Presentation given at Arab Health congress on Jan. 29th 2013, with information about (dual source) Cardiac CT of the coronary arteries with technical & practical information and some clinical use cases
A detailed description of ct coronary angiography and calcium scoring with various aspects regarding the preparation, procedure, limitations and a short review regarding post CABG imaging.
A detailed description of ct coronary angiography and calcium scoring with various aspects regarding the preparation, procedure, limitations and a short review regarding post CABG imaging.
GE Healthcare Revolution ACT EX Clinical Image GalleryGaurav Shah
Designed with your needs in mind, Revolution ACTs helps you improve standards of patient care by providing new levels of image quality. Intelligent technology designed to help you acquire high-quality images using lower doses of radiation, contributing to more accurate diagnoses and lower exposures for patients.
GE Healthcare Revolution ACT EX Clinical Image GalleryGaurav Shah
Designed with your needs in mind, Revolution ACTs helps you improve standards of patient care by providing new levels of image quality. Intelligent technology designed to help you acquire high-quality images using lower doses of radiation, contributing to more accurate diagnoses and lower exposures for patients.
Guideline 11B: RECOMMENDED STANDARDS FOR INTRAOPERATIVE MONITORING OF SOMATOS...Anurag Tewari MD
Somatosensory evoked potentials (SSEPs) can be used intraoperatively to assess the function of the somatosensory pathways during surgical procedures in which the spinal cord, brainstem, or cerebrum is at risk and to localize the sensorimotor cortex
Geometric distortion of functional MR images especially of DWI hinders the visualization of the frontal & temporal regions. This is a simple & reliable approach to get rid of. This needs no special software or hardware & applies to old systems.
Please have a look at the features and Images from our latest installation of MDT centauri 3000 OPEN MRI systems at Chirayu Hospital, Ratnagiri, India.
Magnetic resonance imaging (MRI) is a medical imaging technique that uses a magnetic field and computer-generated radio waves to create detailed images of the organs and tissues in your body.
Most MRI machines are large, tube-shaped magnets. When you lie inside an MRI machine, the magnetic field temporarily realigns water molecules in your body. Radio waves cause these aligned atoms to produce faint signals, which are used to create cross-sectional MRI images — like slices in a loaf of bread.
The MRI machine can also produce 3D images that can be viewed from different angles.
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Why it's done
MRI is a noninvasive way for your doctor to examine your organs, tissues and skeletal system. It produces high-resolution images of the inside of the body that help diagnose a variety of problems.
MRI of the brain and spinal cord
MRI is the most frequently used imaging test of the brain and spinal cord. It's often performed to help diagnose:
Aneurysms of cerebral vessels
Disorders of the eye and inner ear
Multiple sclerosis
Spinal cord disorders
Stroke
Tumors
Brain injury from trauma
A special type of MRI is the functional MRI of the brain (fMRI). It produces images of blood flow to certain areas of the brain. It can be used to examine the brain's anatomy and determine which parts of the brain are handling critical functions.
This helps identify important language and movement control areas in the brains of people being considered for brain surgery. Functional MRI can also be used to assess damage from a head injury or from disorders such as Alzheimer's disease.
MRI of the heart and blood vessels
MRI that focuses on the heart or blood vessels can assess:
Size and function of the heart's chambers
Thickness and movement of the walls of the heart
Extent of damage caused by heart attacks or heart disease
Structural problems in the aorta, such as aneurysms or dissections
Inflammation or blockages in the blood vessels
Should radiologists use messaging services like WhatsApp for professional purposes? Is this compliant with GDPR and HIPAA? What solutions are available?
Is the increasing availability of automated image analysis a possibility to strengthen the application of diffusion-MRI as a biometric parameter, and to enhance the future of image biobanks? Or is this evolution threatening the position of radiologists as medical doctors. Is a redefinition of radiologist as computer technicians inevitable?
Presentation that gives an overview of the impact of IT on radiology, including the growing role of biomarkers and artificial intelligence and deep learning on the (future) radiology profession. The shift to precision medicine and personalized care are explained, the reasons for a re-definition of radiology are addressed.
Presentation of the EUSOMII/ESOI annual meeting in Valencia, Oct. 2016, about the impact of new communication tools on the communication between radiologists, clinicians and patients
In this thesis the impact of digitisation on radiology is analysed based upon diverse initiatives and research projects that were conducted in the period between the early days and now. Various topics such as web-based sharing of radiological images, teleradiology, digital communication and advanced processing of medical data, are discussed. Based on these findings the author formulates his vision and advises about the future role of the radiologist.
In the dissertation The impact of information technology on radiology services the author describes the most important changes that took place in the field of information technology since the end of past century, and their impact on radiology.
