VCUG (VOIDING CYSTO-URETHROGRAM)
Typical Indication: Usually prior diagnosis of hydronephrosis or ?duplicated collecting system on ultrasound. Want to rule out ureterocele, vesio-uretral reflux, and posterior urethral valves (in male).
Procedure:
PEDIATRIC UPPER GI
Procedure:
Typical Indication: Usually prior diagnosis of hydronephrosis or ?duplicated collecting system on ultrasound. Want to rule out ureterocele, vesio-uretral reflux, and posterior urethral valves (in male).
Procedure:
- pt. should be catheterized by rad RN
- Obtain scout and review
- attach water soluble contrast to the foley catheter tubing, switch the flow off
- image the bladder region, cone down and mag up to see the bladder region
- start filling the bladder with gravity
- take a few shots to document the bladder filling
- wait til the bladder fills to capacity, should see rounded external contour
- every now and then scan above the bladder in the region of the kidneys to document or exclude reflux
- when the bladder is full, do bilateral oblique images of the bladder, ask technologist for help with this. Idea is to image posterior aspects of bladder not seen on frontal AP
- check for reflux again. if see reflux, image the reflux in two planes (ap and some oblique)
- voiding shots, *keep filling the pt and they will spontaneously void around the catheter.
- keep checking for the patient voiding using intermittent fluoro
- when see urethra opening, make sure to document by saving images
- if male, image urethra in the lateral oblique plane to "fillet" out the urethra and exclude posterior urethral valves
- if possible, obtain post void image of the bladder
- Procedure complete
PEDIATRIC UPPER GI
- Typically ordered by outpatient ped. GI doc to evaluate some form of vomiting or "spitting up" complaint by pt / pt caretaker.
- Desire is to rule out obstruction in forms of tracheoesophageal fistula, pyloric stenosis (neonatal gastric outlet obstruction), midgut volvulus / malrotation, duodenal atresia
Procedure:
- Obtain scout film of the abdomen, evaluate the gas pattern
- Use thin barium in nursing bottle to administer to patient
- instruct pt. caretaker to feed patient
- scan esophagus to exclude TEF
- scan stomach filling
- want to fill and distend stomach
- typically there will be some time for the stomach to empty
- want to set up so you can "catch" the duodenal sweep as it comes around in a "C loop"
- When see the contrast coming around 4th position of duodenum, take some images in the right lateral position to document posterior pre spinal position of the duodenum (normal anatomy)
- Take some delayed fluoro grabs to document jejunal loops (proximal loops should be to the left of midline)
- Check for reflux: clear esophagus of barium, then shift pat. from R lat to L lat, back and forth approx 7-10 times, then image esophagus (DB method)
- see if barium comes back up into esophagus
- Procedure complete