LET YOUR

RAY
SHINE!
CHAPTER10
Special Radiographic
Procedures of the Reproductive
System

CEDRICK B. MELAÑO, RRT, MPA

PROFESSOR | RADIOGRAPHIC CONTRAST EXAMINATION
VAGINA
•Vagina is a fibro muscular tubular tract leading from the
uterus to the exterior of the body in female mammals, or to the
cloaca in female birds and some reptiles. Female insects and
other invertebrates also have a vagina, which is terminal part of
the oviduct.

• Vagina is the place where semen from the anatomic male is

deposited into the anatomically female person's body at the
climax of sexual intercourse, commonly known as ejaculation.
Around the vagina, pubic hair protects the vagina from
infection and is a sign of puberty.
•The vagina is mainly used for sexual intercourse.
CERVIX
Cervix is the lower, narrow portion of the uterus where it joints
with the top end of the vagina.
Cervix is also called the neck of the uterus.
• it is cylindrical or conical in shape and protrudes through the
upper anterior vaginal wall.
•Approximately half its length is visible, the remainder lies
above the vagina beyond view.
• the vagina has a thick layer outside and it is the opening
where the baby emerges during delivery
UTERUS
•The uterus or womb is the major female reproductive organ of humans.
• it provides mechanical protection, nutritional support, and waste removal for
the developing embryo (weeks 1-8) and fetus (from week 9 until the delivery).
• contractions in the muscular wall of the uterus are important in pushing out
the fetus at the time of birth.
It contains three suspensory ligaments that help stabilize the position of the
uterus and limits its range of movement.
•The uterosacral ligaments, keep the body from moving inferiorly and
anteriorly.
•The round ligaments restrict posterior movement of the uterus.
•The cardinal ligaments also prevent the inferior movement of the uterus.
The uterus is a pear-shaped muscular organ. Its major function is to accept a
fertilized ovum which becomes implanted into the endometrium, and derives
nourishment from blood vessels which develops exclusively for this purpose.
•The fertilized ovum which becomes an embryo, develops into a fetus and
gestates until childbirth. If the egg does not embed in the wall of the uterus, an
anatomically female person begins menstruation and the egg is flushed away.
FALLOPIAN TUBES
• The fallopian tubes or oviducts are two(2) tubes leading from
the ovaries of female mammals into the uterus.
The Fallopian tubes are often called the oviducts and they have
small hairs (cilia) to help the egg cell travel.

OVIDUCTS
•The ovaries are small, paired organs that are located near the
lateral walls of the pelvic cavity.
•These organs are responsible for the production of the ova and
the secretion of hormones.
REPRODUCTIVE TRACT
The reproductive tract or genital tract is the lumen that starts as a
single pathway through the vagina, splitting up into two lumens in
the uterus, both of which continue through the fallopian tubes,
and ending at the distal ostia that open into the abdominal cavity.

In the absence of fertilization, the ovum will eventually traverse

the entire reproductive tract from the fallopian tube until exiting
the vagina through menstruation.

The reproductive tract can be used for various transluminal

procedures such as fertiloscopy, intrauterine insemination and
transluminal sterilization.
 HYSTEROSALPHINGOGRAPHY
Outlines the fallopian tubes and uterus following instillation of a
contrast medium. It is a safe diagnostic and therapeutic tool in the
diagnosis and treatment of the female genital organs.
• Demonstrate patency of oviduct in cases of infertility
• Scheduled about 10 days after start of menstruation.
• CM: liopodol, skiodan, kayopaque, salpix
• AP, PA, OBLIQUE & LATERAL
 HYSTEROSALPHINGOGRAPHY
INDICATIONS AND CONTRAINDICATIONS
Indications
• to study infertility that determines possible structural or functional
defects not obvious by clinical examination.
• abnormal gynecological conditions.
Contraindications
• acute or subacute pelvic inflammation.
• vaginal or cervical infection accompanied by purulent discharge.
• immediate premenstrual or postmenstrual phase.
• active uterine bleeding.
• pregnancy is an absolute contraindication.
 HYSTEROSALPHINGOGRAPHY
PROCEDURE
• after the preliminary film has been inspected the patient is
adjusted in the lithotomy position.
• the gynecologist then introduces a vaginal speculum and clean the
cervix and then inserts a cannula into the uterine cavity through the
cervical canal fitting the cone shaped rubber plug to prevent reflux of
the contrast substance.
• injection of the contrast medium.
PROJECTION
• AP, PA, oblique and lateral, R,P. -2 inches above the symphysis
pubis for frontal projections.
• Use 10x12 film placed lengthwise.
MATERIALS
• Cannula- a tube for the insertion into the body cavities usually for
drainage.
PELVIMETRY
- is the assessment of the female pelvis in relation to the birth of a
baby.
• the terms used in pelvimetry are commonly used in obstetrics.
•clinical pelvimetry attempts to assess the pelvis by clinical
examination.
• pelvimetry can also be done by radiography and MRI.
PELVIC PLANES
• Pelvic inlet- line between the narrowest bony points formed by the
sacral promontory and the inner pubic arch, referred to as
OBSTETRICAL CONJUGATE. The transverse diameter of the pelvic
inlet measures 13.5 cm
• Midpelvis- the line between the narrowest bone points connects
the ischial spines. It typically exceeds 12 cm.
• Pelvic outlet- the distance between the ischial tuberosities
(normally > 10 cm) and the angulation of the pubic arch.
PELVIMETRY
PELVIC TYPES
GYNECOID-The gynecoid pelvis is one that is generally
characteristics of a woman in its bone structure and
therefore its shape. Gynecoid means like a woman,
womanly, female.
Android- triangular inlet and prominent ischial spines.
More angulated pubic arch. Heart is shape.
Anthropoid- inlet is greater than inlet obstetrical
diameter.
Platypelloid- flat inlet with shortened obstetrical
diameter.
TYPES OF PELVIMETER
• Colcher- Sussman (most commonly used)
• Tom's
• Ball's method
PELVIMETRY
PATIENT PREPARATION
• Instruct the patient to remove all garments
• Provide a gown and instruct the patient how to wear it.

