Radiographic examination of blood vessels after injection of contrast medium to visualized abdominal blood vessel and its branches

1. TR Angiografi
Abdominalis,
Hepatica & Renalis
by: Agustina Dwi Prastanti

2. Kompetensi Dasar
Mahasiswa mampu memahami
dan melakukan tatalaksana
pemeriksaan radiografi sistem
vascular abdominalis, hepatica &
renalis

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5. ABDOMINAL AORTOGRAPHY
▫ Abdominal aortography may be
performed to evaluate abdominal
aortic aneurysm (AAA),
occlusion, or atherosclerotic
disease.
▫ Simultaneous AP and lateral
projections are recommended.
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6. ABDOMINAL AORTOGRAPHY
The CIT observes the following
guidelines:
• For the lateral projection, move the
patient’s arms superiorly so that they are
out of the image field.
• Usually, collimate the field in the AP
aspect of the lateral projection.
• Direct the perpendicular central ray at
the level of L2 so that the aorta is
visualized from the diaphragm to the
aortic bifurcation.
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7. ABDOMINAL AORTOGRAPHY
The AP projection shows:
▫ Best the renal artery origins, the aortic
bifurcation, and the course and general
condition of all abdominal visceral
branches.
The lateral projection best shows:
▫ The origins of the celiac and superior
mesenteric arteries because these vessels
arise from the anterior abdominal aorta.
▫ Make the exposure at the end of suspended
expiration (Figs. 23-19 and 23-20)
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9. VISCERAL ARTERIOGRAPHY
▫ Abdominal visceral arteriographic
studies (Fig. 23-22) are usually
performed to visualize tumor
vascularity or to rule out
atherosclerotic disease, thrombosis,
occlusion, and bleeding.
▫ An appropriately shaped catheter is
introduced, usually from a
transfemoral artery puncture, and
advanced into the orifice of the
desired artery
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10. VISCERAL
ARTERIOGRAPHY
The CIT observes the following steps:
• Perform all selective studies initially with the
patient in the supine position for single-plane
frontal images.
• Direct the central ray perpendicular to the
image receptor.
• If necessary, use oblique projections to
improve visualization or avoid superimposition
of vessels.
• For all abdominal visceral studies, obtain
angiograms during suspended expiration.
Selective abdominal visceral arteriograms are
described in the following sections.
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11. CELIAC
ARTERIOGRAM
The celiac artery normally arises
from the aorta at the level of T12 and
carries blood to the stomach and
proximal duodenum, liver, spleen,
and pancreas.
The CIT follows these steps:
• For the angiographic examination,
center the patient to the image
receptor.
• Direct the central ray to L1 (Fig.
23-23).
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12. HEPATIC
ARTERIOGRAM
The common hepatic artery branches
from the right side of the celiac
artery and supplies circulation to the
liver, stomach and proximal
duodenum, and pancreas.
The CIT does the following:
• Position the patient so that the
upper and right margins of the liver
are at the respective margins of the
image receptor (Fig. 23-24)
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13. SPLENIC
ARTERIOGRAM
The splenic artery branches from the left side
of the celiac artery and supplies blood to the
spleen and pancreas.
The steps are as follows:
• Position the patient to place the left and
upper margins of the spleen at the respective
margins of the image receptor (Fig. 23-25).
• Injection of the splenic artery can show the
portal venous system on the late venous
images.
• To show the portal vein, center the patient
to the image receptor.
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14. Superior Mesenteric
Arteriogram
The superior mesenteric artery (SMA) supplies blood to
the small intestine and the ascending and transverse
colon. It arises at about the level of L1 and descends to
L5-S1.
The CIT follows these steps:
• To show the SMA, center the patient to the midline of
the image receptor.
• Direct the central ray to the level of L3 (Fig. 23-26).
• When attempting to visualize bleeding sites, extend the
exposure duration to 60 seconds or as requested by the
radiologist.
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15. Inferior Mesenteric Arteriogram
The inferior mesenteric artery (IMA) supplies
blood to the splenic flexure, descending colon, and
rectosigmoid area. It arises from the left side of the
aorta at about the level of L3 and descends into the
pelvis.
The CIT does the following:
• To visualize the IMA best, use a 15-degree right
anterior oblique (RAO) or left posterior oblique (LPO)
position that places the descending colon and rectum
at the left and inferior margins of the image (Fig. 23-
27). The imaging is the same as that for the SMA.
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16. RENAL ARTERIOGRAM
The renal arteries arise from the right and left
side of the aorta between L1 and L2 and supply
blood to the respective kidney.
The CIT observes the following steps:
• A renal flush aortogram may be accomplished
by injecting 25 mL/sec for a 40-mL total volume
of contrast media through a multiple–side hole
catheter positioned in the aorta at the level of the
renal arteries. A representative selective
injection is 8 mL/sec for a 12-mL total volume.
Fig. 23-27 Selective IMA injection. Fig. 23-
28 Selective left renal artery injection in
early arterial phase.
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17. RENAL ARTERIOGRAM
• For a right renal arteriogram, position the
patient so that the central ray enters at the level
of L2 midway between the center of the spine
and the patient’s right side.
• For a selective left renal arteriogram, position
the patient so that the central ray usually enters
at the level of L1 midway between the center of
the spine and the patient’s left side (Fig. 23-28).
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Long, B. W., Rollins, J. H., &
Smith, B. J. (2016). Merrill’s
Atlas Of Radiographic
Positioning & Procedures Vol. 3
Refference

19. THANKS!
Any questions?
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