Transcript RAD 254 Chapter 25 Interventional Radiography

RAD 254 Chapter 22
Interventional Radiography
Both diagnostic (imaging) and
Therapeutic (interventional)
Brief History
• 1930’s angiography
• 1953 – Seldinger needle
• 1960’s transbrachial selective coronary
angiography (common femoral artery is
still the most commonly accessed artery
for access to other structures)
Imaging procedures
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Angiography
Aortography
Ateriography
Cardiac Catherization
Myelography
Venography
Interventional Procedures
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Stent placement
Embolization
Intravascular stent
Thrombolysis
Balloon angioplasty
Artherectomy
Electrophysiology
Materials needed
• Needle (usually a Seldinger needle – blunt
outer obturator; beveled inner stylet 18 g)
• Guide (glide) wires
• Catheters ( H1 – “headhunter”; C2 –
“Cobra”; Pigtail)
– Heparin saline for “flushing”
– Contrast – most is now nonionic are preferred
over ionic as they have less concentration of
ions and lower adverse effects
Patient Prep and Monitoring
• Informed consent – radiologist visits patient
PRIOR to the procedure and explains it in detail
• Prep – NPO 8 hours prior and usually hydrating
IV’s
• During procedure – cardiac monitoring, blood
pressure and pulse oximetry
• Post – manual pressure on the puncture site
followed by a sand bag for pressure and
monitoring for hours after – prevent bleeding!
Equipment considerations
• Tube
– Focal spot size 1.0 mm/ 0.1 mm
– Disc size 15 cm diameter (heat load)
– Power rating – 80kW (rapid sequence, serial
radiography)
– Expanded anode heat capacity (massive
amounts of heat are produced)
• Couch – non-tilting, slim design with
“stepping” capability
Filming considerations
• Cine camera for cardiac catherization
(camera and fluoro are synchronized so
the fluoro only emits x-ray when the film
frame is accessible)
• Photofluorographic camera
• Charge-Coupled Device (CCD)
photosensitive silicon chips (replacing the
TV camera) convert light to digital video
images