(1) The conventional x-ray unit equipped with a Potter-Bucky diaphragm
and a tilting mechanism is preferred.
(2) When cystoscopy is required, the radiographic-urological table unit may
provide certain advantages.
(3) A cystoscopic layout that suits the needs of the given case should be
readily available. Ordinarily, this layout is made up and supplied.
(1) The patient is placed on the table in the supine position with the median
plane of the body centered to the midline of the table. A 10 x 12-inch film is placed
lengthwise in the Potter-Bucky film tray and it is centered 1 inch above the symphysis
pubis on the median plan of the body. The CR (central ray) is projected perpendicularly
and directed to the center of the film. A preliminary film of the bladder region is made
upon request of the examiner.
(2) To clear away any gas in the rectum, a rectal tube may be inserted. The
tube must be removed before the exposures are made.
(3) The urologist introduces a contrast medium, such as Cystokon, into the
bladder through a urethral catheter in an amount sufficient to distend the bladder (200 to
300 cc). To retain the contrast solution in the bladder during radiography, the catheter
should be clamped.
(4) Cystograms are exposed with the patient's respiration suspended at the
end of exhalation. The first exposure is an AP projection of the bladder region. Usually,
right and left posterior-obliques (45 to 60 body rotation) (figure 2-32) are made
following the AP projection. Additional exposures may include lateral or stereoscopic
projections in the prone or supine positions. A representative cystogram is shown in
(5) In some cases, the AP projection is taken with CR angled 15 to 25
caudad from the vertical relationship (figure 2-34). Similar results may be obtained with
a perpendicular CR and the head of the table elevated 15 to 25 (figure 2-35).