Defecography

Defecography uses an X-ray to look at the shape and position of the rectum as it empties.
The anal canal is lubricated and a soft plastic tip is inserted through the anal canal into the
rectum. The rectum and anal canal are filled with barium paste and the tip is removed.

X-ray dye is placed in the urinary bladder and the vagina. The person drinks barium about
one hour before the test so the small intestine shows up. This way everything in the pelvis
can be seen when the person strains.

The person sits on a toilet-like seat, called a defecography chair, which is attached to the
X-ray table. The table is tilted into the upright position. The person puts their elbows on
their knees. The person is asked to squeeze, to push and to empty the rectum. The X-ray of
these maneuvers is recorded on videotape.

Defecography shows the rectum as it empties. Defecography reveals rectoceles and signs
of rectal descent. In women with rectal descent, there is more rectal length down in the
bottom three inches of the pelvis.

A normal rectum should empty in just a few seconds. In rectal descent it may take 30, 60 or
even 90 seconds to empty, and the rectum may not empty completely. The lower end of the
rectum may close before the upper rectum is empty (flap valving).

People with a tight internal anal sphincter have a big bowl-shaped rectum that empties
slowly through a narrow, short anal opening that never opens up.

People with non-relaxing puborectalis muscles have rectums that do not empty because the
pelvic floor muscles do not relax.

Defecography findings of rectal descent are:

 Rectocele
 Horizontal rectum during push
 Delayed or incomplete rectal emptying
 Delayed or incomplete rectocele emptying
 Rectum protruding into anal canal
 Long rectum in the bottom three inches of the pelvis

Cystography is a fluoroscopic study that images the bladder. It is similar to a voiding

cystourethrogram (VCUG), and the difference between the studies is primarily one of emphasis;

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a cystogram focuses on the bladder and a VCUG focuses on the posterior urethra. The study has
been adapted to CT as a CT cystogram.

Indications
 dysfunctional voiding
 bladder outlet obstruction
 hematuria
 trauma
o fluoroscopic and CT cystography are considered equivalent in the emergent setting 3
 congenital anomalies of the genitourinary tract
 postoperative evaluation of the urinary tract

Procedure

Technique
 insert Foley catheter in bladder, or use an indwelling Foley or suprapubic catheter
 introduce water soluble contrast through the catheter (such as Isovue-300 or Cystografin)
 if looking for a bladder leak after trauma, fill to detrusor contraction or to at least 300 mL
 if looking for a postoperative injury, then fill to a smaller volume (~100-150 mL or until
resistance is felt
 avoid overfilling, so as not to blow out an anastomotic suture
 to try to ensure a detrusor contraction, try to have the patient void, if possible
The following projections should be acquired keeping within the ALARA principle:

 AP scout image
 AP early filling images (if injury or postoperative evaluation, focus on those areas)
 AP and steep obliques of the bladder (try to include the area of where the UVJ would be)
 post-void radiograph
A double contrast cystography (pneumocystography) variation on the standard cystogram is
possible, but is very uncommonly performed.

Retrograde urethrogram (RUG)

A retrograde urethrogram (RUG) is a diagnostic procedure performed most commonly in male

patients to diagnose urethral pathology such as trauma to the urethra or urethral stricture.

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Introduction

Urethrography is most commonly performed via the retrograde injection of radiopaque contrast
into the urethra to elucidate urethral pathology such as rupture of the urethra from trauma or
urethral stricture. It is a commonly used procedure in reconstructive urology for operative
planning as well as a follow-up procedure after urethral reconstruction

What is Hysterosalpingography?
Hysterosalpingography, also called uterosalpingography, is an x-ray examination of a
woman's uterus and fallopian tubes that uses a special form of x-ray called fluoroscopy and
a contrast material.
An x-ray (radiograph) is a noninvasive medical test that helps physicians diagnose and treat
medical conditions. Imaging with x-rays involves exposing a part of the body to a small dose
of ionizing radiation to produce pictures of the inside of the body. X-rays are the oldest and most
frequently used form of medical imaging.
Fluoroscopy is a special x-ray technique that makes it possible to see internal organs in motion.
During a hysterosalpingogram, the uterus and fallopian tubes are filled with a water-soluble
contrast material and the radiologist is able to use fluoroscopy to view and assess their anatomy
and function.

What are some common uses of the procedure?

