Transcript Introduction to Angiographic Procedures and

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Introduction to Angiographic
Equipment & SAFETY (Pt 1) &
Procedures (pt 2)
REFERENCES:
RAD TECH 255 (Rev :2014)
•BUSHONG Ch.27 Interventional Radiography, Ch. 26 Digital Fluoroscopy & Workbook
•MERRILLS Vol. 3, Ch. 25 Circulatory System & Workbook
•SAIA :Radiography Prep Ch.6, Sec. G & Review – Ch.2 Rad Procedures (ref:subspecality list)
•EISENBURG- PATHOLOGY: Rad Pathology – Ch. 7 Cardiovascular
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ANGIOGRAPHY
A general term to describe the radiologic examination of
vascular structures within the body after the introduction of
an iodinated contrast medium.
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Special
Procedures –
Sterile Environment
(like OR)
The Angio TEAM
• Radiologist (Interventional)
• CIT/ CV (R. T.) “Angio Tech”
– Sometimes more than one
• Nurse (Radiology)
• Anesthesiologist (if needed)
• Other specialists (if needed)
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What does this demonstrate?
Name of the Exam ?
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Some history….
• The first angiogram was
performed only months after
Roentgen's discovery
• Which was when?
• Two physicians injected chalk or
mercury salts into an amputated
hand
• and created an
image of the arteries
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Post-mortem injection of mercury compounds,
January 1896
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Other Technologies/Modailities
which demonstrate the vasculature to a greater or less
degree
• CT
• MRI (MRA)
• Ultrasound (particularly Doppler)
• Nuclear Medicine
• are all used to image vessels and
each has its advantages and
disadvantages
• Vessel imaging is a constantly
evolving area.
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Angiography Equipment:
Now primarily uses:
DSA: Digital subtraction
angiography
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This is still considered the gold standard of vessel
imaging when other modalities are inconclusive
Now common practice to be considered as an area
needing advanced training for:
Radiologist: Interventional
R. T. (CIT, CV) etc ANGIO tech
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Technical innovations
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image intensification
three-phase generators
rapid film changers
automatic pressure
injectors
• advanced catheter
technology
• all helped to establish
angiography as an essential
diagnostic tool by the 1960s
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development of interventional techniques
An important offshoot of angiographic
imaging
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have created a therapeutic technology
Embolization
intra-arterial drug therapy
transluminal angioplasty
are among the procedures that have
radically changed and broadened the
scope of the diagnostic imaging
department
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Angiographic
Equipment
& Room
Design
• Vascular studies usually require a room or
suite of rooms
• specifically designed to accommodate the
sophisticated and accessory equipment
needed to perform angiography and
interventional procedures
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• The procedure room should be large enough
to accommodate all of the equipment as
well as radiologic and ancillary staff
• Special procedures sometimes require a
general anesthetic that necessitates extra
equipment and staff.
• These procedures
are also more hazardous
to the patient and each room
must be equipped to deal
with emergencies
that may occur
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Remote Control Center
• Remote computerized
equipment should also
be housed adjacent to
the special room.
• Although there must be
adequate protection for
all operators and staff,
there must at all times
be clear access and
view of the patient
being examined
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EQUIPMENT Needed for Angio*
Biplane C-arm digital imaging
Autoinjector
--syringes, a heating device,
a high-pressure mechanism
a control panel
Image Intensifying screen
Sliding table
Rapid film changer (NOW DIGITAL*)
• Cut film 6 & Cassette changer /magazine
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EQUIPMENT
• Multiple Monitors
• Remote Contol
• Additional Shields
COST: $$$$$$$$$$$$$$
•Angiography equipment
•& MRI scanners
•are major investments
•usually costing between
•$750,000 and $1 million DOLLARS
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ANGIOGRAPHY EQUIPMENT
1. Puncture Needle
Stylet and Cannula
large cannula size
(1.6mm)
2. Guide Wire
--Soft flexible wire with the
strength to pass through
curved vessels
(.6 – 1.0)
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May have 2 C-arm this
Is called what? ________
Should be able to rotate
Around the patient
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Biplane angiography
List 3 advantanges of having 2 tubes simultaneously:
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Angiographic table
• are horizontal only
• but with moving or floating
capabilities
• It is important that during a
procedure, a patient can be
moved without actually being
repositioned, particularly with
the catheter in situ.
