prelim Flashcards
is a medical specialty that uses minimally invasive techniques to diagnose and treat various conditions, often as an alternative to traditional surgery.
Interventional radiology (IR)
It involves the use of medical imaging (like X-rays, CT scans, ultrasound, or MRI) to guide tiny instruments, such as catheters, wires, or needles, to targeted areas in the body.
Interventional radiology (IR)
Interventional radiology (IR) It involves the use of medical imaging (like WHAT
X-rays, CT scans, ultrasound, or MRI
IR It involves the use of medical imaging (like X-rays, CT scans, ultrasound, or MRI) to guide tiny instruments, such as WHAT, to targeted areas in the body.
catheters, wires, or needles
ASPECTS OF INTERVENTIONAL RADIOLOGY INCLUDE:
- Minimally Invasive
- Imaging Guidance
- Treating a Wide Range of Conditions
- Non-Surgical Alternative
Procedures typically require only small incisions or no incision at all, which leads to faster recovery, reduced risk of infection, and less pain compared to traditional surgery.
Minimally Invasive
Minimally Invasive:
- Small incision or puncture - small needle to access
- Catheter based procedure - thin catheter in blood vessels
- Targeted treatment - kung nasa ayos na ang treatment
IR procedures are guided by real-time imaging, which allows for highly precise targeting, increasing the safety and effectiveness of the treatment.
Imaging Guidance
Imaging Guidance:
- Fluoroscopy - real time (usually used)
Ultrasound - biopsy, drain fluid (thoracentesis, paracentesis)
CT Scan - planning, guidance in complex procedure
MRI - less complication in IR, guidance for alteration, involvement of soft tissue
Treating a Wide Range of Conditions: Interventional radiologists can treat conditions affecting many organ systems. Common treatments include:
- Angioplasty and stenting for blocked blood vessels
- Embolization to block abnormal blood vessels or stop bleeding (e.g., for tumors, aneurysms, or gastrointestinal bleeding)
- Biopsy to obtain tissue samples for diagnosis
- Drainage of abscesses or fluid collections
- Tumor ablation (like radiofrequency or cryoablation) to treat cancer
Shrinking tumor, RFA (Radiofrequency Ablation), naglalabas ng electrocity to shrink down ang tumor
Many conditions that once required open surgery can now be treated through IR techniques, offering patients less downtime and fewer complications.
Non-Surgical Alternative
BENEFITS OF INTERVENTIONAL RADIOLOGY
- Minimally invasive
- Reduce risks for lower risk of infection, bleed, any other complication
- Faster recovery vs with the traditional surgery
- Targeted therapy - precise delivery and reduce damage of tissue
- Outpatient procedure
Interventional radiologists often collaborate with other specialists, such as WHAT, to develop treatment plans tailored to the patient’s specific needs.
such as oncologists, cardiologists, or vascular surgeons
WHAT KIND OF THINGS CAN BE DONE IN IR?
- Treatment of vascular problems
- Angiogram/Angioplasty
- Biopsies
- Drainage of fluid collections
- Embolization (blockage) of arteries
- Stop the bleeding or treat tumors
- Treatment of infertility
- Insertion of feeding tube
THESE PROCEDURE CAN REPLACE CERTAIN SURGERIES:
- Faster recovery than with surgery
- Usually, no hospital admission required
- Local anesthesia used instead of general anesthesia
- Safe and effective
is a widely used medical procedure for gaining access to blood vessels or other body cavities, primarily for diagnostic and interventional procedures in fields like interventional radiology, cardiology, and vascular surgery.
Seldinger technique
It allows physicians to safely and accurately introduce catheters, wires, and other instruments into the body with minimal invasiveness.
Seldinger technique
Seldinger technique is a widely used medical procedure for gaining access to WHAT, primarily for diagnostic and interventional procedures in fields like interventional radiology, cardiology, and vascular surgery.
blood vessels or other body cavities
Method for catheterization of vessels
seldinger technque
what year develop seldinger technqie
1953
3 vessels considered:
Femoral -preferred site for arterial (size and accessibility)
Brachial
Axillary
Selection is based on WHAT
based on strong pulse/absence of disease.
