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CT UROGRAM CONTRAST

NOTE: This RIS Code includes a CT IVP

INDICATIONS

INDICATIONS (1-4)

From ACR Criteria:

  • Haematuria, gross, initial imaging

  • Bladder cancer

    • muscle invasive, treated, surveillance

    • non-muscle invasive, treated, symptomatic, surveillance

    • non-muscle, invasive, treated, risk factors, surveillance

  • UTI

    • lower urinary tract, recurrent, complicated or frequent relapses, or no response to conventional therapy

    • lower urinary tract, recurrent, risk factors 

Pathology Demonstrated

PATHOLOGY DEMONSTRATED (1-4)

  • Bladder tumour

  • Tumours in KUB

  • Renal obstruction

  • Blood clot

  • Pyelonephritis

  • Urolithiasis

  • Infection

  • Kidney laceration

Patient Preparation

PATIENT PREPARATION

  • Patient able to lie still for ten minutes

  • Not claustrophobic (sedation may be given)

  • Cognitively capable of following basic instructions

  • Metal artefacts removed from the region of interest, including bras and necklaces

  • No respiratory distress when lying supine

  • Not allergic to Iodine based Contrast

  • No known kidney disease (eGFR below 30 as per RANZCR), however, acute setting consultant may sign to continue with poor renal function

  • No hyperthyroidism, may induce thyroid storm

  • Patient to have 20G cannula in anterior cubital fossa.

  • Preferably patient fasted for 4 hours

  • Urinary catheter to be clamped if doing an CT IVP

ANATOMY INCLUDED

ANATOMY INCLUDED (4)
 

For patients over the age of 40, a non contrast KUB, and seperate nephrogenic and excretory (delayed) phases will be performed. For all patients under the age of 40, a non contrast KUB and a COMBINED dual nephrogenic/excretory phase will be performed. Image examples of this can be seen below. 

Under 40 Years of Age
CT Urogram- Nephrogenic + Excretory Phase (Axial)
CT Urogram- Nephrogenic + Excretory Phase (Coronal)
CT Urogram- Nephrogenic + Excretory Phase (Sagittal)
Over 40 Years of Age
CT Urogram- Nephrogenic Phase (Axial)
CT Urogram- Excretory Phase (Axial)
CT Urogram- Nephrogenic Phase (Coronal)
CT Urogram- Excretory Phase (Coronal)
CT Urogram- Nephrogenic Phase (Sagittal)
CT Urogram- Excretory Phase (Sagittal)

REFERENCES

1. American College of Radiology (ACR). Appropriateness Criteria. [Internet]. 2022 [Updated 2021, cited 10 Aug 2022]. Available from https://www.acr.org/Clinical-Resources/ACR-Appropriateness-Criteria​

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2. Radiopaedia. CT Abdomen-Pelvis (Protocol) [Internet]. 2008 [updated 7 April 2022, cited 23 Aug 2022]. Available from https://radiopaedia.org/articles/ct-abdomen-pelvis-protocol-1?lang=us

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3. Radiopaedia. CT Urography (Protocol) [Internet]. 2008 [updated 7 April 2022, cited 23 Aug 2022]. Available from https://radiopaedia.org/articles/ct-urography-protocol?lang=gb

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4. Radiopaedia. CT Split Bolus Technique [Internet]. 2008 [updated 7 April 2022, cited 23 Aug 2022]. Available from https://radiopaedia.org/articles/ct-urography-protocol?lang=gb

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