Presentation On Hysterosalpingography: BY Mahmud M Alkali I.D: 12/01/09/069 Radiography, Unimaid. 2014/2015 SESSION

PRESENTATION ON
HYSTEROSALPINGOGRAPHY
BY
MAHMUD M ALKALI
I.D: 12/01/09/069
RADIOGRAPHY,UNIMAID.
2014/2015 SESSION.
INTRODUCTION
ANATOMY RELEVANT TO HSG:
Anatomic considerations for hysterosalpingography include
the principal organs of the female reproductive system,
including the vagina, uterus, uterine tubes, and ovaries
The uterus is the central organ of the female pelvis. It is a
pear-shaped, hollow, muscular organ that is bordered
posteriorly by the rectosigmoid colon and anteriorly by the
urinary bladder The size and shape of the uterus vary,
depending on the patient's age and reproductive history. The
uterus is positioned most commonly in the midline of the
pelvis in an anteflexed position supported chiefly by the
various ligaments. The position may vary with bladder or
rectosigmoid distention, age, and posture.
INTRO CONTD
The uterus is subdivided into four divisions: (1) the fundus, (2) the
corpus (body), (3) the isthmus, and (4) the cervix (neck) The fundus is
the rounded, superior portion of the uterus. The corpus (body) is the
larger central component of the uterine tissue. The narrow, constricted
segment, often described as the lower uterine segment that joins the
cervix at the internal os, is the isthmus. The cervix is the distal
cylindrical portion that projects into the vagina, ending as the external
os.
The uterus is composed of inner, middle, and outer layers. The inner
lining is the endometrium, which lines the uterine cavity and undergoes
cyclic changes in correspondence to the woman's menstrual cycle. The
middle layer, the myometrium, consists of smooth muscle and
constitutes the majority of the uterine tissue. The outer surface of the
uterus, the serosa, is lined with peritoneum and forms a capsule
around the uterus.
INTRO CNTD
Uterine tubes: The uterine (fallopian) tubes communicate with the

uterine cavity from a superior lateral aspect between the body and
the fundus. This region of the uterus is referred to as the cornu.
The uterine tubes are approximately 10 to 12 centimeters in
length and 1 to 4 millimeters in diameter. They are subdivided into
four segments. The proximal portion of the tube, the interstitial
segment, communicates with the uterine cavity. The isthmus is
the constricted portion of the tube, where it widens into the central
segment termed the ampulla, which arches over the bilateral
ovaries. The most distal end, the infundibulum, contains fingerlike
extensions termed fimbriae, one of which is attached to each
ovary. The ovum passes through this ovarian fimbria into the
uterine tube, whereif it is fertilizedit then passes into the
uterus for implantation and development.
CNTD
The distal infundibulum portion of the uterine

tubes containing the fimbriae opens into the
peritoneal cavity
HSG
Hysterosalpingography (HSG) is the

radiographic evaluation of the uterus and
fallopian tubes and is used predominantly in
the evaluation of infertility.
It uses contrast media to outline the uterine
cavity and the fallopian tubes.
It determines the presence and the severity of
uterine and fallopian abnormalities.
It is used to monitor the effects of tubal surgery.
INDICATIONS/ CONTRAINDICATIONS
INDICATIONS FOR HSG
Infertility
Recurrent spontaneous
abortion
Post-operative
evaluation following
tubal ligation or reversal
of tubal ligation.
Pre-operative evaluation
prior to myomectomy
CONTRAINDICATIONS
Pregnancy
Active pelvic infection
Recent dilatation or
abortion or immediate to
post-menstruation.
Contrast medium
HOCM or LOCM 300. Volume 10-20ml.

