Cost-effective filming sequence for intravenous urography.

To define an intravenous urography (IVU) film sequence that maximizes sensitivity and minimizes filming costs, we evaluated the effect of omitting films from a standard IVU sequence. We reviewed 82 IVU series that demonstrated abnormalities. Each series comprised 11 films: preliminary abdominal radiograph and nephrotomogram, three 1-minute nephrotomograms, 5-minute abdominal film, 10-minute radiograph with abdominal compression, one frontal and two oblique 15-minute films, and postvoid film. Sensitivity was determined for each film. Eighty-two standard IVUs showed 120 abnormalities. Omitting any one film from the sequence decreased sensitivity by 0% to 12%. Omitting the preliminary film resulted in failure to detect 15 abnormalities (12%). Omitting any nephrotomogram, the 10-minute compression view, or either 15-minute oblique film did not decrease sensitivity. Omitting combinations of these films lowered overall sensitivity. The postvoid film was essential in only one case. We conclude that a sequence of nine radiographs decreases film and processing expenses by 18% without sacrificing sensitivity. Sequences with fewer films substantially reduce detection of common urinary tract abnormalities.