INTERVENTIONAL RADIOLOGY

PRELIM
INTERVENTIONAL
RADIOGRAPHY/RADIOLOGY
- Radiographic contrast study of
organ systems by percutaneous
puncture.

IMAGING MODALITIES USED IN IR

1. High
resolution
Image
Intensified Fluoroscopy
2. Ultrasound
3. CT

ANGIOGRAPHIC PROCEDURE
1. Pre-operative preparation
2. Aseptic Technique on site
3. Catheterization
4. Introduction
of
CM
(Bolus
Technique)
5. Exposures
BLOOD VESSEL ABNORMALITIES
1. MALFORMATION

usually
congenital (present at birth)
2. STENOSIS tapered narrowing
3. STRICTURE abrupt narrowing
due to chronic inflammation
4. BLOCKAGE
a. Thrombus obstruction of
blood
vessel
is
fixed;
partially or fully blocks blood
vessel.
Ex. Tumor, Fat
b. Embolus mobile; material
that causes obstruction of
blood vessel.
DIGITAL RADIOGRAPHY
- imaging
modality
where
conventional x-ray films are
replaced by TV monitor.
DIGITAL
SUBTRACTION
ANGIOGRAPHY (DSA)
- type of fluoroscopic technique
used in IR to clearly visualize
blood vessels in a bony or
dense soft tissue environment.

Invasive test to check for blood

vessel abnormalities.
Type of x-ray involving an
injected dye.
Images are taken before and
after dye introduction.
One image is subtracted from
the other structures to be
removed from the image so that
the blood vessels are more
clearly viewed.

OTHER NAMES OF SCOUT FILM films w/o CM

1. Base film
2. Original film
3. Mask Image
4. Zero film
MASK IMAGE
- Image
taken
introduction of dye

prior

to

IMAGE
INTENSIFIER
(II)/FLUOROSCOPY
- radiologic equipment used to
capture mask image
- produce image of the same area
at a set rate of 1-6 frames/sec
taking all subsequent images
away from the original mask
image
LIVE/CONTRAST IMAGE
- image containing
blood vessel.

contrasted

SUBTRACTION
- process of removing bony
superimposition leaving only
contrasted vessels of interest;
removes unwanted structures.
REGISTRATION
- process of matching one image
over another so that bony

landmarks
are
superimposed

preciously

REVERSAL FILM
- reverse tone image (white to
black; black to white)
- Positive mask

SERIES RADIOGRAPHS
- films that were exposed while
contrast
was
being
administered thru an artery
during
ANGIORUN
rapid
sequence.
- Film taken in rapid sequence w/
aautomatic film changer
ANGIORUN
- The dye or CM is running to the
blood vessel
- Power injection administering
contrast thru catheter in patient
from site of entry to point of
extent interest
POWER INJECTOR
- special type of device
administer CM in DSA

done after CM is injected &

images have been taken (series
film)
match up (register) positive
(subtraction
mask)
created
previously from zero film

REVERSE MASK SERIES

- copying w/ subtraction print film
- reverse image
DSA IMAGE
1. background is pale gray
2. contrast-filled
blood
vessels
appear dark gray
3. produced in real-time by the
computer as the contrast is
injected to the blood vessels
PIXEL SHIFTING
- method to remove artifacts
- manual
technique
allowing
correction of transitional motion
only
- not perfectly removes artifact

to

TYPES OF SUBTRACTION
1. First Order
- simplest
- cancel bony images
- only blood vessels are
seen
EQUIPMENTS USED
a. x-ray duplication machine
b. processor
c. darkroom
d. illuminator device used for
registration of images
2. Second Order
- Performed if zero film is
not the exact density as
film w/ contrast

PATIENT MOTION
- causes subtraction image to
show artifacts that may affect
proper diagnosis
DIGITAL
ANGIOGRAPHY
IMAGE
SEQUENCES
- effective
&
computationally
efficient method to further
reduce motion artifacts
IDEAL
DIGITAL
RADIOGRAPHY
MACHINE
1. capable of obtaining good
images quickly and reliably
2. easy to operate by both
technologist and radiologist
3. flexible
in
its
ability
to
incorporate
changes
in
technology

MASK SERIES COMBINATION

BASIC FUNCTIONS
1. record images

2. subtract images
3. contrast enhanced
images

sequential

RECENT DEVELOPMENTS IN DSA

1. large field Image Intensifier
2. faster rate of TV system
3. high speed digital discs
a. integration of ChargeCoupled Device (CCD) TV
Camera
IMAGING CHAIN
1. DSA X-ray Tube
- Able to produce high-flux
& short exposures to
reduce motion artifacts
- Should be constant (x-ray
output) from exposure to
exposure
for
better
subtraction density from
sequential images
2. DSA X-ray Generator
- Capable
of
rapidly
switching kVp & mAs to
perform
dual
energy
subtraction
3. DSA Image Intensifier
- Should
have
high
absorption efficiency to
use limited x-ray fluence
- Require
high
MTF
(Modulation
Transfer
Function) value for better
visualization of large &
medium size arteries
- Employ
large
area
receptors to be able to
include entire region in a
single injection
4. DSA TV System
- Should
run
in
noninterlaced
mode
to
preserve
temporal
resolution (visual film)
- High signal to noise ratio
(SNR)
to
prevent
degradation of image

