Intravenous Urography Examination Research Articles

Assessment of the effective radiation dose and radiogenic effect in intravenous urography imaging procedures

The pathology of the urinary system is usually investigated using Intravenous Urography (IVU). The study objectives are to quantify patients’ radiation dose and radiation induced malignant tumors risk during IVU examination. The radiation doses during IVU and the subsequent risks from exposure are studied, using data from 50 patients imaged in one hospital. The demographic data given as (mean ± std) was as follows:The age of patients was 39 ± 14 years; height of patients was 1.7 ± 0.1 m, the mass was 69 ± 10 kg and the body-mass-index was 24.3 ± 4.1 kg m−2. The physical exposure parameters recorded were: kVp: 74.04 ± 3.1, mAs: 33.64 ± 4. Moreover, the average number of films per procedure was 5.72 ± 1.49. The entrance-surface air kerma (ESAK) was 2.1 ± 0.64 mGy, and the mean effective dose was 0.131 ± 0.04 mSv. Calculation of the overall cancer risk yielded 5.9 × 10−6 procedures. ESAK (mGy) and effective dose values obtained in this study were comparable with reported studies as shown in the text. The effective and cancer risk are around ten times lower during IVU procedures than for example, contrast enhanced computed tomography urography (CTU) examination. Reduction of doses received by patients to meet the values of the diagnostic reference levels without compromising the quality and clarity of the images is highly recommended. KetwordsRadiation dosimetry; IVU; Radiology; Cancer risk; medical imaging.

A Mathematical Approach Evaluation of Dose Area Product (DAP) Using to Patients Undergoing Intravenous Urography Examinations in Addis Ababa, Ethiopia

Patient dose evaluation is one of the quality assurance programs. Dose area product is a product of surface area of patient that exposed to radiation at the skin entrance multiplied by the radiation dose at the surface. This research focused on a dosimetry, DAP, for specific X-rays examination which is known as Intravenous Urography examination. A cross-sectional study was conducted on 145 adult patients age above 16 years examined using IVU in Addis Ababa, Ethiopia at two public and two private hospitals during February 2012-March 2012.

Anatomic information of urinary tract MSCT using tracking and intravenous urography in case of urolithiasis

Urolithiasis is a stone in the urinary tract area. In previous studies, the use of reconstructed tracking on Multislice Computed Tomography (MSCT) non-contrast urography was able to produce an image of the urinary tract. Intravenous Urography (IVU) examination is a radiographic examination of the urinary system using positive contrast media that is inserted intravenously. This study aims to optimization of information on the anatomy of the urinary tract is needed to help diagnose urolithiasis. This type of research is an experimental observational approach with a comparison of the MSCT anatomical information tracking technique with an IVU examination. The subjects of this study were patients who performed an MSCT and IVU examination with 3 respondents from Radiology Specialists. The data collected is from April to November 2019. The sample used was 60 samples. Non-contrast urography MSCT with tracking technique obtained more optimal results in assessing each anatomy compared to IVU. The overall value of anatomical image non contrast urographic MSCT images with tracking techniques obtained a total value of 2179, While the overall value of the anatomical image on the IVU examination was 1977. MSCT non-contrast urography with tracking is more optimal in establishing the diagnosis in cases of urolithiasis, but IVU examination excels in assessing the function of the urinary tract.

Organ dose in kidney imaging with contrast media

Introduction:Intravenous urography (IVU) test includes high number of images and extended imaging size. These make IVU as a diagnostic method with high absorbed doses by sensitive organs such as intestine and gonads in pelvic-abdominal area. In this study absorbed doses of pelvic-abdomen sensitive organs such as Adrenal, Bladder, Colon and Gonads in IVU test. Method and Materials: Demographic properties of one hundred patients’ who referred for kidney imaging was recorded during one year. Exposure factors were recorded for each patient during IVU test. In this study CALDose software used for Entrance Surface Air Kerma (ESAK) recording. Organ dose was calculated by conversion coefficient of organ × ESAK Results: The age averages of men and women were 52 and 53 years, respectively. The average ESAK dose for patients in one step of each IVU examination was 3.8 mGy. The organ dose of Adrenal, Bladder, Colon and Gonads 1.8, 1.8, 7.0 and 2.0, respectively. Conclusion: These results showed that IVU processing in clouding higher dose to sensitive organs and selection of correct exposures factors can reduce organ dose.

