Hysterosalpingogram: procedure

If a scout image using conventional radiography is taken for a hysterosalpingogram what size IR is used and where do you center? What additional images may be taken

10X12 2" above pubic symphysis RPO + LPO

Why are Hysterosalpingograms performed ______ days after onset menses ?

7-10 days To avoid possibility of pregnancy

What is the pt prep for a hysterosalpingogram?

Bowel prep: laxative, cleansing enema Pain reliever (exam can cause pain/cramping) Empty bladder

What structures must be seen on the AP projections for a hysterosalpingogram?

Pelvic ring centered to collimated field Cannula or balloon catheter within cervix

Where does the contrast spill into it the uterine tubes are patent (unobstructed)?

Peritoneal cavity

What are the pros and cons of using water soluble iodinated contrast for a hysterosalpingogram?

Pros: Absorbed quickly by the body No residue Adequate visualization Cons: Painful when injected and can persist hours following exam

What are the pros and cons of using an oil based contrast media for hysterosalpingograms?

Pros: maximum visualization of structures Cons: Slow absorption rate Persists in body for some time Risk of oil embolus which could reach lungs

What scissor like tool can help with inserted the cannula or balloon catheter into the cervical canal?

Tenaculum

why should the pt empty their bladder before a hysterosalpingogram?

To prevent displacement of the uterus + uterine tubes

What type of contrast media is preferred for a hysterosalpingogram?

Water soluble iodinated contrast

What are the 3 clinical indications for performing a hysterosalpingogram (HSG)

1. Assess Infertility 2. Demonstrate intrauterine pathologies 3. Evaluate uterine tubes after tubal ligation (tubes tied) or reconstructive surgery

What are the 3 contraindications for performing a hysterosalpingogram?

1. Pregnancy 2. Pelvic inflammatory disease 3. Active uterine bleeding

Briefly describe the process of a hysterosalpingogram

1. Pt lies supine in lithotomy position 2. Speculum inserted 3. Vaginal walls + cervix cleansed w/ aseptic solution 4. Cannula/balloon catheter inserted into cervical canal + balloon dilated 5. Speculum remover 6. Pt in trendelenburg position 7. Contrast filled syringe connected to cannula or balloon catheter 8. Contrast injected slowly using fluoro

What is the purpose of an HSG?

1. Shows size, shape, and postion of the uterine cavity 2. Patency (openness) of the uterine tubes 3. Detects lesiosn: polyps, fistulas, neoplasms