PROJECTIONS
AP PROJECTION
• Place the patient in the supine position and center the MSP to
the midline of the table.
• Flex the knees to place the feet flat on the table.
• Separate the thighs and place the transverse scale of the
pelvimeter against the buttocks at the level of the ischial
tuberosity (10 cm below upper border of the film holder, 4 inches
below the level of transverse cm scale)
• Reference point at the level of the superior margin of the
symphysis pubis.
PELVIMETRY
AP PROJECTION
PELVIMETRY
PROJECTIONS
LATERAL PROJECTION
~Place the patient in a true lateral position with the feet together.
Adjust the body and center the midaxillary plane of the body to
the midline of the table.
~Place a radioparent material under and in between the ankles
and the knee joints,
~Adjust the height of the pelvimeter to insert the transverse scale
between the gluteal folds.
~The transverse cm. scale should be parallel to the long axis of the
femoral shaft.
~Recheck the position and adjust the body in a true lateral
position.
~Adjust the IR so that its lower border in a true lateral position. CR
is directed vertically
~Ask the patient to suspend respiration for exposure.
PELVIMETRY
LATERAL PROJECTION
PELVIC PNEUMONOGRAPHY
• Pelvic pneumography, gynecography, and pangynecography are
the terms used to denote radiologic examinations of the female
pelvic organs by means of intraperitoneal gas insufflations.
• These procedure have essentially been replaced by
ultrasonography and other diagnostic techniques.

VAGINOGRAPHY
• is used in the investigation of congenital malformations and
pathological conditions such as vesicovaginal and enterovaginal
fistulas.
• it is performed on a combination fluoroscopic-radiographic
table. The contrast medium is injected under fluoroscopic control,
and spot radiographs are exposed as indicated during the filling.
AMNIOGRAPHY
• A prenatal diagnostic procedure which take x-ray of a mother
after injection of contrast to visual the fetus and uterine linings.
This may be used to confirm a diagnosis of neural tube defects.
AMNION – is the innermost membrane enclosing the developing
fetus and fluid in which it is bathed or float.
NOTE: This procedures is easily replaced by the use of Ultrasound.

PROCEDURES
~UB must be emptied
~Placenta is localized either by the use of radiography or an image
amplifier fluoroscopy.
The abdominal wall is punctured at the location of the placenta
and into the amniotic sac.
After puncture, the radiopaque contrast medium is injected into
the amniotic sac.
AMNIOGRAPHY
PROJECTIONS
~30 mins after injection of CM take AP and Lateral
~RP: for AP – the place of insertion of the needle.
for Lat – where placenta is located.
Note: If the fetus is viable or alive, the CM will stay within the
amniotic sac for 24 hrs and in the GI tract in 2 days:
DISADVANTAGES
1. Induces premature laboring
2. Fetus is exposed to radiation
INDICATION:
• It provides a positive contrast outline of all the structure within
the amniotic fluid or sac: thus, the method may be used to
detect placenta previa
• For the demonstration of fetal death
PLACENTOGRAPHY
• This is employed for the investigation of the walls of the uterus
to locate the site of the placenta in cases of possible placenta
previa.
• Placenta previa occurs when a baby's placenta partially or totally
covers the mother's cervix — the outlet for the uterus. Placenta
previa can cause severe bleeding during pregnancy and delivery.
Note:
• For the demonstration of the uterine wall and for fetography, the
patient is placed in the supine position.
• When cystography is employed, and when air is injected into the
rectum for the demonstration of the lower segment of the uterus
it is customary to examine the patient in the erect position.
PLACENTOGRAPHY
AP PROJECTION
• Patient in supine position, MSP centered to the midline of the
table.
• Center the cassette at the level of the abdominal curve in order to
include the entire uterus.
• Direct the C.R. vertically to the midpoint of the film.
• Suspend respiration for the exposure.
• Structures shown: Posterior view of the fetal skeleton and the
surrounding maternal structures.
LATERAL PROJECTION
• Patient is placed either in the recumbent or erect, preferably erect.
• Adjust the body and center a plane that passes midway between
the anterior axillary plane and the anterior surface of the abdomen
to the midline of the cassette.
• Center the cassette at the level of the apex of the curve of the
abdomen.
• Central ray is directed perpendicularly to the midpoint of the film.
PLACENTOGRAPHY
STRUCTURES SHOWN
• Lateral view of the fetal skeleton. The placenta is most
frequently localized in this view lying on the anterior or
posterior uterine wall.
NOTE: Use soft tissue technique, High mAs, low kVp.
FETOGRAPHY
• This is employed for demonstration of the fetus in the utero,
to detect early pregnancy, and later for the purpose of
determining the age condition, position, and presentation of
the fetus, whether the pregnancy is single or multiple, and
detect any abnormal condition.
FETOGRAPHY - PROJECTION
•PA Projection- for early pregnancy.
• Patient is placed in the prone position
to place the uterus as close as possible
to the film and to diffuse the shadows
of the sacrum and the coccyx.
• MSP centered to the midline of the
table.
• Central ray is directed at an angle 25-
30 degrees toward the head passing
thru the reign of the anus.
• Adjust the cassette and center it to
the direction of the C.R.
MALE REPRODUCTIVE SYSTEM
•The male reproductive system consists of a number of sex organs that
play a role in the process of human reproduction. These organs are
located on the outside of the body and within the pelvis. The main male
sex organs are the penis and the testicles which produce semen and
sperm, which, as part of sexual intercourse, fertilize an ovum in the
female's body; the fertilized ovum (zygote) develops into a fetus, which is
later born as an infant.

