Digital subtraction angiography (DSA) provides high quality images of cerebral vasculature and remains the gold standard. It involves injecting iodinated contrast into arteries and digitally subtracting pre-and post-contrast images to visualize vessels. Modern DSA uses flat panel detectors for higher resolution and lower radiation. It allows 3D reconstruction of vessel anatomy and is useful for diagnosing and treating conditions like aneurysms and AVMs. While very accurate for vessels, DSA cannot simultaneously image bone which CT angiography can provide.
Digital subtraction angiography (DSA) is the gold standard for evaluating the cerebral vasculature. It involves injecting iodinated contrast material into arteries and using subtraction techniques to visualize vessels. The normal anatomy includes the circle of Willis and branches of major arteries. Variants are common. DSA is used to diagnose conditions like aneurysms and arteriovenous malformations. Newer digital systems provide 3D reconstruction and lower radiation exposure compared to older techniques. DSA remains an important tool for interventional procedures and treatment planning of complex vascular lesions.
Digital subtraction angiography (DSA) is the gold standard for evaluating the cerebral vasculature. It involves injecting iodinated contrast material into arteries and using subtraction techniques to visualize vessels. The normal anatomy includes the circle of Willis and branches of major arteries. Variants are common. DSA is used to diagnose conditions like aneurysms and arteriovenous malformations. Newer digital systems provide 3D reconstruction and less radiation exposure compared to older techniques. DSA remains an important tool for interventional procedures and treatment planning of complex vascular lesions of the brain.
Digital subtraction angiography (DSA) is the gold standard for evaluating the cerebral vasculature. It involves injecting iodinated contrast material into arteries and using subtraction techniques to visualize vessel anatomy. The circle of Willis and its major branches including the anterior, middle, and posterior cerebral arteries are described. Variants of vessel anatomy are common. DSA allows diagnosis of conditions like aneurysms and arteriovenous malformations. While newer techniques like CT and MR angiography are available, DSA remains the standard due to its ability to clearly depict complex vascular lesions for treatment planning.
This document discusses Doppler ultrasound of the carotid arteries. It begins with an introduction describing how carotid artery disease can cause strokes and how ultrasound is used to diagnose stenosis to determine surgical candidates. It then describes the anatomy of the carotid arteries and outlines the normal ultrasound appearance. Key points of a carotid ultrasound exam are described including using grayscale, color Doppler, power Doppler and spectral analysis. Different types of carotid plaques are defined as well as how they appear ultrasonographically. Methods for evaluating stenosis and differentiating true from pseudo-spectral broadening are also covered.
Coronary angiography remains the gold standard for detecting coronary artery disease. The technique was first performed in 1958 by Dr. Mason Sones at the Cleveland Clinic. Coronary angiography allows visualization of the coronary arteries, branches, and anomalies to precisely locate lesions. It provides information needed for coronary interventions. The procedure involves accessing the femoral or radial artery and advancing a catheter into the heart to inject contrast dye and image the arteries. It can detect blockages but has limitations like vessel overlap that may obscure lesions. Complications are rare but can include artery damage, embolism, or arrhythmias.
Coronary angiography remains the gold standard for detecting coronary artery disease. The technique was first performed in 1958 by Dr. Mason Sones at the Cleveland Clinic. Coronary angiography allows visualization of the coronary arteries, branches, and anomalies to precisely locate lesions. It remains an important diagnostic tool used to evaluate patients with suspected coronary artery disease. The procedure involves accessing the femoral artery and advancing a catheter into the heart to inject contrast and obtain images of the coronary arteries under fluoroscopy. Precise technique and monitoring are required to minimize risks of potential complications.
Basics of Coronary Angiography Hewad Gulzai.pptxHewad Gulzai
Basics of Coronary Angiography for beginners, MD, DNB, DM students, Nurses, cathlab technicians, physicians and other healthcare members .
hope you will learn something from this ppt. 😀
Digital Subtraction Neuroangiography: What a Resident Should Know Dr. Shahnawaz Alam
This document provides an overview of digital subtraction neuroangiography for residents. It begins with an introduction to the principles and importance of neuroangiography. It then provides detailed descriptions of normal neurovascular anatomy and angiographic views of the extracranial carotid system, anterior and posterior circulations. It discusses indications, contraindications, patient preparation, technique, complications and case examples to illustrate pathologies. The goal is to equip residents with the basic knowledge to interpret images and safely perform neuroangiography.
