Baijal Neha,  Gupta Amit,  D S Dheeksha,  Singh Shivani,  Jana Manisha

Final Pr. ID: Poster #: EDU-030

Congenital urethral anomalies comprise a wide spectrum of developmental disorders. Conventional imaging such as contrast voiding cystourethrography (VCUG) and retrograde urethrography (RGU) are still the first radiological investigations for diagnosis, pre-operative planning based on visualization of urogenital anatomy, and postoperative follow-up.
An understanding of the embryological origin of the urogenital tract is essential for the radiologist to correctly diagnose urethral anomalies. Urogenital sinus is the precursor of bladder, female urethra and posterior urethra in males, which is separated from the hindgut by the urorectal septum. A defect in this septum can give rise to a myriad of anorectal malformations. The anterior urethra in males is derived from fusion of the ventral urethral folds. Any abnormality in proliferation, fusion or canalisation of these embryological structures leads to various congenital anomalies.
Sterile technique and periprocedural antibiotics are essential to avoid introducing or exacerbating urinary tract infection, which can be catastrophic in a child with reflux or bladder outlet obstruction. RGU is typically performed prior to a VCUG.The urethra is cannulated and an iodinated contrast agent such as urografin is injected under fluoroscopic guidance for the evaluation of anterior urethra. The bladder is then catheterised and filled to age-appropriate capacity. The child is allowed to micturate after removal of the catheter to obtain voiding films for evaluation of posterior urethra, and vesicoureteral reflux. A post-void film to look for residual contrast in the bladder completes the study.
In this exhibit, after a review of the embryology and anatomy of the urogenital system, we describe the technique, indications and contraindications of conventional urethrography. This will be followed by a discussion of clinicoradiological features of urethral pathologies in children, including urethral valves, diverticula, megalourethra, Mullerian remnants, persistent cloaca, and syndromic conditions such as Prune belly syndrome. Normal variants and imaging pitfalls will also be discussed.
Conventional urethrography is an age-old, yet simple and useful technique for the evaluation of the pediatric urogenital tract. We revisit this technique and describe its utility in diagnosis and follow-up of urethral anomalies in children. Read More

Authors:  Baijal Neha , Gupta Amit , D S Dheeksha , Singh Shivani , Jana Manisha

Keywords:  retrograde urethrogram, voiding cystourethrogram, conventional urethrography

Veselis Clinton,  Venkatakrishna Shyam Sunder,  Silvestro Elizabeth,  Bennett Brittany,  Srinivasan Abhay,  Acord Michael,  Sze Raymond,  Reid Janet,  Anupindi Sudha

Final Pr. ID: Poster #: EDU-021

Teaching fluoroscopy skills remains an ongoing challenge in pediatric radiology education. Radiologists must be competent to perform a wide range of fluoroscopy procedures and are often required to teach these clinical skills to their peers, junior staff, and students. Teaching procedural skills through frameworks, observation, and feedback, with opportunities for repeated practice, assists in the learner’s acquisition and retention of skills. Fluoroscopy presents patient safety and ethical challenges as “practicing” this skill on patients requires ionizing radiation exposure and often invasive procedures. Through this educational exhibit, we describe a proposed program to improve skill performance, determine competency, and provide feedback. To improve voiding cystourethrogram (VCUG) training two patient models were created for bladder catheterization with different grades of vesicoureteral reflux using 3D printing and silicon rubber. Additional educational materials, including videos and graphical representations, were created to better help the learner understand the steps of the VCUG protocol. A three-component curriculum included 1) Knowledge (indications, contraindications, complications); 2) Communication (with patient and family, with fluoroscopy team); and 3) Performance of the skill (preparation before commencing, steps and dexterity, immediate aftercare of the patient). We modeled our evaluation of the learner from Peyton’s four-step approach to skills teaching (Demonstration, Deconstruction, Formulation, and Performance) to teach the physical performance of the fluoroscopy procedure. Feedback was provided to the learners using the Pendleton Feedback Model. Finally, competency was assessed using the Framework for clinical assessment developed by Miller. This educational exhibit aims to provide radiologists in training with an alternative learning curriculum to better understand and evaluate the steps of the VCUG and its performance on patients in a simulated setting before being performed on patients. Read More

Authors:  Veselis Clinton , Venkatakrishna Shyam Sunder , Silvestro Elizabeth , Bennett Brittany , Srinivasan Abhay , Acord Michael , Sze Raymond , Reid Janet , Anupindi Sudha

Keywords:  Voiding cystourethrogram, VCUG, Fluoroscopy