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DESCRIPTION
Hysterosalpingography (HSG), also called uterosalpinography, is an x-ray examination used to help diagnose a suspected intrauterine tumor, mass or congenital malformation, or where the fallopian tubes may be blocked. An HSG uses a special form of x-ray called fluoroscopy and a contrast material. HSG is often necessary in cases of infertility to help determine the problems involved. Ultrasound techniques have been improved so that they can also diagnose some intrauterine conditions, but not tubal blockage.
An x-ray (radiograph) is a painless medical test that helps health care providers diagnose and treat medical conditions. Radiography involves exposing a part of the body to a small dose of ionizing radiation to produce pictures of the inside of the body. X-rays are the oldest and most frequently used form of medical imaging.
Fluoroscopy is a special x-ray technique that makes it possible to see internal organs in motion. When the uterus and fallopian tubes are filled with a water-soluble contrast material, the radiologist is able to view and assess their anatomy and function.
REASONS FOR PROCEDURE
Infertility. Hysterosalpinography is primarily used to examine women who have difficulty becoming pregnant by allowing the radiologist to evaluate the shape and structure of the uterus, the openness of the fallopian tubes, and any scarring within the peritoneal cavity. It is used to confirm tubal and uterine abnormalities, congenital malformations and traumatic injuries.
Multiple miscarriages. The procedure can be used to investigate repeated miscarriages that result from congenital abnormalities of the uterus and to determine the presence and severity of these abnormalities, including:
- Tumor masses or adhesions.
- Uterine fibroids.
Excessively painful menstruation.
Follow-up to some surgical procedures. Hysterosalpingography is used to monitor the effects of tubal surgery, including:
- Tubal ligation.
- The closure of the fallopian tubes in a sterilization procedure and a sterilization reversal.
- The re-opening of the fallopian tubes following a sterilization or disease-related obstruction.
RISK INCREASES WITH
Undiagnosed vaginal bleeding.
Pelvic inflammatory disease (PID).
Pregnancy.
DESCRIPTION OF PROCEDURE
PREPARATION FOR THE PROCEDURE
The hysterosalpingography procedure is best performed one week after menstruation but before ovulation to make certain that you are not pregnant during the exam.
This procedure should not be performed if you have an active inflammatory condition. You should notify your health care provider or technologist if you have a chronic pelvic infection or an untreated sexually transmitted disease at the time of the procedure.
On the night before the procedure, you will be asked to take a laxative or an enema to empty your bowels, so that the uterus and surrounding structures can be seen clearly.
Prior to the procedure, you may be given a mild sedative or over-the-counter medication to minimize any potential discomfort. Some health care providers prescribe an antibiotic prior to and/or after the procedure.
You should inform your health care provider of any medications you are taking and if you have any allergies, especially to contrast material. Also inform your health care provider about recent illnesses or other medical conditions.
You may be asked to remove some or all of your clothes and to wear a gown during the exam. You may also be asked to remove jewelry, eye glasses and any metal objects or clothing that might interfere with the x-ray images.
Women should always inform their health care provider or x-ray technologist if there is any possibility that they are pregnant. Many imaging tests are not performed during pregnancy because radiation can be harmful to the fetus. If an x-ray is necessary, precautions will be taken to minimize radiation exposure to the baby. See X-ray Safety for more information about pregnancy and x-rays.
THE TECHNICAL PROCEDURE
The procedure may be done in a hospital or in the office of a radiologist usually on an outpatient basis. The equipment typically used for this examination consists of a box-like structure containing the x-ray tube and fluoroscopic equipment that sends the x-ray images to a television-like monitor for viewing that is located in the examining room or in a nearby room. This structure is suspended over a table on which the patient lies. A drawer under the table holds the x-ray film or image recording plate that captures the images.
X-rays are a form of radiation like light or radio waves. X-rays pass through most objects, including the body. Once it is carefully aimed at the part of the body being examined, an x-ray machine produces a small burst of radiation that passes through the body, recording an image on photographic film or a special image recording plate.
Fluoroscopy uses a continuous x-ray beam to create a sequence of images that are projected onto a fluorescent screen, or television-like monitor. When used with a contrast material, which clearly defines the area being examined by making it appear bright white, this special x-ray technique makes it possible for the physician to view internal organs in motion. Still images are also captured and stored either on film or electronically on a computer.
X-ray images are maintained as hard film copy (much like a photographic negative) or, more likely, as a digital image that is stored electronically. These stored images are easily accessible and are sometimes compared to current x-ray images for diagnosis and disease management.
THE PROCEDURE - WHAT TO EXPECT
The patient is positioned on her back on the exam table, with her knees pulled to her chest or her feet held up with stirrups. A speculum is inserted into the vagina and the cervix is grasped with a tenaculum (a hood-like instrument). The dye catheter apparatus is inserted into the cervix and attached to the cervix. The speculum is removed and the patient carefully situated underneath the fluoroscopy device.
The dye (contrast medium) is slowly released into the uterus, filling the uterine cavity through the catheter. The fluoroscopic x-rays are taken. There may be some discomfort felt as the dye is injected. You may be asked to change positions for different x-ray views. The x-rays will show the outline of the uterus and fallopian tubes as the dye fills them.
In some cases, if certain abnormalities are encountered, the patient will be asked to rest and wait up to 30 minutes so that a delayed image can be obtained. This delayed image may provide clues to a patient's condition that the original images with contrast material do not. On occasion, an x-ray will be taken the next day to ensure that there is no scarring surrounding the ovaries.
When the procedure is complete, the catheter will be removed and the patient will be allowed to sit up.
When the examination is complete, the patient will be asked to wait until the radiologist determines that the images are of high enough quality for the radiologist to read. The hysterosalpingogram is usually completed within 30 minutes.
The exam should cause only minor discomfort. There may be slight discomfort when the catheter is placed and the contrast material is injected, but it should no last long. There are also the slight irritation of the peritoneum, causing generalized lower abdominal pain, but this should be minimal and not long lasting.
EXPECTED OUTCOME
A radiologist is a health care provider specially trained to supervise and interpret radiology examinations. He/she will analyze the images and send a signed report to your referring health care provider, who will share the results with you.
Normal findings reveal a symmetrical uterine cavity, the dye flowing through unblocked fallopian tubes, and there is no leak of dye from the uterus.
The x-rays may help reveal any abnormality in the shape/size of the uterine interior scarring, tumors (fibroids) or a blockage in the fallopian tubes.
POSSIBLE COMPLICATIONS
Some benefits of HSG is that it is a minimally invasive procedure with rare complications. It is a relatively short procedure that can provide valuable information on a variety of abnormalities that can cause infertility or problems carrying a fetus to term. No radiation remains in a patient's body after an x-ray examination and x-rays usually have no side effects. However, there is always some risk with HSG and x-rays in general.
COMPLICATIONS RELATED TO THE PROCEDURE
Allergic reaction to the dye used in the test (hives, itching, low blood pressure).
Uterine perforation.
Infection. In the event of a chronic inflammatory condition, pelvic infection or untreated sexually transmitted disease, be certain to notify the health care provider or technologist before the procedure to avoid worsening the infection.
RADIATION RISKS
There is always a slight chance of cancer from radiation. However, in most cases, the benefit of an accurate diagnosis is considered more important and outweighs the risk of radiation exposure.
As long as the equipment is well serviced and regularly checked for radiation levels, the effective radiation dose from this procedure is about 1 mSv, which is about the same as the average person receives from background radiation in about four months. Special care is taken during x-ray examinations to use the lowest radiation dose possible while producing the best images for evaluation. National and international radiology protection councils continually review and update the technique standards used by radiology professionals. State-of-the-art x-ray systems have tightly controlled x-ray beams with significant filtration and dose control methods to minimize stray or scatter radiation. This ensures those parts of a patient's body not being imaged receive minimal radiation exposure.
Women should always inform their health care provider or x-ray technologist if there is any possibility that they are pregnant. If your menstrual period is delayed, a HSG is usually contraindicated.
MoonDragon's Obgyn Procedures: X-ray Safety
TREATMENT
GENERAL MEASURES
Some symptoms, such as mild cramping, a slow pulse, some nausea or dizziness may occur following the procedure. These are temporary.
HSG LIMITATIONS
Hysterosalpingography only sees the inside of the uterus and fallopian tubes. Abnormalities of the ovaries, wall of the uterus, and other pelvic structures may be evaluated with MRI or ultrasound. Infertility problems may be from causes not evaluated with hysterosalpingography, including, but not limited to, low or abnormal sperm count or the inability of a fertilized egg to implant in the uterus.
Conditions detected by the hysterosalpingogram may require further testing for confirmation; usually a laparoscopy or hysteroscopy (use of a small lighted telescope to view internal organs).
MEDICATION
A mild sedative may be administered prior to the procedure.
Following the procedure, use mild painkillers, such as acetaminophen if necessary.
ACTIVITY
No restrictions once any temporary symptoms disappear.
DIET
No special diet. However, you should follow a healthy, balanced nutritional program for a healthy immune system and to assist in a rapid recovery.
NOTIFY YOUR MIDWIFE OR HEALTH CARE PROVIDER IF...
Any of the following occurs:
- Increased pain or swelling in the genital area.
- Signs of infection: headache, muscle aches, dizziness or a general ill feeling and fever.
- Excessive bleeding.
INFORMATION ABOUT RADIOLOGY TESTS AND PROCEDURES
Note: Some of the information about x-rays and HSG Testing was obtained from RadiologyInfo.org. Thank you for your well-informed website.
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