Download RAD 354 Chapt 22 Interventional Radiology

RAD 354 Chapt 22 Interventional
Radiology
• Diagnostic Imaging
• Therapeutic (interventional)
Brief History
• 1930’s angiography
• 1953 – Seldinger needle/technique
• 1960’s transbrachial selective coronary
angiography (common femoral artery is the
MOST commonly accessed artery for access to
other internal organs/structures)
Seldinger Needle
Seldinger Technique
• The blunt tipped outer cannula is filled with
the SHARP inner (cutting) stylet and cuts
through the artery. The cutting stylet is
removed and the blunt outer cannula is fitting
into the artery. The guide/glide wire can be
inserted trough the outer obturator and into
the artery and threaded toward the area of
interest. When it reaches the desired area,
the catherter is placed OVER the guidewire
and pushed to the right location.
Seldinger technique con’t
• Once the catheter reaches the correct
location, the guidewire is removed and
contrast can be introduced through the
catheter to the proper site
Imaging Procedures
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Angiography
Aortography
Ateriography
Cardiac Catherization
Myelography
Venography
Interventional Procedures
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Stent placement
Emobization
Intravascular stent
Thrombolysis
Balloon angioplasty (PTA)
Artherectomy
Electrophysiology
Materials Needed
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Informed consent
Needle (usually Seldinger 18 g)
Guide/glide wires
Catheters (H1- “headhunter,” C2 – “Cobra,”
Pigtail)
• Heparin saline for “flushing”
• Contrast – most is now nonionic – fewer side
effects
Pt. Prep and Monitoring
• Prep – NPO 8 hours prior and usually
hydrating IV’s
• During procedure – cardiac monitoring, blood
pressure and pulse ox
• Post – MANUAL pressure on the puncture site
(usually 20 minutes), followed by a sandbag
for several hours after to prevent bleeding
• Lots of water!!!
Equipment Considerations
• Tube
– Focal spot size 1.0mm/0.1mm
– Disc size 15cm diameter (heat load)
– Power rating – 80kW (rapid sequence, serial
radiography)
– Expanded anode hear capacity (massive amounts
of heat are produced)
Couch – non-tilting, slim design with “stepping”
capability
Filming Considerations
• Cine camera for cardiac catherization (cam
and fluoro are synchronized so the fluoro only
emits x-ray when the film frame is accessible)
• Photofluorographic camera
• Charge-Coupled Device (CCD) – photosensitive
silicon chips (replacing the TV camera) convert
light to digital video images
Balloon Tip for PTA
Balloon Imaging
Pig tail
Stent
Wireless Technology