1 / 18

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

kay
Download Presentation

Contribution of other modalities for pathology

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  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

More Related