Site should be WJAT
cleaned, area draped, local anesthesia given.
In 1953, who published his technique for obtaining percutaneous access to blood vessels.
Dr. Sven-Ivar Seldinger
ADVANTAGES OF SELDINGER TECHNIQUE
- Minimally invasive
Precise access allow as accuracy controlled of access - Versatility - wide range of procedure
- Reduce risk of complications
SELDINGER TECHNIQUE (STEP-BY-STEP)
- Insertion of needle
- Placement of needle in lumen
- Insertion Guidewire thru needle
- Removal of needle to guidewire position
- Threading of catheter to area of interest- fluoro used
- Removal of guide wire- catheter remains in place.
Revolutionized percutaneous access to vascular structures hollow organs body cavities
The Seldinger Technique
used cannula in seldinger technique
18 gauge
what entr point and use of Modified Seldinger Technique
neonatal jugular vein and fine catheter
IR TOOLS
Cannulas
Guide wires
Vascular Sheaths
cathethers
is a hollow tube, often made of stainless steel or a similar material, that is inserted into the body to provide access to blood vessels, tissues, or other structures for diagnostic or therapeutic purposes.
cannula
Typically, these cannulas are used to create a safe entry point for procedures like:
- Angiography - Imaging of blood vessels
- Embolization Blocking blood vessels to treat tumors or abnormal growths
- Drainage For removing fluids, like abscesses or cysts
- Biopsy - Taking tissue samples for diagnosis
The size and design of the cannula may vary depending on the procedure being performed. For example, the cannula used in percutaneous interventions is WHAT
typically smaller and minimally invasive, often inserted through the skin with the guidance of imaging techniques (like X-ray or ultrasound).
It used to navigate and position various devices like catheters, balloons, stents, and other therapeutic instruments within blood vessels or other anatomical structures
GUIDE WIRES
They provide support and guidance during procedures, ensuring accurate placement of instruments while minimizing damage to surrounding tissues.
GUIDE WIRES
GUIDE WIRES
It used to navigate and position various devices like WHAT, and other therapeutic instruments within blood vessels or other anatomical structures.
catheters, balloons, stents
They provide support and guidance during procedures, ensuring accurate placement of instruments while minimizing damage to surrounding tissues.
GUIDE WIRES
different kinds of guide wire
- straight
- angle m
- BK M
- J 3mm
- J 2mm
- angle
TYPES OF GUIDE WIRES
- TYPES OF GUIDE WIRES
- Standard Guide Wires
- Stiff Guide Wires
- Hydrophilic Guide Wires
- Floppy or Soft Tip Guide Wires
- Core-wire Based Guide Wires:
Used for general procedures like angiography or catheter placement.
Standard Guide Wires
These provide more support for complex interventions, like stent placement or embolization.
Stiff Guide Wires
Coated with a layer that becomes slippery when hydrated, making them easier to insert and navigate through vessels.
Hydrophilic Guide Wires
The tip is very soft to reduce the risk of vessel perforation, and is often used for less complex, more delicate procedures.
Floppy or Soft Tip Guide Wires
these have a more rigid core, typically used for tougher navigation, like in the arterial system.
Core-wire Based Guide Wires
FEATURES OF GUIDE WIRES
- Flexibility:
- Stiffness
- Coating
- Length and Diameter
- Tip Design
It used to facilitate the insertion and management of devices like guide wires, catheters, and other instruments into blood vessels during diagnostic or therapeutic procedures.
VASCULAR SHEATHS
It’s a hollow, flexible tube that serves as a funnel through which instruments can be advanced while providing a stable access point to blood vessels.
VASCULAR SHEATHS
TYPES OF VASCULAR SHEATHS
- Standard Sheaths
- Sheaths with Introducers (Dilators)
- Large-Bore Sheaths
- Hemostasis Sheaths
Used for common vascular access, like femoral, radial, or jugular access, often for diagnostic or routine interventions.
