1. Introduction to Angiographic Equipment & SAFETY (Pt 1) & Procedures (pt 2)
REFERENCES: RAD TECH 255 (Rev :Sp 2010)
BUSHONG Ch.22 Interventional Radiography, Ch. 27 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)
MACE: Rad Pathology – Ch. 8 Cardiovascular

2. ANGIOGRAPHY
A general term to describe the radiologic examination of vascular structures within the body after the introduction of an iodinated contrast medium.

3. 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)

4. What does this demonstrate? Name of the Exam ?#2 #1

5. 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
Post-mortem injection of mercury compounds, January 1896

6. Ultrasound (particularly Doppler) Nuclear Medicine
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.

7. Angiography Equipment: Now primarily uses: DSA: Digital subtraction angiography
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

8. image intensification three-phase generators rapid film changers
Technical innovations
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

9. development of interventional techniques
An important offshoot of angiographic imaging
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

10. 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

11. 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

12. 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

13. 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

14. EQUIPMENT Multiple Monitors Remote Contol Additional Shields
COST: $$$$$$$$$$$$$$
Angiography equipment
& MRI scanners
are major investments
usually costing between
$750,000 and $1 million DOLLARS

15. 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)

17. May have 2 C-arm this
Is called what? ________
Should be able to rotate
Around the patient

18. Biplane angiography
List 3 advantanges of having 2 tubes simultaneously:

19. 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.
Angiographic table
Remote Control –
Floating table top to move
During the injection of contrast -
the table can move to follow the contrast

20. 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

21. EQUIPMENT Must be able to pivot 180 degrees
Intensifiers are 12 and 16 inches (larger)
Needs constant potiental – mA
FOCAL SPOTS
LARGE: 0.6 & 1.2
SMALL & 0.3

22. Angiographic Equipment
Generator:
This must be a three-phase or high-frequency 12-pulse machine and at least 1000 mA to accommodate the rapid, short, and high exposure values required in angiography

23. 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

24. HEAT UNITS
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?

26. 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

27. 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.

28. MedCon: G. Puck film changer

29. 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.

31. 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.

32. Film Changer Features (5)
Program selector:
This allows the operator to set speeds and film quantity
to suit the exam being undertaken.
Programs can be designed
To fit standard requirements of various procedures.

33. Film Changer Features (5)
Supply magazine
Transport mechanism
Compression table
Receiving cassette
Program selector

35. 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.

36. CINE – 35 MM roll film

38. Pressure Injectors In most angiographic studies
contrast must be administered at a consistent speed
either faster
as in abdominal angiography
or slower as in lymphangiography
SAFETY MEASURES: P 638
LIGHT / ALARM /

40. 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

42. Pressure injectors are motor driven and have the following major components
Control panel where parameters for injections are 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.

43. Radiation SAFETY

44. What are the CARDINAL RULES OF PROTECTION?

45. LIH - stays on screen

54. 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.

55. This will be covered with Digital Fluoro – week 12
Pt 1 Equipment: