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Contribution of other modalities for pathology

Contribution of other modalities for pathology. Radioisotope scans. US invaluable in assessing kidneys morphology but not renal function Diethylene triamine denta acetic acid (DTPA)=radioactive tracer

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Contribution of other modalities for pathology

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  1. Contribution of other modalities for pathology

  2. Radioisotope scans • US invaluable in assessing kidneys morphology but not renal function • Diethylene triamine denta acetic acid (DTPA)=radioactive tracer • IV injection as bolus to access renal perfusion, pelvicalyceal system dilatation and obstructive uropathy • US images for further data of renal uptake, excretion and drainage, localised areas of poor function

  3. Computer Tomography Cyst • Cysts with complex acoustic characteristic • Further evaluation the calcified wall associate with malignancy • Differentiate cyst from diverticulum as latter fill with contrast • contrast showing parapelvic cyst location

  4. Computer tomography Benign focal renal tumours • Angiomyolipomas with smaller & more echogenic (shadow) than carcinomas • Ability to identify fact content of lesion

  5. Computer Tomography Malignant renal tract masses • Small isoechoic massses miss by US • Equivocal CT scan more sensitive in small lesion detection • CT for staging purposes • Identify primary & other smaller metastases not identified on US

  6. Computer Tomography • Renal tract inflammation • Acute pyelonephritis indistinct between cortex & medullary pyramids for US • CT detect subtle, inflammatory changes • Focal pyelonephritis well demonstrated on CT

  7. Computer Tomography • Tuberculosis & Xanthogranulomatous pyelonephritis • CT demonstrate subtle inflammatory changes affect calyces in early stages • Defferentiate TB from XGP with more sensitive to extrarenal spread of disease

  8. X-ray • CXR demonstrat metastases in lungs • Confirm presence of stones in renal tract (non opaque by US) • Essential adjunct to investigate renal colic in obscured by overlying bowel • More obvious staghorn calculi

  9. IVU • Cyst cause filling defect • Miss small (benign) renal masses • Best to confirmation of cause & identification of exact renal obstruction level • Essential adjunct to investigate renal colic in obscured by overlying bowel

  10. Angiography • Severe stenosis difficult to identify colour flow in kidney • Reduction waveform by velocity with tiny, damped trace • Gold standard for stenosis • Invasive & possibly toxic nature • Only grade & treat after positive US scan

  11. Patient Preparation & Management

  12. Patient Preparation • Wear comfortable, loose-fitting clothing • Eat only fat-free food the evening prior to your examination • Do not eat anything after midnight the night • Following this, drink four 8 oz. glasses of water at one sitting. • Do not empty or bladder again prior to the examination

  13. Patient Management • Procedure takes 30 minutes • Lying down for the procedure • clear, water-based conducting gel to transmission of the sound waves • transducer (probe) move over abdomen • little discomfort, slightly cold and wet with conducting gel • No ionizing radiation exposure

  14. Role of radiographer • Understand bubble physics and instrument settings • Optimizing the image requires a firm understanding of how changing instrument settings will affect the bubble and your image • Understand when contrast is indicated • As the front line user, should initiate the decision to use contrast

  15. Patient Selection • Sonographer is in primary position to identify need for contrast enhancement • Suboptimal endocardial visualization • Suspected intracavitary mass • Order for contrast must originate from physician • Physician approval sought on a case-by-case basis • Standing order may be instituted to decrease overall procedure time and increase patient throughput • Order may come from referring physician

  16. Patient Selection Protocol for Contrast • Patients with limited acoustic windows • Inadequate imaging of 2/6 segments in any single view • Incomplete Doppler velocity profiles • Proper equipment • Harmonics • Mechanical index display and adjustment • Adequate training

  17. Performing a Contrast Ultrasound Study • Obtain physician order • May be a standing order where allowed • Explain procedure to patient • Obtain informed consent if required • Establish IV access • Determine optimal mode of administration • Continuous infusion vs bolus • Optimize equipment settings • Recognize and correct for artifacts • Acquire images

  18. Reference • Bates, Jane A. (2001). Abdominal Ultrasound. London: Churchill Livingstone • Taragin, Benjamin. (2003). Abdominal Ultrasound.Retrieved from http://health.allrefer.com/health/abdominal-ultrasound-info.html

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