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The kidneys & ureters are located in the ___ space Retroperitoneal The ___ glands are located directly superior to the kidneys Suprarenal (Adrenal) glands The structures that create a 20 angle between the upper pole & lower pole of kidney Psoas Major muscles The specific namefor the mass of fat that surrounds each kidney Perirenal fat or adipose capsule The degree of rotation from supine that is required to place the kidneys parallel to the IR 30 2 Landmarks that can be palpated to locate the kidneys xiphoid process and iliac crest The term that describes an abnormal drop of the kidneys when the patient is placed erect nephroptosis 3 functions of the urinary system 1. remove nitrogenous waste 2. regulate water levels 3. Regulate acid base balance A buildup of nitrogenous waste in blood Uremia The longitundinal fissure found along the central medial border of the kidney Hilum The peripheral or outer portion of the kidney Cortex The term that describes the total functioning portion of the kidney Renal parenchyma The microscopic functional & structural unit of the kidney Nephron The structure of the medulla that is made up of a collection of tubules that drain into the minor calyx Renal pyramids Another name for the glomerular capsule Bowman's capsule TRUE or FALSE: The glomerular capsule & proximal & distal convoluted tubules are located in the medulla of the kidney FALSE, Cortex TRUE or FALSE: The efferent aterioles cary blood to the glomeruli FALSE, afferent Name structures located in the cortex of the kidney (hint: 5) Distal & proximal convoluted tubule, Glomerular capsule, Afferent & Efferent arterioles Name structures located in the medulla of the kidney (hint: 4) Loop of henle, Descending & Ascending limb, Collecting tubule 2 processes that move urine through the ureters to the bladder Perisalsis and Gravity The structure that is located more anterior as compared with the others Urinary Bladder The name of the junction found between the distal ureters & urinary bladder ureterovesical junction The name of the inner, posterior region of the bladder formed by the 2 ureters entering & the urethra exiting Trigone The name of the small gland found just inferior to the male bladder Prostate Gland The total capacity for the average adult bladder 350 to 500 ml The structure that considered to be most posterior Kidneys 2 ways intravenous contrast media is administered 1. Bolus injection 2. Drip infusion TRUE or FALSE: The patient must sign an informed consent form before a venipuncture procedure is performed on a pediatric patient TRUE For most IVUs, veins in the ___ are recommended for venipuncture Antecubital Fossa The most common size of needle used for bolus injections on adults 18 to 22 gauge 2 most common types of needles used for bolus injection of contrast media 1. Butterfly 2. Over the needle catheter TRUE or FALSE: The bevel of the needle needs to be facing downward during the actual puncture into a vein FALSE, upward TRUE or FALSE: If extravasation occurs during the puncture, the tech should slightly retract the needle & then push it forward again FALSE, needle should be withdrawn and pressure applied TRUE or FALSE: If unsuccessful during the intial puncture, a new needle should be used during the second attempt TRUE TRUE or FALSE: The radiologist is responsible for documenting all aspects of the venipuncture procedure in the patient's chart FALSE, the person who performs it is responsible Name the iodinated contrast media from the charactertistics listed: Uses a parent compound of a benzoic acid; creates a hypertonic condition in the blood plasma; Poses a greater risk for disruptiing homeostasis, may increase the severity of side effects Ionic Name the iodinated contrast media from the characteristics listed: Doesn't significantly increas osmolality in blood plasma; is more expensive; is near a isotonic solution; uses a parent compound of an amide or glucose group Nonionic Name the first 3 steps of a venipuncture procedure in order 1. Wash hands and put on gloves 2. Select site, apply tourniquet & cleanse the site 3. Initiate puncture Name the last 3 steps of a venipuncture procedure in order 4. Confirm entry and secure needle 5. Prepare and proceed with injection 6. needle or catheter removal The compound is a common anion in ionic contrast media Diatrizoate or iothalamate Any disruption in the physiological functions of the body that may lead to a contrast media