Angulated views in coronary
angiography
An Indroductory lecture for cath lab technicians
Dr Awadhesh Kumar Sharma
MD(Gold ...
Dr Awadhesh Kumar Sharma
 Dr.Awadhesh Kumar Sharma is a young, diligent and dynamic interventional cardiologist. He did
h...
Cineangiographic equipments
 A Generator
 X Ray tube – under the patients table
 Image Intensifier- attached to a posit...
CranialView- image intensifier is tilted towards the
head of the patient
CaudalView- image intensifier is tilted down
to...
Importance of angulated
views
 Proper delineation of coronary & peripheral
vascular anatomy
 Origin & course of vessel
...
Standard Angiographic Views
 An easy way to identify the tomographic views is to use the anatomic
landmarks - catheter in...
Standard Angiographic Views
RAO-Caudal view: 100
to 200
RAO and 150
to 200
caudal
 Best for visualizing-
 Left main bifu...
Standard Angiographic Views
Left Coronary Artery
RAO 20 Caudal 20
LM
LAD
Diagonal
Septals
Distal
LAD
LCx
RAO 20 Caudal 20
...
 LAO-Cranial view: 300
to 600
LAO and 150
to 300
cranial
Best for visualizing
 Mid and distal LAD
 Distal LCx in a left...
Standard Angiographic Views
Left Coronary Artery
LAO 50 Cranial 30
LM
LAD
Diagonal
Septals
Distal
LAD
LCx
PA 0 Cranial 30
...
Left Coronary Artery
 PA-Cranial view: 00
lateral and 300
cranial
 Best for visualizing -
 Mid LAD
 Distal LAD
Left Coronary Artery
 Shallow RAO-Cranial view: 00
to 100
RAO and 250
to 400
cranial
Best for visualizing –
 Mid and dis...
Left Coronary Artery
LAO-Caudal view: 400
to 600
LAO and 100
to 300
caudal
Best for visualizing-
 Left main,
 Proximal L...
Standard Angiographic Views
Left Coronary Artery
PA0 Caudal 30
LM
LAD
Diagonal
Septals
Distal
LAD
LCx
LAO 50 Caudal 30
OM
...
Left Coronary Artery
PA-Caudal view: 00
lateral and 200
to 300
caudal
Best for visualizing
 Distal left main bifurcation
...
Left Coronary Artery
PA projection: 00
lateral and 00
cranio-caudal
Best for visualizing
 Ostium of the left main
Left lateral view:
Best for visualizing
Proximal LCx,
Proximal and distal LAD
Also good for visualizing LIMA to LAD anasto...
Standard Angiographic Views
 LAO 30: 300
LAO
 Best for visualizing ostial and proximal RCA
 RAO 30: 300
RAO
 Best for ...
Standard Angiographic Views
Right Coronary Artery
LAO 30
Proximal
RCA
PDA
Distal
RCA
Mid
RCA
RAO 30
Mid
RCA
PDA/
PLV
PA 0 ...
RAO and LAO
Ventriculography:
RAOVentricle  LAOVentricle
Left Ventriculogram
Systolic View
RAO
Left Ventriculogram
Diastolic View
RAO
Cerebral circulation
APView- Common carotid,External carotid,
Internal carotid,Vertebral arteries
LateralView- Bifurcati...
Commonly used angiographic
views
 Most favorable angulation for iliac angiography is the
contralateral oblique angle, gen...
Angulated views in coronary angiography,an introductory lecture for cath lab technicians   dr awadhesh
Angulated views in coronary angiography,an introductory lecture for cath lab technicians   dr awadhesh
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Angulated views in coronary angiography,an introductory lecture for cath lab technicians dr awadhesh

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Angulated views in coronary angiography,an introductory lecture for cath lab technicians dr awadhesh

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Angulated views in coronary angiography,an introductory lecture for cath lab technicians dr awadhesh

