How does one evaluate IVP films?

Preliminary film. The scout film is in essence a plain film of the abdomen cen-tered low (i.e., a KUB).
Think gas, mass, stones, bones.
Find renal shadows and evaluate the size and axis (should parallel the axis of the psoas muscles).
Evaluate renal shadows and the course of the ureters and bladder for calcifications, which can be obscured once contrast medium is excreted.
Look for bowel pathology (evaluate the caliber and wall thickness).
Examine the bony structures.
Check the corners of the film (lung bases).

Nephrogram. Evaluate the following:
Size: normal adult kidney is 10 to 16 cm; magnification adds about 25%.
Shape: Reniform (bean shaped).
Symmetry: Prompt bilateral, symmetric nephrograms?
Contour: Any local indentations (e.g., scar versus fetal lobulations) or bulges (e.g., masses or cysts)?
Orientation: Axes parallel to the outer margins of the psoas muscles?
Position: in renal fossa or ectopic or absent?

Pyelogram. Evaluate the following:
Calices should be evenly distributed and reasonably symmetric. The normal calyx is cupped, and the dilated calyx is clubbed. The renal pelvis is extremely variable in location, size, and shape (look for filling defects within contrast-filled structures).
Ureters usually are seen in only part of their length on any one plain film because of obliteration of the lumen by peristalsis. No portion of either ureter should be more than 7 mm in diameter. Note any displacement of these structures (e.g., medially from retroperitoneal fibrosis or laterally from adenopathy or AAA).
Bladder should have a smooth outline. After micturition, the bladder should be empty; otherwise, there is a postvoid residue.