interventional imaging

• Angiography


  A medical imaging technique used to visualize the inside or lumen of blood vessels and organs of the body, with particular interest in the arteries, veins and the heart chambers

  
• Angiography


  • Diagnostic and interventional procedure

  
• Types of angiogram


  • CTA
  • MRA
  • DSA
  • Coronary Angiography

  
• Personnel in the Angio Room


  • Radiologist/Specialist
  • Cardiovascular nurse
  • Radiologic Technologist (Radiographer)
  • Anesthesiologist team
• Equipment


  • X-ray generators
  • Controls
  • X-ray Tubes
  • System to record events of procedure (DSA system)
  • Automatic injectors
• Previous imaging system: Cut Film Changer & Cine Fluoro (Cardiac Cath Camera)
• DSA (Digital Subtraction Angiography)


  Immediate subtraction and playback, Excellent contrast resolution, Reduces contrast up to 75%, Post-processing: remasking, pixel shift, windowing, quantitation of stenosis

  
• Electromechanical injector


  • Overcomes arterial pressure and maintains bolus, Maintains flow rate, Flow rate affected by: Viscosity, Length + diameter catheter, Injection pressure, Vessel selected
• Components of electromechanical injector

  • Control panel
  • Syringe
  • Heating device
  • High-pressure mechanism
• Safety devices of electromechanical injector

  • Acceleration regulators
  • Pressure-limiting devices
• Preparation before angiography procedure


  1. Admitted a day before to the ward

  2. Fast for 8 hours

  3. LMP/history of allergies checked

  4. CT/PT, BT checked

  5. HIV/AIDS checked

  6. Shaving of puncture site
• Preparation before angiography procedure

  1. Full explanation of procedure

  2. Consent form

  3. Premed: pherngan & pethidine

  4. Previous radiograph

  
• Clotting time


  The time required for blood to clot in a glass tube
• Prothrombin time (PT)


  A blood test that measures the time it takes for the liquid portion (plasma) of your blood to clot. Normal range is 12 to 15 seconds
• Bleeding time (BT)


  A crude test of hemostasis (the arrest or stopping of bleeding). It indicates how well platelets interact with blood vessel walls to form blood clots. Less than 15 minutes
• Trolley preparation


  • Angiography set
  • Angiography basin
  • I/I cover
  • Surgical blade
  • J-Teflon Guidewire (0.035" x 150cm)
  • Radifocus Guidewire M Angle (0.035" x 150cm)
  • Media contrast
  • Normal saline injection
  • Povidone iodin
  • Heparin saline
  • Plaster handyplast
  • Angiography catheters (COBRA,HEAD HUNTER)
  • Syringe 5ml,10ml,20ml
  • Shealth introducer
  • 3 way stopcock
• Guide wires


  • For introduction, stabilization and positioning of angiographic catheters, With J-tip or straight end, Lengths: 150 cm, 175 cm, 200 cm, 260 cm, Fabricated of stainless steel, Contain an inner core wire tapered at the end to a soft, flexible tip, Categorized by: length,configuration of the tip, stiffness of GW and coating
• Angiography catheters


  • Different shapes,sizes and multipack configurations, For selective and flush, Catheter diameter is categorized in French (Fr) sizes, Usually made of plastic (polyurethane, polyethylene, Teflon, or nylon)
• Types of angiography catheters

  • Flush Catheters (pigtail)
  • Access Catheters (head hunter, cobra)
  • Sizing Catheter
• Common catheter shapes


  • Headhunter tip (H1) -> femoral approach to brachiocephalic vessels
  • Simmons /Sidewinder -> approach sharply angled vessels
  • Cobra (C2)-> gentle curved (celiac, renal, mesenteric)
  • Pigtail -> side holes for compact bolus
• High pressure tubing lines

  Pressure: 82 bar / 1200 psi
• Care of patient during examination


  Patient is comfortable, Immobilize, Suitable head rest, Communicate with patient, Observe patient continuously: BP, Patient condition, ECG & BP automatic device, Pulse Oximeter
• Guideline: optimal practice for Sedation and Patient monitoring in vascular and IR


  • Clinical assessment of the patient prior the procedure
  • Visiting the patient on the ward the day before the procedure
  • Keeping a patient fasting for liquids and solids prior to a procedure
  • Administration of oxygen
  • Staff for recovery area
• Sedative drugs


  Benzodiazepines (Diazepam, Midazolam)

  Analgesics: pethidine
• Patient monitoring in vascular and IR

  A trained nurse is designated to monitor ECG,BP and pulse, Monitoring by electrocardiography (ECG), automatic blood pressure measurement and pulse oximetry devices (Mandatory), The code or "crash" chart for life-threatening emergencies must be accessible
• Management of complications


  • Resuscitation facilities: Defibrillator
  • Emergency drugs: Atropine, Naloxone, Flumazenil
  • Attend a refresher course in CPR (cardio-pulmonary resuscitation) and life-support
  • Anaesthetic involvement
• Care of patients after procedure


  Apply pressure on puncture site till bleeding stops, Check for hemorrhage, BP and pulse hourly for 4 hours, 4 hourly for 24 hours
• Don't bend the leg of the puncture site
• Puncture sites


  • Femoral Artery
  • Brachial Artery
  • Axillary Artery
• Seldinger Technique


  1. Insertion of needle into femoral artery

  2. Insertion of guide wire

  3. Removal of needle

  4. Threading of catheter to region of interest

  5. Removal of guide wire
• General complications of catheter techniques

  • Haemorrhage/haematoma
  • Arterial thrombus
  • Infection
  • Damage to local structures
  • Arteriovenous fistula
• Radiation protection


  • Proximity to patient, Radiation protection devices, Leaded glasses pulled into place, Minimal fluoro use, Collimation, Wear OSL/badges
• Cerebral angio images


  • Vertebrobasilar
  • AP Thoracic Aorta
  • Celiac Arteriogram