Hysterosalpingography is primarily used to examine women who have difficulty becoming
pregnant by allowing the radiologist to evaluate the shape and structure of the uterus, the
openness of the fallopian tubes, and any scarring within the uterine or peritoneal (abdominal)
cavity.
The procedure can be used to investigate repeated miscarriages that result from congenital or
acquired abnormalities of the uterus and to determine the presence and severity of these
abnormalities, including:

 Tumor masses
 Adhesions
 Uterine fibroids

Hysterosalpingography is also used to evaluate the openness of the fallopian tubes, and to
monitor the effects of tubal surgery, including:

 Blockage of the fallopian tubes due to infection or scarring

 Tubal ligation
 The closure of the fallopian tubes in a sterilization procedure and a sterilization reversal
 The re-opening of the fallopian tubes following a sterilization or disease-related blockage

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 ADVANTAGES OF CT SCAN
 There are several advantages that CT has over traditional 2D medical radiography. First,
CT completely eliminates the superimposition of images of structures outside the area of
interest. Second, because of the inherent high-contrast resolution of CT, differences
between tissues that differ in physical density by less than 1% can be distinguished.
Finally, data from a single CT imaging procedure consisting of either multiple contiguous
or one helical scan can be viewed as images in the axial, coronal, or sagittal planes,
depending on the diagnostic task. This is referred to as multiplanar reformatted imaging.
 CT is regarded as a moderate- to high-radiation diagnostic technique. The improved
resolution of CT has permitted the development of new investigations, which may have
advantages; compared to conventional radiography, for example, CT angiography avoids
the invasive insertion of a catheter. CT colonography (also known as virtual
colonoscopy or VC for short) is far more accurate than a barium enema for detection of
tumors, and uses a lower radiation dose. CT VC is increasingly being used in the UK and
US as a screening test for colon polyps and colon cancer and can negate the need for
a colonoscopy in some cases.
 The radiation dose for a particular study depends on multiple factors: volume scanned,
patient build, number and type of scan sequences, and desired resolution and image
quality. In addition, two helical CT scanning parameters that can be adjusted easily and
that have a profound effect on radiation dose are tube current and pitch. Computed
tomography (CT) scan has been shown to be more accurate than radiographs in
evaluating anterior interbody fusion but may still over-read the extent of fusion.

DISADVANTAGES
Cancer

The radiation used in CT scans can damage body cells, including DNA molecules, which can
lead to radiation-induced cancer. The radiation doses received from CT scans is variable.
Compared to the lowest dose x-ray techniques, CT scans can have 100 to 1,000 times higher
dose than conventional X-rays. However, a lumbar spine x-ray has a similar dose as a head
CT. Articles in the media often exaggerate the relative dose of CT by comparing the lowest-dose

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x-ray techniques (chest x-ray) with the highest-dose CT techniques. In general, the radiation dose
associated with a routine abdominal CT has a radiation dose similar to 3 years average
background radiation (from cosmic radiation).

Some experts note that CT scans are known to be "overused," and "there is distressingly little
evidence of better health outcomes associated with the current high rate of scans."

Early estimates of harm from CT are partly based on similar radiation exposures experienced by
those present during the atomic bomb explosions in Japan after the Second World War and those
of nuclear industry workers. Some experts project that in the future, between three and five
percent of all cancers would result from medical imaging.

An Australian study of 10.9 million people reported that the increased incidence of cancer after
CT scan exposure in this cohort was mostly due to irradiation. In this group one in every 1800
CT scans was followed by an excess cancer. If the lifetime risk of developing cancer is 40% then
the absolute risk rises to 40.05% after a CT.

Some studies have shown that publications indicating an increased risk of cancer from typical
doses of body CT scans are plagued with serious methodological limitations and several highly
improbable results, concluding that no evidence indicates such low doses cause any long-term
harm.

A person's age plays a significant role in the subsequent risk of cancer. Estimated lifetime cancer
mortality risks from an abdominal CT of a 1-year-old is 0.1% or 1:1000 scans. The risk for
someone who is 40 years old is half that of someone who is 20 years old with substantially less
risk in the elderly. The International Commission on Radiological Protection estimates that the
risk to a fetus being exposed to 10 mGy (a unit of radiation exposure, see Gray (unit)) increases
the rate of cancer before 20 years of age from 0.03% to 0.04% (for reference a CT pulmonary
angiogram exposes a fetus to 4 mGy). A 2012 review did not find an association between
medical radiation and cancer risk in children noting however the existence of limitations in the
evidences over which the review is based.

CT scans can be performed with different settings for lower exposure in children with most
manufacturers of CT scans as of 2007 having this function built in. Furthermore, certain

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conditions can require children to be exposed to multiple CT scans. Studies support informing
parents of the risks of pediatric CT scanning.