Digital subtraction angiography (DSA) is the gold standard for evaluating the cerebral vasculature. It involves injecting iodinated contrast material into arteries and using subtraction techniques to visualize vessels. The normal anatomy includes the circle of Willis and branches of major arteries. Variants are common. DSA is used to diagnose conditions like aneurysms and arteriovenous malformations. Newer digital systems provide 3D reconstruction and lower radiation exposure compared to older techniques. DSA remains an important tool for interventional procedures and treatment planning of complex vascular lesions.
Digital subtraction angiography (DSA) is the gold standard for evaluating the cerebral vasculature. It involves injecting iodinated contrast material into arteries and using subtraction techniques to visualize vessels. The normal anatomy includes the circle of Willis and branches of major arteries. Variants are common. DSA is used to diagnose conditions like aneurysms and arteriovenous malformations. Newer digital systems provide 3D reconstruction and less radiation exposure compared to older techniques. DSA remains an important tool for interventional procedures and treatment planning of complex vascular lesions of the brain.
Digital subtraction angiography (DSA) is the gold standard for evaluating the cerebral vasculature. It involves injecting iodinated contrast material into arteries and using subtraction techniques to visualize vessel anatomy. The circle of Willis and its major branches including the anterior, middle, and posterior cerebral arteries are described. Variants of vessel anatomy are common. DSA allows diagnosis of conditions like aneurysms and arteriovenous malformations. While newer techniques like CT and MR angiography are available, DSA remains the standard due to its ability to clearly depict complex vascular lesions for treatment planning.
This document discusses Doppler ultrasound of the carotid arteries. It begins with an introduction describing how carotid artery disease can cause strokes and how ultrasound is used to diagnose stenosis to determine surgical candidates. It then describes the anatomy of the carotid arteries and outlines the normal ultrasound appearance. Key points of a carotid ultrasound exam are described including using grayscale, color Doppler, power Doppler and spectral analysis. Different types of carotid plaques are defined as well as how they appear ultrasonographically. Methods for evaluating stenosis and differentiating true from pseudo-spectral broadening are also covered.
Coronary angiography remains the gold standard for detecting coronary artery disease. The technique was first performed in 1958 by Dr. Mason Sones at the Cleveland Clinic. Coronary angiography allows visualization of the coronary arteries, branches, and anomalies to precisely locate lesions. It provides information needed for coronary interventions. The procedure involves accessing the femoral or radial artery and advancing a catheter into the heart to inject contrast dye and image the arteries. It can detect blockages but has limitations like vessel overlap that may obscure lesions. Complications are rare but can include artery damage, embolism, or arrhythmias.
Coronary angiography remains the gold standard for detecting coronary artery disease. The technique was first performed in 1958 by Dr. Mason Sones at the Cleveland Clinic. Coronary angiography allows visualization of the coronary arteries, branches, and anomalies to precisely locate lesions. It remains an important diagnostic tool used to evaluate patients with suspected coronary artery disease. The procedure involves accessing the femoral artery and advancing a catheter into the heart to inject contrast and obtain images of the coronary arteries under fluoroscopy. Precise technique and monitoring are required to minimize risks of potential complications.
Basics of Coronary Angiography Hewad Gulzai.pptxHewad Gulzai
Basics of Coronary Angiography for beginners, MD, DNB, DM students, Nurses, cathlab technicians, physicians and other healthcare members .
hope you will learn something from this ppt. 😀
Digital Subtraction Neuroangiography: What a Resident Should Know Dr. Shahnawaz Alam
This document provides an overview of digital subtraction neuroangiography for residents. It begins with an introduction to the principles and importance of neuroangiography. It then provides detailed descriptions of normal neurovascular anatomy and angiographic views of the extracranial carotid system, anterior and posterior circulations. It discusses indications, contraindications, patient preparation, technique, complications and case examples to illustrate pathologies. The goal is to equip residents with the basic knowledge to interpret images and safely perform neuroangiography.
Carotid artery disease is commonly seen in association with atherosclerosis and complicate the situation. clearcut guidelines with necessary surgical details are provided in presentations.
This document discusses various cardiac testing modalities including chest radiography, cardiac catheterization, nuclear cardiology, and intravascular ultrasound. Chest radiography uses X-rays to image the chest and can detect conditions like pneumonia and congestive heart failure. Cardiac catheterization inserts a catheter into the heart and uses dye and X-rays to evaluate heart function and detect issues like blockages. Nuclear cardiology uses radioactive tracers and imaging to evaluate blood flow and identify areas of damaged heart muscle. Intravascular ultrasound attaches an ultrasound probe to a catheter to image the inside of arteries and detect plaque buildup.
