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Hysterosalpingography Hysterosalpingography, also called uterosalpingography, is an x-ray examination of a woman s uterus and fallopian tubes that uses.

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Presentation on theme: "Hysterosalpingography Hysterosalpingography, also called uterosalpingography, is an x-ray examination of a woman s uterus and fallopian tubes that uses."— Presentation transcript:

1 Hysterosalpingography Hysterosalpingography, also called uterosalpingography, is an x-ray examination of a woman s uterus and fallopian tubes that uses a special form of x- ray called fluoroscopy and a contrast material.

2 History For the first HSG Carey used collergol in Lipiodol was introduced by Sicard and Forestier in 1924 and remained a popular contrast medium for many decades.Lipiodol Later, water-soluble contrast material was generally preferred as it avoided the possible complication of oil embolism.

3 common uses of the procedure The uterus : Shape, cavity, fibroids and adhesions. The cervix : Shape, canal and incompetence. Fallopian tubes : Shape, canal and patency.

4 preparation After menstruation but before ovulation. Exclude pregnancy. Exclude infections : PID, STD and vaginal discharges. Avoid constipation & gaseous bowel distension.

5 preparation Analgesia and antibiotic prior to or after the procedure may be given. History of any recent illnesses, medications or allergies, especially to barium or iodinated contrast materials. Sensitive remove of some or all of patient clothes and to wear a gown during the exam. Remove jewelry, eye glasses and any metal objects or clothing that might interfere with the x-ray images

6 preparation Aseptic conditions Speculum is inserted into the vagina,the cervix is cleansed. VW canula or a catheter is then inserted into the cervix. The speculum is removed and the patient is carefully situated underneath the fluoroscopy device. Plain film to be taken The contrast material then begins to fill the uterine cavity( ~9 ml), fallopian tubes and peritoneal cavity through the catheter Fluoroscopic images are taken (2-3 films). Delayed films after 30 minutes can be taken

7 What will patient experience during and after the procedure? This exam should cause only minor discomfort. There may be slight discomfort and cramping when the catheter is placed and the contrast material is injected, but it should not last long. There may also be slight irritation of the peritoneum, causing generalized lower abdominal pain, but this should also be minimal and not long lasting. Most women experience vaginal spotting for a few days after the examination, which is normal.

8 Complications Complications of the procedure include Radiation effect infection, infection allergic reactions to the materials used,allergic intravasation of the material, intravasation and, if oil-based material is used, embolisation. embolisation

9 Oil based and water based contrasts The dye is urograffin ( same used in IVP/IVU). Oil based can open a mucus pulg, less infection, but more pain and extravasation

10 Saline sonogram Use ultrasound and no risk for ionizing radiation. Spillage in the peritoneal cavity can be seen, but from which tube cannot be determined

11 Who interprets the results A radiologist is best, but referring gynecologist interested in infertility can do also

12 A normal hysterosalpingogram

13 Normal HSG A normal result shows the filling of the uterine cavity and the bilateral filling of the fallopian tube with the injection material. To demonstrate tubal patency spillage of the material into the peritoneal cavity needs to be observed.peritoneal cavity

14 Normal HSG

15 Intrauterine polyps

16 Blocked distal ends

17 Huge uterine fibroid

18 Unilateral blockage and adhesions


20 Asherman Syndrome

21 Distal Bilateral Blocked Tubes










31 Magnetic resonance imaging Magnetic resonance imaging (MRI), or nuclear magnetic resonance imaging (NMRI), is primarily a medical imaging technique most commonly used in radiology to visualize detailed internal structure and limited function of the body.medical imagingradiology

32 MRI MRI provides much greater contrast between the different soft tissues of the body than computed tomography (CT) does, making it especially useful in neurological (brain), musculoskeletal, cardiovascular, and oncological (cancer) imaging.contrast computed tomographyneurological musculoskeletalcardiovascular oncological Unlike CT, it uses no ionizing radiation, but uses a powerful magnetic field.ionizing radiationmagnetic

33 History Magnetic resonance imaging is a relatively new technology. The first MR image was published in 1973 and the first cross-sectional image of a living mouse was published in January 1974 The first studies performed on humans were published in 1977 X-rayX-ray By comparison, the first human image was taken in 1895

34 2003 Nobel Prize Reflecting the fundamental importance and applicability of MRI in the medical field, Paul Lauterbur of the University of Illinois at Urbana- Champaign and Sir Peter Mansfield of the University of Nottingham were awarded the 2003 Nobel Prize in Physiology or Medicine for their "discoveries concerning magnetic resonance imaging".Paul LauterburUniversity of Illinois at Urbana- ChampaignSir Peter Mansfield University of NottinghamNobel Prize in Physiology or Medicine

35 Modern 3 tesla clinical MRI scanner.tesla

36 Applications In clinical practice, MRI is used to distinguish pathologic tissue (such as a brain tumor) from normal tissue. brain tumor While CT provides good spatial resolution (the ability to distinguish two structures an arbitrarily small distance from each other as separate),spatial resolution MRI provides comparable resolution with far better contrast resolution (the ability to distinguish the differences between two arbitrarily similar but not identical tissues).contrast resolution

37 MRI versus CT A computed tomography (CT) scanner uses X- rays, a type of ionizing radiation, MRI, on the other hand, uses non-ionizing radio frequency (RF) signals to acquire its imagescomputed tomographyX- raysionizing radiationradio frequency CT may be enhanced by use of contrast agents containing elements of a higher atomic number than the surrounding flesh such as iodine or barium. Contrast agents for MRI are those which have paramagnetic properties, e.g. gadolinium and manganese.contrast agentsiodine bariumparamagneticgadoliniummanganese Both CT and MRI scanners can generate multiple two-dimensional cross-sections (slices) of tissue and three-dimensional reconstructions.

