Lesson 1 and 2: Introduction to Interventional Radiology Flashcards
(168 cards)
1
Q
this involves the use of needles and contrast media to enter and highlight an artery
A
angiography
2
Q
it was the first interventional radiology procedure performed in the 1930s
A
angiography
3
Q
this involves entering select coronary arteries through an artery of the arms
A
transbrachial selective coronary angiography
4
Q
in the 1960s, he pioneered transbrachial selective coronary angiography
A
Mason Jones
5
Q
this involves entering an artery in the thigh
A
transfemoral angiography
6
Q
it was developed in the 1960s to examine selective visceral, heart, and head arteries
A
transfemoral angiography
7
Q
he introduced coronary angiography
A
Melvin Judkins
8
Q
he introduced visceral angiography
A
Charles Dotter
9
Q
he described a method of arterial access in which a catheter was used
A
1953 Sven Ivar Seldinger
10
Q
an 18-gauge hollow needle with a stylet
A
seldinger needle
11
Q
it is most often used for arterial access in angiography
A
common femoral artery
12
Q
location of the common femoral artery
A
pulse in the groin below the inguinal ligament, which passes between the symphysis pubis and the anterior superior iliac spine (ASIS)
13
Q
needle gauge size for olive
A
14
14
Q
needle gauge size for orange
A
15
15
Q
needle gauge size for purple
A
16
16
Q
needle gauge size for pink
A
18
17
Q
needle gauge size for brown
A
19
18
Q
needle gauge size for yellow
A
20
19
Q
needle gauge size for green
A
21
20
Q
needle gauge size for black
A
22
21
Q
needle gauge size for sky blue
A
23
22
Q
needle gauge size for blue
A
25
23
Q
needle gauge size for gray
A
27
24
Q
needle gauge size for lavender
A
30
25
this allows the radiologist to position the catheter within the vascular network
guidewires
26
these are fabricated of stainless steel and contain an inner core wire that is tapered at the end to a soft, flexible tip
guidewires
27
it allows the safe introduction of the catheter into the vessels
guidewires
28
a variation of the tip configuration that was initially designed for use in atherosclerosis vessels filled with plaque
J-tip
29
similar to guidewires, these are designed in many different shapes and sizes
catheters
30
unit for catheter diameter
French (Fr) size
31
3 Fr is equivalent to _____ in diameter
1 mm
32
it catheter shape is used for the femoral approach to the brachiocephalic vessels
H1 or headhunter tip
33
he designed the H1 or headhunter tip
Vincent Hinck
34
it catheter shape is highly curved for approach to sharply angled vessels
simmons catheter
35
this catheter shape was also designed for cerebral angiography but was later adopted for visceral angiography
simmons catheter
36
it has an angled tip joined to a gentle curve and is used for introduction into celiac, renal, and mesenteric arteries
C2 or cobra catheter
37
these have side holes for ejecting contrast media into a compact bolus
pigtail catheter
38
purpose of catheters with side holes (pigtail catheter)
it help reduce a possible whiplash effect
39
it has low concentration of ions (low osmolality) which results to reduced physiologic problems and adverse reactions for patients undergoing angiographic injection
non-ionic contrast media
40
most common complication associated with catheter angiography
continued bleeding at the puncture site
41
other risk factors of angiography
related kidney failure
42
procedure room
size: not less than 20 ft. along any walls and not less than 500 ft^2
should be finished with consideration for maintaining a clean and sterile environment
43
importance of procedure room size
to accommodate the quantity of equipment required and the large number of people involved in most procedures
44
control room
size: large, perhaps 100 ft^2
this room should communicate directly with the viewing area
it should have positive air pressure and filtered incoming air
45
personnel
a radiographer who specializes in IR requires additional skills
two or three radiographers may be present in the IR suite, as well as the interventional radiologists and a radiology nurse, who carefully monitors the patient
during the procedure that require the patient to be highly medicated, an anesthesiologist also may be present
46
interventional radiology x-ray tube: focal spot size
1.0 mm or 0.3 mm
large for heat load, small for magnification radiography
47
interventional radiology x-ray tube: disc size
15 cm in diameter, 5 cm thick
to accommodate heat load
48
interventional radiology x-ray tube: power rating
80 kW
for rapid sequence, serial radiography
49
interventional radiology x-ray tube: anode heat capacity
1 MHU (mega heat unit)
to accommodate heat load
50
formula for magnetic factor
M = SID / SID - OID or
M= SID/SOD
51
formula for focal spot blur
focal spot blur = (effective focal spot) OID / SOD
52
this means blood vessel
angio
53
the radiological study of blood vessels in the body after the introduction of iodinated contrast media
angiography
54
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
subtraction
55
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
digital subtraction angiography
56