This document provides information on carotid Doppler ultrasound studies, including:
- Anatomy of the carotid arteries and branches
- Technique for performing carotid Doppler ultrasound exams, including patient positioning, transducer use, and Doppler settings
- Analysis of waveforms in normal carotid arteries versus arteries with disease
- Causes of carotid artery disease and common sites of extracranial arterial disease
- Characterization of carotid plaques based on echogenicity, morphology, and other properties.
Carotid artery Doppler uses ultrasound to examine the carotid arteries in the neck. It can detect plaques, stenosis, dissections, and other abnormalities. A normal study shows the carotid bifurcation into the internal and external carotid arteries, with the internal carotid having low resistance flow and the external carotid having reduced diastolic flow. Doppler waveform analysis examines flow patterns to identify abnormalities. The test is used to evaluate risks of stroke and transient ischemic attacks.
This document discusses intravascular ultrasound (IVUS) as an imaging technique to evaluate coronary arteries. IVUS uses ultrasound waves to image the arterial walls and plaque in cross-section, providing information beyond what can be seen with angiography alone. The summary describes:
1) IVUS uses a catheter-mounted transducer to emit ultrasound waves into the artery and interpret the reflected waves to generate tomographic images of the arterial walls and plaque.
2) IVUS can characterize plaque morphology, distribution, and composition, aiding in diagnosis and treatment planning.
3) Some applications of IVUS include assessing indeterminate lesions, optimizing stent placement, and evaluating stent failures.
Three key points about imaging the orbit:
1. CT scans provide the best view of bony details and calcifications in the orbit, and can detect small fractures and foreign bodies. Slice thickness and tissue windows must be optimized for diagnostic quality.
2. Different x-ray views (like Waters, Caldwell's, and lateral) allow visualization of specific orbital structures and are useful for identifying pathology in different areas.
3. Features seen on imaging like changes in bone density, orbital size and shape, and structures like the optic canal can indicate conditions like tumors, infections, fractures, and vascular abnormalities affecting the orbit. Precise imaging analysis is important for diagnosis.
The document discusses coronary angiography, which is used to visualize the coronary arteries and detect blockages. It remains the gold standard for diagnosing coronary artery disease. The procedure involves inserting a catheter into an artery and using contrast dye and x-rays to view the arteries. It can be used for diagnostic purposes or to guide interventional procedures like angioplasty and stenting to open blocked arteries. The goals, indications, contraindications, and basic procedure steps are outlined.
Peripheral angiography is a radiological procedure used to examine arteries and veins after injecting contrast media. It involves puncturing an artery such as the femoral artery using the Seldinger technique and threading a catheter over a guidewire to inject contrast media and obtain images. The procedure is used to diagnose and treat various vascular conditions. Precise positioning, sterile equipment and contrast injection are needed to obtain diagnostic images of the peripheral vasculature.
This document provides an overview of carotid artery ultrasound evaluation. It describes the normal anatomy of the carotid arteries and their branches. The protocol for a carotid ultrasound examination is outlined, including patient positioning, transducer selection, scanning sequences, and evaluation of stenosis. Key anatomical structures are defined, such as the intima-media complex. Non-atherosclerotic diseases that can involve the carotid or vertebral arteries, such as fibromuscular dysplasia, dissection, vasospasm, and aneurysms are also reviewed. The limitations of carotid ultrasound are noted.
This document discusses the anatomy, embryology, and imaging of the superior vena cava (SVC). It begins with an introduction to the SVC's role as the largest central vein in the mediastinum. Imaging plays an important role in identifying congenital variants and pathologies. The document then covers the embryological development of the SVC, its normal anatomy and tributaries, and techniques for imaging it with various modalities like CT, MR, and venography. It discusses congenital variants like persistent left SVC and aneurysms. It also reviews acquired conditions like strictures, thrombus, and various tumors that can affect the SVC.
The document provides information on performing carotid artery scanning, including vessel identification, recommended scanning protocols, waveform analysis, sample volume placement, and Doppler measurements. The key objectives are to identify the carotid and vertebral arteries, understand normal and abnormal waveforms, demonstrate proper techniques for sample volume placement, angle correction, and Doppler measurements like peak systolic velocity and end diastolic velocity. The document aims to educate ultrasound technicians on performing high quality carotid artery scans to evaluate for disease.