Standard Sheaths
These include a dilator to assist with easier insertion into the vessel
Sheaths with Introducers (Dilators)
Used in procedures that require the insertion of larger devices, like for stent placement or large embolization agents.
Large-Bore Sheaths
These sheaths incorporate advanced valves or mechanisms that ensure tight hemostasis to reduce blood loss, particularly in procedures with larger puncture sites.
Hemostasis Sheaths:
it is a long, flexible tube that is inserted into blood vessels or other body cavities to diagnose or treat various medical conditions.
CATHETER
CATHETER serve as a tube for delivering fluids (like WHAT,
contrast agents, medications, or embolic agents
CATHETER serve as a tube for delivering fluids (like contrast agents, medications, or embolic agents), removing fluids (likeWHAT), or performing interventions (such as stent placement or balloon
drainage from abscesses or cysts
CATHETER serve as a tube for delivering fluids (like contrast agents, medications, or embolic agents), removing fluids (like drainage from abscesses or cysts), or performing interventions (such as WHAT
stent placement or balloon
TYPES OF CATHETERS
Diagnostic Catheters
- Angiographic Catheters
- Venous and Arterial Catheters
Therapeutic Catheters
- Balloon Catheters
- Stent Delivery Catheters
- Embolization Catheters
- Drainage Catheters
Specialty Catheters:
- PICC (Peripherally Inserted Central Catheter)
- Dialysis Catheters
Biopsy Catheters
catheter Used during angiography to inject contrast dye into blood vessels for imaging. They come in a variety of shapes and sizes to navigate different blood vessels, from the femoral to the coronary arteries.
Angiographic Catheters
catheter Used for diagnostic purposes to obtain pressure readings or to guide the placement of other devices.
Venous and Arterial Catheters
Catheters Used in angioplasty procedures to open narrowed or blocked blood vessels.
Balloon Catheters to widen the vessel.
The balloon at the tip of the catheter is inflated to widen the WHAT
the vessel.
Catheters These are designed to carry stents (small mesh tubes) into position within a blood vessel to keep it open after angioplasty.
Stent Delivery Catheters
Used to deliver embolic agents (like coils, particles, or liquids) to block blood flow to tumors or abnormal blood vessels.
Embolization Catheters
These are used to remove fluids, such as pus or bile, from a body cavity or organ (e.g., abscess drainage, biliary drainage).
Drainage Catheters
A long catheter that is inserted through a peripheral vein and advanced to the central veins for long-term medication administration or intravenous therapy.
PICC (Peripherally Inserted Central Catheter)
Used for hemodialysis to access a patient’s blood vessels for the exchange of waste and fluids.
Dialysis Catheters
Used to obtain tissue samples from targeted organs or masses.
Biopsy Catheters
Pioneer in the field of minimally procedure invasive (Catheterization)
CHARLES T. DOTTER, M.D.
He developed continuous x-ray angiocardiography.
CHARLES T. DOTTER, M.D.
he Performed first angioplasty procerdure (1964)
CHARLES T. DOTTER, M.D.
father of IR
CHARLES T. DOTTER, M.D.
Professor, use skills not only in interpret but also use technical skills to help patient use advantage it in IR
CHARLES T. DOTTER, M.D.
DOTTER’S CONTRIBUTION
- Angioplasty (1964)
- Concept Radiology of Interventional
- Embolization Technique
- Vascular Access
- Teaching and Mentorship
- level 4 in selected hospoital requires not only space, expensive
- CAT lab
- comonly male ang radtech, mabigat ang machine and procedure is matagal 25-40 mins
DIGITAL SUBTRACTION ANGIOGRAPHY
Using of imgaing technology to capture xray images unlike with digital technology to have an precise image
digital
refers to process remove of the background structure, bone tissue and not related with vessels and by removing visisbility nung blood vessels in naeenhance, clearer of vessel
SUBTRACTION
ginagait to visualize the blood vessel, allows to see the - vascular system, it refers to arteries and veins with the use of cntrast to enhancethe visilibility of vessel,
imaging technique
develop to ehance visiliblity of blood vessel tatanggalin yung bone, tissue, manual na ginagawa, time consuiming, less efficient
subtraction technique
uses to evaluate the vascular disease the aneurysm, malformation, and blockages.