A short biodegradable helical spiral ureteric stent provides better antireflux and drainage properties than a double-J stent

The use of ureteric stents is a standard treatment for the relief of ureter blockages for benign or malignant reasons. The most common stent design in clinical use is a double-J stent with coiled ends to avoid stent displacement. However, there are a number of complications associated with stent use. A double-J stent design bypasses the ureterovesical junction, enables bladder pressure reflection to the renal pelvis and causes vesicoureteral reflux (VUR). This may result in scarring and renal failure. An animal model was used to investigate whether VUR can be avoided in stented ureters using a short biodegradable partial helical spiral stent design that leaves the ureterovesical junction intact. Eight female pigs were used. Ureters on the left side were stented using a short helical spiral SR-PLGA stent (group A) and ureters on the right side using double-J stents (group B). Simulated voiding cystoureterography and standard intravenous urography examinations were performed on all eight animals at 4 weeks and on the remaining four animals at 8 weeks. An SR-PLGA single coiled partial stent demonstrated superior drainage properties to a double-J stent at 4 weeks (p = 0.020). A marked but not statistically significant difference in favour of a SR-PLGA stent was also observed at 8 weeks (p = 0.102). A statistically significant difference was observed in VCUG findings in favour of group A at immediate postoperative control as well as in the 4 and 8 week follow-up studies (p = 0.011, p = 0.010, p = 0.046, respectively). A self-expandable, SR-PLGA partial ureteric stent presented with superior drainage and antireflux properties compared to a double-J stent. The reflux commonly related to double-J stent use can be minimized by using a partial ureteric stent design.

The clinical application of extracorporeal shock wave lithotripsy about intravenous urography with realtime positioning

Objective To investigate the clinical efficacy of extracorporeal shock wave lithotripsy(ESWL) treatment of ureteral calculi with intravenous urography real-time positioning Methods May 2008 to April 2009,31 patients with clinical diagnosis of ureteral calculi with intravenous urography examination using realtime understanding of the secretory function of the kidney,stone location and degree of obstruction in its positioning EWSL treatment,to observe the effect.Results 1 case of ureteral stones,in addition to three cases of the stones wrapped diverted to open surgery,the rest have achieved satisfactory results.Conclusion Intravenous urography using real-time positioning EWSL treatment is good for lower ureteral stones in a reliable treatment methods. Key words: Intravenous urography; Extracorporeal shock wave lithotripsy; Ureteral calculi; Efficacy

A comparison of the efficacy, adverse effects, and patient compliance of the sena-graph®syrup and castor oil regimens for bowel preparation.

Sena-Graph syrup has recently been formulated by an Iranian pharmaceutical company for being used in bowel evacuation before radiography, colonoscopy and surgery. This study compares the efficacy, adverse effects and patient compliance of two bowel preparation regimens with castor oil and Sena-Graph syrup in of outpatients for Intravenous Urography (IVU). One hundred and fourteen consecutive outpatients were randomized to receive either the standard bowel preparation with 60 mL of castor oil or the test method with 60 mL of Sena-Graph syrup before IVU examination. Demographic data of patients and their prior bowel preparation experience were collected before the examination. Two radiologists, blinded to the method of bowel preparation, reviewed the radiographs and graded the bowel preparation. The compliance and acceptability of both regimens were assessed by using structured questionnaires filled by the patients. The Numbers, ages, weights and gender distribution of patients and their prior bowel preparation experience in the two groups did not differ significantly. The cleanliness scores for the castor oil and Sena-Graph group were 3.97 ± 0.971 and 4.87 ± 0.917, respectively. The results indicated that Sena-Graph syrup causes a better bowel cleansing compared castor oil. Adverse effects in Sena-Graph groups were significantly lower than the castor oil group. Acceptability of the regimen in patients who used Sena-Graph was higher than the other group. The Sena-Graph regimen is significantly more effective and better tolerated than of Castor oil regimen in bowel cleansing. The incidence and severity of the adverse effects from Castor oil was higher than Sena-Graph.