Cerebral aneurysms arise from focal degeneration of arterial walls. The most common type is saccular aneurysms, which protrude from arterial bifurcations and lack an internal elastic lamina. Aneurysms can present with subarachnoid hemorrhage, cranial nerve palsy, headache or seizures. Imaging plays a key role in diagnosing aneurysms and evaluating risks. Computed tomography best identifies acute subarachnoid hemorrhage but may miss small bleeds. Catheter angiography remains the gold standard for precise aneurysm characterization to guide treatment.
cerebral aneurysm mohammad abu sad (1).pptxMohamadAbusaad
This document discusses cerebral aneurysms, including their anatomy, types, causes, presentation, diagnosis, and management. It describes the three main types of aneurysms - saccular, fusiform, and dissecting. Risk factors for rupture include size, shape, location, and multiple aneurysms. Diagnosis is typically made using CT, CTA, MRI/MRA, or DSA imaging. Management involves stabilizing patients and then treating aneurysms either surgically via clipping or endovascularly via coiling to prevent rebleeding. Endovascular coiling is now the preferred initial approach for many aneurysms.
This document provides information on carotid-cavernous fistulas (CCFs). It discusses the anatomy of the cavernous sinus and pathophysiology of CCFs. It notes that CCFs represent 12% of dural arteriovenous fistulas. The majority are caused by trauma, especially in young males, while spontaneous CCFs occur more in older females. Clinical presentation depends on flow rate, with high flow direct CCFs causing eye symptoms and low flow indirect CCFs having insidious onset. Treatment options include conservative management, endovascular embolization, and radiosurgery, with the approach depending on fistula type and symptoms.
This document provides an overview of venography, which is an imaging technique used to examine veins. It discusses the basic principles of venography, including ascending and descending techniques. It describes the anatomy of veins and provides diagrams. It also covers indications, contraindications, techniques, and potential complications of lower limb, upper limb, and peripheral varicography venography procedures. The goal of venography is to accurately diagnose conditions like deep vein thrombosis.
Cardiovascular CT is a valuable tool for evaluating congenital heart disease in children. It provides high spatial and temporal resolution to depict complex anatomy. Key applications include assessing pulmonary blood flow in pulmonary atresia, vascular rings prior to surgery, coronary artery anomalies, and postoperative complications. Careful patient preparation and protocols are needed given pediatric concerns. CT enables simultaneous evaluation of vascular structures, airways, and cardiac function to comprehensively evaluate complex congenital heart disease.
This document provides an overview of angiography and the course of blood vessels supplying the brain. It describes the aortic arch and its branches, as well as the internal carotid artery in detail. The internal carotid artery is discussed in segments from the cervical segment through the cavernous segment. Common variants and anomalies are described for various segments including the persistent trigeminal artery originating from the cavernous segment of the internal carotid artery.
Arteriography and interventional radiologyMilan Silwal
Angiography involves the radiologic examination of blood vessels after injection of iodinated contrast medium. Arteriography specifically examines arteries, while venography examines veins. Techniques include non-invasive ultrasound and MRI, minimally invasive CT or MRI with contrast, and invasive catheterization. Catheters and guide wires are used to access vessels and inject contrast medium. Potential complications include contrast reactions, embolism, infection, and vessel damage. Indications for arteriography include evaluating congenital anomalies, aneurysms, stenoses, arteritis, trauma, embolism, vascular malformations, fistulas, hemorrhage, and masses.
Carotid artery disease is commonly seen in association with atherosclerosis and complicate the situation. clearcut guidelines with necessary surgical details are provided in presentations.
This document discusses various cardiac testing modalities including chest radiography, cardiac catheterization, nuclear cardiology, and intravascular ultrasound. Chest radiography uses X-rays to image the chest and can detect conditions like pneumonia and congestive heart failure. Cardiac catheterization inserts a catheter into the heart and uses dye and X-rays to evaluate heart function and detect issues like blockages. Nuclear cardiology uses radioactive tracers and imaging to evaluate blood flow and identify areas of damaged heart muscle. Intravascular ultrasound attaches an ultrasound probe to a catheter to image the inside of arteries and detect plaque buildup.
