RadteraHysterosalpingogram (HSG)
Fluoro+ ContrastOB-GYNverify
Indications
- Infertility workup — tubal patency assessment
- Recurrent pregnancy loss (uterine cavity evaluation)
- Suspected uterine anomaly (septate, bicornuate, unicornuate)
- Assessment of tubal occlusion devices / post-tubal ligation or reversal
- Intrauterine adhesions (Asherman), polyps, submucosal fibroids
Patient prep
- Schedule in proliferative phase, days ~7-12 of cycle (after menses, before ovulation)
- Exclude pregnancy and active pelvic infection/STI; pregnancy test
- Consider pre-procedure NSAID for cramping; antibiotic prophylaxis if hydrosalpinx or PID history per protocol
- Empty bladder before exam
Contrast
AgentWater-soluble iodinated contrast (e.g., Omnipaque 240/300 body cavity formulation)
Routetranscervical via cannula/balloon catheter into uterine cavity
DoseSlow injection of ~5-20 mL until uterine cavity fills and tubes opacify with peritoneal spill
TimingReal-time fluoroscopy during slow injection
Technique
- Sterile speculum exam; cannulate/cervix occlude with balloon or cervical cup
- Inject contrast slowly under fluoroscopy to outline the endometrial cavity
- Document cavity contour, then continued filling to opacify fallopian tubes
- Capture free intraperitoneal spill (confirms patency)
- Oblique/spot images to separate tubes and define cornua; delayed image for spill if needed
Series / Sequences
| # | Series / Sequence | Plane | Notes |
|---|---|---|---|
| 1 | Scout | AP pelvis | Baseline, calcifications |
| 2 | Early cavity fill | AP | Cavity contour — filling defects, anomalies |
| 3 | Full fill with tubes | AP + obliques | Tubal course, hydrosalpinx, occlusion |
| 4 | Free peritoneal spill | AP | Confirms tubal patency |
Key points
- Strictly avoid in pregnancy, active pelvic infection, and within ~6 months of pregnancy termination; do not perform during menstruation
- Time to early follicular/proliferative phase to minimize pregnancy risk and improve cavity assessment
- Watch for venous/lymphatic intravasation (excess pressure) — stop injecting
- Oil-soluble contrast has shown improved fertility outcomes in some studies but water-soluble is standard for diagnostic clarity and safety; oil agents carry granuloma/embolism risk
- Antibiotic prophylaxis if dilated tubes/hydrosalpinx (infection risk)
References
• ACR–SPR Practice Parameter for the Performance of Hysterosalpingography
• Omnipaque (iohexol) prescribing information — hysterosalpingography indication (GE Healthcare USPI)
• Radiopaedia: Hysterosalpingography
• Omnipaque (iohexol) prescribing information — hysterosalpingography indication (GE Healthcare USPI)
• Radiopaedia: Hysterosalpingography
Source: Researched — verify against your institution
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Reference template — verify and adapt to your scanner, vendor and institution before clinical use. Not a substitute for clinical judgment.