ANGIOGRAPHY
Angio-“ is a prefix derived from the Greek word angeion, which means
vessel.
medical term vessel
angio
It is commonly used in medical terminology to refer to blood vessels or related structures.
Angio-
A medical imaging technique used to visualize the inside of blood vessels.
Angiogram
A procedure to widen narrowed or obstructed blood vessels, typically arteries.
Angioplasty
The formation of new blood vessels
Angiogenesis
It is simply a technique by which bone images subtracted structures are or canceled out from a film of bones plus opacified vessels, leaving unobscured image of vessels
SUBTRACTION
BENEFITS OF DSA
- produce allow reel time imaging, kung ano nagyayari kay patient sa live monitoring
- high resolution and contrast resolution improve visualization
- ability to assess the both of anatomy and blood vessel
it is a type of imaging technique used primarily to visualize blood vessels, especially for detecting abnormalities such as blockages, aneurysms, or stenosis.
Digital for Subtraction Angiography
Digital for Subtraction Angiography.
It is a type of imaging technique used primarily to visualize blood vessels, especially for detecting abnormalities such as WHAT
blockages, aneurysms, or stenosis.
In DSA, a contrast dye is injected into the WHAT, and a series of X-ray images are taken.
bloodstream
DSA is commonly used in procedures like:
- Diagnosing issues in the brain (e.g., aneurysms, strokes).
- Visualizing coronary arteries in cases of heart disease.
- Assessing peripheral vascular disease.
The first angiograms were done in the what year using X-ray technology and a contrast medium injected into the blood vessels. These early methods were limited and often unclear due to the inability to easily differentiate blood vessels from surrounding structures.
1920 or Early Angiography (1920s-1960s)
in what year , subtraction techniques were developed to improve image clarity. The goal was to enhance the visibility of blood vessels by subtracting the static (non-vascular) structures, such as bones and tissues, from the X-ray images.
1960s
Introduction of Subtraction Techniques (1960s)
In the 1960s, subtraction techniques were developed to improve image clarity. The goal was to WHAT
to enhance the visibility of blood vessels by subtracting the static (non-vascular) structures, such as bones and tissues, from the X-ray images.
in wat year Initially, these subtraction techniques were manual and required film-based processes, which were time-consuming and less efficient.
Introduction of Subtraction Techniques (1960s)
in what year
The introduction of digital imaging was a breakthrough. The combination of digital technology with subtraction techniques enabled the creation of Digital Subtraction Angiography (DSA).
Digital Revolution (Late 1970s-1980s)
The major advantage of DSA over previous methods was its ability to WHAT
produce high-quality images in real-time, providing clearer visualization of blood vessels without the clutter of surrounding tissue.
in what year, a significant milestone in DSA was the development of the first commercially available digital subtraction angiography systems.
1978
in what year saw rapid improvements in both hardware and software for DSA systems, making the technique more accurate, faster, and easier to use. The ability to visualize blood vessels in real time became vital for both diagnosis and interventional procedures, such as stent placements or catheter-guided treatments.
The 1980s and 1990s
what further improved the ability to assess complex vascular structures, especially in the brain and coronary arteries.
3D imaging and high-resolution digital subtraction
3D imaging and high-resolution digital subtraction further improved the ability to assess WHAT , especially in the brain and coronary arteries.
complex vascular structures
3D imaging and high-resolution digital subtraction further improved the ability to assess complex vascular structures, especially in WHAT
brain and coronary arteries.
in what year,
With the advent of advanced computational techniques and multislice CT and MRI angiography, DSA remains one of the gold standards in certain cases, especially when precise Imaging and interventions (like catheter-based treatments) are required.