This document provides information on carotid Doppler ultrasound studies, including:
- Anatomy of the carotid arteries and branches
- Technique for performing carotid Doppler ultrasound exams, including patient positioning, transducer use, and Doppler settings
- Analysis of waveforms in normal carotid arteries versus arteries with disease
- Causes of carotid artery disease and common sites of extracranial arterial disease
- Characterization of carotid plaques based on echogenicity, morphology, and other properties.
Carotid artery Doppler uses ultrasound to examine the carotid arteries in the neck. It can detect plaques, stenosis, dissections, and other abnormalities. A normal study shows the carotid bifurcation into the internal and external carotid arteries, with the internal carotid having low resistance flow and the external carotid having reduced diastolic flow. Doppler waveform analysis examines flow patterns to identify abnormalities. The test is used to evaluate risks of stroke and transient ischemic attacks.
This document discusses intravascular ultrasound (IVUS) as an imaging technique to evaluate coronary arteries. IVUS uses ultrasound waves to image the arterial walls and plaque in cross-section, providing information beyond what can be seen with angiography alone. The summary describes:
1) IVUS uses a catheter-mounted transducer to emit ultrasound waves into the artery and interpret the reflected waves to generate tomographic images of the arterial walls and plaque.
2) IVUS can characterize plaque morphology, distribution, and composition, aiding in diagnosis and treatment planning.
3) Some applications of IVUS include assessing indeterminate lesions, optimizing stent placement, and evaluating stent failures.
Three key points about imaging the orbit:
1. CT scans provide the best view of bony details and calcifications in the orbit, and can detect small fractures and foreign bodies. Slice thickness and tissue windows must be optimized for diagnostic quality.
2. Different x-ray views (like Waters, Caldwell's, and lateral) allow visualization of specific orbital structures and are useful for identifying pathology in different areas.
3. Features seen on imaging like changes in bone density, orbital size and shape, and structures like the optic canal can indicate conditions like tumors, infections, fractures, and vascular abnormalities affecting the orbit. Precise imaging analysis is important for diagnosis.
The document discusses coronary angiography, which is used to visualize the coronary arteries and detect blockages. It remains the gold standard for diagnosing coronary artery disease. The procedure involves inserting a catheter into an artery and using contrast dye and x-rays to view the arteries. It can be used for diagnostic purposes or to guide interventional procedures like angioplasty and stenting to open blocked arteries. The goals, indications, contraindications, and basic procedure steps are outlined.
Peripheral angiography is a radiological procedure used to examine arteries and veins after injecting contrast media. It involves puncturing an artery such as the femoral artery using the Seldinger technique and threading a catheter over a guidewire to inject contrast media and obtain images. The procedure is used to diagnose and treat various vascular conditions. Precise positioning, sterile equipment and contrast injection are needed to obtain diagnostic images of the peripheral vasculature.
This document provides an overview of carotid artery ultrasound evaluation. It describes the normal anatomy of the carotid arteries and their branches. The protocol for a carotid ultrasound examination is outlined, including patient positioning, transducer selection, scanning sequences, and evaluation of stenosis. Key anatomical structures are defined, such as the intima-media complex. Non-atherosclerotic diseases that can involve the carotid or vertebral arteries, such as fibromuscular dysplasia, dissection, vasospasm, and aneurysms are also reviewed. The limitations of carotid ultrasound are noted.
This document discusses the anatomy, embryology, and imaging of the superior vena cava (SVC). It begins with an introduction to the SVC's role as the largest central vein in the mediastinum. Imaging plays an important role in identifying congenital variants and pathologies. The document then covers the embryological development of the SVC, its normal anatomy and tributaries, and techniques for imaging it with various modalities like CT, MR, and venography. It discusses congenital variants like persistent left SVC and aneurysms. It also reviews acquired conditions like strictures, thrombus, and various tumors that can affect the SVC.
The document provides information on performing carotid artery scanning, including vessel identification, recommended scanning protocols, waveform analysis, sample volume placement, and Doppler measurements. The key objectives are to identify the carotid and vertebral arteries, understand normal and abnormal waveforms, demonstrate proper techniques for sample volume placement, angle correction, and Doppler measurements like peak systolic velocity and end diastolic velocity. The document aims to educate ultrasound technicians on performing high quality carotid artery scans to evaluate for disease.