a Portuguese neurologists developed the technique of contrast x-ray cerebral angiography to diagnose diseases such as tumors and arteriovenous malformations
1927 Egas Moniz
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the year Egas Moniz won the nobel prize
1949
58
a Dutch radiologist, he was the first to proposed the idea of subtraction images in 1935, when he was able to produce subtracted images using plain films
Ziedes des Plantes
59
with its introduction in the 1953, the procedure became safer as no sharp devices need to remain inside the vascular lumen
seldinger technique
60
photographic method used to eliminate unwanted images
no addition of information, only purpose is to make diagnostically important information to see
conventional subtraction technique
61
this was first described by a Dutch radiologist, Zeides des Plantes, in 1935
conventional subtraction technique
62
three conditions for conventional subtraction technique
scout film
angiogram film-contrast
no motion of head
63
principles of subtraction
scout film shows the structural details of the skill and the 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 the angiogram, only the opacified vessel pattern would remain visible
64
it can change films – 6/s or 1/5s
two of these changers can be coupled electronically and mechanically and will operate out of phase or synchronously with each other
radiographs in two planes simultaneously-one mounted vertically and other horizontally
AOT changer
65
a large steel container, inside the container are arranged a number of strong wire separators
loading magzine
66
a shallow, polished metal container
lid is a sliding section in a side which can be pushed down by firm finger pressure and is retained by central spring located catch
receiving cassette
67
mechanically easier to wind roll films
roll film changer
68
this is a complex electronic device that receives the image-forming x-ray beam and converts it into a visible-light image of high intensity
image-intensifier tube
69
it converts the pattern of the x-ray beam into a bright visible-light image
image-intensifier tube
70
it contains the tube component
glass or metal envelope
71
this provides structural support but more importantly maintains vacuum
glass or metal envelope
72
it protects the tube from rough handling and breakage
glass ot metal envelope
73
when an x-ray interacts with this, its energy is converted into visible light; this is similar to the effect of radiographic intensifying screens
input phosphor
74
component of input phosphor
cesium iodide (CsI)
75
they are grown as tiny needles and are tightly packed in a layer of approximately 300 µm
each crystal is approximately 5 µm in diameter
this results in micro-light-pipes with little dispersion and improved spatial resolution
cesium iodide (CsI)
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another active element of the image-intensifier tube, which is bonded directly to the input phosphor with a thin transparent adhesive layer
photocathode
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it is a thin metal layer usually composed of cesium and antimony compound that responds to stimulation of input phosphor light by the emission of electrons
photocathode
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this emits electrons when illuminated by the input phosphor
photocathode
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this is similar to thermionic emission, which refers to electron emission that follows heat stimulation
photoemission
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it is electron emission that follows light stimulation
photoemission
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the site where accelerated electrons interact and produce light
output phosphor
82
it is located at the other side of the anode
output phosphor
83
component of output phosphor
zinc cadmium sulfide
84
a technique by which bone structure images are subtracted, or canceled out, from a film of bones and opacified vessels, leaving an unobscured image of the vessels
photographic subtraction technique
85
this technique can be applied in all forms of angiography, wherever the vessels are superimposed in bone structures
photographic subtraction technique
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he introduced the photographic subtraction technique
Zeides des Plantes
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year when angiography was first successively used for the human body
1923
88
a swedish doctor who pioneered the seldinger technique, which laid down the foundation of interventional radiology
1953 Sven Ivar Seldinger
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he first proposed the idea of interventional radiology
1963 Charles Dotter
90
he opened a new era of percutaneous angioplasty through accidental operation, marking the formation of interventional radiology
1964 Chrales Dotter
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importance of interventional radiology in medicine
diagnose and treat patients using the least invasive techniques currently available in order to minimize risk to the patient and improve health outcome
these procedures have less risk, less pain, and less recovery time in comparison to open surgery
it is now a therapeutic and diagnostic specialty that comprises a wide range of minimally invasive image-guided therapeutic procedures as well as invasive diagnostic imaging techniques
92
repair or unblocking of blood vessels
angioplasty
93
a small mesh tube that treat narrow or weak arteries
stenting
94
dissolving blood clots
thrombolysis
95
block blood flow to cancer cells
embolization
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this is used to reduce nerve pain
radiofrequency ablation
97
biopsies
the studies of tissues
98
most common interventional radiology procedures
angiography
angioplasty/stent
chemoembolization
thrombolysis
biopsy
RF ablation
cryoablation
IVC filter
99
benefits of interventional radiology procedures
increased effectiveness
reduced complications
outpatient vs. inpatient stay
lower costs
less pain
quicker recovery time
100
risk of interventional radiology procedures
increased exposure to radiatiton
101
it is introduced by Ziedes des Plantes
photographic subtraction
102
this is a technique by which bone structure image is subtracted or cancelled out
from the film of bones and opacified vessels leaving an unobscured image of the vessels
photographic subtraction
103
purpose of subtraction in angiography and other specialized procedure
to fully define all vessels containing contrast material and at the same time eliminate the confusing overlying bone images
104
matching one image over another so that bony landmarks are precisely superimposed
registration
105
reverse tone duplicate of radiographic image, showing black changed to white and white to black
reversal film or mask film
106
film showing bone structures only, with no patient motion between it and subsequent contrast studies
zero film or scout film
107
radiographic image obtained with the contrast media induced in the patient
series film
108
the simplest method of photographic subtraction
first order subtraction
109
procedures of first order subtraction
take scout film
the scout film is reversed using contact printer to obtain the reversal mask film
take series film
finally register the reversal mask film and series film together with blank film to obtain the final film
the process cancel out bony structure and reveal the anatomy of interest which appears in black
110
the simplest zero film obtained in the first order subtraction is usually not the exact reversal of the density of the selected angiographic film
the imperfection can be corrected
second order subtraction
111
they developed the second order subtraction
Hanafee and Shinno
112
procedures of second order subtraction
take scout film
the scout film is reversed using contact printer to obtain the reversal mask film
take series film
the series film is reversed using contact printer to obtain the reversal film
register scout film and series reversal film together with a blank film to obtain the second mask film
finally register the mask film, series film, second mask film, and blank film to obtain the final film
113
based on digital fluoroscopy/fluorography systems, which are equipped with special software and display facilities
modern DSA system
114
this was developed to improved vessel contrast
digital subtraction angiography
115
it is a technique that uses a computer to subtract two images, obtained before and after contrast media is injected into the vessels of interest
digital subtraction angiography
116
the anatomical structures that are the same in the two images can be removed and the resulting image shows the vessels only
digital subtraction angiography
117
the image before the contrast agent is administered
mask film
118
it has two separate image memories, one for the mask and the other for the images with contrast medium
these two image memories are subtracted from one another arithmetically, and the result to an image processing and display unit
DSA processor
119
adjusts contrast and brightness
image processing
120
image processing parameters
remasking
pixel shifting
edge enhancement
landmarking
noise smoothing
121
correcting misregistered images
remasking
122
a process that is used to correct the inaccurate images during DSA
remasking
123
it diminishes what is blurry on the image in the monitor
pixel shifting
124
this enhances resolution of a certain display presented in the monitor
pixel shifting
125
edges of the vessels can be enhanced so that small details can be made more obvious
edge enhancement
126
it operates by reducing the statistical fluctuations in each pixel by averaging the pixel with its closest neighbor
noise smoothing
127
this help equalize image pixel
noise smoothing
128
the visual prominence of noise has been suppressed by averaging, but resolution is decreased
noise smoothing
129
this gives random variation of image brightness which causes the image to appear grainy
noise
130
noise =
decrease brightness
decreased resolution
131
this is useful for the placement of catheters and wires in complex and small vasculature
roadmapping
132
factors affecting image quality
resolution
contrast
brightness
image lag
distortion
133
the proves by which something is separated into its component part
