These are specialized dynamic studies where in the case of the IVP and VCU the upper and lower urinary tract is evaluated.
The sialogram evaluates the salivary glands and the dacrocystogram the lacrimal system.
Speech studies evaluate speech abnormalities.
Use is made of water soluble contrast material in all the investigations other than the speech studies where barium is used.
Fluoroscopy is used to obtain multiple images which are evaluated.
Due to the use of x-rays, female patients must make sure they are not pregnant.
Intravenous pyelogram (IVP)
This study evaluates the structure and to some extent the function of the renal tract (kidneys, ureters and bladder).
Specialised x-ray equipment and technique is used called tomography.
Pregnancy must be excluded due to the radiation risk.
Intravenous contrast material is used. A history of allergies is thus important.
The IVP has largely been superseded by CAT scanning which excludes renal stones and also defines other pathology.
What is going to happen?
You will be asked to lie on your back on the x-ray table. A needle will be placed in the forearm for contrast injection. A control x-ray will be taken to look for calcifications. The contrast will be injected and x-rays taken at intervals. At the end you will be asked to empty your bladder and another x-ray will be taken standing up.
Is it going to be painful?
The needle placement is slightly uncomfortable. The injection of contrast may result in a metallic taste in the mouth and a hot feeling in the body. This is normal and quickly disappears.
Do I need you make a booking?
You will need to arrange the study with the radiology department as blood tests may need to be ordered prior to the IVP. Special medication will also be given if you have an history of iodine allergy.
Indications
- Renal stones
- Obstruction
- Infection/inflammation
- Tumours
Voiding cystourethrogram (VCU)
This is a technique in which a person’s urethra and urinary bladder are observed while the person is urinating.
What is going to happen?
You will be asked to lie on your back on the x-ray table. In some instances the urethra may first be opacified in a male patient if there is a possibility of a stricture. The urethra is then anesthetised using local anaesthetic after which a catheter is passed into the bladder. The bladder is filled with contrast material until the patient needs to urinate. This is done while the radiologist observes for any reflux of contrast back up the ureters. Several x-rays are taken. You will than stand up and be asked to urinate while pictures are taken.
Is it painful?
There will be some discomfort during the urethrogram and also a burning feeling during passing of the catheter.
Are there any risks with this test?
Radiation is used so you must not be pregnant. Iodinated contrast is used with a small risk of an allergic reaction. There is a possibility of injury to the urethra or possible extravasation of contrast with increased pressure injection.
Should I make a booking?
It is preferable to make a booking.
Indications
To evaluate:
- Strictures
- Vesicoureteric reflux
- Tumours
- Irritable bladder
- Bladder rupture in the setting of trauma
- Follow-up for bladder rupture
- To evaluate the prostate
- In patients being considered for kidney transplant.
Sialogram
A sialogram is an x-ray of the salivary glands. The parotid and the submandibular glands are the salivary glands which are amenable to imaging. The opening for the parotid gland is adjacent to the 2ndmolar in the upper jaw. The opening for the submandibular glands is in the midline under the tongue.
The study involves radiation so be sure you are not pregnant.
Iodine contrast material is used so a history of allergies must be given to our staff.
What is going to happen?
You will lie on your back. Control x-rays will be done to exclude duct stones. A catheter will be inserted into the opening and contrast injected to opacify the duct. Several x-rays from different positions will be taken. After the procedure you will be given lemon juice to determine if the stimulus results in clearance of contrast from the duct.
Is it painful?
You may experience some discomfort during contrast injection as the duct dilates.
Do I need a booking?
It is preferable to make a booking to alleviate any delay for the patient.
Speech Studies
Since the late fifties video fluoroscopy has been used for assessment for of speech abnormalities.
The aim of the study is to establish factors that contributes to velopharyngeal incompetency in a patient with a repaired cleft palate. Palate repair alone is sometimes not sufficient to achieve velopharygeal closure e.g. the palate may be short and scarred with reduced mobility or the pharynx may be too deep for a palate that is too short. Most of the information about the site, height and amount of closure can be obtained.
How is the procedure performed?
Small quantities of barium are introduced via the nostrils and oral cavity. This is to ensure the nasal passages, nasopharynx and mouth are coated to enhance the study. The studies are performed in the basal and lateral projections. Static images with and without phonation are performed. Exposures are made during sustained speech to asses for velopharyngeal closure.
Is it painful?
No. It is usually well tolerated by the children.
Will my child be exposed to high levels of radiation?
No. The radiation dose is low.