Ir Flashcards
(215 cards)
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Interventional Radiology
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A medical specialty using imaging guidance to diagnose and treat diseases through minimally invasive procedures.
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Image-Guided Surgery / Pin-hole Surgery
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Procedures using small incisions
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catheters
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Interventional Radiologist
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A medical doctor performing minimally invasive procedures guided by imaging
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using catheters and needles.
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Historical Milestones
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1930s-1960s – Diagnosis-focused with angiography
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Charles Dotter – Introduced therapeutic interventional radiography
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First Case – Percutaneous Transluminal Angioplasty (PTA)
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Mason Jones (1960s) – Pioneered Transbrachial Selective Coronary Angiography
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Melvin Judkins – Developed Transfemoral Angiography (through groin)
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Sven Ivar Seldinger (1953) – Introduced Seldinger Technique (percutaneous vascular access)
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Seldinger Technique (Steps)
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15
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Insert Seldinger needle into femoral artery (confirm pulsating blood).
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Remove stylet.
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Insert guidewire.
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Remove needle
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keep guidewire.
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Thread catheter over guidewire.
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Advance catheter under fluoroscopy.
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Common Equipment
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Guidewires
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Passageway for catheters
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Stainless steel
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flexible tip
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Coatings: Teflon
Heparin
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Tips: Straight or J-Tipped
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Diameter: 0.035 in (standard)
0.014–0.018 in (small vessels)
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Catheters
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Measured in French (Fr); 3 Fr = 1 mm
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Non-selective: Rapid injection in large vessels
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Selective: Directed injections into branch vessels
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Types of Catheters
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Cobra (C2): For renal
celiac
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Simmons (Sidewinder): For cerebral/visceral angiography
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Head Hunter (H1): For brachiocephalic vessels via femoral
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X-RAY TUBE DESIGN
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Cathode
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Tungsten filament
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Negatively charged glass envelope
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Produces 1% X-rays
99% heat
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Anode
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Positively charged
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Made of molybdenum
copper
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Components: Target
Rotating anode tube
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Target: Tungsten (90%) + Rhenium (10%)
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Stator: Motor that spins the anode
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Rotor: Rotates the target
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Focal Spot Size
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Determines resolution
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Actual focal spot = area on the anode hit by electrons
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Sizes:
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Small: 0.4–0.6 mm (30–50 kW)
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Large: 0.8–1.2 mm (75–100 kW)
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Third: 0.3 mm (10–20 kW)
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Recommended Sizes
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0.3 mm: Infants
toddlers
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0.4–0.6 mm: Children
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0.7–1.0 mm: Adults
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COLLIMATION ASSEMBLY
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Purpose: Shapes/limits X-ray beam
improves image
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Beam blocking blades: Shape beam
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Beam filters: Reduce low-energy rays
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Wedge filters: Reduce intense areas of radiation
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ANGIOGRAPHIC EQUIPMENT
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X-Ray Generators
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Controls:
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Tube Voltage (kV)
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Tube Current (mA)
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Exposure Time (s)
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Generator Controls Include:
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Voltage
Current
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Transformer
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Adjusts voltage
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Rectification
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Converts AC to DC for X-ray tubes
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X-RAY PARAMETERS
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Tube Voltage (kVp)
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Determines electron energy
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60–80 kVp ideal
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<60 kVp = excessive dose
poor penetration
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Tube Current (mA)
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Determines number of X-ray photons
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Pulse Width
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Duration of exposure (3–10 ms)
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Adult: 10 ms
Pediatric: 6 ms
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Pulse Rate
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Images/sec
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30 fps (pediatrics)
14 fps (nonvascular)
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Beam Filtration
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Removes low-energy X-rays
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Range: 0.1–0.9 mm Cu
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Dose Rate
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Affected by kVp
mA
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Impacts image quality and radiation dose
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IMAGING CHAIN
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Components
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Image Intensifier
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TV Camera (CCD)
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TV Monitor
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Flat Panel Detector
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Image Intensifier (II)
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Converts X-rays → light → electronic signal → amplified light
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II Components
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Input Phosphor (Cesium Iodide): Produces light
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Photocathode: Emits electrons
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Output Phosphor: Converts electrons to light
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CCD Camera
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Converts light into digital signals
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Replaces analog TV cameras
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Flat Panel Detector
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Indirect: CsI → light → charge
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Direct: a-Se → X-rays → charge
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Sizes: 23×23
30×40
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ANGIOGRAPHIC PROCEDURES
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Angiography
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Imaging of blood vessels using contrast media
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Types
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Arteriography: Arteries
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Venography: Veins
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Angiocardiography: Heart
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Team Members
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Radiologist
Scrub Nurse
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Pre-Procedure
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Medical history
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NPO 8 hrs
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Premeds
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Shaving/cleaning site
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Informed consent
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Access Sites
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Femoral
Axillary
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Femoral vein (venous access)
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Contrast Media
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Water-soluble
non-ionic iodinated
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Risks
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Bleeding
thrombosis
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Post-Procedure
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Remove catheter
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Apply pressure or closure device
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DIGITAL SUBTRACTION ANGIOGRAPHY (DSA)
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Definition
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Removes bone/soft tissue from images
showing only contrast-filled vessels
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History
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Egas Moniz (1927): Cerebral angio
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Ziedses des Plantes (1935): Subtraction
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Seldinger (1953): Safe access
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TYPES OF SUBTRACTION
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Temporal Subtraction
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Mask Mode: Subtract pre-contrast image (mask)
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Time Interval Difference: Subtract previous frame from current
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Dual-Energy Subtraction
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Uses high and low kVp images
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Pros: Less motion artifact
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Cons: Needs advanced equipment
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Hybrid Subtraction
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Combines temporal + dual energy
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Best for reducing motion artifacts
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DSA TECHNIQUES
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Road Map Technique
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Subtracts contrast-filled static image from live fluoroscopy
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Aids in catheter/guidewire navigation
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Fluoroscopy Fade
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Overlay of static image onto real-time
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Dynamic 3D Road Mapping
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3D overlay on 2D fluoroscopy
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Stepping table/gantry methods
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Rotational Angiography
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X-ray tube rotates 90°–180° during image acquisition
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CEREBRAL ANGIOGRAPHY
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Purpose
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Diagnose vascular pathologies in brain/neck
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Indications
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Aneurysm
stenosis
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Contraindications
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Pregnancy
bleeding disorders
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Contrast
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Non-ionic iodinated (5–10 mL depending on case)
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Common Vessels
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CCA
ICA
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Anatomy Focus
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Circle of Willis: Collateral blood supply
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Anterior Circulation: ICAs
ACAs
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Posterior Circulation: Vertebral
Basilar
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THORACIC ANGIOGRAPHY
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Purpose
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Study thoracic vasculature (aorta
lungs)
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Types
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Thoracic Aortography
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Pulmonary Arteriography
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Indications
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Aneurysms
stenosis
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Contrast Used
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Iodine-based
CO₂ (30–50 mL average)
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Imaging Techniques
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DSA
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CT Angiography (CTA)
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Magnetic Resonance Angiography (MRA)
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Procedure Overview
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NPO 8 hrs
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Local anesthesia
Seldinger technique
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Contrast injection
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Bi-plane or angled projections
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Post Procedure
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Pressure applied to puncture site
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Bedrest 4–10 hrs
monitor vitals
