Lab Positioning for GU SYSTEM IVP & Cysto & ERCP

1. Lab Positioning for GU SYSTEMIVP & Cysto & ERCP 2014 revised

2. 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) • 10 - 15 MIN (AP with contrast) • RPO/LPO (30º rotation) Special IMAGES: • DELAY FILMS (PA /AP/PA) • UPRIGHT (1” below IC) • Kidneys & bladder drop • POST VOID

3. SCOUT14 X 17KUB

4. Kidneys “cone down:

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

6. 1 min blush nephrogram

7. 5 minute cone down

8. 10 MINUTES – BLADDER NOT YET FULL

9. RPO/LPO taken between10 – 15 minutes (time marker ?)

11. RPO

14. 15 min fulldone AP or PA

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

17. RESIDUAL CONTRAST CHECK WITH RADIOLOGIST MAY WANT ANOTHER POST VOID

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

19. 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 (30 -40 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 221 - but the male information starts on page 223)

20. 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)

22. MALE CYSTOAP, RPO, LPO, LAT C/R @PS

25. Lateral Cysto

27. FEMALE CYSTOAP, RPO, LPO, ? LAT

31. Foley balloon seen

32. VCUG

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

41. LAO or RPO for RUQ

42. Drainage film

43. RUQ- RPO