Hattery R R, Williamson B, Hartman G W, LeRoy A J, Witten D M
Department of Diagnostic Radiology, Mayo Clinic, Rochester, MN 55905.
Radiology. 1988 Jun;167(3):593-9. doi: 10.1148/radiology.167.3.3363117.
In these times of rapid advances in radiographic imaging, intravenous urography should be performed in an optimal way. The urographic examination should involve consultation between the referring physician and the radiologist. Necessary patient information should be accessible. McClennan said "patient selection for urographic studies should be efficacious with the radiologist exerting appropriate control so that the urogram is truly a consultative imaging service integrated into the total patient management." We share this view, and it is an extension of the philosophy of practice emphasized by other leaders in uroradiology. Cost containment, new imaging technologies, risk/benefit considerations, and evolving patterns of patient care have had a significant influence on genitourinary tract imaging. In addition, current debate about contrast media, digital radiography, efficacy, and utilization will undoubtedly have an influence on imaging during the next decade. Utilization of intravenous urography has decreased significantly in the past 15 years. Our volume of examinations has declined approximately 50% since 1970. This decline in our practice is attributed to several complex factors such as previous overutilization of screening urography for hypertension; the impact of US and CT for evaluation of obstruction, retroperitoneal disease (adenopathy and fibrosis), renal failure, and renal masses; concern about contrast medium-induced renal failure; and fewer repeat studies because of improved quality of intravenous urography in general radiology practice. In addition, overutilization of urography in patients with hematuria, prostatism, history of urinary tract infection, etc, continues to be debated in the medical community. In our integrated group practice, we have also observed overutilization of "high-tech" procedures in lieu of urography for evaluation of suspected urinary tract disease. Swings of the pendulum are inevitable in diagnostic imaging because of evolving technology and the art of medical practice. Although some differences of opinion about the details of urographic technique and indications for urography may exist, most would agree on the philosophy of producing a high-quality urographic examination. That philosophy focuses on producing the highest quality examination in each patient so that a diagnosis of normal or abnormal can be made accurately and confidently. Failure to demonstrate the entire urinary tract is a common cause of diagnostic error and one that can largely be eliminated by careful attention to the technical details of the examination.
在放射成像技术飞速发展的时代，静脉肾盂造影应采用最佳方式进行。肾盂造影检查应由转诊医生和放射科医生共同协商。应获取必要的患者信息。麦克伦南说：“肾盂造影检查的患者选择应有效，放射科医生应进行适当控制，以使肾盂造影真正成为融入患者整体管理的咨询性影像服务。”我们认同这一观点，这也是泌尿放射学其他领军人物所强调的实践理念的延伸。成本控制、新的成像技术、风险/效益考量以及不断变化的患者护理模式对泌尿生殖道成像产生了重大影响。此外，当前关于造影剂、数字放射摄影、有效性和利用率的争论无疑将在未来十年对成像产生影响。在过去15年中，静脉肾盂造影的使用率显著下降。自1970年以来，我们的检查量下降了约50%。我们实践中这种下降归因于几个复杂因素，如以往对高血压筛查性肾盂造影过度使用；超声和CT对梗阻、腹膜后疾病（淋巴结病和纤维化）、肾衰竭和肾肿块评估的影响；对造影剂所致肾衰竭的担忧；以及由于普通放射科实践中静脉肾盂造影质量提高而减少的重复检查。此外，医学界仍在争论血尿、前列腺增生、尿路感染病史等患者对肾盂造影的过度使用问题。在我们的综合团队实践中，我们还观察到在评估疑似泌尿系统疾病时，存在用“高科技”程序代替肾盂造影的过度使用情况。由于技术的不断发展和医学实践的艺术，诊断成像中钟摆的摆动是不可避免的。尽管对于肾盂造影技术细节和肾盂造影适应证可能存在一些意见分歧，但大多数人会认同进行高质量肾盂造影检查的理念。该理念侧重于为每位患者进行最高质量的检查，以便能够准确且自信地做出正常或异常的诊断。未能显示整个尿路是诊断错误的常见原因，通过仔细关注检查的技术细节，这一问题在很大程度上是可以消除的。
