Company Confidential

Business Line X-ray

10
9

APPLICATION NEWS
July 2004

Table of contents

1.0 Introduction:................................................................................................................................ 2
2.0 Justification:................................................................................................................................ 2
3.0 Technique:................................................................................................................................... 2
4.0 Positions...................................................................................................................................... 4
4.1 Left Coronary : LAO 55° - RAO 55° , 25° Cranial ............................................................... 4
4.2 Left Coronary : LAO 55° - RAO 55° , 25° Caudal................................................................ 5
4.3 Right Coronary : LAO 55° - RAO 55° , 25° cranial.............................................................. 6
4.4 Right venous graft: LAO 55° - RAO 55° , 25° cranial .......................................................... 7
4.5 Right venous graft: LAO 55° - RAO 55° , 25° caudal .......................................................... 8
5.0 Conclusion .................................................................................................................................. 8

Author:

Andrew Martin, Senior International Cardiac Application Specialist

Subject:

Cardiac Rotational Angiography, Tip’s and hints for the best IQ

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1.0 Introduction:
As of this date all new Allura FD 10’s have the ability to perform Cardiac Rotational
Angiography. This is a new feature that requires careful set up to ensure excellent IQ. These
application notes will endeavor to give you all the information required to perform a complete
study.

2.0 Justification:

2.1 So why do rotational scans instead of static position imaging for coronary angiography?

Reduces patient dose

– as, on average 3 to 4 scans can replace the 7 to 10 acquisition runs required to complete a
routine diagnostic coronary examination. As each scan requires 101 images @ 50Hz (120 @
60Hz), comparing this to the average of 75/80 images per run, shows the potential for
considerable dose saving i.e. 404 images compared with 750/800.
Contrast dose saving:
- less runs = less contrast used.
More views:
- as each scan covers 110° of rotation, it is like taking 101 (120) different views of the coronary =
more angular coverage of the coronary

3.0 Technique:
Rotational angiograpy has been around for at least 10 years, 3DRA for 8 or so years. The main
differences in respect to Coronary Rotational Angiograpy (CRA) are the dynamic range
within the region of interest and the size of the detector.

Initial set up of the patient is extremely critical;

Arms should be raised above the head, not left by the side.

When using the fluoro to confirm the start / stop positions it is recommended that the arrested
respiration technique be use.

Arrested respiration technique should be used during acquisition.

As the catheter tip is the only constant feature on any of the images, its position within the
field of view at the start and stop positions becomes critical.

As you can see on the following exammples, you sub divide the image into 16 sections. Then
it is possible to identify the correct start / stop position by centering the catheter tip within the
relevant area.

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 Example 1 : static image

1 2 3 4

5 6 7 8

9 10 11 1

13 14 15 16

The field of view (FoV) is mentally subdivided into 16 sub regions. The idea is
that if you know where the catheter tip should be positioned within this matrix for
the start and stop fluoro images, then there should be no problem in maintaining
the relevant coronary within the FoV throughout the whole of the rotational
acquisition run. If the catheter is positioned in the correct zones within the images
of the start & stop positions then given normal anatomy the whole of the relevant
coronary tree will be visible throughout range of the rotational angiogram.

Contrast should be visible throughout the relevant coronary for the duration of the CRS.
Therefore the injection should start immediately before the start of the scan.

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4.0 Positions
4.1 Left Coronary : LAO 55° - RAO 55° , 25° Cranial

Fig 2

Start position :

Catheter tip in position 2

Fig 3

Stop position :

Catheter tip in position 2/3

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4.2 Left Coronary : LAO 55° - RAO 55° , 25° Caudal
Fig 4

Start position :

Catheter tip in position 1

Fig 5

Stop position :

Catheter tip in position 6/7

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\
4.3 Right Coronary : LAO 55° - RAO 55° , 25° cranial

Fig 6

Start position :

Catheter tip in position 6

Fig 7

Stop position :

Catheter tip in position 2

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4.4 Right venous graft: LAO 55° - RAO 55° , 25° cranial
Fig 8

Start position :

Catheter tip in position 2

Fig 9
Stop position :

Catheter tip in position 2

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4.5 Right venous graft: LAO 55° - RAO 55° , 25° caudal

Fig 10

Start position :

Catheter tip in position 2

fig 11

Stop position :

Catheter tip in position 2

5.0 Conclusion
Although coronary rotational scan initially appears complicated if you follow the basic rules then
you should have no problem in achieving excellent IQ