  1. 1. Angulated views in coronary angiography An Indroductory lecture for cath lab technicians Dr Awadhesh Kumar Sharma MD(Gold Medalist),DM Cardiology
  2. 2. Dr Awadhesh Kumar Sharma  Dr.Awadhesh Kumar Sharma is a young, diligent and dynamic interventional cardiologist. He did his graduation from GSVM Medical College Kanpur and MD in Internal Medicine from MLB Medical college Jhansi.Then he did his superspecilization degree DM in Cardiology from PGIMER & DR Ram Manohar Lohia Hospital New Delhi. He had excellent academic record with Gold medal in MBBS,MD and first class in DM. He was also awarded chief ministers medal in 2009 for his academic excellence by former chief minister of UP Hon. Mayawati in 2009.He is also receiver of GEMS international award. He had many national & international publications. He had special interest in both invasive & non invasive cardiology. He had performed more then 5000 invasive cardiac intervention procedures successfully till date including coronary angiography, simple & complex angioplasty, peripheral vessels angiography & angioplasty, carotid angiography & angioplasty,ASD ,PDA device closures, Mitral & pulmonary valvotomy. He is also in editorial board of many national & international journal- Journal of clinical medicine & research(JCMR),Clinical cardiology update, EC Pulmonology and Respiratory Medicine. He is also active member of reviewer board of many journals. He is also international associate fellow of American college of cardiology. He is active member of many professional bodies including Indian MedicalAssociation, Cardiological Society of India,APVIC, ICC,API. He had worked in NABHApproved Gracian Superspeciality Hospital Mohali as Consultant Cardiologist since 2014-2016. Currently he is working asAssistant Professor of cardiology at LPS Institute of Cardiology, GSVM Medical college, Kanpur(UP)under Govt of UP.
  3. 3. Cineangiographic equipments  A Generator  X Ray tube – under the patients table  Image Intensifier- attached to a positioner such as C-arm, over the patients table  Optical system  Digital convertor  TV monitors  Control Unit
  4. 4. CranialView- image intensifier is tilted towards the head of the patient CaudalView- image intensifier is tilted down toward the feet of the patient APView – image intensifier is in central position LateralView – image intensifier is on left side of the patient horizontally at body level
  5. 5. Importance of angulated views  Proper delineation of coronary & peripheral vascular anatomy  Origin & course of vessel  Eccentric lesion
  6. 6. Standard Angiographic Views  An easy way to identify the tomographic views is to use the anatomic landmarks - catheter in the descending aorta, spine and the diaphragm. The rough rules are:  RAO vs. LAO- If the spine and the catheter are to the right of the image, it is LAO and vice versa. If central, it is likely a PA view  Cranial vs. caudal - If diaphragm shadow can be seen on the image, it is likely cranial view, if not, it is caudal Catheter and spine to the LEFT RAO view No diaphragm shadow Caudal view Catheter at the CENTER PA view No diaphragm shadow Caudal view Spine to the RIGHTLAO view Diaphragm shadow Cranial view
  7. 7. Standard Angiographic Views RAO-Caudal view: 100 to 200 RAO and 150 to 200 caudal  Best for visualizing-  Left main bifurcation  Proximal LAD  Proximal to mid LCx Left Coronary Artery
  8. 8. Standard Angiographic Views Left Coronary Artery RAO 20 Caudal 20 LM LAD Diagonal Septals Distal LAD LCx RAO 20 Caudal 20 Knowledge of the orientation of the artery for a given view can help identify the probable path of the artery in the setting of complete occlusion Distal LAD fills by collaterals LAD Best for visualization of LM bifurcation and proximal LAD and LCx
  9. 9.  LAO-Cranial view: 300 to 600 LAO and 150 to 300 cranial Best for visualizing  Mid and distal LAD  Distal LCx in a left dominant system  Separates out the septals from the diagonals Left Coronary Artery
  10. 10. Standard Angiographic Views Left Coronary Artery LAO 50 Cranial 30 LM LAD Diagonal Septals Distal LAD LCx PA 0 Cranial 30 LM LAD Diagonal Septals Distal LAD LCx Best for visualization of LM proximal and mid LAD Best for visualization of proximal and mid LAD and splaying of the septals from the diagonals. Also ideal for visualization of distal LCx
  11. 11. Left Coronary Artery  PA-Cranial view: 00 lateral and 300 cranial  Best for visualizing -  Mid LAD  Distal LAD
  12. 12. Left Coronary Artery  Shallow RAO-Cranial view: 00 to 100 RAO and 250 to 400 cranial Best for visualizing –  Mid and distal LAD and the  Distal LCx (LPDA and LPL)  Separates out the septals from the diagonals
  13. 13. Left Coronary Artery LAO-Caudal view: 400 to 600 LAO and 100 to 300 caudal Best for visualizing-  Left main,  Proximal LAD  Proximal LCx  Spider view
  14. 14. Standard Angiographic Views Left Coronary Artery PA0 Caudal 30 LM LAD Diagonal Septals Distal LAD LCx LAO 50 Caudal 30 OM LM LAD Diagonal Distal LAD LCx OM ‘Spider’ view Best for visualization of LM bifurcation and proximal LAD and LCx Best for visualization of LM bifurcation, proximal LAD and LCx and OM
  15. 15. Left Coronary Artery PA-Caudal view: 00 lateral and 200 to 300 caudal Best for visualizing  Distal left main bifurcation  Proximal LAD  Proximal to mid LCx
  16. 16. Left Coronary Artery PA projection: 00 lateral and 00 cranio-caudal Best for visualizing  Ostium of the left main
  17. 17. Left lateral view: Best for visualizing Proximal LCx, Proximal and distal LAD Also good for visualizing LIMA to LAD anastomotic site Left Coronary Artery
  18. 18. Standard Angiographic Views  LAO 30: 300 LAO  Best for visualizing ostial and proximal RCA  RAO 30: 300 RAO  Best for visualizing mid RCA and PDA  PA Cranial: PA and 300 cranial  Best for visualizing distal RCA bifurcation and the PDA  Left lateral view: Left Lateral 900  Ostium of the RCA  Midportion of the RCA  Separation of RCA with its RV branches Right Coronary Artery
  19. 19. Standard Angiographic Views Right Coronary Artery LAO 30 Proximal RCA PDA Distal RCA Mid RCA RAO 30 Mid RCA PDA/ PLV PA 0 Cranial 30 Proximal RCA PDADistal RCA Mid RCA Best for visualization of ostial and proximal RCA Best for visualization of mid RCA and PDA Best for visualization of distal RCA and its bifurcation
  20. 20. RAO and LAO Ventriculography: RAOVentricle  LAOVentricle
  21. 21. Left Ventriculogram Systolic View RAO
  22. 22. Left Ventriculogram Diastolic View RAO
  23. 23. Cerebral circulation APView- Common carotid,External carotid, Internal carotid,Vertebral arteries LateralView- Bifurcation of Common carotid artery into External carotid & Internal carotid artery
  24. 24. Commonly used angiographic views  Most favorable angulation for iliac angiography is the contralateral oblique angle, generally 30 to 40 °  The optimal view for the common femoral bifurcation is 30 to 45° of ipsilateral oblique angulation  SFA can be imaged in an anteroposterior view with the addition of an oblique angle if a stenosis is suspected.  The popliteal artery, tibeoperoneal trunk, and trifurcation are best imaged in an ipsilateral oblique angle (30°).  Infrapopliteal runoff can be performed in either an anteroposterior or an ipsilateral oblique projection N Engl J Med. 2006;354:379 –386 Vasc Endovascular Surg. 2002;36:439–445 LAO 30

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