Modern Era (2000s-Present)
remains one of the gold standards in certain cases, especially when precise Imaging and interventions (like catheter-based treatments) are required.
DSA
is still a key tool in interventional radiology, particularly in assessing vascular conditions that cannot be diagnosed using non-invasive imaging alone.
DSA
DSA is still a key tool in interventional radiology, particularly in assessing vascular conditions that cannot be diagnosed using WHAT
non-invasive imaging alone.
who is Portuguese neurologist developed the technique of contrast x-ray cerebral angiography to diagnose diseases, such as tumors and arteriovenous malformations.
Egas Moniz
The Portuguese neurologist Egas Moniz in what year developed the technique of contrast x-ray cerebral angiography to diagnose diseases, such as tumors and arteriovenous malformations.
1927
The Portuguese neurologist Egas Moniz in 1927 developed the technique of WHAT, such as tumors and arteriovenous malformations.
technique of contrast x-ray cerebral angiography to diagnose diseases .
The Portuguese neurologist Egas Moniz in 1927 developed the technique of contrast x-ray cerebral angiography to diagnose diseases, such as WHAT.
such as tumors and arteriovenous malformations.
who is The ideas of subtraction images was first proposed in 1935, when he was able to produce subtracted images using plain films.
Dutch radiologist Ziedses des Plantes
The ideas of subtraction images was first proposed by the Dutch radiologist Ziedses des Plantes in what year, when he was able to produce subtracted images using plain films.
1935
The ideas of subtraction images was first proposed by the Dutch radiologist Ziedses des Plantes in 1935, when he was able to produce WHAT
produce subtracted images using plain films.
also known as film-based subtraction angiography,
conventional subtraction technique in angiography
The conventional subtraction technique in angiography, also known as
film-based subtraction angiography
was an early method developed to enhance the visibility of blood vessels on X-ray images.
conventional subtraction technique in angiography, also known as film-based subtraction angiography
It helped to reduce the visual interference from bones, tissues, and other static structures, allowing a clearer view of the blood vessels.
CONVENTIONAL SUBTRACTION TECHNIQUE
The core idea behind conventional subtraction is to take two sets of X-ray images:
- Initial (mask) image
- Subsequent (contrast-enhanced) image
This is a baseline image taken before the injection of contrast dye. It shows the structures of the body (bones, tissues, etc.), but not the blood vessels, since they haven’t been highlighted yet.
Initial (mask) image
Initial (mask) image: This is a baseline image taken before the injection of contrast dye. It shows the structures of the body (bones, tissues, etc.), but not WHAT
not the blood vessels, since they haven’t been highlighted yet.
After the contrast dye is injected into the vascular system, a second X-ray image is taken. This image shows both the blood vessels (highlighted by the contrast) and the surrounding structures.
Subsequent (contrast-enhanced) image
process of dsa image:
a) mask image/scout film, (b) highlight the blood vessel, (c) subtraction process
BASIC COMPONENTS OF DSA MACHINES
- X-ray Source
- Detector System
- Workstation/Computer System
- Contrast Injection System
- Patient Table/Positioning System
The machine includes a high-powered X-ray tube that emits X-rays directed at the patient. The X-rays are used to create images of the internal structures, especially blood vessels, after the contrast dye is injected.
X-ray Source
After the X-rays pass through the body, a detector (typically a flat-panel detector) captures the X-ray images. This detector converts the X-ray data into digital signals.
Detector System
Detector System: After the X-rays pass through the body, a detector (typically WHAT) captures the X-ray images. This detector converts the X-ray data into digital signals.
a flat-panel detector
The DSA machine includes a powerful computer that processes the raw data from the detector. The computer is responsible for performing the digital subtraction (removing background structures) and enhancing the the clarity of of the blood vessels.
Workstation/Computer System
Workstation/Computer System: The DSA machine includes a powerful computer that processes the raw data from the detector. The computer is responsible for performing the digital subtraction (removing WHAT) and enhancing the the clarity of of the blood vessels.
background structures
A device used to inject the contrast material into the bloodstream. This system is synchronized with the imaging process to capture the vascular images at the right moments.
Contrast Injection System
A movable table allows for precise positioning of the patient during the procedure, ensuring accurate imaging from multiple angles.
Patient Table/Positioning System
TYPES OF DSA MACHINES
- Angiography Systems with Rotating C-arm
- Fixed and Mobile Systems
In modern DSA machines, a C-arm (a movable arm with X-ray equipment) can rotate around the patient to capture images from multiple angles, improving the accuracy and detail of the vascular images.
Angiography Systems with Rotating C-arm
DSA systems can either be fixed (installed in a dedicated room, such as an angiography suite) or mobile (portable units that can be brought to different locations in a hospital, like emergency or intensive care units).
Fixed and Mobile Systems
indication in diagnostic:
- Non traumatic Subarachnoid Hemorrhage (SAH)
- Arterial dissection or laceration
- Aneurysm
- Pseudoaneurysm
- Thrombosis
- Arterio-venous malformation (AVM)
- Arterio-venous fistula (AVF)
- Tumor vascularity
indication in therapeutic
- Embolisation
- Stenting
- Thrombolysis
- Thrombectomy
CONTRAINDICATION
No absolute contraindication.
- Poor renal reserve
- Deranged coagulogram.
- Allergic to contrast media.
are not normally seen in an x-ray image, because of low tissue contrast.
Blood vessels
To increase image contrast, contrast agents, which are dense fluids with elements of high atomic numbers, such as WHAT are injected into a blood vessel during angiography. Because of its higher density and high atomic number, iodine absorbs photons more than blood and tissue.
iodine
To increase image contrast, contrast agents, which are dense fluids with elements of high atomic numbers, such as iodine, are injected into a blood vessel during angiography. Because of its WHAT
higher density and high atomic number, iodine absorbs photons more than blood and tissue.
This creates detailed images of the blood vessels in real time.
contrast media
The first contrast media used for intravascular injection were called
high-osmolar contrast media (HOCM).
is the measure of the particle concentration in a solution.
osmolality
MATERIAL USED in DSA
Catheters
Vascular Sheath
Medicut
Guidewires
Contrast Media
Surgical Blade
Saline
Syringes
Local Anesthesia
Heparin
Surgical Gloves
Elastoplast
PREPARATION for DSA
Pre-Procedural Preparation (For Patient)
- Medical History and Evaluation
- Blood test
- Discontinuing Medication
- Fasting
- Consent
Pre-Procedural Preparation (For the Team)
- Sterilization
- Monitoring Set-up
- Sedation or Anesthesia
During the Procedure
- Contrast Injection
- Positioning
- Imaging.
Post-Procedural Care
- Observation
- Hydration
- Activity Restriction
- Check the insertion site
Potential Risks and Complication to Discuss
- Allergic Reaction
- Kidney Issues
- Bleeding or Infection
- Radiation Exposure
is an application materials and methods to create, to preserve or duplicate images.
Imaging chain.
is a multidisciplinary field concerned with the generation, collection, duplication, analysis, modification and visualization of images including imaging things that human eyes cannot detect.
Imaging science
is a process by which the other image is formed and interpreted and conceptualized as a chain of physical events.
Imaging chain
Imaging chain begins with the
radiometry of the electromagnetic energy that create image
which is the main machine using different angiography procedures.
fluoroscopy
It is the main modality to the radiologists and also to the radtech and others staff perform ing under interventional radiology because it involves active diagnosis during the exam
fluoroscopy
Fluoroscopic tubes are designed ro operated for a WHAT
long period at lower mA.
Common imaging modalities that use isin IR
fluoroscopy, ultrasound, computed tomography and magnetic resonance imaging.
Three common types of guide wires:
(1) starter wires, (2) selective (3) exchange.