A real revolution has been provoked in radiology by the complete digitisation of medical imaging and the deep integration of Internet in both society and healthcare. Digital archiving, processing and distribution of radiological images, as well as the development of various types of teleradiology, are an important part of this change.
Radiology is facing many new challenges and opportunities due to the on-going exchangeability, integration and automated analysis of medical data and images. Other major trends such as the increasing personalisation of medicine and growing engagement of patients in their healthcare process are also significantly influencing this turnaround in radiology.
How do radiologists use social media? This lecture gives a better insight about both the advantages and downsides of using social media as a medical professional.
Presentation given at the European Congress of Radiology, ECR 2015 in Vienna, March 4th. About usage of mobile devices in radiology, current changes in radiology due to increasing use of mobile devices and growing wireless connectivity. About mobile radiology, m-Health & social media in radiology and medicine
Presentation of EuSoMII congress highlighting the similarities and controversies regarding the usage of teleradiology, in the context of the political, economical and legal evolutions in Europe and the USA. Presentation is based upon new JACR paper, accepted for publication in Sept. 2014 - EuSoMII, Warsaw, Sept 2014 - http://www.eusomii.org
Presentatie gehouden tijdens de Openingssessie van de Radiologendagen 2012 in Den Bosch, waarbij de digitale veranderingen worden toegelicht en de impact daarvan op het specialisme radiologie. Aan de hand van diverse voorbeelden wordt toegelicht waarom radiologie toe is aan een herdefinitie. Zie ook corresponderende artikel voor meer uitleg.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- 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
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
State-of-the-art Cardiac CT of the coronary arteries
1. Cardiac CT
E. R. Ranschaert
Radiologist
Arab Health Congress, Jan 28-31, 2013
2. Introduction
Technical aspects
Scanning procedure
Indications for c-CTA
Clinical cases
64 slice
dual source CT
Copyright E. R. Ranschaert
3. Coronary CTA
Main purpose: morphology
Detection and analysis of
coronary artery disease
Depict anatomy of coronary
vasculature
Possible to obtain functional
information in same scan
contractility of myocardium
valve morphology and function
“viability” of myocardium
(perfusion-CT)
Copyright E. R. Ranschaert
5. Multislice CT - MDCT
Evolution of Cardiac CT is
strongly linked to technical
improvements in CT-
scanners
Preferably 64-slice scanner
or more
Our current machine:
dual source CT 2x64 slice
(Somatom Definition Flash)
Other vendors: 256-slice or
higher
Copyright E. R. Ranschaert
6. Volume coverage – helical scan
Time to cover heart decreases with larger detector arrays,
shorter tube rotation times and faster table movement
4 x 1 mm slice 16 x 1mm slices 64 x 0.5 mm slices
4 mm 16 mm 32 mm
~48 sec ~12 sec ~6 sec
Copyright E. R. Ranschaert 0.5 s rotation, 0.33 pitch
Courtesy of Sue Edyvean, ImPACT – www.impactscan.org
7. “Old” generation scanners
16-slice 64-slice
Images used with permission of James Carr, MD
Copyright E. R. Ranschaert
8. Newer generation scanners
Complete coverage High pitch
Toshiba Acquilion Siemens Definition Flash
Seq 256-slice, spiral 64-slice 2x 64 slice
single rotation fast pitch, no gaps
Copyright E. R. Ranschaert Courtesy of Sue Edyvean, ImPACT – www.impactscan.org
9. Multi-sector scanning
Min. 2 sectors needed per image
Graphics used with permission of Sue Edyvean, ImPACT – www.impactscan.org
Copyright E. R. Ranschaert
10. Multi-sector scanning
GE Philips Siemens Siemens Toshiba
1 tube 2 tubes
# sectors 1,2,4 up to 5 1 or 2 1 or 2 up to 5
Graphics used with permission of Sue Edyvean, ImPACT – www.impactscan.org
Copyright E. R. Ranschaert
11. Dual source CT
(0,285 s rotation for entire heart)
Graphics used with permission of Sue Edyvean, ImPACT – www.impactscan.org Copyright E. R. Ranschaert
14. Patient Preparation
General CT-preparation:
Renal function, hydration, stop Metformin if
GFR<60, premedication for iodine allergy
Specific cardiac-CT preparation:
Information sheet specifically for cardiac CT
Beta-blockers: P.O. (in advance)
Other premedication if needed
Copyright E. R. Ranschaert
15. Day of scanning
