VASCULAR

IMAGING
EQUIPMENTS
By Dr. Sangam Gupta
Resident Of Radiodiagnosis
Rural Medical College, Loni
HISTORY
● In 1923, angiography was first successfully used for the human body.
● In 1953, a Swedish doctor Sven-Ivar Seldinger pioneered the Seldinger
Technique, which laid down the foundation of Interventional Radiology.
● In 1963, Charles Dotter first proposed the idea
of Interventional Radiology.
● In 1964, Charles Dotter opened a new era of
percutaneous angioplasty through accidental
operation, marking the formation of
Interventional Radiology.
INTRODUCTION
● Vascular imaging is used to evaluate blood vessels – with the exception of the
coronary arteries, which are assessed with a CT scan – and help diagnose conditions
associated with abnormal blood flow.
● Technologies that are used to generate images of the blood vessels include: vascular
ultrasound, computed tomography angiography (CTA), and magnetic resonance
angiography (MRA), fluoroscopy/ digital subtraction angiography (DSA).
● Vascular imaging is performed by inserting a thin tube (catheter) through an artery
such as at the base of the leg (the femoral artery), the elbow (brachial artery), or the
wrist (radial artery). A catheter is advanced to the desired blood vessel by viewing a
fluoroscopic image (X-ray), and a contrast agent is injected in order to examine to
see the movement and condition of the blood vessels.
Equipments
Angiography Equipment
1. X-ray tube

● Two ceiling track-mounted X-ray tubes alongwith an image intensified fluoroscope

mounted on C or an L arm.
● A large diameter massive anode disc(15cm diameter, 5cm thick) to accommodate
heat load.
● Cathodes designed for magnification & serial radiography.
● A large focal spot of 1mm for heat load.
● A small focal spot( no more than 0.3mm) is necessary for spatial resolution of small
vessel magnification.
2. Generators

● High frequency and high voltage generators.

● Three phase, 12 pulse power is used.

3. Patient couch

● Stationary couch with a floating,tilting or rotating table top.

● Controls for couch positioning are located on side of table and also on a floor switch.

● May also have a computer controlled stepping capability.

4. Image receptor
● Cinefluorographic camera —now obsolete.

● Nowadays, Digital image receptors are used with a television camera pickup tube or
a charge coupled device (CCD).
Technique & requirements for
vascular access
Procedures

1. Arteriography : imaging arteries

2. Venography: imaging veins

3. Angiography: imaging heart and associated vessels

4. Lymphography : imaging lymphatic vessels/nodes.

Seldinger Technique
Equipments required
1. Puncture Needle -
● consist of stylet and cannula
● Large cannula size (1.6mm)
● Size is based on external
diameter of Needle.
2. Guide wire -
● soft flexible wire with the strength to
pass through curved vessels
● Size 0.6 -1.0
● Used as a platform over which a
catheter is to be advanced.
3. Introducer Sheaths -
● Consist of an inner dilater and outer sheath
with an hemostatic valve.
● They vary from 4-30 French and 11-90cm in
length
● They are introduced as for catheters over the
wire and then inner dilator is removed.
4. Catheters -
Arterial access used are
1. Femoral artery
2. Radial artery
3. Brachial artery
Femoral Artery DSA image

Anatomy
Radial Artery
Anatomy
Brachial artery
Anatomy
Digital Subtraction
Angiography
SUBTRACTION?

It is simply a technique by which bone structures images are subtracted

or canceled out from a film of bones plus opacified vessels, leaving an
unobscured image of the vessels.
 What do you mean by DSA?
The acquisition of digital fluoroscopic
images combined with injection of
contrast material and real time
subtraction of pre and post contrast
images to perform angiography is
referred to as Digital Subtraction
Angiography.

DSA is the ‘gold standard’ to diagnose

aneurysm and stenosis in cerebral
vessels.
History
● The Portuguese neurologist Egas Moniz, (Noble prize winner 1949) in 1927
developed the technique of contrast X-ray cerebral angiography to diagnose diseases,
such as tumours and arteriovenous malformations.
● The idea of subtracting image was first proposed by the Dutch radiologist Ziedses des
Plantes in the 1935, when he was able to produce subtracted images using plain
films.
The principles of subtraction are based on the following:
● The scout film shows the structural details of the skull and adjacent soft tissue.
● Angiogram film shows exactly the same anatomic details, if the patient does not
move, plus the opacified blood vessels.
● If all the information in the scout film could be subtracted from angiogram film, only
the opacified vessel pattern would remain visible.
DSA Machine
 Indications
Diagnostic Therapeutic

1. Non traumatic Subarachnoid hemorrhage 1. Embolisation

(SAH) 2. Stenting
2. Arterial dissection or laceration. 3. Thrombolysis
3. Aneurysm 4. Thrombectomy
4. Pseudoaneurysm
5. Thrombosis
6. Arterio-venous malformation
7. Arteriovenous fistula
8. Tumor vascularity
 Contrast media

● Blood vessels are not normally seen in an X-ray image, because of low tissue
contrast.
● 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 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.
● The first contrast media used for intravascular injection were called high-osmolar
contrast media (HOCM). (osmolality is the measure of the particle concentration in a
solution.)
● HOCM had osmolarity seven to eight times higher than plasma. This high osmolarity
caused adverse effects such as pain, endothelial damage, thrombosis, and increased
pressure in the pulmonary circulation.
● Low-osmolar contrast media (LOCM) were first developed in the 1970's and these
helped to reduce these side effects.
● One of the major risks of modern iodine contrast media is an allergic reaction to
iodine.
Cerebro-vascular Anatomy as appreciated in DSA
Circle of Willis
Diagnostic usage : ACA aneurysm
MCA aneurysm
Arterio-venous malformation
Tumour vascularity
Therapeutic usage : Coiling of cerebral aneurysm
Stenting of ICA stenosis

Stenosis After Stenting

Thrombolysis

Post
thrombolysis
Advancement in DSA
1. Road mapping : useful for placement of catheters and wires in complex and small
vasculature.
2. Xperia CT : clinicians can access CT-like imaging right on the angio system so that
they can assess soft tissue, bone structure and other body structures before, during or
after an interventional procedure.
3. 3D rotational angiography (3D-DSA): to determine best working angle for
endovascular treatment of intracranial aneurysm.
CTA vs 3D DSA vs MRA

CTA 3D DSA MRA

Venography
Basic Principles
Venography can be divided into following sections :
Indications

1. Deep venous thrombosis

2. To demonstrate incompetent perforating veins
3. Oedema of unknown cause
4. Congenital abnormality
THANK YOU