Special Radiological Procedures

lecture 1
Methods of imaging of the heart and
angiocardiography
By
MSc. Zeyad Tareq Al-Dulaimi
4th.Stage
3rd.stage
2023-2024
 Methods of imaging of the heart and angiocardiography

Methods of imaging of the heart

1. Chest radiography

2. Fluoroscopy and angiocardiography

3. Echocardiography

4. Computed tomography (CT)

5. Magnetic resonance imaging (MRI)

6. Radionuclide imaging:

(a) Ventriculography

(b) Myocardial perfusion imaging

Angiocardiography
.‫ﺗﻢ اﺳﺘﺒﺪال اﻟﻘﺴﻄﺮة اﻟﺘﺸﺨﯿﺼﯿﺔ إﻟﻰ ﺣﺪ ﻛﺒﯿﺮ ﺑﺘﺼﻮﯾﺮ اﻷوﻋﯿﺔ اﻟﺘﺎﺟﯿﺔ اﻟﻤﻘﻄﻌﯿﺔ وﺗﺨﻄﯿﻂ ﺻﺪى اﻟﻘﻠﺐ‬
1. Diagnostic catheterization has largely been replaced by CT
coronary angiography and echocardiography.
.‫ﻋﺎدةً ﻣﺎ ﯾُﺴﺘﺨﺪم ﺗﺨﻄﯿﻂ اﻷوﻋﯿﺔ اﻟﺪﻣﻮﯾﺔ ﻛﺠﺰء ﻣﻦ اﻹﺟﺮاء اﻟﻌﻼﺟﻲ اﻟﺘﺪاﺧﻠﻲ وﯾﻤﻜﻦ إﺟﺮاؤه ﺑﺎﻟﺘﺰاﻣﻦ ﻣﻊ ﻗﺴﻄﺮة اﻟﻘﻠﺐ‬
2. Angiocardiography is usually used as part of an interventional
therapeutic procedure and can be performed simultaneously
with cardiac catheterization.
.‫ﯾﺘﻢ ﺧﻼﻟﮭﺎ ﻗﯿﺎس اﻟﻀﻐﻮط وﻗﯿﺎس اﻟﺘﺄﻛﺴﺞ ﻓﻲ ﻏﺮف اﻟﻘﻠﺐ واﻷوﻋﯿﺔ اﻟﺘﻲ ھﻲ ﻗﯿﺪ اﻟﺘﺤﻘﯿﻖ‬
3. During which pressures and oximetry are measured in the
cardiac chambers and vessels that are under investigation.
.‫ اﻋﺘﻤﺎدًا ﻋﻠﻰ اﻟﻤﺸﻜﻠﺔ اﻟﺴﺮﯾﺮﯾﺔ‬،‫ﯾﺘﻢ ﻓﺤﺺ اﻟﻘﻠﺐ اﻷﯾﻤﻦ واﻟﻘﻠﺐ اﻷﯾﺴﺮ واﻷوﻋﯿﺔ اﻟﻜﺒﺮى ﻣﻌًﺎ أو ﻛﻞ ﻋﻠﻰ ﺣﺪة‬
4. The right heart, left heart and great vessels are examined
together or alone, depending on the clinical problem.
 Indications
..‫أﻣﺮاض اﻟﻘﻠﺐ اﻟﺨﻠﻘﯿﺔ واﻟﺸﺬوذات ﻓﻲ اﻷوﻋﯿﺔ اﻟﺪﻣﻮﯾﺔ اﻟﻜﺒﺮى‬
1. Congenital heart disease and anomalies of the great vessels.
.‫ﻣﺮض اﻟﺼﻤﺎم‬
2. Valve disease.
.‫ﻣﺮض ﻋﻀﻠﺔ اﻟﻘﻠﺐ وﺗﻘﯿﯿﻢ وظﯿﻔﺔ اﻟﺒﻄﯿﻦ‬
3. Myocardial disease and assess ventricular function.

Contrast Medium

Low osmolar contrast material (LOCM) 370 mg I mL−1 (Table 9.1).

‫ﻣﮭﻢ‬
Equipment
.‫ ﻟﺘﺴﮭﯿﻞ اﻹﺳﻘﺎطﺎت اﻟﻤﺤﻮرﯾﺔ‬C ‫اﻟﺘﻨﻈﯿﺮ اﻟﻔﻠﻮري اﻟﺮﻗﻤﻲ ذو اﻟﺴﻄﺤﯿﻦ واﻟﺘﺼﻮﯾﺮ اﻟﺸﻌﺎﻋﻲ اﻟﺴﯿﻨﻤﺎﺋﻲ ﺑﺄذرع‬
1. Biplane digital fluoroscopy and cine radiography with C-arms to
facilitate axial projections.
‫ﺟﮭﺎز ﻗﯿﺎس اﻟﻀﻐﻂ‬
2. Pressure recording device
‫ﺟﮭﺎز ﺗﺨﻄﯿﻂ اﻟﻘﻠﺐ اﻟﻜﮭﺮﺑﺎﺋﻲ‬
3. Electrocardiogram (ECG) monitor
‫ﻣﺤﻠﻞ اﻷوﻛﺴﺠﯿﻦ ﻓﻲ اﻟﺪم‬
4. Blood oxygen analyzer
‫اﻟﻘﺴﻄﺮة‬
5. Catheter:

(a) For pressure measurements and blood sampling: Cournand

(Fig. 9.1), 4–7F

(b) For angiocardiography: National Institutes of Health (NIH)

(Fig. 9.2) or pigtail (Fig. 9.3), 4–8F.

Figure (1): The catheter that used for Angiocardiography.

Technique

1. Right-sided cardiac structures and pulmonary arteries are

examined by introducing a catheter into a peripheral vein.
(a) In babies, by introducing a catheter into the femoral vein.

(b) In adults, the right antecubital or basilic vein may be used.

 * The catheter, or introducer, is introduced using the Seldinger
technique. (The NIH catheter must be introduced via an
introducer, as there is no end hole for a guidewire.)

2. Left-sided cardiac structures and the aorta.

(a) In children, by manipulating a venous catheter through a patent

foramen ovale.

(b) In adults, by introducing a catheter into the femoral artery.

3. The catheter is manipulated into the appropriate positions for

recording pressures and oxygen saturation. Following this,
angiography is performed.

Image Acquisition

1. Using digital angiography at 7.5 frames s−1.

2. the X-ray beam is angulated relative to the axial planes of the
heart.
3. The long axis of the heart is usually oblique to the long axis of
the patient’s body.
4. digital angiography with movable C-arms which allow correct
positioning without disturbing the patient.
5. Supplementary angulations of the X-ray beam from the
cardiac axes are used. Useful views are:
A. 40 degrees cranial/40 degrees left anterior oblique (LAO).

B. long axial 20 degrees right anterior oblique (RAO).

Thank you