Value of Kidney-Ureter-Bladder Radiography in the Erect Position in Addition to Standard Intravenous Urography Examination

Objectives: To determine if additional kidney-ureter-bladder radiography in the erect position can improve the diagnostic yield of standard intravenous urography (IVU) examination. Subjects and Methods: This prospective study was conducted from March to July 2007 on 108 consecutive patients (65 males and 43 females, age ranging from 20 to 50 years) who were referred to the Department of Radiology, Al-Amiri Hospital, Kuwait, for IVU examinations. After 15 min, a film was done in the erect position in addition to the routine IVU protocol. Results: Additional information was demonstrated in the erect radiograph as follows: detecting nephroptosis in 18 (17%) patients, improved visualization of the ureters in 58 (54%) patients, and differentiation between phleboliths and ureteric stone was possible in 12 (11%) patients. Conclusions: Our study demonstrated significant additional findings in the erect position (at 15 min) compared to the supine position.

The effect of <i>In Vivo</i> intravenous administration of Sodium meglumine diatrizoate on some haematological parameters

To investigate the in-vivo effects of intravenous administration of sodium meglumine diatrizoate on some haematological parameters in a Nigerian population. Blood samples were collected before and one hour after intravenous injection of sodium-meglumine diatrizoate from 50 subjects undergoing intravenous urography examinations who had no history of and laboratory confirmed diseases that may affect haematological parameters. Standard laboratory methods were used to assay the haemoglobin concentration (Hb), packed cell volume (PCV), total white blood cell (WBC) count and differentials and blood film for any morphological changes in the red blood cells (RBC). Comparisons were made between the mean values of these haematological parameters before and one hour post injection using paired t-test for any statistically significant differences. There were statistically significant reductions in the mean values of Hb concentration and the neutrophil count one hour post injection compared with their pretest values (p < 0.05). The lymphocytes were also significantly increased post injection compared to the pretest values whereas 70% of the erythrocytes were morphologically altered from their approximately 100% normocytic shape at pre-test. Intravenous administration of sodium-meglumine diatrizoate causes in-vivo reduction in Hb concentration and neutrophil count in humans as well as poikilocytosis of the erythrocytes. Some of these effects have the potential of triggering or exacerbating crisis in a sickle cell anaemia subject which is endemic in our locality. Caution should therefore be exercised in the choice and administration of radiological contrast agents to sickle cell subjects. Preparations that are iso-osmolar with plasma and have less probability in precipitating crises should be preferred instead.

Impact of digital imaging on radiation doses to the patient during X-ray examination of the urinary tract

To compare radiation doses given to patients undergoing IVU (intravenous urography) before and after digitalization of our X-ray department. IVU examinations were monitored with dose area product meters before and after the X-ray department changed to digital techniques. The first step was a change from film-screen to storage phosphor plates, while the second step involved changing to a flat panel detector. Forty-two patients were included for the film-screen situation, 69 when using the storage phosphor plates, and 70 using the flat panel detector. A dose reduction from 41.8 Gycm2 to 31.5 Gycm2 was achieved with the first step when the film-screen system was replaced with storage phosphor plates. A further reduction to 12.1 Gycm2 was achieved using the flat panel detector. The introduction of the flat panel detectors made a considerable dose reduction possible.

Intravenous Urography in Evaluation of Asymptomatic Microscopic Hematuria

In 2001, the American Urologic Association Best Practice Policy Panel recommended CT or intravenous urography (IVU) over ultrasonography as the initial imaging modality in patients with asymptomatic microhematuria. We here present results of a study initiated many years ago and completed prior to 2001 that provides information pertinent to the use of IVU as the initial imaging modality for such patients. This study compared the results of IVU and ultrasonography in patients 40+ years of age who were referred to a single urology department for evaluation of microscopic hematuria between 1994 and 2000. There were 290 patients who agreed to participate by undergoing ultrasonography in addition to IVU; 247 completed both tests. There were 81 men and 166 women with a mean age of 56.4 years (range 40-86 years). Thirty patients (12%) were smokers. A renal lesion or mass suggestive of tumor was found in 8 patients (3.2%); 3 patients had this finding on the IVU examination and 5 on ultrasonography. None of the patients had such a lesion/mass on both examinations. Two patients with suspect lesions were ultimately found to have renal-cell carcinoma. Both of the patients with renal cancer had a suspect lesion on the ultrasound examination but not on the contemporaneous IVU. Intravenous urography may miss lesions/masses that lead to a diagnosis of upper-tract neoplasia.