LOCM have no advantage with regard to image
quality or side effects but the non-ionic dimer,
iotrolan, is associated with a lower incidence
and decreased severity of delayed pain.
Equipment for HSG
Fluoroscopy with spot film devices

HSG tray
Open-sided speculum,cannula or a ballon-tip
catheter.
Antiseptic Solution
Glooves
Lubricating jelly
10ml syringes
16g and 18g needles e.t.c
HSG TRAY AND FLOUROSCOPY

MACHINE
Patient preparation
.-The patient should abstain from intercourse prior the
procedure,unless she uses a reliable method of
contraception. OR using the10 day rule method
-The examination can be booked between the 4th and
10th days in a patient with regular 28-day cycle.
-Apprehensive patients may need premedication.
-Because patients may experience cramping during the
examination, women are advised to take a nonsteroidal
anti-inflammatory drug 1 hour prior to the procedure.
Preliminary film
Coned PA view of the pelvic cavity
Technique
1. The patient is placed supine on the

fluoroscopy table in the lithotomy or modified
lithotomy position.( The patient lies supine on the
table with knees flexed, legs abducted and heels
together.)
2. Using aseptic technique the operator inserts a
speculum and cleans the vagina and cervix with
chlorhexidine.
3. The anterior lip of the cervix is steadied with
the vulsellum forceps and the cannula is inserted
into the cervical canal.
Technique
If a Foley catheter is used, there is usually no

need to grasp the cervix with the vulsellum
forceps.
4. Care must be taken to expel all air bubbles

from the syringe and the cannula.
5. Place a metallic marker over one side of the

pelvis to indicate the right or left side of the
patient.
Films
A scout radiograph of the

pelvis is obtained with the
catheter in place before
contrast material is
instilled.The first image
(Pic F1) is obtained during
early filling of the uterus
and is used to evaluate for
any filling defect or
contour abnormality. Small
filling defects are best
seen at this stage.
Films cntd
The second image

(Pic F2) is obtained
with the uterus fully
distended. The shape
of the uterus is best
evaluated at this
stage, although small
filling defects may be
obscured when the
uterus is well
opacified.
Films cntd
3. The third image (Pic F3) is obtained to

demonstrate and evaluate the fallopian tubes.
Films cntd
The fourth image (Pic F4) should exhibit free

intraperitoneal spillage of contrast material
films
Oblique views of the fallopian tubes may be

obtained as needed to elongate the tubes or
displace superimposed structures.
Complications of HSG
A) Due to contrast medium:
Allergic reaction
Intravasation of contrast medium
B) Due to the technique:
Pain; when using forceps,during insertion of
cannula e.t.c
Bleeding from trauma to the uterus or cervix
C) Infection
D) Abortion
After Care
Ensure that there is no bleeding after

procedure.
Before discharging patient, make sure the
patient is fit to leave the department without
any serious complications.
CONCLUSION
HSG is a valuable tool in the evaluation of the

uterus and fallopian tubes.
And it is used predominantly in the evaluation
of infertility.
HSG is a fluoroscopic examination of the
uterus and the fallopian tubes, most commonly
used in the investigation of infertility or
recurrent spontaneous abortions.
REFERENCES
A Guide to Radiological Procedures by Stephen
Chapman.
Simpson WL, Beitia LG, Mester J.
Hysterosalpingography: a reemerging study.
Radiographics.26(2): 419-31
Chalazonitis A, Tzavara I, Laspas F et-al.HSG :
technique and applications. Curr probi Diagn
Radiol. 38 (5): 199-205.
Renbaum L, Ufberg D, Sammel M et-al.
Reliability of clinicians versus radiologists for
detecting abnormalities on hysterosalpingogram
films. Fertil. Steril. 2002; 78 (3): 614-8.

Presentation On Hysterosalpingography: BY Mahmud M Alkali I.D: 12/01/09/069 Radiography, Unimaid. 2014/2015 SESSION

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Presentation On Hysterosalpingography: BY Mahmud M Alkali I.D: 12/01/09/069 Radiography, Unimaid. 2014/2015 SESSION

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PRESENTATION ON

Uterine tubes: The uterine (fallopian) tubes communicate with the

The distal infundibulum portion of the uterine

Hysterosalpingography (HSG) is the

HOCM or LOCM 300. Volume 10-20ml.

Equipment for HSG

Fluoroscopy with spot film devices

HSG TRAY AND FLOUROSCOPY

1. The patient is placed supine on the

If a Foley catheter is used, there is usually no

4. Care must be taken to expel all air bubbles

5. Place a metallic marker over one side of the

A scout radiograph of the

The second image

3. The third image (Pic F3) is obtained to

The fourth image (Pic F4) should exhibit free

Oblique views of the fallopian tubes may be

Ensure that there is no bleeding after

HSG is a valuable tool in the evaluation of the

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