Lab Positioning for GU SYSTEM IVP & Cysto & ERCP 2014 revised

IVU /IVP 2014 FOR SERIES NOTES SCOUT (14 X 17) Kidney cone down (11x14) – 1 min or 5 min (upper abd) (KUB with contrast-all 14 X 17) MIN (AP with contrast) RPO/LPO (30º rotation) Special IMAGES: DELAY FILMS (PA /AP/PA) UPRIGHT (1” below IC) – Kidneys & bladder drop POST VOID 2

3 SCOUT 14 X 17 KUB

4 Kidneys “cone down:

5 3 – 5 min film CONE DOWN 1min & 5 min (KIDNEYS) (some may want 1min, 3min, 6min, 9min)

6 1 min blush nephrogram

7 5 minute cone down

8 10 MINUTES – BLADDER NOT YET FULL

9 RPO/LPO taken between 10 – 15 minutes (time marker ?)

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11 RPO

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14 15 min full done AP or PA

15 Additional imaging: Upright – can show mobility of kidneys and bladder (see cysto for more info)

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17 RESIDUAL CONTRAST CHECK WITH RADIOLOGIST MAY WANT ANOTHER POST VOID

18 CYSTOGRAMS & VCUG Indications? CHILDREN ADULT MALE : – AP, OBL’s (30º to 40º rotation) – & LAT FEMALE – AP, OBL’s (40º to 60º rotation) FLUORO OR OVERHEADS

CYSTOGRAMS (only) : (CONE DOWN ON THE BLADDER) FOR FEMALES - 10 X 12 CW – CR 2" above PS (2" below ASIS) Crosswise Perpendicular CR only (no angles) - AP, BOTH OBLIQUES (40-60 degrees) - so just use 40degrees (LATERAL ?) FOR MALES -10 X 12 LW – AP, BOTH OBLIQUES ( degrees) CR centered AT PS For LATERAL only - CR 2" above PS (2" below ASIS) (The book was somewhat confusing - the lateral (pg 222) showing a male patient - is shown as the same centering as for the Female pg but the male information starts on page 223)

VCUG ONLY : VOIDING CYSTO URETHROGRAMS Need to cone down on bladder to include urethra and distal ureters (for reflux) FOR FEMALES & MALES - 11x14 LW – (BUT - cone down as needed for the SIZE of the patient) see page 223 & 224 Perpendicular CR only (no angles) - ONE OBLIQUE (RPO OR LPO) – (40 degrees) TAKE IMAGE WHILE VOIDING - CR CENTERING JUST ABOVE THE PS (PUBIC SYMPHYSIS) FOR BOTH MALE AND FEMALE (you would never use a 14 x 17 for cystograms, unless the refulux went all the way to the kidneys are you were instructed to do so by the Radiologist)

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22 MALE CYSTO AP, RPO, LPO, LAT

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Lateral Cysto 25

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27 FEMALE CYSTO AP, RPO, LPO, ? LAT

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31 Foley balloon seen

32 VCUG

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36 HEPATOBILIARY & the Gall Bladder (GB) RT 124 rev Sp 2010

37 PA SCOUT 14 X 17 or 11 x 14 RUQ - PA OR AP

38 This position will be tested in lab Taken as a scout and post – contrast filling For ERCP

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40

LAO or RPO for RUQ

42 Drainage film

RUQ- RPO