowed. But if the patient has diabetes or not to fast (on the advice of a doctor), the procedure for such patients should be undertaken immediately. Patients are also entitled to be supplied saline / laxative (bowel drug) and instructed to eat the day before testing to remove all air and digested in the intestines and digestive organs to facilitate the image of the kidney and urinary excretory duct can be seen clearly. Patients must sign the letter of agreement as a sign of understanding and agreed to undergo IVU.
During the test
When patients arrive at the appointed date, radiographers should be prepared, and the contrast media tools that are appropriate to the patient. radiographers will play a role in ensuring that patients are willing to (follow directions) and IVU test went smoothly. patient's blood pressure will be checked in advance to check the condition of the kidneys. patients are asked to change clothes on a hospital gown and radiopaque items such as jewelry, cell phones, watches, underwear and all metal must be ensured is isolated from the patient to avoid interference in the image of the film. after changing the patient first asked to lie down and relax before the contrast media into the blood vessels / veins. In this examination, the procedure will take approximately 40 to 60 minutes.initially, radiographers will take x-rays at the patient's abdomen without contrast media. thereafter, the radiographers will introduce contrast media into the venous vessels in the arm. After that, the process of taking x-rays which would be done on the abdomen and pelvis. Currently, the patient will be asked to hold breath for a few seconds.
Radiation Protection
Direct lead rubber gonad protection is used with the 'apron partial' or shield of Kings Lyn when the anatomy involved gonad structure. In addition, the reduced dose, kVp and mAs are given to patients in order to reduce scatter radiation. Make sure the inspections go smoothly and perfectly that once again does not need to be done, and it can reduce excessive doses received by patients.
Projection
Type / Cassette size
kVp / mAs
Inspection sequence
Purpose
Prelim film
- (14 x 17 inch)
- Grid
70-75 /
25-30
Passed the initial inspection prior to contrast media.
-Ensure that patients bowel preparation.
-In reference to the position of the kidney.
-Knowledge of any presence radiopaque
Immediate film
- (10 x 12 inch)
- Grid
68 -72 /
25-30
Exposure is passed when it is finished injection of contrast media (30 seconds - 1 minute)
Showing early-stage renal absorption systems.
Renal-size measured in this film series.
5 minute film
- (10 x 12 inch)
- Grid
70-75 / 25- 30
Exposure is done after 5 minutes of injections.
- 'Full' KUB showing the urinary system.
15 minute film
(14 x 17 inch)
*compression
- Grid
65-70 /
25 - 30
Exposure performed 15 min after injection (10 minutes after the movie 15 minutes)
-Pressure is the renal kolimasi exposure in the area to see clearly the renal system kalkull.
-Technique 'head down'
Release film
(14 x 17 inch)
- Grid
70-75 /
25-30
Exposure is open after the pressure / position of 'head down' to the supine position
- 'Full' KUB with bladder area looks at a series of mini file.
-The entire urinary system will look at this film series.
Patient Care After The Procedure
First of all, make sure the patient is in a stable. After that, make sure the patient understands any preparation instructions are complete. check the patient's understanding of how to accept the decision, then direct the patient can change their clothes. patients will return to the ward or outpatient can return to daily unit treatment.
Kilovoltage
(kv)
Miliamperage
Second(mAs)
Film Focus Distance(cm)
Grid
(yes/no)
Focus
Automatic Exposure Control(AEC)
Size
Cassette
65-70
50-100
100
yes
broad
yes
35x43 cm
24x30 cm
Assessment of image
the film must have ID, and markers must be state and correct in the proper area on the film. In addition, evidence of collimation on four sides together around the convergence point. Additionally, the optimum exposure should penetrate all the filling of contrast media. Contrast of these structures should be optimized to fully describe the renal tissue and soft structures.
What are the risks to IVU?
Intravenous urography is a safe examination. However, if circumstances permit, and you can make the best, you should be aware of adverse effects and know about risk at the end after this examination. The effect is that patients will receive radiation X-rays on their bodies. amount of radiation received by patients during urography examination is similar to a person who receives from natural radiation environment of over 14 months. The most important one is that if the patient is pregnant women and confirmed, they suggested not to undergo an x-ray because it will give your baby defect before the baby is born. So, first tell your doctor if you are confirmed pregnant.
Complication
This happened during and after this examination, the patient will experience a reaction due to the problem of lack of congenial body injection of contrast media. If patients experience irritation and shortness of breath during and after the inspection. Then be told as soon as possible to the radiographers and the treatment will be given immediately to prevent injury to the body.
Things to do in the event of a reaction to contrast media:
Ensure that patients do not panic and try to calm the patient. Provide first aid. Monitor the patient to an ECG machine.Notify the emergency unit, hemodialysis unit, and surgery to be ready to accept admission if patients with more serious patients.Inform the specialist and the doctor in charge of the patient
criteria for assessing radiographs
• Structures that are shown.
A whole urinary system are shown (from the kidney to the bladder dista). 'Symphysis pubis' should be included in the boundaries of the recorder.
Only part of the urinary system looks at the series diopak particular radiograph taken after injection of contrast media
• Position.
illiac wing ribs are symmetrical and show that there is no rotation.
• Collimation and point of convergence
Collimation field should include the desired anatomical structure. Concentrated at the highest point of convergence in the plane of the illiac crest midsagital.
• the exposure factor.
There is no ambiguity caused by respiration or patient movement.
A technique and an appropriate exposure factors should demonstrate clearly the system of the urinary system in all the series of radiographs.
Mark R / L should look at all the serial radiographs.