Interventional radiologists reduce massive possibility to traditional surgery or open surgery and keyhole surgery (also known WHat as treatment be given by a small plastic tube about the size of ‘straw’.
laparoscopic surgery
also known laparoscopic surgery
keyhole surgery
helps diagnose and treat many condition of the blood vessels, bones, joints, and digestive, and also the urinary, respiratory, reproductive system
Fluoroscopy
wherein shoot images and see if there’s any blockages and after obtaining images from angiogram and they see blockages it can now proceed to angiography wherein putting a stent, balloon and etc.
angiogram
The fundamental are modality that uses in IR is the
C-arm or the fluoroscopy.
Generally, HOW MANY ceiling track mounted radiographic x-ray tubes are required, with an image intensified fluoroscope mounted on a C or an U arm.
two
Generally, two ceiling track mounted radiographic x-ray tubes are required, with an image intensified fluoroscope mounted on a WHAT
a C or an U arm.
is a fluoroscopy system, the fluoroscopy is a method that provide reel time, xray images particularly with the for guiding for various diagnostic and interventional procedure
C-arm machine
are generally not used in diagnostic, they are made for surgery.
C-arms
is a mobile imaging unique use primarily for fluoroscopic imaging during surgical or orthopedic procedure and it is also consist of computer workstation to use or view, manipulate, store and transfer that acquired images.
C-arm
mostly seen in diagnostic radiology, a basic xray. Adjusted to 180 deg to use fluoroscopic procedure like barium enema or barium swallow. It is characterized by an x ray source and detector on a gantry that typically approaches the patient and operating table from the superior aspect.
U-arm machine
X-ray tube, also called
Roentgen tube
A small focal spot of HOWMANY MM is necessary for the spatial resolution necessities of small vessel magnification radiography.
not greater than .3 mm
SID (Source-to-Image Receptor Distance) needed for the interventional radiology is HOW ANY CM
100 cm
OID (Object to Image Receptor Distance) is HOW MANY cm to improve the image contrast,
40 cm
Interventional fluoroscopy uses WHAT to guide small instruments such as catheters through blood vessels or other pathways in the body.
ionizing radiation
Radiation related risk associated with fluoroscopy includes
- Radiation related risk associated with fluoroscopy includes
Radiation induced injuries to the skin and underlying tissues which occur to shortly after the exposure or burns - Radiation induced cancer which may occur sometime later and life.
During a fluoroscopy procedure, an WHAT is passed through the body.
X-ray beam
the image is transmitted to a monitor so the movement of a body part or of an instrument or contrast agent ALSO CALLED WHAT) through the body can be seen in detail.
“X-ray dye”
are the most effective personal radiation protection means and should be worn by everyone in a fluoroscopy room (except the patient).
LEAD APRONS
LEAD APRONS may reduce the dose received by over WHAT depending on the energy of the X-rays (kV setting) and the lead equivalent thickness of the apron
90% (85%-99%)
GOLDEN RULE FOR RADIATION MANAGEMENT IN FLUOROSCOPY
“KEEP THE TUBE CURRENT AS LOW AS POSSIBLE BY KEEPING THE KVP AS HIGH AS POSSIBLE”
this is maximum voltage that apply across the x-ray tube where in determined the energy of the x-ray that produced
kVp (kilovolt peak
this refers to the number of electrons that flowing travel from the cathode to the anode wherein the one determine in how many x-ray photons that produced,
Tube current (mA)
if the kVp overly ⬆️, it can result
⬇️ image contrast make it harder to distinguish between different tissue
skip
good luck! ⭐
is commonly used to visualize blood vessels to diagnose various conditions such as blockage, aneurysm, or narrowness of blood vessels.
Angiography
T or f. Not alll radiological procedures carry a risk.
False all
Contraindications may, therefore, be WHAT
relative (the majority) or absolute.
Factors that increase the risk to the patient can be considered under three headings:
due to radiation
due to the contrast medium
due to the technique.
is significant concern in many radiological procedure especially in involve fluoroscopy like angiography
Radiation exposure
- amount of radiation that is used in angiography and varies depending on complexity and duration of the procedure.
Dose of radiation
PRINCIPLES IN THE USE OF DIAGNOSTIC RADIATION:
Justification that a proposed examination is of net benefit to the patient.