3-4 h in advance: no meal, no coffee, no tea
2h in advance 25-100 mg metoprolol
P.O. (selective β1 receptor blocker)
Fine tuning HR with IV injection, 5-20 mg extra
Selection of scan protocol depending on bpm
variability
For Flash: ≤65 bpm and regular HR needed
Copyright E. R. Ranschaert
16. ECG monitoring on scan
ECG monitoring is used to “freeze” cardiac motion
Images made during phase of least cardiac motion
Phase is given as % of R-R interval
Courtesy of Sue Edyvean, ImPACT – www.impactscan.org
Copyright E. R. Ranschaert
17. Scanning
Breath hold on ¾ of full inspiration (prevents
Valsalva manoeuvre)
Breathing instructions are practiced with
patient before scanning
Nitroglycerine spray immediately before
scanning 1 puff
Contrast (high iodine concentration) is injected
at 5-6 ml/sec
Copyright E. R. Ranschaert
18. Stable HR needed
Motion needs to be repeatable – regular heart rate
reduce potential for mis-registration
applies for both axial and helical
iiiii
iiiii
iiiii
ECG
Copyright E. R. Ranschaert
20. Calcium scoring
First calcium score is
determined
low dose non-enhanced
triggered scan
Semi-automated
calculation of score
Decision to make c-CTA
based upon score and
age
Score 0 >60j: no cCTA
>600: no cCTA
Copyright E. R. Ranschaert
21. Selection CTA scan protocol
3 acquisition modes with ECG synchronisation
1. Retrospective gating
2. Prospective triggering = sequential/axial =
“adaptive sequence” (Siemens)
3. FLASH = prospective triggering spiral scan with
very high pitch
Copyright E. R. Ranschaert
22. 1. Retrospective gating
Spiral scan technique
Small overlapping pitch ≅ 0,2
Heart scanned in all phases
Breath hold = 7-12 sec
Retrospective selection of
best phase for
reconstruction/reviewing
Functional information
10-12 mSv
Courtesy of Sue Edyvean, ImPACT – www.impactscan.org
Copyright E. R. Ranschaert
23. Cardiac CT – ECG phases
Optimal phase for reconstruction for CTA
diastole @ ~ 70 %
Optimal reconstruction phase
R R
70% R-R
Eg. 50 60 70 80
Courtesy of Sue Edyvean, ImPACT –R. Ranschaert
Copyright E. www.impactscan.org
24. 2. Prospective triggering
ACS: Adaptive Cardio Sequence
Sequential technique
ECG-signal is used to trigger scanning
(R-wave)
“Padding” opens scan pulse
(30-80% RR)
With “padding” more phases are
available for review (steps of 1 – 20%)
Dose reduction up to 87% compared
with retrospective scanning (2,5 - 3 mSv)
Usable in patients with slightly irregular
heart beat
Courtesy of Siemens: Thomas Flohr, Cardiac CT Acquisition modes
Copyright E. R. Ranschaert
25. Triggering
R wave recognised - scan triggered
Radiation on
(and attenuation
data acquired)
Courtesy of Sue Edyvean, ImPACT – www.impactscan.org
Copyright E. R. Ranschaert
26. Management of extrasystoles
Selection Low / Medium / High protocol depends on
HR (60-85 bpm)
ACS makes analysis of ECG, ectopic heart beats are
detected
Start of scan is prospectively based upon last 3 cycles
Scan is omitted & delayed when extrasystole is
detected before scan
Scan is repeated when extrasystole occurs during or
shortly after scan
Flex padding uses extended acquisition window: gives
more flexibility to find optimal reconstruction phase
Copyright E. R. Ranschaert
27. Copyright E. R. Ranschaert
Padding
„padding‟ for
CTA
Radiation on
(and attenuation
data acquired)
480° rotation
28. Copyright E. R. Ranschaert
Padding
„padding‟ for
CTA
Radiation on
(and attenuation
data acquired) 70
Required data
for image
recon.
29. Copyright E. R. Ranschaert
Padding
Axial scanning with „padding‟
More flexibility with reconstructed phase position
„padding‟ for
CTA
Radiation on
(and attenuation
data acquired). 60
Required data
for image
recon.
30. Copyright E. R. Ranschaert
Padding
Axial scanning with „padding‟
More flexibility with reconstructed phase position
„padding‟ for
CTA
Radiation on
(and attenuation
data acquired).
Required data
for image
recon.
31. 3. Flash – single beat, high pitch
• 2 Sectors of data acquired simultaneously in ¼ rotation = 75 ms
• Whole heart in 3¼ rotations = 0,28 sec
• No misregistration, no stair-step artefacts: 1 shot!
Copyright E. R. Ranschaert Courtesy Siemens
32. Which protocol to use?
RETROSPECTIVE:
Only with patients that are not suited for prospective
scanning due to arythmia, high HR or both
If functional imaging is needed (LVA)
PROSPECTIVE:
Stable and low HR
Slight arythmia
With ACS: 65-85 bpm
Low – medium – high protocol
Also LVA possible with adaptive sequence (padding)
Use Flash whenever possible!
SCCT guidelines on radiation dose and dose-optimization strategies in cardiovascular CT,
Halliburton SS et al., J Cardiovasc Computed Tomogr (2011)5, 198-224
Copyright E. R. Ranschaert
34. Indications for c-CTA
Calcium scoring
Risk stratification
Decisive before CTA examination
Coronary CTA
Anatomy of coronary vessels (CAG difficult)
CAD (low to intermediate risk)
Stent viability
Anatomy and patency of grafts after CABG
Functional analysis
Copyright E. R. Ranschaert
35. Calcium scoring
“Gatekeeper” for further cardiac
examination if pre-test probability is low and
EST is not possible
Added value in risk stratification (re-
stratification of medium risk)
With men and female >60y
score = 0 is very reassuring (high NPV)
Copyright E. R. Ranschaert
36. Assessment of stenoses
Visual assessment
Significant
(obstructing) is > 50%
Non-significant or non-
obstructive < 50%
Resolution vs. CAG:
20% margin is taken Non-obstructing stenosis
Significant stenosis
into account
Copyright E. R. Ranschaert
37. Limitations of cCTA
Irregular HR
obesity
stents < 3 mm
Calcium and stents:
“blooming” artefacts lower
specificity of cCTA
Copyright E. R. Ranschaert
38. Copyright E. R. Ranschaert
Blooming Artefact
Blooming artefact – calcium/stent obscures vessel
Improvement with better spatial resolution
Improved spatial
resolution
and display
(recon alg., fov)
49
Courtesy of Sue Edyvean, ImPACT – www.impactscan.org
39. Copyright E. R. Ranschaert
Diagnostic accuracy of cCTA
CAG is gold standard
cCTA
Ideally patients with
stable HR +
stable AP complaints Sens 96-99%
or atypical chest pain
Very useful to exclude
Spec 88-91%
significant CAD: high
NPV NPV >90%
Low to intermediate risk patiënts
40. Anatomy
Left main stem
RCA
AM
PDA Cx
Diag branch
LAD
Copyright E. R. Ranschaert
48. Case 3
M, 33y
SEH left thoracic pain
irradiation to left arm
CAG: no significant
stenoses demonstrated,
“catheter spasm”
In history probably limited
myocardial infarction
cCTA performed 3m later
Copyright E. R. Ranschaert
49. yright E. R. Ranschaert
Non-stenosing non-calcified plaque in prox. circumflex artery
50. Case 4
M, 43j
Chest pain, arm pain while
painting during 30 min
Normal EST,
ECG normal
cCTA
Copyright E. R. Ranschaert
51. Case 4
Chronically
occluded RCA
ectatic coronary
system
Copyright E. R. Ranschaert
52. RCA
Reinjection via left system
Copyright E. R. Ranschaert
54. Case 5
Woman, 1967
Atypical precordial
pain PA
Ao
Cycling test negative
Low risk
PA
RCA
Ao
Copyright E. R. Ranschaert
55. Anomalous RCA
Anomalous RCA arising
from left sinus of valsalva
AA PA Most common pathway for
ectopic RCA
RCA
Associated with sudden
cardiac death in 30% of pts
Dilatation of Ao during
RCA
PA excercise comprises RCA,
may lead to AMI
inter-arterial course of RCA
Ao
Copyright E. R. Ranschaert
57. Anatomic variant
Left CA main branch: origin
posterior on AA
from non-coronary sinus of
Valsalva
Retro-aortic course
Usually no clinical
relevance
LA
D
Cx
Copyright E. R. Ranschaert
69. Findings case 4
LIMA – LAD anastomosis Distal LAD
Stenosis
Copyright E. R. Ranschaert
70. Case 5
History Calcium scoring
Female, 1963
Referred by GP for atypical
chest pain, dyspnea with
effort
Bicycle ergometry: not
conclusive
ECG mild abnormalities
Copyright E. R. Ranschaert
71. Case 6
cCTA Flash mode
MIP
Copyright E. R. Ranschaert
73. Case 6 – stent evaluation
Pre-stenting Post-stenting
Copyright E. R. Ranschaert
74. Case 6: stent evaluation
Stent LAD Diagonal branch
Copyright E. R. Ranschaert
75. Case 7
Female, 51 y
Dyspnoea with effort,
fatigue, no chest pain
FA: father sudden death at
55y, probably AMI
ECG normal
Copyright E. R. Ranschaert
76. Case 7
RCA
Non-calcified stenosis 70%
Copyright E. R. Ranschaert
77. The End
Thank you!
http://nl.linkedin.com/in/eranschaert/
e.ranschaert@jbz.nl