Radiographic Procedures · ARRT 2025
Urinary System & Contrast Studies for the ARRT Exam
Retrograde urography, cystography, VCUG, the 30-degree urographic oblique, the three ureteral constrictions, and myelography at L3-L4 for the ARRT Radiography exam.
Overview
Urinary System and Contrast Studies covers urinary anatomy, the contrast studies of the urinary tract, and three special studies: myelography, hysterosalpingography, and arthrography. Every study answers two questions: did the contrast travel antegrade (with the normal flow) or retrograde (against it), and is the study functional or structural? Only two of the five urinary studies are functional: the IVU, because the kidney must excrete the contrast, and the VCUG, because the patient must void.
The anatomy carries hard numbers the ARRT exam likes. The psoas major muscles set the kidneys at two angles: about 20 degrees from the midsagittal plane, and about 30 degrees of backward rotation in cross-section. That 30 degrees is why urographic obliques are 30 degrees and not 45, laying the elevated kidney parallel to the receptor and throwing the downside ureter clear of the spine. The ureters have three constricted points where a stone can lodge: the ureteropelvic junction, the pelvic brim, and the ureterovesical junction, the tightest of the three.
The procedure screens work through retrograde urography (done by a urologist in surgery), retrograde cystography (filled by gravity only, 150 to 500 mL, never under pressure), the VCUG (males imaged in a 30-degree RPO), and the retrograde urethrogram through a Brodney clamp.
The special studies close it out: myelography punctures the subarachnoid space at L3-L4, most often for a herniated nucleus pulposus; hysterosalpingography tests tubal patency 7 to 10 days after the onset of menstruation; and arthrography aspirates the joint before injecting. Procedures is 72 of 200 scored questions, the largest domain on the exam.
What you’ll learn in this chapter
The 35 lessons in this chapter break down as follows. The full lesson content is unlocked when you start a free account.
Urinary & Special Studies
- Urinary System & Special Contrast Studies
Anatomy
- The Kidneys
- Inside the Kidney
- Quiz
- Ureters, Bladder and Urethra
Contrast media
- Contrast Media for Urography
Patient prep
- Preparation, History and Contraindications
IVU
- The IVU, and Why It Is Dropped
- Quiz
Retrograde urography
- Retrograde Urography
- Quiz
Cystography
- Retrograde Cystography
VCUG
- Voiding Cystourethrography
- Quiz
RUG
- The Retrograde Urethrogram
Which way in
- Antegrade or Retrograde, Functional or Structural
- Quiz
Clinical indications
- What You Are Looking For
Image critique
- Critiquing a Urinary Film
- Quiz
Myelography
- Myelography
- Myelogram Positions, and Afterwards
- Quiz
Hysterosalpingography
- Hysterosalpingography
- Quiz
Arthrography
- Arthrography
- Knee and Shoulder Arthrograms
- Quiz
Special studies
- The Three Special Studies at a Glance
Recap
- What to Carry Out of This Chapter
- Quiz
- Quiz
- Quiz
- Quiz
- Quiz
Key terms in this chapter
These are the 8 terms most likely to appear on the ARRT registry from this chapter. Use them as a flashcard pre-quiz.
- Antegrade vs. Retrograde
- Antegrade contrast travels the way the fluid normally travels; retrograde contrast is pushed backward against that flow. The IVU is the only antegrade study in the urinary set.
- Functional Study
- A study that depends on the patient's physiology doing something. Only the IVU (the kidney must excrete) and the VCUG (the patient must void) qualify; the rest show structure only.
- Trigone
- The smooth triangular area on the inner posterior bladder surface, formed by the two ureteral openings and the internal urethral opening. Firmly attached to the pelvic floor while the rest of the lining folds into rugae.
- Ureterovesical Junction
- The third and tightest ureteral constriction, where the ureter enters the bladder. Most stones that get stuck lodge here, and its valve failure is vesicoureteral reflux.
- Nephron
- The structural and functional unit of the kidney, about 1 million per kidney. Filtrate runs glomerulus, proximal tubule, loop of Henle, distal tubule, collecting tubule, and becomes urine at the minor calyx.
- Voiding Cystourethrography (VCUG)
- The bladder is filled retrograde through a urethral catheter, then the catheter comes out and the patient voids during imaging. Males are positioned in a 30-degree RPO; it is where vesicoureteral reflux shows.
- Myelography
- Contrast placed in the subarachnoid space, usually at L3-L4, to study the spinal cord and nerve roots. Herniated nucleus pulposus is the most common clinical indication.
- Hysterosalpingography
- Contrast injected through the cervix to outline the uterine cavity and test the patency of the uterine tubes. Typically performed 7 to 10 days after the onset of menstruation, with water-soluble iodinated contrast.
Sample practice question: Thorax and Abdomen
One free sample from the 75-question Thorax and Abdomen bank. See the format, the rationale style, and the difficulty before you sign up.
On a properly positioned and exposed PA chest radiograph in an adult, how many posterior ribs should be visible above the diaphragm to indicate adequate inspiration?
Show answer and rationale
A, Incorrect: 8 posterior ribs typically indicates underinspiration. Repeat with full inspiration.
B, Correct: Correct. The standard is at least 10 posterior ribs visible above the diaphragm on a properly inspired adult PA chest. Underinspiration (only 8 visible) compresses lung markings and may mimic pulmonary disease.
C, Incorrect: Counting anterior ribs is less reliable because they're more variable and angle differently. Use posterior ribs as the standard.
D, Incorrect: Costophrenic angle visibility is part of quality assessment but does not specifically indicate inspiration adequacy.
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Frequently asked questions
What does the ARRT Radiography Radiographic Procedures category cover?
Urinary System and Contrast Studies covers urinary anatomy, the contrast studies of the urinary tract, and three special studies: myelography, hysterosalpingography, and arthrography. Every study answers two questions: did the contrast travel antegrade (with the normal flow) or retrograde (against it), and is the study functional or structural? Only two of the five urinary studies are functional: the IVU, because the kidney must excrete the contrast, and the VCUG, because the patient must void.
How many lessons are in the Urinary System & Contrast Studies for the ARRT Exam chapter?
This chapter contains 35 lessons across 17 sections, plus a knowledge-check quiz at the end. The full lesson content is unlocked with a Premium subscription. The free tier includes 3 complete chapters.
Is this chapter aligned with the ARRT 2025 Content Specifications?
Yes. Every chapter on this site maps directly to the ARRT Radiography Content Specifications effective 2025. This chapter falls under the Radiographic Procedures domain of the official ARRT exam blueprint.