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1.

Definition
2. Indication & Contraindication
3. Contrast Media
4. Equipment
5. Preparation
6. The Procedure Of Perform
7. Catheterization Technique
8. Technically Of Imaging
9. Radiation of Protection
10. Conclusion
1. American College of Radiology -PRACTICE
PARAMETER FOR THE PERFORMANCE OF
HYSTEROSALPINGOGRAPHY-2014
2. Research Gate- Hysterosalpingography: Technique
and Applications-2009
3. European Society of Radiology-
Hysterosalpingographic Technique and Findings in
InfertileWomen-2014
4.http://www.slideshare.net/airwave12/hysterosalpingog
raphy-33184676
DEFINITION
Hystero  Uterus
Salpingo Tuba Fallopii

The radiographic to evaluation of uteryna


and fallopii tubes, after injection of a
radio-opaque contrast medium through
the cervix canal
INDICATION & CONTRA INDICATION

HSG is used predominantly in the evaluation of


infertility

Also be used in other cases, such as pain in the pelvis


tract,congenital or anatomic abnormalities, anomalies
of the menstrual cycle, and abnormal menses

The main contraindication of the examination is


possible pregnancy, cases of severe cardiac
or renal deficiency, or in cases of recent uterine
ortubal surgery
CONTRAST MEDIA
In the past, oil-soluble contrast media
were mainly used

Maximal to visualization of uterine


structure

Particularly if an oil-based contrast agent is


used, injection should be halted immediately if
myometrial or venous intravasation is
observed
Today, we use all available iodinated
hydrosoluble contrast media/watersoluable
contrast- media

Absorbed easily, does not leave a residue within


reproductive tract, provides adequate
visualization,

Cause pain & persist four hour after procedur


EQUIPMENT

UNDER FLUOROSCOPY SUPERVISION


Gynecologic Strirrup
Sterill Instrument
PREPARATION

1. The scheduling of the procedure should be


done between days 5 to 10 of the menstrual
cycle

2. The patient is asked to refrain from unprotected


sexual intercourse from the date of her period until
after the investigation to be certain there is no risk of
pregnancy
3. Patients can be instructed to take a
nonsteroidal antiinflammatory an hour before
the procedure

4. The risk of infection is rare and has been reported to


be less than 1%, antibiotic prophylaxis with 500mg of
azithromycin can be given to all women during the
procedure but is not warranted
THE PROCEDURE OF PERFORM
1. Before the patient enters the room, the sterile instrument tray is
prepared and checked.
2. Place equipment within reach and set it to your own standards.
3. Use a 20cc syringe and attached to the balloon catheter or 8-
French paediatric foley catheter, then between 5 to 10cc of
contrast material is pour into the system.
4. Second eliminate air bubbles remaining in the system before
inserting it, since they may confuse interpretation and
unnecessarily prolong the procedure
5. Also check with a 5cc syringe that the balloon system is
working before using it .
6. The patient is placed supine at the end of the fluoroscopic table
with her knees bent in a modified lithotomy position, and draped
with a sheet.
7. Support patients head with a pillow, this can help the patient
feel more comfortable
CATHETERIZATION TECHNIQUE
• The patient is placed on the fluoroscopic machine in a
gynecologic examination position

• Cleaning the external genital area with antiseptic


solution, the vagina is dilated by a gynecologic
dilator

• The cervix is localized and cleansed with iodine


solution

• The uterine cervix is straightened by one


(at the 12 o’clock position) or two (at the 9
and 3 o’clock positions) surgical forceps
exercising a degree of pulling

• The outside uterine cervix ostium is catheterized


Technically of Imaging
1. The contrast media should be injected slowly, using low
steady pressure with constant fluoroscopic monitoring of
uterine and tubal filling.
2. A small amount of contrast is used early in the
examination to best visualize subtle intrauterine
abnormalities such as polypsor synechiae, which may be
obscure when the uterine cavity is completely filled.
3. Contrast injection is continued as the uterine tubes
opacify, with the endpoint of the examination being
demonstration of bilateral tubal spillage into the
peritoneal cavity.
4. Monitor the examination when possible by watching the
patient´s face.
Appropriate images should be produced to demonstrate
normal and abnormal findings

Supine frontal views are routinely obtained, and


oblique and prone views may be obtained as
indicated
1. Air bubbles
2. Uteryn Fold
3. Synechiae
Post Procedure Care

The patient should be instructed to


contact the imaging physician or
referring physician if she develops
fever, persistent pain, or unusual
bleeding following the procedure.
The patient can be told to expect a
sensation of menstruation
RADIATION OF PROTECTION

Responsibility for safety in the workplace by keeping


radiation exposure to staff, and to society as a
whole, “as low as reasonably achievable” (ALARA)
and to assure that radiation doses to individual
patients are appropriate, taking into account the
possible risk from radiation exposure and the
diagnostic image quality necessary to achieve the
clinical objective .
CONCLUSION

HSG remains the front-line imaging


modality in the investigation of
infertility. It is an accurate means of
accessing the uterine cavity and
tubal patency, but has a low
sensitivity for the diagnosis of pelvic
adhesions, which is why it cannot
replace laparoscopy.