Cerebral aneurysms arise from focal degeneration of arterial walls. The most common type is saccular aneurysms, which protrude from arterial bifurcations and lack an internal elastic lamina. Aneurysms can present with subarachnoid hemorrhage, cranial nerve palsy, headache or seizures. Imaging plays a key role in diagnosing aneurysms and evaluating risks. Computed tomography best identifies acute subarachnoid hemorrhage but may miss small bleeds. Catheter angiography remains the gold standard for precise aneurysm characterization to guide treatment.
cerebral aneurysm mohammad abu sad (1).pptxMohamadAbusaad
This document discusses cerebral aneurysms, including their anatomy, types, causes, presentation, diagnosis, and management. It describes the three main types of aneurysms - saccular, fusiform, and dissecting. Risk factors for rupture include size, shape, location, and multiple aneurysms. Diagnosis is typically made using CT, CTA, MRI/MRA, or DSA imaging. Management involves stabilizing patients and then treating aneurysms either surgically via clipping or endovascularly via coiling to prevent rebleeding. Endovascular coiling is now the preferred initial approach for many aneurysms.
This document provides information on carotid-cavernous fistulas (CCFs). It discusses the anatomy of the cavernous sinus and pathophysiology of CCFs. It notes that CCFs represent 12% of dural arteriovenous fistulas. The majority are caused by trauma, especially in young males, while spontaneous CCFs occur more in older females. Clinical presentation depends on flow rate, with high flow direct CCFs causing eye symptoms and low flow indirect CCFs having insidious onset. Treatment options include conservative management, endovascular embolization, and radiosurgery, with the approach depending on fistula type and symptoms.
This document provides an overview of venography, which is an imaging technique used to examine veins. It discusses the basic principles of venography, including ascending and descending techniques. It describes the anatomy of veins and provides diagrams. It also covers indications, contraindications, techniques, and potential complications of lower limb, upper limb, and peripheral varicography venography procedures. The goal of venography is to accurately diagnose conditions like deep vein thrombosis.
Cardiovascular CT is a valuable tool for evaluating congenital heart disease in children. It provides high spatial and temporal resolution to depict complex anatomy. Key applications include assessing pulmonary blood flow in pulmonary atresia, vascular rings prior to surgery, coronary artery anomalies, and postoperative complications. Careful patient preparation and protocols are needed given pediatric concerns. CT enables simultaneous evaluation of vascular structures, airways, and cardiac function to comprehensively evaluate complex congenital heart disease.
This document provides an overview of angiography and the course of blood vessels supplying the brain. It describes the aortic arch and its branches, as well as the internal carotid artery in detail. The internal carotid artery is discussed in segments from the cervical segment through the cavernous segment. Common variants and anomalies are described for various segments including the persistent trigeminal artery originating from the cavernous segment of the internal carotid artery.
Arteriography and interventional radiologyMilan Silwal
Angiography involves the radiologic examination of blood vessels after injection of iodinated contrast medium. Arteriography specifically examines arteries, while venography examines veins. Techniques include non-invasive ultrasound and MRI, minimally invasive CT or MRI with contrast, and invasive catheterization. Catheters and guide wires are used to access vessels and inject contrast medium. Potential complications include contrast reactions, embolism, infection, and vessel damage. Indications for arteriography include evaluating congenital anomalies, aneurysms, stenoses, arteritis, trauma, embolism, vascular malformations, fistulas, hemorrhage, and masses.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...rightmanforbloodline
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kol...rightmanforbloodline
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Versio
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
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Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
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4. CIRCLE OF WILLIS
• Grand Vascular Station of the Brain
• Classical –18% to 20%
• Majority circles shows anomaly-52%
• Most frequent anomaly is hypoplasia of ACA-24%
• Accesory vessels in the form of duplication/triplicationsof
ACOM (2 M.C.) -12%
Fetal posterior cerebral artery-10%
9. MIDDLE CEREBRALARTERY
• Larger terminal branch of ICA
• Run laterally in stem of lateral sulcus
• Curves on superolateral surface
• Runs backwards in depth of posterior ramus of lateral
sulcus
10. • M1 segment =horizontal segment from origin to its
bifurcation (it is in sylvian fissure)
• M2 segment =lacunar segment -in the insula loops over
insula—laterally to exit from sylvian fissure
• M3 segment = opercular branch-from sylvian fissure &
ramify over cerebral cortex
• Anomalies of MCA are uncommon
13. • 2 major terminal br of PCA—
•
• parieto occipital art & calcarine art
14. POSTERIOR FOSSA
• Vertebral artery
• Basilar artrery
• Vertebral arteries
• Originate from the subclavian arteries
• Left VA is dominant in 60% cases
16. BASILAR ARTERY
• Right and left VA unite to form basilar artery
• Courses infront of pons (Prepontine cistern)
terminates in the interpeduncular cistern
• 3cm in length,1.5 to 4mm in width
18. Normal VARIANTS
• Fenestrations and duplications
• Variants of the circle of Willis
• Persistent carotid-basilar anastomoses
• Anomalies identified in the skull base
23. Imaging Techniques
• Vascular structures of brain can be imaged by 4
means:
• 1. DSA: gold standard
• Invasive and risk of nephrotoxic contrast,ionising
radiation
• 2. Vascular ultrasound: least invasive, can be
done bedside, cost effective.