Análise retrospectiva das urografias excretoras em um serviço de radiologia de um hospital geral

OBJETIVO: Fazer uma revisão de 225 exames de urografia excretora, analisando estatisticamente as principais alterações relacionadas com o trato urinário, e reafirmar a utilidade do método. MATERIAIS E MÉTODOS: Estudo retrospectivo e descritivo realizado a partir de levantamento de 225 exames de urografia excretora realizados no período de 2/1/2002 a 29/11/2002, no Serviço de Radiologia do Hospital Santa Cruz da Beneficência Portuguesa de Niterói. RESULTADOS: Do total de 225 exames, 173 (76,9%) apresentaram alterações radiológicas (anatômicas, congênitas, adquiridas, funcionais, relacionadas a litíase, cirurgias e outros) e 52 (23,1%) foram normais. A alteração mais freqüente foi a urolitíase (35,9%), seguida da dilatação do sistema pielocalicial (9,9%). Observamos que 110 (48,9%) eram pacientes do sexo masculino e 115 (51,1%), do sexo feminino. O paciente mais jovem tinha apenas dois meses de idade e o mais idoso, 84 anos. CONCLUSÃO: Apesar do advento de novas técnicas diagnósticas como o ultra-som, a tomografia computadorizada e a ressonância magnética, a urografia excretora continua tendo importante papel diagnóstico, além de constituir excelente ferramenta de auxílio à programação cirúrgica do urologista.

Dose and image quality in the comparison of analogue and digital techniques in paediatric urology examinations.

In paediatric radiology it has been recognised that children have a higher risk of developing cancer from the irradiation than adults (two to three times); therefore, increased attention has been directed towards the dose to the patient. In this study the effect on patient dose and image quality in replacing the exposure in micturating cystourethrography (MCUG) examinations with the stored fluoroscopy image has been investigated. In the intravenous urography (IVU) examination we compared analogue and digital image quality, but the dose measurements were performed on a phantom. Standard clinical X-ray equipment was used. Sixty-eight patients in each of two centres were studied for the MCUG. Doses were measured with a dose-area product (DAP) meter and the image quality was scored. A non-parametric statistical analysis was performed. For the IVU, a phantom was used in the dose measurements but clinical images were scored in the comparison between analogue and digital images. For the MCUG, replacing the exposure with stored fluoroscopy images lowered the DAP value from 0.77 to 0.50 Gy cm2. The image quality did not show any difference between the techniques; however, if reflux was to be graded, exposure was needed. For the IVU, the doses could be lowered by a factor of 3 using digital techniques. The image quality showed no statistical difference between the two techniques. There is a potential for a substantial dose reduction in both MUCG and IVU examinations using digital techniques.

Investigation into patient doses for intravenous urography and proposed Irish diagnostic reference levels.

With the introduction of Council Directive 97/43/Euratom, all member states should establish relevant diagnostic reference levels for X-ray examinations. Diagnostic reference levels help to facilitate standardisation and optimisation within departments and attempt to reduce dose variations between hospitals. High variation of individual patient doses for plain-film examinations by up to a factor of 75 was demonstrated by a previous Irish study, which highlighted the necessity for further investigation into other examinations in Ireland. The current work aimed to establish reference values for intravenous urography (IVU) examinations, an important contributor to collective dose. Eleven Irish hospitals were randomly selected, representing 30% of the total number of hospitals. Dose-area product (DAP) readings for IVUs were recorded along with technical and procedural details. Resultant data demonstrated mean hospital and individual patient DAP variations of a factor of 4 and 58, respectively. Stepwise regression analysis demonstrated that number of images taken, method of image acquisition and patient weight were the main causal agents for dose variations recorded. A proposed diagnostic reference level of 12 Gy cm(2) was established at the level of the third-quartile value of the mean hospital DAP values. This article provides evidence of large variations in DAP values for IVU examinations. It is hoped that application of the proposed DRL of 12 Gy cm(2 )will reduce the size of these variations.

Differences in effective dose estimation from dose-area product and entrance surface dose measurements in intravenous urography.

In this study, measurements of dose-area product (DAP) and entrance surface dose (ESD) were carried out in a sample of 25 adult patients who underwent intravenous urography (IVU). These measured quantities were used to estimate the effective dose E from the IVU examination, a quantity closely correlated to radiation risk. Estimating E involves the use of conversion coefficients that have been determined for specific X-ray views in a mathematical phantom. These are obtained under conditions which are not usually met in clinical practice. As a result, the E estimates using the two different measurable quantities can be quite different. Analysis of the calculation procedure suggests that the E estimate using the DAP measurements, in addition to being more practical, could be more accurate than using ESD measurements, as DAP is sensitive to the X-ray field size settings. Furthermore, it is shown that in the absence of the appropriate equipment, a reliable E estimate can be obtained from the ESD calculated using the exposure data for each X-ray view.