resolution
134
this refers to the amount of detail which is observable
resolution
135
it may be formulated on the number of pairs of black and white lines on image forming or image recording device can demonstrate in a length of ___
resolutiion, 1 mm
136
it is determined by no. of vertical scan lines (e.g. 625)
vertical resolution
137
in recent years the manufacturers of radio diagnostic imaging equipment have developed this definition TV system which employ ___ or even more lines
1249
138
the ____ of the image on a TV screen clearly depends on the ____ of the original image focused onto the signal plate of the pick up tube
contrast
139
both ___ and ___ affects the contrast of a TV image
camera, monitor
140
this reduces contrast by a factor of approx. 0.8 and the monitor enhances by a factor of 2
vidicon camera
141
the term ___ and ___ are often used when describing the aspect of TV image
luminance, brightness
142
it can be defined as light emitted per unit area from a surface
luminance
143
unit for luminance
candela per square meter (cd/m^2)
144
this helps maintain the image intensifier exposure rate based on the subject’s thickness
automatic brightness control
145
it is critical to the patient dose and image quality
automatic brightness control
146
this monitors the light output from an area of the face of the image intensifier and it tries to maintain the signal travel within an approximate range of that output and adjust tube potential (kVP) and tube current (mA) according to predefined algorithm
automatic brightness control
147
it refers to control of x-ray exposure levels
automatic brightness control
148
if brightness is controlled by varying sensitivity the TV system, this terms is used
automatic gain control
149
it is fairly simple and inexpensive way to control image brightness
automatic gain control
150
the term used to describe inability of an imaging system to follow rapid changes in its input image
image lag
151
this occur in the image intensifier or in the optical coupling system which links its output phosphor to the signal plate of the TV pick up tube
distortion
152
indications for DSA
non traumatic subarachnoid hemorrhage (SAH)
arterial dissection or laceration
aneurysm
pseudoaneurysm
thrombosis
arterio-venous malformation (AVM)
arterio-venous fistula (AVF)
tumor vascularity
gastrointestinal bleed/uterine artery bleed
therapeutic
153
contraindications for DSA
poor renal reserve
allergic to contrast media
recent barium examination – abd. angio
154
a type of fluoroscopy technique used in interventional radiology to clearly visualize blood vessels in a bony or dense soft tissue environment
digital subtraction angiography
155
a fluoroscopic technique used extensively in interventional radiology for visualizing blood vessels
digital subtraction angiography
156
radiopaque structures such as bones are eliminated (subtracted) digitally from the image, thus allowing for an accurate depiction of the blood vessels
digital subtraction angiography
157
it is performed for diagnostic and therapeutic purposes of vessel visualization in the body
digital subtraction angiography
158
angiography is largely possible because of Seldinger technique for intravascular access
1953
159
digital subtraction angiography, whereby a pre-contrast image is acquired, then subtracted from subsequent post-contrast images, was made possible because of real-time refreshing of the resulting images
1970s
160
the development of DSA was a result of the research of medical physics groups at the University of Wisconsin, the University of Arizona and the Kinderklinik in Kiel, West Germany
early 1970s
160
the feasibility of DSA for human subjects was demonstrated
1978
161
prototype commercial DSA systems were introduced at the Universities of Arizona and Wisconsin, the Cleveland Clinic, and South Bay Hospital in Redondo Beach, California
1980
162
pre-procedural evaluation
presence of atherosclerotic disease (e.g. prior myocardial infarction)
diabetes
renal function status
medications
allergies and previous exposure to iodinated contrast media
prior surgical procedures, especially vascular
reports from previously performed angiograms, if any
review of any relevant vascular Imaging studies (e.g. pre-procedural CT)
angiogram
163
procedural technique
for every purpose, there is at least one technique, but common to them all is the application of DSA for visualization
164
this depends on the nature of the procedure and whether it was performed on an inpatient or outpatient basis
post procedural care
165
post procedural care:
patient should be immobilized for ___ to ___ hours and keep on ___ position, frequent observations should be done to look for ___, which is the commonest complications
4 to 6, puncture site hematoma
166
local complications (puncture site) of DSA
from the puncture site: commonest complication
thrombus formation: blood clot
local tissue damage
pseudoaneurysm: false aneurysm, pooling of blood at the artery walls
arteriovenous fistula: abnormal connection of arteries and veins
166
systemic complications of DSA
thromboembolism
air embolism
vessel dissection
contrast medicated nephrotoxicity