reaction is the basis for this theory Chemotoxic theory The normal creatinine level of an adult 0.6 to 1.5 mg/dl Normal BUN levels for an adult 8 to 25 mg/100 ml Metformin hydrochloride is taken for this condition Diabetes mellitus Metformin should be withheld for ___ hours following a conttrast media procedure (Hint: Think Eddie Murphy movie) 48 hours 4 general categories of contrast media reactions 1. mild 2. moderate 3. severe 4. organ specific This type of reaction is a true allergic response to iodinated contrast media Anaphylactic reaction This type of reaction is due to the stimulation of the vagus nerve by introduction of contrast media, which causes heart rate & bp to fall Vasovagal reaction TRUE or FALSE: Vasovagal reactions are not considered to be life threatening FALSE TRUE or FALSE: Acute renal failure may occur 48 hours following an iodinated contrast media procedure TRUE Hypersensitivity to iodinated contrast media, Anuria, multiple myeloma, diabetes mellitus, sever hepatic renal disease, congestive hear failure, pheochromocytoma, patient taking metformin, renal failure, acute or chronic are contraindications of what? Contraindications that may prevent from having a contrast media procedure performed List symptoms for a mild reaction to contrast media Lightheadedness, mild hives List symptoms for a moderate reaction to contrast media Tachycardia, angioedema List symptoms for a severe reaction to contrast media Brachycardia, hypotension, Laryngeal swelling, cardiac arrest List symptoms for a Organ specific reaction Anuria TRUE or FALSE: Mild level contrast media reactions do not usually require medication or medical assistance TRUE TRUE or FALSE: Urticaria is the formal term for excessive vomiting FALSE, hives The leakage of contrast media from a vessel into the surrounding tissues Extravasation A temporary failure of the renal sytem is this type of reaction Organ specific An expected outcome to the introduction of contrast media side effect Name the symptoms that represent normal Side effects Metallic taste, temporary hot flash Name the symptoms that represent the mild level reaction Itching, vomiting Name the symptoms that represent the moderate level reaction Angioedema, Severe urticaria (hives) Name the symptoms that represent the Severe level reaction Convulsions, Bradycardia, respiratory arrest Name the symptoms that represent the Organ specific reaction Pulmonary edema, extravasation Situation: What should the tech do first when a patient is experiencing either a moderate or a severe level contrast media reaction? Call for medical assistance The primary purpose of the premedication procedure before an iodinated contrast media procedure To reduce the severity of contrast reactions The drug that often given to the patient as part of the premedication procedure Combination of benadryl & prednisone The type of patient that is likely a candidate for the premedication procedure before a contrast media study Asthmatic patient Situation: In addition to notifying a nurse or physician when contrast media has extravasated into the soft tissues, what should the tech first do to increase reabsorption? Elevate the affected extremity TRUE or FALSE: Tissue inflammation from extravasted contrast media peaks 1 to 2 hours following the incident FALSE, 24 to 48 hours The term IVP is incorrect in a radiographic exam of the kidneys, ureters & bladder follwoing intravenous injection of contrast media because of this reason IVP is a study of the renal pelvis The correct term & abbreviation for the exam of the kidneys, ureters, and bladder Intravenous Urogram, IVU Specific aspect of the kidney that is visualized during an IVU Collecting system of the kidney Common pathologic indication for an IVU Hematuria Rare tumor of the kidney pheochromocytoma Passage of large volume of urine Polyuria Presence of glucose in urine Glucosuria Excess urea & creatinine in the blood Uremia Diminished amount of urine being excreted Oliguria Presence of gas in urine Pneumouria Indicated by presence of uremia, oliguria or anuria Acute renal failure Constant or frequent involuntary passage of urine Urinary incontinence Backward return flow of urine Urinary Reflux Absence of a functioning kidney Renal agenesis Complete cessation of urinary secretion Anuria Act of voiding Micturition Inability to void Retention Enlargement of the prostate gland Benign prostatic hyperplasia Fusion of the lower poles of kidneys during the development of the fetus