• Best choice for imaging vessels close to skin
surface.
24. • Drawback: limited anatomic coverage, deep
vessels cant be imaged, operator dependent,
requires skill.
25. • 3 CT angio: main drawbacks are contrast use and
radiation exposure,
• calcifications are overestimated.
• Preferred for aorta and coronaries
• 4 MRA : non invasive, no radiation exposure.
• Preferred for carotids and intracranial vessels as MRI
brain can also be obtained
• widely used in neurological disorders
26. • ANGIO?
• ‘ANGIO means blood vessel’
• SUBTRACTION?
• 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”
27. DSA
• Acquisition of digital fluoroscopic images
combined with injection of contrast material
and real time subtraction of pre- and post
contrast images to perform angiography is
referred to as digital subtraction angiography
28. HISTORY
Portuguese neurologist
Prize winner 1949), in
Egas Moniz,( Nobel
1927 developed the
technique of contrast x-ray cerebral angiography
to diagnose diseases,
such as tumors and arteriovenous
malformations.
29. • Idea of subtraction images was first proposed
by the Dutch radiologist Ziedses des Plantes in
the 1935, when he was able to produce
subtracted images using plain films.
30. HISTORICAL DEVELOPMENT
• CONVENTIONAL SUBTRACTION TECHNIQUE:
• Photographic method used to eliminate
unwanted images.
• No addition of information; only purpose to
make diagnostically important information
31. • Developed in 1970s, University of Wisconsin,
University of Arizona, University of Kiel.
• USA
• Commercial systems introduced in 1980.
32. • 3 conditions:
• SCOUT FILM
• ANGIOGRAM FILM-CONTRAST
• NO MOTION OF HEAD
33. PRINCIPAL
• Principles of subtraction
following:
are based on the
• Scout film shows the structural details of the
skull and the adjacent soft tissue.
• Angiogram film shows exactly the same
anatomic details, if the patient does not move,
plus the opacified blood vessels.
34. • If all the information in the scout film could be
subtracted from the angiogram film, only the
opacified vessel pattern would remain visible.
37. WHY DSA?
• Digital subtraction angiography (DSA) was developed
to improve vessel contrast.
• Technique that uses a computer to subtract two
images, obtained before and after contrast media is
injected into the vessels of interest.
• Anatomical structures that are the same in the two
images can be removed and the resulting image
shows the vessels only
38. • Modern DSA systems are based on digital
fluoroscopy/fluorography systems, which are
equipped with special software and display
facilities
39. • Image before the contrast agent is
administered is called the mask image.
•
• Once the contrast is administered, a sequence
of images are taken by a television camera in
analog form, which is then digitised by
computer
40. • DSA processor 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
goes to an image processing and display unit.
44. Contra indications
• No absolute contraindication.
• Poor renal reserve.
• Deranged coagulogram.
• Allergic to contrast media
45. Contrast Media
• Blood vessels are not normally seen in an x-ray
image, because of low tissue contrast.
• To increase image contrast, contrast agents,
which are dense fluids with elements of high
atomic numbers, such as iodine, are injected into
a blood vessel during angiography. Because of its
higher density and high atomic number, iodine
absorbs photons more than blood and tissue.
46. Creates detailed images of the blood vessels in
real time.
• First contrast media used for intravascular
injection were called high-osmolar contrast
media (HOCM).
47. • High osmolarity caused adverse effects such as
pain, endothelial damage, thrombosis, and
increased pressure in the pulmonary circulation.
• Low-osmolar contrast media (LOCM) were first
developed in the 1970's reduce side effects.
• Major risks of modern iodine contrast media is an
allergic reaction to iodine
48. • Non ionic Iso-osmolar contrast media.
• 30-40% dilution with normal saline.
• 50 ml of diluted contrast media is enough to do
a standard cerebral angiogram with total 8
projections.
• Approx. 5-8 ml diluted contrast / injection.
