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Hello and welcome to Noon Conferences hosted by MRI Online. Noon Conference

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was born out of the pandemic to keep the radiology community connected with

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free live conferences, and make learning accessible from anywhere. The overwhelming

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positive response to this has only strengthened our mission to transform

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the way radiologists learn and thrive, no matter the stage of your career

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or where in the world you practice. You can access the recording of

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this Noon Conference, and previous Noon Conferences by creating a free MRI

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Online account. The link will be provided in the chat box.

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Dr. Alka Singhal, Associate Director of Radiology at Medanta Radiology,

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she is an expert in diagnostic whole body ultrasound imaging, including

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abdomen, and fetal doppler with 3D vascular studies, neck, parathyroid,

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thyroid and MSK. A reminder that there will be a Q&A session at

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the end of the lecture for any questions you may have for Dr. Singhal. Please

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use the Q&A feature to submit your questions, and we will get to

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as many as we can before our time is up. With that being

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said, we welcome you. Dr. Singhal, please take it from here.

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Thank you. Thank you for the warm welcome, thank you for inviting me

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for this fabulous talk today, on renal arterial doppler. And

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so am I visible? Am I audible? And I'll just share my screen.

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So, okay. So, good to go. Okay. So, good afternoon everyone.

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Good evening for those on the other parts of the world, and for all

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your different times, welcome everybody to this fabulous session of Renal

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Transplant Doppler Ultrasound Evaluation. Now, doing cross sectional imaging,

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sometimes ultrasound has a modality, but radiologists kind of get left behind.

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And more so in the other parts of the world where ultrasound is predominantly

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being done by others apart from main radiologists. But here in India,

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we do radiologists are doing the scanning as well. So,

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having worked across the countries, having worked in Australia, having worked

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in Canada, having worked here in India, so I understand how different countries

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work with their own protocols, and their guidelines. And I've tried to summarize

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things in a more simple manner to be suitable for anybody who's doing

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the ultrasound work. Thank you. So, now just to start with renal arterial

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doppler, we do understand that, we've worked through doppler optimization.

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We've worked through the basic ultrasound knobology controls, and we had

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explored in all of those and we are trying to focus predominantly on

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just the ultrasound doppler. So, moving down to the history of renal transplant

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dopplers. So, we've had a very steep rise in the outcomes in the...

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Since 1954 when the first transplant was done. Now we have reached to

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doing transplant between not even identical twins, not even related siblings,

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but just the immunosuppression, and the other techniques have so much advanced

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that we are really, really getting better and better.

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And so the background, so why do we do the renal transplant?

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So, it's basically end stage liver disease. So, it's improved the life quality

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more so, and the duration, the expectancy. So, we have got better surgical

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techniques, better immunosuppression, and better types of matching. So,

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that also means there are people traveling far across away from the centers

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to all the remote places around the world where they would be constantly

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monitored for any inadvertent events or anything. So, we are all required

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to be aware of each and everything so we can diagnose them timely

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and manage the patient. Now, before we go ahead, what are the types

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of liver? What are the types of kidney transplants? So, one is a

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disease donor kidney transplant or a living donor kidney transplant. So,

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when we have organ failure, multi organ failure in any patient,

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so where we can get our kidneys for example,

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or a living donor. So, commonly the practice is for a living donor for renal

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transplant. Now preemptive kidney transplant is the preferred option. What

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does that mean is, before the kidney function is deteriorated to the point

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of needing dialysis. If we come across, and if we communicate and if we

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are able to do a transplant, then it definitely has better survival for

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the graft. It has a better, quality of life for the patient and

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everything. So, that is the preferred option and is adopted. So,

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there's a lot of pre transplant, donor recipient evaluation and donor evaluation

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and matching and all those factors. And very close following up that goes

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on for the successful transplant. Now, my question, so I'm sure you are

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all aware of it, where do you look for a kidney that is transplanted? So,

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we need kidneys, we all know where they're located. So where are the

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transplant kidneys located? So, where is it placed? It depends upon the

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kind of surgical technique that we've adopted. We'll come to that.

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So, just my question, just a brainstorming. Is it extraperitoneally on the

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right side more common? Intraperitoneally or the left side?

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So, of course, yes, it's extraperitoneally in the right iliac fossa, unless

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you're doing in different areas which we'll come to in a short while. Now,

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understanding the surgical technique, that is the most, most important thing

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that you can find out before you will be able to do the

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doppler evaluation. Because understanding the surgical anatomy, understanding

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the donor anatomy always, always supports you because then you can see which

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arteries were there, which segmental arteries were there, which were going

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where and what. So, then you can connect the dots together,

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which goes for any other part. Be it liver transplant, be it kidney transplant,

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be it any surgery. Looking at patient's history and clinical notes is the

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most, most important thing that you can do. So, typically at open surgery

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the graft is placed extraperitoneally in the right iliac fossa. So,

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it's preferred because a vascular anastomosis with the right iliac vein

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is more straightforward, and the vein being more superficial and more horizontal.

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And robotic renal transplants are done with the blood construction and they're

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partly intraperitoneal. So, that's the... So, basically it's an end to side

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anastomosis. So, what all are you going to evaluate? So you have got

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to evaluate basically all the vascular anastomoses. So, one is the renal

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artery, which is an anastomosed end to side anastomosis, the donor renal

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artery with the external iliac artery. Or alternatively to the internal

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iliac artery, and the other factors, especially in cases of elderly,

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in cases of the diabetic or there's any other insulin...