Procedures · ARRT Radiography
Urinary System & Contrast Studies for the ARRT Exam
Retrograde urography, cystography, VCUG, the 30-degree kidney rotation, 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 urinary 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 (on the exam until 28 February 2027), because the kidney must excrete the contrast, and the VCUG, because the patient must void.
The anatomy carries hard numbers. 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 the IVU obliques (on the exam until 28 February 2027) 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, where most stones that get stuck lodge.
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, with herniated nucleus pulposus among the lesions most often shown; hysterosalpingography tests tubal patency 7 to 10 days after the onset of menstruation; and arthrography aspirates the joint before injecting. Procedures is the largest domain on the exam: 66 of 200 scored questions to 28 February 2027, 72 from 1 March 2027.
What you’ll learn in this chapter
The 21 study slides and 14 quiz questions in this chapter break down as follows. 3 chapters are free in full with a free account. The others come with a paid plan, and paid plans open soon.
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, the Reference Study
- 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 8 key terms 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 (on the exam until 28 February 2027) 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; on the exam until 28 February 2027) 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 ureteral constriction, where the ureter enters the bladder. Most stones that get stuck lodge here. Urine flowing backward from the bladder up into the ureter is vesicoureteral reflux.
- Nephron
- The structural and functional unit of the kidney, about 1 million per kidney. Filtrate collects in the glomerular (Bowman) capsule around each glomerulus, then runs 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 among the lesions it most often shows.
- 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 question from the Thorax and Abdomen subcategory, like those in its 285-question bank. Several chapters share each sample, so it may not match this chapter's topic. 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 falls short of the count.
B, Correct: Correct. At least 10 posterior ribs above the diaphragm indicates adequate inspiration. Bontrager also notes that patients with pulmonary disease or trauma may be unable to reach 10.
C, Incorrect: Bontrager's count uses posterior ribs, not anterior ribs.
D, Incorrect: Costophrenic angle visibility is part of quality assessment but does not specifically indicate inspiration adequacy.
Read 3 chapters free.
The free tier unlocks 3 complete chapters, 50 practice questions, and 1 sample timed exam. No credit card required.
Frequently asked questions
What does the Urinary System & Contrast Studies for the ARRT Exam chapter 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 urinary 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 (on the exam until 28 February 2027), because the kidney must excrete the contrast, and the VCUG, because the patient must void.
How many study slides are in the Urinary System & Contrast Studies for the ARRT Exam chapter?
This chapter has 21 study slides and 14 quiz questions across 17 sections. This chapter is free in full with a free account.
Is this chapter aligned with the current ARRT Content Specifications?
Every chapter on this site is mapped to the ARRT Radiography Content Specifications, but our line-by-line check against ARRT's outline isn't finished, so keep ARRT's outline beside it. Nothing here follows your exam date, so check which version applies to you. This chapter falls under the Procedures domain of the official ARRT exam blueprint.