Horsehoe kidney Inflammation of the capillary loops of the glomeruli of the kidneys Glomerulonephritis Artificial opening between the urinary bladder & aspects of the large intestine Vesicorectal fistula A large stone that grows & completely fills the renal pelvis Staghorn calculus Increased blood pressure to the kidneys due to atherosclerosis Renal hypertension Normal kidney that fails to ascend into the abdomen but remains in the pelvis Ectopic kidney Multiple cysts in 1 or both kidneys Polycystic kidney disease Rapid excretion of contrast media Renal hypertension Mucosal changes within bladder Cysitis Bilateral, small kidneys with blunted calyces Chronic Bright Disease Irregular appearance of renal parenchyma or collecting sytem Renal cell carcinoma Signs of abnormal fluid collections Vesicorectal fistula Abnormal rotation of the kidney Malrotation Elevated or indented floor of bladder BPH Signs of obstruction of urinary system Renal calculi A condition characterized by regions or areas of subcutaneous swelling due to allergic reaction to food or drugs Angioedema Contraction of the muscles within the walls of the bronchi & bronchioles, producing a restriction of air passing through them Bronchospasm Loss of consciousness due to reduced cerebral blood flow Syncope Trademark name for a diuretic drug Lasix An eruption of wheals (hives) often due to a hypersensivity to food or drugs Urticaria TRUE or FALSE: The patient should void before an IVU to prevent possible rupture of the bladder if compression is applied TRUE Primary purpose of ureteric compression Enhance filling of the pelvic/renal system with contrast media 6 conditions that could contraindicate the use of ureteric compression 1. Possible ureteric stones 2. Abdominal masses 3. Abdominal aneurysm 4. Recent abdominal surgery 5. Severe abdominal pain 6. Acute abdominal trauma The time when for the IVU exam to start At start of injection of contrast media 5 step imaging sequence for a routine IVU 1. 1 minute nephrogram 2. 5 minute full KUB 3. 10 to 15 minute full KUB 4. 20 minute posterior R & L obliques 5. Postvoid prone PA or erect AP Primary difference between a standard & a hypertensive IVU Shorter time between projections The department where most retrograde urograms are performed Surgery TRUE or FALSE: A retrograde urogram exames the anatomy & function of the pelvicalyceal system FALSE, Nonfunctional TRUE or FALSE: The Brodney clamp is used for male and female retrograde cystourethrograms FALSE, males only These procedures involves a direct introduction of the contrast media into the structure being studied 1. Retrograde urogram 2. Retrograde cystogram 3. Retrograde urethrogram The alternative imaging modality that is NOT routinely being used to diagnose renal calculi MRI TRUE or FALSE: Urinary studies on pediatric patients should be scheduled early in the morning to minimize the risk for dehydration TRUE TRUE or FALSE: Nuclear medicine is highly effective in demonstrating signs of vesicoureteral reflux TRUE TRUE or FALSE: The number of retrograde urography procedures for urethral calculi has been reduced as a result of the increased use of CT TRUE Situation: Who should the tech contact if he or she has difficulty placing the needle into the vein of a pediatric patient during an IVU? A phlebotomist or physician TRUE or FALSE: The patient does not require extensive bowel preparation before a CT scan for renal calculi TRUE The imaging modality that is used to detect subtle tissue changes following a renal transplant MRI 4 reasons a scout preparation is taken before the injection of contrast media for an IVU 1. Verify Patient preparation 2. Determine whether expsoure factors are acceptable 3. Verify positioning 4. Detect any abdominal calcifications kV range that is recommended for an IVU 70 - 75 kV The ionzation chambers that should be activated for an AP scout projection Upper Right and Left ionization chambers TRUE or FALSE: Both the female midline dose & the female gonadal dose for an average unshielded AP projection for an IVU are in the 100 to 200 mrad range FALSE TRUE or FALSE: Male and female patients should have the gonads shielded for an AP scout projection FALSE, males only TRUE or FALSE: Tomograms taken during an IVU with an exposure angle of 10 or less are called zonography TRUE The stage of an IVU where the renal parenchyma are best seen Within 1 minute following injection The number of tomograms (zonograms) are usually produced during a routine IVU 3 The