Tractus Urinarius

Plain radiography of the abdominal and pelvic cavity is carried

out to visualize:
• outline of the kidneys, surrounded by their perirenal fat;
• the lateral border of the psoas muscle;
• opaque stones in the kidney area, in the line of the ureters
and in the region of the bladder;
• calcifications within the kidney or in the bladder wall;
• the presence of gas within the urinary tract.

Radiation protection
The ‘pregnancy rule’ should be observed unless permission has
been given to ignore it in the case of emergency. If the whole of
the renal tract including bladder is to be visualized, then no gonad
shielding is possible for females; for males, a lead sheet can be
placed over the lower edge of the symphysis pubis to protect the
testes. If the bladder and lower ureters are not to be included on
the image, then females can also be given gonad protection by
placing a lead-rubber sheet over the lower abdomen to protect
the ovaries. Other methods discussed previously that reduce
radiation dose to the patient should be followed.

Preparation of the patient

If possible, the patient should have a low-residue diet and laxatives
during the 48 hours prior to the examination to clear the
bowel of gas and faecal matter that might overlie the renal tract.
In the case of emergency radiography, no bowel preparation is
possible. The patient wears a clean gown.

Proyeksi AP

Position of patient and cassette

• The patient lies supine on the X-ray table, with the median
sagittal plane of the body at right-angles to and in the midline
of the table.
• The hands may be placed high on the chest, or the arms may
be by the patient’s side and slightly away from the trunk.
• The size of cassette used should be large enough to cover the
region from above the upper poles of the kidneys to the symphysis
pubis (e.g. a 35 x 43-cm cassette).
• The cassette is placed in the Bucky tray and positioned so
that the symphysis pubis is included on the lower part of the
film, bearing in mind that the oblique rays will project the
symphysis downwards.
• The centre of the cassette will be approximately at the level of
a point located 1 cm below the line joining the iliac crests. This
will ensure that the symphysis pubis is included on the image.
• A wide immobilization band is applied to the patient’s
abdomen and, depending on the patient’s condition, compression
is applied. This compression is more effective if a
long pad is placed along the midline under the compression
band before tightening the band.
Direction and centring of the X-ray beam
• The vertical central ray is directed to the centre of the cassette,
which is in the midline about the level of the lower
costal margin in the mid-axillary line. The X-ray beam is
collimated to just within the margins of the cassette.
• Using a high mA and a short exposure time, the exposure is
made on arrested respiration after full expiration.

Notes
• Small opacities overlying the kidney may be inside or outside
the kidney substance. A further radiograph taken on arrested
respiration after full inspiration might show a difference in
extent and direction of movement of the kidney and calcification
lying outside the kidney.
• In some cases it may be necessary to include a collimated
kidney area if the superior renal borders are excluded in the
full-length film.

Additional information about the relationship of opacities to

the renal tract may be obtained with posterior oblique projections.
The right posterior oblique projection shows the right
kidney and collecting system in profile and the left kidney
en face. Similarly, the left posterior oblique projection shows the
left kidney in profile and the right kidney en face.
A lateral projection may be necessary to confirm or otherwise
the presence of opacities anterior to the renal tract, which will
be seen superimposed on the antero-posterior projection.
Proyeksi RPO

Position of patient and cassette

• The patient lies supine on the table. The left side of the trunk
and thorax is raised until the coronal plane is at an angle of
15–20 degrees to the table.
• The patient is moved across the table until the vertebral column
is slightly to the left side of the midline of the table;
then the patient is immobilized in this position.
• For the kidney area alone, a 24 _ 30-cm cassette is placed
transversely in the Bucky tray and centred to a level midway
between the sterno-xiphisternal joint and umbilicus.
• For the whole of the renal tract, a 35 _ 43-cm cassette might be
required; this is centred at the level of the lower costal margin.

Direction and centring of the X-ray beam

• The vertical central ray is directed to the centre of the cassette.

Note
Excessive rotation of the patient will show the right kidney
projected over the spine.
Proyeksi Lateral

Position of patient and cassette

• The patient is turned on to the side under examination, with
the hands resting near the head. The hips and knees are
flexed to aid stability.
• With the median sagittal plane parallel to the table, the
vertebral column (about 8 cm anterior to the posterior skin
surface) is positioned over the midline of the table and an
immobilization band applied.
• The cassette is placed in the tray and, for the kidney area, is
centred to LV1/2, about 5 cm superior to the lower costal
margin.

Direction and centring of the X-ray beam

• The vertical central ray is directed to the centre of the
cassette and the exposure made on arrested expiration.

Alternative Trend lenburg

The Trendelenburg position
(wherein the head end of the
table is
lowered about 15°) provides
some of the same results as
the
compression procedure without
as much risk to the patient
whose
symptoms contraindicate
ureteric compression
PROYEKSI AP IVU

Clinical Indications
• Scout demonstrates abnormal calci cations
that may be urinary calculi.
After injection, the AP projection may
demonstrate signs of obstruction, hydronephrosis,
tumor, or infection.

Technical Factors
• Minimum SID—40 inches (102 cm)
• IR size—35 × 43 cm (14 × 17 inches),
portrait; for a nephrogram—30 × 35 cm
(11 × 14 inches if available), landscape
• Grid
• Analog—70 to 75 kV range
• Digital systems—80 to 85 kV range
• Minute markers where applicable

Shie lding Shield radiosensitive tissues

outside the region of interest.
Patient Position Situate the patient supine,
with a pillow for the head, arms at the sides,
away from the body, and support under the
knees to relieve back strain.

Part Position
• Align midsagittal plane to centerline of table
and to CR.
• Ensure no rotation of trunk or pelvis.
• Include symphysis pubis on bottom of IR without
cutting off
upper kidneys

CR
• CR is perpendicular to IR.
• Center CR and IR to level of iliac crest and to
midsagittal plane.
• Nephrogram: Center CR midway between xiphoid
process and
iliac crest.

Recommended Collima tion Collimate on all four

sides to
anatomy of interest.
Respira tion Suspend respiration after expiration
and expose.
OT : Have patient empty bladder immediately before
beginning the
examination so that contrast medium in the bladder is
not diluted. Explain
procedure and obtain a clinical history before
injecting contrast medium.
Be prepared for possible reaction to the contrast
medium.