RENAL SYSTEM

CYSTOGRAPHY
Anatomy
Radionuclide cystography

 The are 2 forms

 Direct and indirect
 Most commonly used
Direct

 Performed in 3 phases
 Filling of bladder
 Micturation
 Post micturation
Direct
 Done to determine
 Presence or absents of reflux
Normally valve action at ureterovesicular
junction
 Depends on:
 Oblique entry of ureter into bladder
 Adequate length of intramural ureter
 Contraction of ureterotrigonal muscles
 Active ureteral peristalsis
 Reflux associated with UTIs
Radionuclide

 Tc99m Tin colloid

 1mCi
 Other materials
 Catheterization materials
 Saline –warm
 Mixing not recommended
Patient preparation

 Patient voids
 Catheterize patient
 No other special prep
Position

 Patient supine on imaging table

 Camera positioned posteriorly
 Patient symmetrically positioned
 Hands on the side of patient
SET UP:

Dynamic study

 Frame size 128x128

 Frame rate 30s/f
 Total time 60minutes
PROCEDURE:

 Activity introduced
 Full bladder
 When predicted volume achieved
 Patient complains
 Voiding around catheter
 Cessation of passive flow into bladder
 Aseptically remove catheter
 Patient sits on Bedpan/urinal
 Camera positioned posteriorly to include gut and
catheter removed as pt voids.
Results

 Mild activity confine to the ureter

distally -Grade 1-2
 Moderate activity extends to
pelvicalyceal system- Grade 3
 Distended redundant collecting
system - Grade 4-5
Indirect

 It is a combination of a renogram
and direct cystogram