coming
from
Image
Insifier
5. DSA Camera
- Should run at faster rate
analog
to
digital
converters
6. DSA Image Processor
- Capable
of
accepting
images in semi real-time
& redisplay them at the
same rate
- Perform
pre-processing
function
to
enhance
incoming information
- High
speed,
wide
bandwidth
system
to
accept large amounts of
information
at
short
periods of time, redisplay
images & manipulated for
image enhancement
7. Digital Discs
- Records digital images in
real-time
- Long-term storage
1. Magnetic Storage
2. Photographic films
3. Laser Disc modern
type
DSA diagnose acute stroke (CVA)
Benefits:
1. Diagnostic
2. Therapeutic
- Placing of stent (tube of
wire mesh)
- Repair of torn or weak
areas
- Removal of blockage
Px PREP:
1. NPO for 12 hours
2. Nude wear hospital gown
PROCEDURE
1. Application of anesthesia on site
2. Insertion of catheter (leg/arm)
3. Injection of dye
4. Exposures

POST-EXAMINATION
ORDERS
(required)
1. Removal of catheter (w/ time
limit)
2. Compression of site for 10-20
minutes
3. Px lies flat for several hours to
lessen the risk of bleeding
4. Hydration to flash out dye
DSA
IN
INTRACRANIAL
ANGIOGRAPHY
- Radiographic contrast study of
the blood vessels inside the
brain
2 ROUTES IN PERCUTANEOUS
ANGIOGRAPHY
1. Subclavian Vein
2. Internal Jugular Vein
VENOUS CUTDOWN
- Surgical procedure of skin
incision, exposure of blood
vessel, insertion of catheter and
anchoring
TAMPONADE absorbent plug

d. Arteriovenous
Malformation (AVM)
6. Provide accurate mopping
surgical intervention heart or
brain
ARTERIOSCLEROSIS
- Chronic condition characterized
by thickening & hardening of
arteries & build-up of plaque on
arterial walls
- Slows
or
impairs
blood
circulation
ATHEROSCLEROSIS
- Form of arteriosclerosis where
there
are
localized
accumulations of lipid or fat
containing
material
(ATHEROMAS) w/in or beneath
intimal surfaces of blood vessel.
ATHEROSIS
- Fatty degeneration
vessel walls

of

EMBOLISM
- Blood clot, air bubble or foreign
material that travels & blocks
the flow of blood.

PERCUTANEOUS
FEMORAL
CATHETERIATION
using
SELDINGERS APPROACH has
replaced venous cut down as method
of choice for gaining vascular access

ISCHEMIA
- Decrease in blood supply

PURPOSE OF ANGIOGRAPHY
1. Detect abnormalities
2. Detect blockages

NECROSIS
- Tissue death

INDICATIONS
1. Identify atherosclerosis
2. Diagnose heart disease
3. Evaluate kidney function
4. Detect renal cyst tumor
5. Detect vessel malformations
a. Aneurysm
b. Tumor
c. Blood clot

blood

INFARCTION
- Cell injury/death 2o to embolism

PLAQUE
- Fatty material that is deposited
on the internal wall of the blood
vessel
DEVICES
CATHETER

long, thin, flexible tube used in

angiography to inject CM in
blood vessel

CANNULA
- tube/sheath enclosing trocar
TROCAR
- instrument w/ a triangular tip
used for aspiration (removal of
fluids)
GUIDEWIRE
- wire inserted into a blood vessel
(artery) to lead a catheter to a
certain location in the body
STYLET
- inner wire inside a needle
NEEDLE
- pointed
device
used
puncturing,
insertion
aspiration

for
and

SITES OF ARTERIAL PUNCTURE

1. Groin femoral (most common
approach)
2. Armpit axillary
3. Elbow brachial
4. Neck carotid
TYPES OF CM INJECTION
1. Manual use of syringe
2. Mechanically injected using
automatic injector

AUTOMATIC INJECTOR
- device used to propel a large
volume of CM rapidly to an
angiogram site
AUTOMATIC
FILM
CHANGER
(RAPID CASSETTE CHANGER)
- used in order to take exposures
in rapid succession because dye
dissipates quickly due to high
arterial flow
COMPLETION OF STUDY
1. the catheter is slowly &
carefully removed
2. apply pressure to site
3. application of pressure bandage
(thick)
provides pressure
ORDER OF INSERTION
1. Needle w/ stylet (wire)
2. Stylet is removed
3. Insertion of guidewire
4. Insert catheter
5. Removal of guidewire