O valor da tomografia computadorizada helicoidal sem contraste na avaliação de pacientes com dor no flanco

Os nossos objetivos foram estabelecer a eficácia da tomografia computadorizada sem contraste em diagnosticar a ureterolitíase, calcular a freqüência dos principais sinais tomográficos e medir a concordância interobservador, comparando-a com os resultados obtidos na urografia excretora, realizando estudo prospectivo duplo-cego em 25 pacientes com cólica nefrética. Em ambos os procedimentos avaliamos a existência de aumento renal, hidronefrose e cálculo ureteral. Deste último, descrevemos a sua localização e dimensão. Nos exames de tomografia computadorizada sem contraste procuramos também por estrias perirrenais, edema periureteral e o sinal do halo. Em 23 dos 25 exames de tomografia computadorizada sem contraste (92%) e em 17 das 25 urografias excretoras (68%) houve concordância dos resultados entre os dois observadores. Em 21 dos 25 pacientes os resultados dos dois métodos foram concordantes. Concluímos que a tomografia computadorizada sem contraste apresenta eficácia superponível à urografia excretora na avaliação de pacientes com cólica nefrética, sendo um método reprodutível e sem promover o desconforto do uso do contraste endovenoso.

Sonographic diagnosis of ureteral tumors.

We present our experience with transabdominal ultrasonographic diagnosis of ureteral tumors. During the years 1989 to 1998, 16 patients were diagnosed as having ureteral tumors. These patients were referred for sonographic examination for evaluation of hematuria (seven patients) or flank pain (four patients) or for follow-up screening in patients who were asymptomatic but at high risk for transitional cell carcinoma because of known past bladder tumor (five patients). Ten of these patients underwent intravenous urography examination, three patients had retrograde pyelography, and 11 patients underwent CT scanning. Ultrasonography revealed the ureteral tumors in all 16 patients, which appeared as hypoechoic intraluminal soft tissue. Three tumors were localized in the upper ureter, four in the middle ureter, and nine in the distal ureter. The degree of ureterohydronephrosis was minimal (two cases), mild (five cases), moderate (eight cases), or severe (one case). Eleven tumors caused local widening of the ureteral diameter. On intravenous urography, four patients had a nonfunctioning kidney, three patients had unexplained ureterohydronephrosis, and three patients showed ureteral filling defects, of which only two had irregular contours. On retrograde pyelography, two patients had filling defects (one of which with smooth margins), and one had a truncated ureter. On CT the tumor was clearly demonstrated in only seven patients. We found that ultrasonography can be a useful diagnostic tool in the workup of ureteral tumors.

Maximum Embryo Absorbed Dose from Intravenous Urography: Interhospital Variations

The purpose of this study was to determine the maximum embryo dose during intravenous urography (IVU) examinations, when inadvertent irradiation of a pregnant woman occurs, and to investigate the variation of doses received from different institutions. Doses at average embryo depth from IVU examinations have been measured in four institutions, using a Rando phantom and thermoluminescent crystals. In order to estimate the maximum range of embryo doses, radiologists were asked to carry out examinations with the same technique as in female patients with acute ureterla obstruction. The range of doses estimated at embryo depth for the institutions participating in this study was 5.77 to 35.3 mGy. The considerable interhospital variation found in dose can be explained by different equipment and techniques used. A simple method of estimating embryo dose from pelvic radiographs reported previously was found to be also applicable to IVU examinations. Absorbed dose at 6 cm, the average embryo depth, was found significantly less than 50 mGy.

A comparison of tomography and zonography during intravenous urography

Purpose: Wide angle tomography is used regularly during excretion urography to overcome the problem of bowel shadows obscuring the kidneys. Because Methods: A specially constructed renal phantom was used to establish radiation dose levels for tomography and zonography. Subjective analyses on su Results: Statistical analysis demonstrated that fewer exposuresper intravenous urography examination were necessary for zonography (1.6) compared w Conclusions: This investigation suggests zonography should replace tomography for routine excretion urography with potential benefits for patient d

Dose-area product values in frequently performed complex paediatric radiology examinations.

Mean values of the dose-area product for barium meal, micturating cystourethrography and intravenous urography examinations from three health centres and for four age groups are presented in this study. Values measured are between 13% and 86% higher than results previously reported, which justifies the importance of applying procedures which reduce risks to patients.