38 MRI versus CT MRI can generate cross-sectional images in any plane (including oblique planes).plane In the past, CT was limited to acquiring images in the axial (or near axial) plane. The scans used to be called Computed Axial Tomography scans (CAT scans). However, the development of multi- detector CT scanners with near-isotropic resolution, allows the CT scanner to produce data that can be retrospectively reconstructed in any plane with minimal loss of image quality.isotropic

39 MRI versus CT For purposes of tumor detection and identification in the brain, MRI is generally superior. However, in the case of solid tumors of the abdomen and chest, CT is often preferred due to less motion artifact. Furthermore, CT usually is more widely available, faster, less expensive, and may be less likely to require the person to be sedated or anesthetized. MRI is also best suited for cases when a patient is to undergo the exam several times successively in the short term, because, unlike CT, it does not expose the patient to the hazards of ionizing radiation.

40 How MRI works The body is largely composed of water molecules which each contain two hydrogen nuclei or protons.largely composed of water moleculeshydrogen nucleiprotons When a person goes inside the powerful magnetic field of the scanner, the magnetic moments of these protons align with the direction of the field. magnetic fieldmagnetic moments A radio frequency electromagnetic field is then briefly turned on, causing the protons to alter their alignment relative to the field. When this field is turned off the protons return to the original magnetization alignment. These alignment changes create a signal which can be detected by the scanner.

41 How MRI works Diseased tissue, such as tumors, can be detected because the protons in different tissues return to their equilibrium state at different rates.tumors By changing the parameters on the scanner this effect is used to create contrast between different types of body tissue. Contrast agentsContrast agents may be injected intravenously to enhance the appearance of blood vessels, tumors or inflammation.intravenouslyblood vessels tumorsinflammation Contrast agents may also be directly injected into a joint in the case of arthrograms, MR images of joints.

42 ionizing radiation MRI uses no ionizing radiation and is generally a very safe procedure.ionizing radiation Ionizing radiation consists of subatomic particles or electromagnetic waves that are energetic enough to detach electrons from atoms or molecules, ionizing them.subatomicparticleselectromagnetic waveselectronsatoms moleculesionizing Examples are : radio wavesradio waves, microwaves, terahertz radiation, infrared radiation, visible light, ultraviolet radiation, X-rays and gamma rays.microwavesterahertz radiation infrared radiationvisible lightultraviolet radiationX-raysgamma rays

43 Safety issues Safety issues, including the potential for bio stimulation device interference, movement of ferromagnetic bodies, and incidental localized heating, have been addressed in 2002 and expanded in 2004.

44 Economics of MRI MRI equipment is expensive. 1.5 tesla scanners often cost between $1 million and $1.5 million USD. 3.0 tesla scanners often cost between $2 million and $2.3 million USD. Construction of MRI suites can cost up to $500,000 USD, or more, depending on project scope. Even though it is of cost effective benefit and insurance companies cover its use.

45 Indications MRI is used to image every part of the body, and is particularly useful for neurological conditions, for disorders of the muscles and joints, for evaluating tumors, and for showing abnormalities in the heart and blood vessels.

46 Pregnancy & MRI No effects of MRI on the fetus have been demonstrated. In the 1 st trimester the fetus may be more sensitive to the effects particularly to heating and to noise. contrast agents; gadolinium compounds are known to cross the placenta and enter the fetal bloodstream and should be avoided.gadolinium MRI without contrast agents is the imaging mode of choice for pre-surgical, in-utero diagnosis and evaluation of fetal tumors, primarily teratomas,teratomas

47 Contrast agents Most coomoly used are chelates of gadoliniumchelatesgadolinium More safer than iodinted contrast in x-rays and CT. Less nephrotoxic. Rare anaphylactic shock. Rare renal fibrosis. Recently a new contrast agent named gadoxetate, with less side effects. gadoxetate

48 Claustrophobia the fear of having no escape and being closed in. Nervous patients may still find the following strategies helpful: Advance preparation visiting the scanner to see the room and practice lying on the table visualization techniques chemical sedation general anesthesia For babies and young children chemical sedation or general anesthesia are the norm, as these subjects cannot be instructed to hold still during the scanning session general anesthesia Alternative scanner designs, such as open or upright systems, can also be helpful where these are available. Though open scanners have increased in popularity, they produce inferior scan quality Coping while inside the scanner holding a "panic button" closing eyes as well as covering them (e.g. washcloth, eye mask) listening to music on headphones or watching a movie with a Head-mounted display while in the machineHead-mounted display Scan Rooms with lighting, sound and images on the wall. Some rooms come with images on the walls or ceiling.

49 Implants and foreign bodies Pace makers Prosthestic metallic valves Aneurysm clips Surgical prosthesis Cochlear and eye implants. Copper IUCD

50 discomfort Obese patients and pregnant women may find the MRI machine to be a tight fit. Pregnant women may also have difficulty lying on their backs for an hour or more without moving.

51 Acoustic noise Acoustic noise associated with the operation of an MRI scanner can also exacerbate the discomfort associated with the procedure. Acoustic noise

52 Peripheral nerve stimulation (PNS) The rapid switching on and off of the magnetic field gradients is capable of causing nerve stimulation. Volunteers report a twitching sensation when exposed to rapidly switched fields,










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