Chap2N X-ray KUB, RGU MCUG

• 2 days before examination – soft diet
• 1 day before examination, take 3 dulcolax tab at 1pm and 8pm
• Fasting at least 6 hours before examination

• True AP ( no rotation )
• spinous process aligned with midline of vertebra column
• distance pedicles to spinous process same ( both side )
• sacrum center & aligned with symphysis pubis

• Good penetration – visualize bony trabecular patterns & cortical outlines of lumbar vertebra & pelvis. 
• Good contrast & density – can demonstrate psoas muscle , kidneys and other soft tissues.

Gas, mass, bones and stones

• Extent of ROI
• Rule out rotation
• Bony pathologies-

Scoliosis, lordosis, kyphosis

Fracture, osteoporosis, osteophytes

Osteolytic and osteosclerotic lesions like mets

Congenital anomalies-spina bifida, extrophy epispadias complex

• Kidneys
• Liver
• Spleen
• Bladder
• Psoas and other muscles

- descends obliquely and laterally from T12 to iliac crest

-visualized only if adequate retroperitoneal fat

- usually straight

-convex in athletic musculature fluid collection in psoas sheath

• -absence of psoas margin – lack of retroperitoneal fat, scoliosis (often one side) - fluid collection in retro peritoneal space - retroperitoneal tumours – retroperitoneal LN dissection
• kidneys - visualized only if enough perirenal fat

fd

Sump - The proximal portion of the bulbous urethra. 

Cone - Just proximal to the sump, the bulbous urethra assumes a conical shape at the bulbomembranous junction

In newborn infant bladder lies above the symphysis pubis  until at about 5 yrs of age bladder floor lies at or below the level of symphysis

Verumonatnum - Ovoid filling defect in the posterior part of the prostatic urethra

Entire male urethra forms reverse ‘S’ bend in lateral position, with first bend of bulbar urethra and second in penoscrotal junction

If the posterior urethra fills before voiding neurogenic or internal sphincter deficiency is suspected unless patient has undergone recent prostatectomy

1.30 degrees LAO, with right leg abducted & knee flexed.

2.Supine PA

3.30 degrees RAO, with left leg abducted & knee flexed.

When the posterior urethra is optimally opacified and the verumontanum visible, the bulbomembranous junction -1–1.5 cm distal to the inferior margin of the verumontanum

When the posterior urethra is suboptimally opacified, the bulbomembranous junction can be arbitrarily localized where an imaginary line connecting the inferior margins of the obturator foramina intersects the urethra

< 1 year - Weight (kg) × 7 = capacity (ml)

< 2 years  - (2 × age in years + 2) × 30 = capacity (ml)

> 2 years -  (Age in years/2 + 6) × 30 = capacity (ml)

• Scout film – X-ray KUB
• Filling phase
• Voiding phase - stricture, reflux 
• Post-void phase - PVRU

• Start with scout film
• Exposure  
• Centrality
• Bony defects, deformities, surgical implants
• UB outline, capacity, and presence of any diverticula
• Upper tracts, passive/active reflux
• Anterior urethra, posterior urethra
• Any filling defect, narrowing, irregularity, dye extravasation, diverticula
• Residual volume