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   Instructional Material Radiographic Technique 106 A. LEARNING OBJECTIVE B. LEARNING MATERIAL Meeting 8 th   RETROGRADE AND ANTEGRADE CYSTOGRAPHY After the learning process students are able to Comprehend the principles of Examination procedure and positioning technique retrograde and antegrade cystography. In the end of learning process, students are able to Perform radiographic examination procedure and radiographic positioning technique of retrograde and antegrade cystography in accordance with the good criteria. To achiee the learning ob!ect on this topic you will learn the following #.   $esription procedure and positioning technique of retrograde and antegradecystography %.   &adiographic anatomy retrograde and antegradecystography '.   &eiew Exercise (ith &adiographs ).   &adiographic positioning *.   Clinical indications +.   Patient position, part position, and ealuation criteria C. MATERIAL DESCRIPTION &adiography examination of retrograde and antegrade cystography is radiographiy examination that use contrast media positie and-or negatie to see anatomy fisiologys and patologys of urinary bladder.   Instructional Material Radiographic Technique 10 RADIOGRAPHIC ANATOMY O! RINARY BLADDER The anatomy of urinary bladder as follows Pict #. /allbladder #.   RINARY BLADDER The urinary bladder is a musculomembranous sac that seres as a reseroir for urine. The bladder is situated immediately posterior and superior to the pubic symphysis and is directly anterior to the rectum in the male and anterior to the aginal canal in the female. The apex of the bladder is at the anterosuperior aspect and is ad!acent to the superior aspect of the pubic symphysi . The most fixed part of the bladder is the nec0, which rests on the prostate in the male and on the pelic diaphragm in the female. The bladder aries in si1e, shape, and position according to its content. It is freely moable and is held in position by folds of the peritoneum. (hen empty, the bladder is located in the pelic caity. As the bladder fills, it gradually assumes an oal shape while expanding superiorly and anteriorly into the abdominal caity. The adult bladder can hold approximately *22 ml of fluid when completely full. The desire for micturition urination occurs when about %*2 ml of urine is in the bladder. The ureters enter the posterior wall of the bladder at the lateral margins of the superior part of its base and pass obliquely through the wall to their respectie internal orifices 3ig. # 45+. The e two opening are about I inch %.* cm apart when the bladder is empty and about % inches * cm apart when the bladder is distended. The openings are equidistant from the internal urethral orifice, which is situated at the nec0  lowest Pa6t of the bladder. The triangular   Instructional Material Radiographic Technique 108 area between the three orifices is called the trigone. The mucosa oer the trigone is always smooth, whereas the remainder of the lining contains folds, called rugae, when the bladder is empty. 1.   REVIE$ E%ERCISE $ITH RADIOGRAPHS 7ome anatomic parts are more diffcult to isuali1e on radiographs than on drawings. 8oweer, a good understanding of the location and relationship between arious parts helps in this identification. A.   &enal Calyces 9.   &enal Pelis C.   Abdominal :reter $.   Pelic :reter E.   :rinary 9lader &.   RADIOGRAPHIC PROCED RE :rograms should hae the same contra t, den ity, and degree of soft tissue density as do abdominal radiographs. The radiographs must show a sharply defined outline of the 0idneys, lower border of the lier, and lateral margin of the psoas muscles. The amount of bone detail isible in these studies aries according to the thic0ness of the abdomen. CONTRAST MEDIA &etrograde urography 3igs. # 45#4 and # 45 # ; was first performed in # ;2) with the introduction of air into the urinary bladder. <n # ;2+ retrograde urography and cystography were performed with the first opaque medium, a colloidal siler   Instructional Material Radiographic Technique 10' preparation that is no longer used. 7iler iodide, which is a nontoxic inorganic compound, was introduced in #;# #. 7odium iodide and sodium bromide, also inorganic compounds, were fir t used for retrograde urography in #;#4. The bromides and iodides are no longer widely used for examinations of the renal peles and ureters because they in=itate the mucosa and commonly cause considerable patient discomfort. 9ecau e a large quantity of solution is required to fill the urinary bladder, iodinated salts in concentrations of '2> or Ie are used in cystography. A large selection of commercially aailable contrast media may be used for all types of radiographic examinations of the urinary system. It i important to reiew the product insert pac0aged with eery contrast agent. Excretory urography 3igs. # 45%2 and # 45% # was first reported by &owntree et al in # ;%'.= These inestigators used a # 2> solution of chemically pure sodium iodide as the contrast medium. 8oweer, this agent was excreted too slowly to gie a satisfactory demonstration of the renal peles and ureters, and it also proed too toxic for functional distribution. Early in # ;%;, &oseno and 6ep0ins% introduced a compound containing sodium iodide and urea. The latter constituent, which is one of the nitrogenous substances remoed from the blood and el iminated by the 0idneys, sered to accelerate excretion and thus quic0ly fill the renal peles with opacified urine. Although satisfactory renal images were obtained with this compound, patients experienced considerable di tress as a result of its toxicity. <n # ;%;, 7wic0 deeloped the organic compound :roselectan, which had an iodine content of )%>. The present5day ionic contrast media for excretory urography are the result of extensie research by many inestigators. These media are aailable under arious trade names in concentrations ranging from approximately *2> to ?2>. 7terile solutions of the media are supplied in dose5si1e ampules or ials. In the early I ;?2s, research was initiated to deelop non ionic contrast media. $eelopment progressed, and seeral nonionic contrast agents are currently aailable for urographic, ascular, and intrathecal in!ection. Although non ionic contrast media are generally less li0ely to cause a reaction in the patient, they are twice as expen ie as ionic agents. @any institutions hae deeloped criteria to determine which patient receies which contrast medium. The choice of whether to use an ionic or nonionic contrast medium depends on patient ris0 and economics.
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