Hysterosalpingography
Hysterosalpingography, also called
uterosalpingography, is an x-ray
examination of a woman’s uterus and
fallopian tubes that uses a special form of xray called fluoroscopy and a contrast
material.
History
 For the first HSG Carey used collergol in
1914.
 Lipiodol was introduced by Sicard and
Forestier in 1924 and remained a popular
contrast medium for many decades.
 Later, water-soluble contrast material was
generally preferred as it avoided the
possible complication of oil embolism.
common uses of the procedure
The uterus :
Shape , cavity , fibroids and adhesions.
The cervix :
Shape , canal and incompetence.
Fallopian tubes :
Shape , canal and patency.
preparation
After menstruation but before ovulation.
Exclude pregnancy.
Exclude infections : PID , STD and vaginal
discharges.
Avoid constipation & gaseous bowel distension.
preparation
Analgesia and antibiotic prior to or after the
procedure may be given.
History of any recent illnesses , medications
or allergies, especially to barium or
iodinated contrast materials.
Sensitive remove of some or all of patient
clothes and to wear a gown during the
exam.
Remove jewelry, eye glasses and any metal
objects or clothing that might interfere
with the x-ray images
preparation
Aseptic conditions
Speculum is inserted into the vagina,the cervix is
cleansed.
VW canula or a catheter is then inserted into the
cervix.
The speculum is removed and the patient is
carefully situated underneath the fluoroscopy
device.
Plain film to be taken
The contrast material then begins to fill the uterine
cavity( ~9 ml), fallopian tubes and peritoneal
cavity through the catheter
Fluoroscopic images are taken (2-3 films).
Delayed films after 30 minutes can be taken
What will patient experience
during and after the procedure?
This exam should cause only minor discomfort.
There may be slight discomfort and cramping
when the catheter is placed and the contrast
material is injected, but it should not last long.
There may also be slight irritation of the
peritoneum, causing generalized lower
abdominal pain, but this should also be minimal
and not long lasting.
Most women experience vaginal spotting for a few
days after the examination, which is normal.
Complications
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Complications of the procedure include
Radiation effect
infection,
allergic reactions to the materials used,
intravasation of the material,
and, if oil-based material is used,
embolisation.
Oil based and water based
contrasts
The dye is urograffin ( same used in IVP/IVU).
Oil based can open a mucus pulg , less infection
, but more pain and extravasation
Saline sonogram
Use ultrasound and no risk for ionizing
radiation.
Spillage in the peritoneal cavity can be seen ,
but from which tube cannot be determined
Who interprets the results
A radiologist is best , but referring gynecologist
interested in infertility can do also
A normal hysterosalpingogram
Normal
HSG
 A normal result shows the filling of the
uterine cavity and the bilateral filling of the
fallopian tube with the injection material. To
demonstrate tubal patency spillage of the
material into the peritoneal cavity needs to
be observed.
Normal HSG
Intrauterine polyps
Blocked distal ends
Huge uterine fibroid
Unilateral blockage and
adhesions
Asherman Syndrome
Distal Bilateral Blocked
Tubes
NORMAL HSG
Magnetic resonance imaging
Magnetic resonance imaging (MRI), or nuclear
magnetic resonance imaging (NMRI), is
primarily a medical imaging technique
most commonly used in radiology to
visualize detailed internal structure and
limited function of the body.
MRI
MRI provides much greater contrast between the
different soft tissues of the body than
computed tomography (CT) does, making it
especially useful in neurological (brain),
musculoskeletal, cardiovascular, and
oncological (cancer) imaging.
Unlike CT, it uses no ionizing radiation, but uses
a powerful magnetic field.
History
Magnetic resonance imaging is a relatively new
technology.
The first MR image was published in 1973
and the first cross-sectional image of a living
mouse was published in January 1974
The first studies performed on humans were
published in 1977
X-ray By comparison, the first human
image was taken in 1895
2003 Nobel Prize

Reflecting the fundamental importance and
applicability of MRI in the medical field, Paul
Lauterbur of the University of Illinois at UrbanaChampaign and Sir Peter Mansfield of the
University of Nottingham were awarded the
2003 Nobel Prize in Physiology or Medicine for
their "discoveries concerning magnetic
resonance imaging".
Modern 3 tesla clinical MRI
scanner.
Applications
 In clinical practice, MRI is used to
distinguish pathologic tissue (such as a
brain tumor) from normal tissue .
 While CT provides good spatial resolution
(the ability to distinguish two structures an
arbitrarily small distance from each other
as separate),
 MRI provides comparable resolution with
far better contrast resolution (the ability to
distinguish the differences between two
arbitrarily similar but not identical tissues).
MRI versus CT
 A computed tomography (CT) scanner uses X-
rays, a type of ionizing radiation, MRI, on the
other hand, uses non-ionizing radio frequency
(RF) signals to acquire its images
 CT may be enhanced by use of contrast agents
containing elements of a higher atomic number
than the surrounding flesh such as iodine or
barium. Contrast agents for MRI are those which
have paramagnetic properties, e.g. gadolinium
and manganese.
 Both CT and MRI scanners can generate multiple
two-dimensional cross-sections (slices) of tissue
and three-dimensional reconstructions.
MRI versus CT
 MRI can generate cross-sectional images
in any plane (including oblique planes).
