Coronary artery angiography the procedure performed by the buildup and the procedure work is carried out by this technique to help the team 👏 to get the best experience during our terms 😀 visit the site and visit the website and get the information obtained from cardiac and other information to help offer individual medical imaging tests 😀 the benefits of the body of a cardiac CT for the procedure work you 👍

1. Coronary Angiographic Anatomy
Dr . Mohamed Seleem
Cardiology Consultant
National Heart Institute

9. Figure 3a. Left coronary artery anatomy.
Hoffmann U et al. Radiographics 2006;26:963-978
©2006 by Radiological Society of North America

10. Figure 2a. Right coronary artery anatomy.
Hoffmann U et al. Radiographics 2006;26:963-978
©2006 by Radiological Society of North America

11. “ CARDIAC CATHETERIZATION LABORATORY ”

12.  Projections
 To visualise the coronary arteries several
projections are necessary. When mentioning
the various projections, remember that L.A.O.
rotation indicates that the Image Intensifier is
rotated to the left side of the patient. R.A.O.
rotation indicates that the Image Intensifier is
rotated to the right side of the patient. Using
cranial angulation the Image Intensifier
angulates to the patient’s head while using the
caudal angulation the Image Intensifier
angulates towards the patient’s feet.

13.  To recognize the different vessels one can think
of the following hints:
- The Circumflex lies closest to the spine
- Only the LAD (Left Artery Descendens) reaches
the apex
- In L.A.O. position, the apex points to the left
- In L.A.O. position, the LAD lies to the left
- In L.A.O. position, the spine is on the right
- In R.A.O. position, the spine is on the left
- In R.A.O. position, the apex points to the right.
- In L.A.O. position, the RCA (Right Coronary
Artery) resembles a “C”.

32. Left Coronary artery R.A.O.

37. Left Coronary artery in Left
Lateral

38.  Right Coronary artery
 L.A.O. 45o + 15o caudal angulation
 This projection allow the whole study of the
R.C.A. and clearly defines the region of the crux
of the heart.

39. Right Coronary artery in L.A.O. 45o + 15o
caudal

40. Right Coronary artery in R.A.O. 45

41.  Right Coronary artery
 Left lateral projection
 This projection permits the study of the second
(vertical segment of the right coronay artery and
the collateral branches (conus branch, right
ventricular artery, right marginal artery)

42. Right Coronary artery in Left
lateral

43.  Left ventricle angiogram
 To measure various pressures and to visualize
how well the left ventricle contracts, a pigtail
shaped catheter is used. This catheter has
several side holes to make it possible to inject
contrast using a high flow rate.
 The left ventricle can be divided into several
areas to determine which part of the ventricle
muscle is not functioning properly.
 The projection most used to visualise the left
ventricle is RAO 30o

46.  Optimize image quality
The patient’s treatment depends on the
diagnosis. Therefore the image quality plays a
major role. To obtain the best image quality, the
following factors have to be taken into account.

47.  Shutters
 Shutters are built in the system to adjust
the field of view and to avoid showing
white margins at the edges of the image
that might interfere with the perception
of image detail. Be aware that if the field
of view is set too small, there is a risk to
miss some of the anatomy.

48.  Wegde filters
 To prevent distracting highlights in the
region of interest (lung tissue) that will
affect image quality, wedge filters can
be used.

49.  Protocol
 Image quality is also determined by the
protocol selected. Within each protocol
several parameters are optimised for a
certain exposure technique or
projection. It is therefore of utmost
importance to select the correct protocol
before starting a diagnostic exposure
run.

50.  Image Intensifier position
 The image intensifier is moved away
from the patient in preparation of the
next projection using a different rotation
and or angulation. To avoid air gaps
that deteriorate image quality, the
distance between the image intensifier
and the patient should be minimized
every time again after change in
projection view.

51.  Patient communication
 A good patient communication will
reduce patient physical or respiratory
movement during image acquisition.

52.  Catheter position
 When starting an image acquisition, the
best image quality is achieved when the
whole anatomy of the coronary arteries
is visible without having to move the
table.
 This is possible when having the
catheter tip positioned correctly within a
certain area of the field of view on the
monitor.

53.  To give an indication of the position of
the catheter tip for each projection, the
field of view is divided into 9 zones.
 If the tip is within the zone 1,2,3 or 5,
then in most of the acquired runs the
whole anatomy of the coronary arteries
will be within the field of view without
having to move the table.
 Examples:

54.  To give an indication of the position of
the catheter tip for each projection, the
field of view is divided into 9 zones.
 If the tip is within the zone 1,2,3 or 5,
then in most of the acquired runs the
whole anatomy of the coronary arteries
will be within the field of view without
having to move the table.
 Examples:

55. Left coronary arterty and
Circumflex

56. Left coronary arterty and
Circumflex

57. Right coronary
artery

67. THANK YOU