ALARA doses should be kept As Low As Reasonably Achievable, economic and social factors being considered.
FEMALE PATIENT THAT CAN UNDERGO RADIATION RELATED PROCEDURE:.
Women who denied recent sexual intercourse.
Women who were menstruating at the time.
Women who had been taking an oral contraceptive pill for no fewer than 3 months and were satisfied that it was effective.
Women who had an intrauterine contraceptive device for no fewer than 3 months and had found it effective
THE CHAIN OF RESPONSIBILITY FOR ENSURING THAT THE FETUS IS NOT EXPOSED TO IONIZING RADIATION IS:
The patient
The referring clinician
The radiologist
The radiographer
HIGH RISK FACTORS WITH IV CONTRAST ADMINISTRATION:
- A previous severe adverse reaction to contrast medium
- Asthma or a significant allergic history
- Proven or suspected hypersensitivity to iodine
- B-blockers
- Heart disease
- Infants and small children
- Hepatic failure
- Moderate to severe impairment of renal function
- Myelomatosis
- Poor hydration
- Sickle-cell anaemia
- Co-administration of Metformin (glucophage)
Thyrotoxicosis
Pregnancy
is part of contrast media or is a ingredient of cm
Iodine
Most commonly artery: (for catheter technique
- femoral artery
- radial artery
- jugylar veun
- brachial artery
For the advantages of catheter techniques:
Minimally invasive
Reel time imaging
Therapeutic options
Puncture sites
- femoral
Brachical
Aciallary
Aorta
Most frequently used in puncture site
Femoral artery
A high approach is preferable of puncture site
Brachial artery
A puncture site for historical interest only
Aorta
This is the most frequently used punctures site providing access to the left ventricle, aorta and all its branches
FEMORAL ARTERY PUNCTURE
It also has the lowest complication. rate of the peripheral sites.
FEMORAL ARTERY PUNCTURE
Complication for femoral artery puncture
Bleeding and hematoma
Arterial dissection
Infection
Pseudoaneurysm
Thrombosis - blood clot or forming of blood clot in puncture site leading to vessels embolism
Nerve injury but in rare cases, it occurs when the vessels is weak
Contrast reaction
In
FEMORAL ARTERY PUNCTURE
This is the most frequently used punctures site providing access to the WHAT
to the left ventricle, aorta and all its branches
In femoral artery what are the CONTRAINDICATIONS:
Blood dyscrasias
Femoral artery aneurysm
Marked tortuosity of the iliac vessel that many prevent further advancement of the guide-wire or catheter
This approach associated with higher incidence is of complication, it should only be used if femoral artery puncture is not possible.
High brachial artery
Indications for femoral artery puncture:
,- cardiac catherization
Peripheral vascular procedure
- Intra Arterial drug delivery
The hemodynamic monitoring
Indications for high brachial artery:
- Cardiac catheterization
- Peripheral arterial access
- The intra arterial blood sampling
- ## the hemodynamic monitoring
For high brachial artery CONTRAINDICATIONS
Atherosclerosis of the axillary or subclavian arteries
Subclavian artery
This approach associated with is higher incidence of complications and should only be used if femoral or high brachial artery puncture is not possible.
Axiallary puncture
Indications for axillary puncture:
- Angiography and angioplasty
- Cardiovascular intervention
- Intra arterial drug administration
- The hemodynamic monitoring
For axillary artery CONTRAINDICATIONS
Atherosclerosis of the axillary or subclavian arteries
Subclavian artery aneurysm.
COMPLICATIONS OF ANY CATHETER TECHNIQUES:
- Due to anesthetics
- Due to contrast medium
- Due to technique itself
AFTER CARE
1.Bed rest this should be for at least 4-6 hours. Larger catheters require longer bed rest and observation.
2. Careful observation of the puncture site.
3. Pulse and blood pressure observation 30 minutes for 4 h and then 4-hourly for the remainder of 24 hours, if the larger catheter systems are used.
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