specific position, taken during an IVU, that will place the left kidney parallel to the IR RPO The amount of obliquity that is required for the LPO/RPO projections taken during an IVU 30 The position that will best demonstrate possible nephroptosis Erect How An enlarged prostate gland will appear on a postvoid radiograph taken during an IVU Prostate gland will indent the floor of the bladder The pneumatic paddle will be placed in this location for the ureteric compression phase of an IVU Just medial to the ASIS and lateral to the spine, placed over the outer pelvic brim Specific anatomy that is examined during a retrograde ureterogram Primarily the ureters A retrograde pyelogram is primarily a nonfunctional study of this structure Renal pelvis CR angle is used for the AP projection taken during a cystogram 10 to 15 caudad TRUE or FALSE: For a lateral cystogram, both the male & female does are in the 100 mrad range TRUE Specific position that is recommended for a male patient during a voiding cystourethrogram 30 degree RPO Situation: A radiograph of an AP scout projection of the abdomen, taken during an IVU, reveals that the symphysis pubis is cut off slightly. The patient is too large ot include the entire abdomen on a 35 x 43 cm IR. What should the Tech do? Second bladder shot using a small IR, crosswise. Larger IR centered 1 or 2 inches higher to include upper Abdomen Situation: A nephrogram is ordered as part of an IVU study. When the nephrogram image is processed, there is a minimal amount of contrast media within the renal parenchyma & the calyces are beginning to fill with contrast. What is the problem? Too long of a delay between shots Situation: A 45 RPO radiograph taken during an IVU reveals that the left kidney is foreshortened. What modification is needed to fix this on the repeat? Decrease RPO to 30 instead of 45 Situation: An AP projection taken during the compression phase of an IVU reveals that the majority of the contrast media has left the collecting system of the kidneys. The tech placed the pneumatic paddles near the umbilicus & ensured that they were inflated. What can be improved? Place pneumatic paddles just medial to ASIS to allow compression of distal ureters against brim Situation: An AP axial projection radiograph taken during an cystogram reveals tah the floor of the bladder is supeimposed over the symphysis pubis. What can the tech do to fix this? Increase caudad angle 10 to 15 Situation: A patient comes to the radiology department for an IVU. While taking the clinical history, the tech learns the patient has renal hypertension. How must the tech modify the IVU imaging sequence to fit the patient's condition? Decrease time between projections Situation: A patient comes to the radiology department for an IVU. The AP scout reveals an abnormal density near the L-Spine that the radiologist suspects is an abdominal aortic aneurysm. What should the tech do about the ureteric compression phase of the study that is part of the procedure protocol? Do not perform it Situation: A patient comes to the radiology department for an IVU. The patient history indicates that he may have an enlarged prostate gland. Which projection will best demonstrate this condition? Erect prevoid AP Situation: A patient with a history of bladder calculi comes to the radiology department. A retrograde cystogram has been ordered. During the interview, the patient reports that had a severe reaction to contrast media in the past. What other imaging modality can be performed to best diagnose this condition? Ultrasound, CT, NM Situation: The patient has a calculi in the kidney. What is the preferred imaging modality for this situation when iodinated contrast media cannot be used? CT and NM Situation: A patient comes to the radiology department for an IVU. As the patient's clinical history is being reviewed it is discovered that he is diabetic. What additional questions should the patient be asked during the interview before this procedure? If patient is taking metformin, if yes, document it Situation: During an IVU, the patient complains of a metallic taste & has a sudden urge to urinate. What action should the tech take? No medical treatment required. Tell patient is is a normal reaction Situation: While reviewing the chart of a patient scheduled for a IVU, the tech discovers that the BUN of the patient is 15 mg/100 ml with a creatinine level of 1.3 mg/dl. Can this patient safely undergo an IVU? Both levels are normal, continue exam