53. PREPARATION
• Nil orally 4-6 hrs.
• On trolley
• In hospital gown
• Groin shave
• Records
• Should be well
hydrated.
• Should void before
procedure.
• Peripheral pulses
marked.
• I.V line in place.
• Informed consent
54. PROCEDURE
• Gaining arterial access.
• Selective arterial catheterization.
• Image acquisition.
• Closure of arterial access.
• Post processing
• Hard copy
55. • Patients may be sedated to reduce anxiety.
• Monitor of vitals
• Local anesthetic is usually used in the area
where the catheter is to be inserted,
• Most common femoral artery
56. PROCEDURE
• Small incision given, medicut is inserted into the artery,
• Fluoroscopy is used to guide the needle to the proper
position .
• Needle is then removed after placing guide wire in the
artery and vascular sheath is inserted over the guide wire
.
• Catheter is then inserted along the guide wire through the
sheath
57. • When the catheter is in the correct position, the wire is
pulled out and dye is injected through the catheter.
• Images are acquired during contrast injection.
• Injections can be made directly into the artery of interest
(selective arteriography)
59. POSTPROCEDURAL CARE
• After the catheter is removed compression is applied to
the puncture site
• Bed rest for a minimum of 4 hours
• During rest patient is monitored and vital sign like
peripheral pulse like distal to Puncture are regularly
• Extremity is also checked for warmth, color, numbness to
ensure circulation has not been disrupted.
71. Digital subtraction angiography based
advances
• Better visualization and less radiation exposure
are key tenets in the development of digital
subtraction angiography
• Complexity of disease types increases and
more technically challenging, cutting-edge
procedures are performed
72. • Digital subtraction angiography systems with flat
panel : ADVANTAGES-
• High spatial resolution, wide dynamic range,
square field of view, and real-time imaging
capabilities with no geometric distortion—all of
which may be used for improve image quality,
reduced patient exposure to radiation
73. • Hatakeyama et al have shown that two-dimensional (2D)
and three-dimensional (3D)digital subtraction angiography
using the flat panel detector system of the direct
conversion type, with low radiation dose, is superior in
image quality for visualizing small intracranial vessels with
significantly decreased radiation exposure compared with
digital subtraction angiography with the conventional
image intensifier television system
• Hatakeyama Y
,Kakeda S, Korogi Y
,et al. Intracranial 2D and 3DDSA with flat panel detector of the
direct conversion type: initial experience. Eur Radiol 2006;16:2594 –2602.
76. • Allura Xper FD20/10 biplane flat detector
system with integrated 3D for intricate
neurovascular procedures.
• 3D- reconstructions
• Xper CT
• SPECTRA BEAM
• 3D Roadmapping
• multi-modality information integration
77.
78. • Redefines image clarity and captures
information at a resolution four times greater
than conventional X-ray systems.
79. Xper CT
• With XperCT clinicians can access CT-like imaging right
on the angio system so can assess soft tissue, bone
structure and other body structures before, during or after
an interventional procedure.
• XperCT reconstruction is created from rotational
acquisition performed on the Allura Xper system.
• This reconstruction can be overlaid with the 3D vascular
image.
80. • 3D soft tissue imaging supports diagnosis
planning, interventions and treatment follow-up
• XperCT can be combined with Allura 3D-RA
images to visualize soft tissue and vascular
anatomy on one image.
81. Spectra Beam
• Basically a selectable copper beam filtration
• Combination of Spectra Beam with the MRC-
tube allows increased X-ray output with better
filtration of soft radiation.
• Reduces patient X-ray dose for cardiac and
vascular applications, while maintaining the same
image quality.
82. Disadvantage of DSA
• Limited spatial resolution
• Artifacts
• Small visual field
• Not a good technique for neoplasm
83. Conclusion
• Despite recent advances in CT angiography and
MR angiography, DSA remains the standard
imaging technique for evaluation of the
cerebral vasculature .
• 3D reconstruction
during rotational
of the dataset acquired
DSA represents the latest
development in the neurovascular imaging .
84. has taken a prominent role in
• 3D-DSA
treatment planning by enabling better
appreciation of the morphology of complex
vascular lesions before endovascular or surgical
management.
• Superior in the performance of sophisticated
tasks such as aneurysm volume measurement
85. • On the other hand, inability of 3D-DSA to
simultaneously image osseous and vascular
structures is noted as a weakness of this
technique compared with CT angiography .