PENIS
•The penis is the male intromittent organ. It has a long shaft and an
enlarged bulbous-shaped tip called the glans penis, which supports and
is protected by the foreskin. When the male becomes sexually aroused,
the penis becomes erect and ready for sexual activity. Erection occurs
because sinuses within the erectile tissue of the penis become filled with
blood. The arteries of the penis are dilated while the veins are
compressed so that blood flows into the erectile cartilage under
pressure. The penis is supplied by the pudendal artery.
SCROTUM

•The scrotum is a pouch-like structure that hangs behind the penis. It

holds and protects the testicles. It also contains numerous nerves and
blood vessels. During times of lower temperatures, the Cremaster
muscle contracts and pulls the scrotum closer to the body, while the
Dartos muscle gives it a wrinkled appearance; when the temperature
increases, the Cremaster and Dartos muscles relax to bring down the
scrotum away from the body and remove the wrinkles respectively.

The scrotum remains connected with the abdomen or pelvic cavity by

the inguinal canal. (The spermatic cord, formed from spermatic artery,
vein and nerve bound together with connective tissue passes into the
testis through inguinal canal.)
TESTIS
•Testis has two major functions: To produce sperm by meiotic
division of germ cells within the seminiferous tubules,[1] and to
synthesize and secrete androgens that regulate the male
reproductive functions. The site of production of androgens is the
Leydig cells that are located in the interstitium between
seminiferous tubules.
EPIDIDYMIS
•The epididymis is a long whitish mass of tightly coiled tube. The
sperm that are produced in the seminiferous tubules flow into the
epididymis. During passage via the epididymis, the sperm undergo
maturation and are concentrated by the action of ion channels
located on the apical membrane of the epididymis.
VAS DEFERENS

•The vas deferens, which is also known as the sperm duct, is a

thin tube approximately 30 centimetres (0.98 ft) long that
starts from the epididymis to the pelvic cavity. It carries the
spermatozoa from the epididymis to ejaculatory duct.

Accessory glands
Three accessory glands provide fluids that lubricate the duct
system and nourish the sperm cells. They are the seminal
vesicles, the prostate gland, and the bulbourethral glands
(Cowper glands).
MALE REPRODUCTIVE CONTRAST STUDY
Radiologic examination of the seminal ducts are performed in
the investigation of selected genitourinary abnormalities such
as cysts, abscesses, tumors, inflammation and sterility. The
regional terms applied to these examination are:
• Vesiculography
• Epididymography
• Or epididymoviseculography
The CM employed for these procedures water soluble iodine
contrast. A gaseous CM can also be injected into each scrotal
sac to improve contrast in the examination of the extrapelvic
structures.
Note: All of these procedures are now replaced by
ultrasound with is non-invasive and free from radiation
exposure.
PROSTATOGRAPHY
Radiologic examination of the Prostate.

Procedure:
~Patient is requested to empty his bladder
~Preparation of the patient is same as that in cystography
~Exposure taken at the end of exhalation

Projection
~Patient in Prone position
~Center MSP to the midline of the table. This places the gland
closer to the IR and allow coccyx and sacrum to be projected
above the region of the prostate by angulating the CR.
~CR is directed 20-25 degrees cephalad
NOTE: this has been replaced by Ultrasound.
END OF LECTURE