Remote Control –
Floating table top to move
During the injection of contrast the table can move to follow the contrast
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Angiographic Equipment
Single or biplane image intensification
• A C-arm or U-arm device is preferable
• the equipment can be rotated rather than the
patient when visualization of the catheter is
critical
• simultaneous biplane
visualization exposures
are needed to reduce the
number of injections
of contrast required
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EQUIPMENT
• Must be able to pivot 180
degrees
• Intensifiers are 12 and 16
inches (larger)
• Needs constant potiental – 1500
mA
• FOCAL SPOTS
– LARGE: 0.6 & 1.2
– SMALL 0.2 & 0.3
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Angiographic Equipment
Generator:
• This must be a three-phase or highfrequency 12-pulse machine and at least
1000 mA to accommodate the rapid, short,
and high exposure values required in
angiography
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Angiographic Equipment
Tube Ratings
X-ray tube:
• High-speed rotating anode tubes. The object of an
angiogram is to produce the highest quality
radiographs in the shortest time possible
• a 0.3 mm small focal spot will produce the best
detail
• tube rating can be exceeded because of the rapid
succession of exposures needed
• usual to have a 0.6-mm focal spot tube
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HEAT UNITS
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Cerebral Study
1 image / 3 sec for 5 min
1 image/20 sec for 10 min
HF Generator used (like which phase?)
• What is the formula?
• What are the heat units for this one study?
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automatic film changer
• Because of the high pressure of arterial
blood flow, the CONTRAST will
dissipate through the patient's system
quickly, so images must be taken in
rapid succession.
• An automatic film changer is used
because the manual changing of x-ray
film can eat up valuable time
• Now DSA done digitally
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Film changers –
NOW OBSOLETE
• the ability to move film in rapid succession,
• allowing for a number of exposures to be
registered each on its own film
• There are a number of makes, the most
common at present being the Puck system
(Siemens) which uses cut film. PUCK-U
• Programmable - allowing the operator to vary
the speed and the number of films passing
through the changer
• Speeds vary from 3 to 12 films per second,
• These changers can also be single or
biplane, allowing for simultaneous exposures.
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MedCon: G. Puck film changer
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Film Changer Features (5)
Supply magazine. This is a light-tight box
that can be filled with film in the darkroom
and then attached to the film changer.
Transport mechanism. This consists of a
series of compression roller devices that
moves the film from the supply magazine to
a pair of intensifying screens and then to the
receiving cassette.
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Film Changer Features (5)
Compression table. This contains a pair of screens.
As soon as the film is positioned between them,
they compress the film and the exposure is
automatically triggered. As soon as the exposure
is complete, the compression is released and the
film advanced to the receiving cassette.
Receiving cassette. This is the magazine that holds
the exposed film. When the examination is
complete, the cassette is removed from the
changer and taken to the darkroom to be
unloaded. It is returned empty to the changer.
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Film Changer Features (5)
Program selector:
• This allows the operator to set speeds and film
quantity
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to suit the exam being undertaken.
Programs can be designed
• To fit standard requirements of various
procedures.
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Film Changer Features (5)
Supply magazine
Transport mechanism
Compression table
Receiving cassette
Program selector
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Equipment
Cine radiography.
Fluoroscopy unit with TV monitor:
Single or biplane fluoroscopy units are available.
Video equipment – DIGITAL RECORDING
Other image recording devices: Images can be
acquired and stored in a digital format
(postprocessing). This is the fundamental principle
of DSA.
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CINE – 35 MM roll film
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Pressure Injectors
• In most angiographic studies
• contrast must be administered
consistent speed
• either faster
• as in abdominal angiography
• or slower as in lymphangiography
SAFETY MEASURES: P 638
LIGHT / ALARM /
at
a
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Pressure Injectors
• Warms contrast – improve viscosity
• Piston – motor driven plunger
• SAFETY MEASURES (p.638)
• Flashing light – audible tone – message
• OPERATIONAL ERROR – OMISSION
• PREVENTS EXESSIVE PRESSURE
FLOW RATE CONTROLLED
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Pressure injectors
• Control
panel where parameters for injections are
are motor driven and have the following major components
set.
• Motor drive mechanism is the electromechanical
device that drives the plunger into the syringe at a
specific pressure
• Syringes are always removable for sterilization
purposes or are disposable.
• Heating system maintains the contrast at near
body temperature to reduce shock and lower the
viscosity of certain contrast media.
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Radiation
SAFETY
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What are the
CARDINAL RULES OF PROTECTION?
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LIH - stays on screen
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Digital Fluoroscopy
• Fluoroscopy is a common
technique used by clinical
physicians to obtain real
time images of moving
body parts and internal
structures of a patient
compared to static
radiographic examinations.
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Digital Fluoro –
Continued next lecture
Pt 1 Equipment: