Angiography is a general term that describes the radiologic examination of vascular structures within the body after the introduction of an iodinated contrast media or gas.

1. THORACIC
Angiographic
Procedures

2. Basic understanding:
Circulatory System
● The circulatory system has two complex systems of
intimately associated vessels.
1. blood-vascular system (artery, vena)
2. lymphatic system
Together, the blood-vascular and lymphatic systems
carry oxygen and nutritive material to the tissues. They
also collect and transport carbon dioxide (CO2) and
other waste products of metabolism from the tissues to
the organs of excretion:
the skin, lungs, liver, and kidneys.

3. Angiography is a general term
that describes the radiologic examination
of vascular structures within the body
after the introduction of an iodinated contrast
media or gas.
Definisi Angiography

4. Indications
• A stenosis or occlusion is commonly caused by
atherosclerosis and is an indication for an
arteriogram.
• Cerebral angiography is performed to detect
and verify the existence and exact position of an
intracranial vascular lesion such as an
aneurysm.
• Other vascular examinations evaluate
suspected tumors by opacifying the organ of
concern; after a diagnosis is made, these lesions
may be amendable to some type of intervention.
• Interventional radiology assists in the diagnosis
of lesions and then is used to treat these lesions
through an endovascular approach
Indications and contraindications
Contraindications
• Allergic reaction severely impaired
renal function, impaired blood clotting
factors, and inability to undergo a
surgical procedure or general
anesthesia.
• Because the risks of general anesthesia
are greater than the risks associated
with most angiographic procedures,
conscious sedation may be used for the
procedure

5. Contrast media, risks and medication
Contrast
media
Risks
(iodine based)
Medication
• Iodine based
• CO2
• Nausea
• uncomfortable
burning sensation
• invoke allergic
reactions
• shock
• lose consciousness
• Antihistamines
and steroids to
help prevent
anaphylactic
reactions to
contrast media
• Anti allergic

6. Angiographic equipment
● Neddlees
● Guidewir
e
● Sheats

7. Seldinger technique

8. • Explanation potential complications include a vasovagal reaction; stroke; heart
attack; death; infection; bleeding at the puncture site; nerve, blood vessel, or tissue
damage; and an allergic reaction to the contrast media
• Informed consent
• Patients are usually restricted to clear liquid intake and routine medications before
undergoing angiography
• Solid food intake is restricted to reduce the risk of aspiration related to nausea
• Thoughtful communication from the CIT (Cardiovascular and Interventional
Technologist) and physician calms and reassures the patient.
• The CIT or physician should warn the patient about the sensations caused by the
contrast media and the noise produced by the imaging equipment. This information
also reduces the patient’s anxiety and helps ensure a good radiographic series with no
patient motion.
Patient preparation

9. Preparation examining rooom
● Cleanliness and advance preparation are of vital importance in procedures
that must be carried out under aseptic conditions
● Preparation of the room includes having life-support and emergency
equipment immediately available
● The CIT should observe the following guidelines in preparing the room:
- Check the angiographic equipment and all working parts of the equipment,
and adjust the controls for the exposure technique to be employed.
- Have restraining bands available for application in combative patients.
- Adapt immobilization of the head (by suitable strapping) to the type of
equipment employed
- Ensure patient information is entered correctly on acquisition equipment.

10. Radiation protection
• The patient is protected by filtration totaling not less than 2.5 mm of aluminum
• By sharp restriction of the beam of radiation to the area being examined, and
• By avoidance of repeat exposures.
• Leaded glass

11. • Physician (usually an
interventional radiologist),
• CIT (assists in performing
procedures that require sterile
technique, operating
monitoring devices, emergency
equipment, and radiographic
equipment, instruction in
patient care techniques and
sterile procedure)
• Other specialists, such as an
anesthetist or a nurse
Angiography team

12. Angiography
Thoracic
Venography/
phlebography
Aortography
Pulmonary
Cardiography
Arteriography
Abdomen

13. Thoracic Aortography
Thoracic aortography refers to a minimally invasive x-ray
examination of the body's main artery, the aorta. It is used
to diagnose diseases of the aorta, such as an aortic aneurysm.
For the examination, a catheter is used to administer an x-ray
contrast agent into the aorta. Aortography is an angiographic
method of examination.

14. • Aortography is usually
performed with the patient
in the supine position for
simultaneous frontal and
lateral imaging, with the
central ray perpendicular to
the imaging system
• For introduction of a
translumbar aortic catheter,
the patient must be in the
prone position.
Patient positions

15. • Thoracic aortography may be performed to rule out an
aortic aneurysm or to evaluate congenital or postsurgical
conditions.
• The examination is also used in patients with aortic
dissection. Biplane imaging is recommended so that
anteroposterior (AP) or posteroanterior (PA) and lateral
projections can be obtained with one injection of contrast
media.
Thoracic Aortography

16. • For lateral projections, move the patient’s arms superiorly so that they do
not appear in the image.
• For best results, increase lateral SID, usually to 60 inches (152 cm), so that
magnification is reduced.
• If biplane equipment is unavailable, use a single-plane, 45-degree right posterior oblique
(RPO) or left anterior oblique (LAO) body position, which often produces an adequate
study of the aorta.
• For all projections, direct the perpendicular central ray to the center of the chest at the
level of T7. The entire thoracic aorta should be visualized, including the proximal
brachiocephalic, carotid, and subclavian vessels. The contrast media are injected at rates
ranging from 23 to 35 mL/sec for a total volume of 50 to 70 mL.
• Make the exposure at the end of suspended inspiration
The CIT observes the following guidelines:

17. Long, B. W., Rollins, J. H., & Smith, B. J. (2016). Merrill’s Atlas Of
Radiographic Positioning & Procedures Vol. 3
Refference