In this presentation, we’ll be doing a very brief overview of some of the radiographic
procedures performed on the reproductive system.
Most are performed under fluoroscopy, and overhead views are typically very limited
to reduce radiation exposure to the patient.
The procedures performed for females can be broken down into two categories.
Procedures performed when pregnant, and procedures performed when not pregnant.
Non-pregnant exams include Hysterosalpingography (HSG), Pelvic pneumonography, and Vaginography.
Exams performed during pregnancy include Fetography, Pelvimetry, and Fetal cephalometry
Hysterosalpingography is performed to determine the size, shape, and position of the uterus
and uterine tubes.
It can delineate lesions such as polyps, submucous tumor masses, or fistulous tracts, as well
as investigate patency of the uterine tubes in patients who are unable to conceive.
It involves introduction of water-soluble radiopaque contrast into the uterus via a
cannula.
For procedure prep, the intestinal tract should be cleaned before examination, and a laxative
administered for constipation.
Cleansing enemas may also be required before examination, and the meal preceding examination
is typically withheld.
It should be scheduled within 10 days following onset of menstruation because the endometrium
is least congested at this time and there’s the least risk of irradiating fertilized ovum.
Before the procedure, the patient should empty their bladder, irrigate vagina and clean perineal
region, as instructed with supplies provided by radiologic technologist (RT).
A preliminary scout image made, then the patient is placed in lithotomy position.
The physician places speculum into vagina and the uterine cannula is placed in cervix.
Contrast is injected under fluoroscopy to fill the uterus, and should spill into peritoneal
cavity if tubes are patent.
Images should demonstrate the pelvic region, centered about 2 inches (5 cm) above the pubic
symphysis.
All contrast media should be visible, including any “spill” areas.
A short scale of contrast is desired, with kVp range in the 70’s for appropriate attenuation
of the iodinated contrast.
Pelvic Pneumonography has been virtually replaced by sonography and other diagnostic techniques,
so this presentation will not cover this exam.
Vaginography can be used to investigate congenital malformations and fistulae.
Thin barium sulfate or water-soluble iodinated contrast media may be used.
Contrast introduced via rectal retention tube inserted into vagina.
After images are made, the patient asked to expel as much of contrast as possible.
Vaginal irrigation is used to remove remaining contrast
This image portrays a lateral view depicting a rectovaginal fistula.
Due to radiation protection standards, pregnant patient procedures are typically preferred
to be performed under Sonography, so discussion is limited to procedural definitions.
Fetography is imaging of the fetus in utero, and should be avoided until after week 18
of gestation.
Pelvimetry and fetal cephalometry demonstrate the architecture of the pelvis compared with
the size of the fetal head.
Placentography shows the walls of the uterus to locate the placenta in cases of placenta
previa, a condition where the placenta covers the mother’s cervix.
Radiographic Procedures for males include those performed on the seminal ducts and the
prostate gland.
For the seminal ducts, we typically see vesculography, epididymography and epididymovesigulaography.
Examination of the Seminal Ducts is performed in the investigation of genitourinary abnormalities,
such as Cysts, Abscesses, Tumors, Inflammation and Sterility.
Water-soluble iodinated contrast is introduced via Injection into ductus deferens, which
requires a small incision into scrotum.
Urethroscopic catheterization of ejaculatory ducts should include images centered to upper
border of pubic symphysis.
We typically do not perform prostatography any longer.
Sonography is the preferred imaging modality for investigation of the prostate to minimize
radiation dose to the gonads.
A Vesiculogram can be performed to see the epididymis to screen for cancer, inflammation
or other abnormalities.
In the image on the right, we see an abscess.