 In the past, CT was limited to acquiring
images in the axial (or near axial) plane.
The scans used to be called Computed
Axial Tomography scans (CAT scans).
However, the development of multidetector CT scanners with near-isotropic
resolution, allows the CT scanner to
produce data that can be retrospectively
reconstructed in any plane with minimal
loss of image quality.
MRI versus CT
 For purposes of tumor detection and identification
in the brain, MRI is generally superior.
 However, in the case of solid tumors of the
abdomen and chest, CT is often preferred due to
less motion artifact.
 Furthermore, CT usually is more widely available,
faster, less expensive, and may be less likely to
require the person to be sedated or anesthetized.
 MRI is also best suited for cases when a patient is to
undergo the exam several times successively in the
short term, because, unlike CT, it does not expose
the patient to the hazards of ionizing radiation.
How MRI works
 The body is largely composed of water
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molecules which each contain two hydrogen
nuclei or protons .
When a person goes inside the powerful
magnetic field of the scanner, the magnetic
moments of these protons align with the
direction of the field.
A radio frequency electromagnetic field is then
briefly turned on, causing the protons to alter
their alignment relative to the field.
When this field is turned off the protons return to
the original magnetization alignment.
These alignment changes create a signal which
can be detected by the scanner.
How MRI works
Diseased tissue, such as tumors ,can be detected
because the protons in different tissues return to
their equilibrium state at different rates.
By changing the parameters on the scanner this
effect is used to create contrast between
different types of body tissue.
Contrast agents may be injected intravenously to
enhance the appearance of blood vessels ,
tumors or inflammation.
Contrast agents may also be directly injected into a
joint in the case of arthrograms, MR images of
joints.
ionizing radiation
MRI uses no ionizing radiation and is generally a
very safe procedure.
Ionizing radiation consists of subatomic particles
or electromagnetic waves that are energetic
enough to detach electrons from atoms or
molecules, ionizing them.
Examples are :
radio waves, microwaves, terahertz radiation,
infrared radiation, visible light, ultraviolet
radiation, X-rays and gamma rays.
Safety issues
Safety issues, including the potential for bio
stimulation device interference, movement of
ferromagnetic bodies, and incidental
localized heating, have been addressed in
2002 and expanded in 2004.
Economics of MRI
 MRI equipment is expensive.
 1.5 tesla scanners often cost between $1 million
and $1.5 million USD.
 3.0 tesla scanners often cost between $2 million
and $2.3 million USD.
 Construction of MRI suites can cost up to
$500,000 USD, or more, depending on project
scope.
 Even though it is of cost effective benefit and
insurance companies cover its use.
Indications
MRI is used to image every part of the body,
and is particularly useful for neurological
conditions,
for disorders of the muscles and joints, for
evaluating tumors,
and for showing abnormalities in the heart and
blood vessels.
Pregnancy & MRI
 No effects of MRI on the fetus have been
demonstrated.
 In the 1st trimester the fetus may be more
sensitive to the effects—particularly to heating
and to noise.
 contrast agents; gadolinium compounds are
known to cross the placenta and enter the fetal
bloodstream and should be avoided.
 MRI without contrast agents is the imaging
mode of choice for pre-surgical, in-utero
diagnosis and evaluation of fetal tumors,
primarily teratomas,
Contrast agents
 Most coomoly used are chelates of gadolinium
 More safer than iodinted contrast in x-rays and
CT.
 Less nephrotoxic.
 Rare anaphylactic shock.
 Rare renal fibrosis.
 Recently a new contrast agent named
gadoxetate, with less side effects.
Claustrophobia
 the fear of having no escape and being closed in.
 Nervous patients may still find the following strategies helpful:
 Advance preparation
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visiting the scanner to see the room and practice lying on the table
visualization techniques
chemical sedation
general anesthesia For babies and young children chemical sedation or general
anesthesia are the norm, as these subjects cannot be instructed to hold still
during the scanning session
 Alternative scanner designs, such as open or upright systems, can also be
helpful where these are available. Though open scanners have increased in
popularity, they produce inferior scan quality
 Coping while inside the scanner
 holding a "panic button"
 closing eyes as well as covering them (e.g. washcloth, eye mask)
 listening to music on headphones or watching a movie with a Head-mounted
display while in the machine
 Scan Rooms with lighting, sound and images on the wall. Some rooms come
with images on the walls or ceiling.
Implants and foreign bodies
 Pace makers
 Prosthestic metallic valves
 Aneurysm clips
 Surgical prosthesis
 Cochlear and eye implants.
 Copper IUCD
discomfort
Obese patients and pregnant women may find
the MRI machine to be a tight fit.
Pregnant women may also have difficulty lying
on their backs for an hour or more without
moving.
Acoustic noise
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Acoustic noise associated with the
operation of an MRI scanner can also
exacerbate the discomfort associated with
the procedure.
Peripheral nerve stimulation
(PNS)
The rapid switching on and off of the magnetic
field gradients is capable of causing nerve
stimulation. Volunteers report a twitching
sensation when exposed to rapidly switched
fields,
ADENOMYOSIS
BLOG ANNO
FAETAL TERATOMA
MRI FETUS
MRI PELVIMETRY
PELVIC MALIGNANCY
PELVIC MALIGNANCY
XRAY PELVIMETRY