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/abdomi nal-ultrasound-info.html