How to identify Coronary Arteries

when viewing Angio Cine

film/CD’s
Image Intensifier  “I.I.”
 Anterior – Posterior - AP

Image Intensifier

The II is parallel midline

of the patient

Patient
 Terminology

• Anterior • Oblique
• Posterior • Cranial
• Inferior • Caudal
• Superior • Proximal
• Medial • Distal
 Camera Angles Summary
• AP = Anterior-Posterior, The Image Intensifier (II) is
completely vertical
• LAO = Left Anterior Oblique, The II is to the left of the
patient
• RAO = Right Anterior Oblique, The II is to the right of
the patient
• Cranial Skew, The II is angled towards the patient’s
head
• Caudal Skew, The II is angled towards the patient’s feet
 Angiographic Landmarks
• Spine
• Ribs
• Sternum
• Catheter
 Helpful Hints
General
• LAO View – Spine on the right side of the screen.
• RAO View – Spine on the Left side of the screen.
• Upward slope of the ribs will point to the spine.
RIGHT CORONARY ARTERY
(LAO Cranial)

Spine is on the Right

• RCA forms
a “C”
Different positions of I.I
RCA LAO View

1. SA Nodal
2. Conus
3. RV Branch
4. Acute Marginal
5. PLV Branch
6. PDA
 RIGHT CORONARY ARTERY
(RAO )

Spine is on • RCA
the Left forms an
“L”
RCA RAO View

1. SA Nodal
2. Conus
3. RV Branch
4. Acute Marginal
5. PLV Branch
6. PDA
 Helpful Hints
Right Coronary Artery
• LAO View – resembles the Letter “C”
• RAO View – resembles the Letter “L”
• PDA is generally seen more inferior on the screen than
the PLA.
LAO Cranial Angiogram of RCA
RAO Angiogram of RCA
LEFT CORONARY ARTERY
(RAO Caudal)
LEFT CORONARY ARTERY
(RAO Cranial)
LCA RAO View

1. Left Main
2. LAD
3. Circumflex
4. Diagonals
5. Septals
6. Obtuse Marginals
LCA in the RAO Position

Septal
Diagonal

Circumflex
LAD
LEFT CORONARY ARTERY
(LAO Cranial)
 LCA LAO Cranial View

1. Left Main
2. LAD
3. Circumflex
4. Diagonals
5. Septals
6. Obtuse Marginals
LEFT CORONARY ARTERY
(LAO Caudal)
 LCA Caudal-also known as
“The SPIDER Shot”

1. Left Main
2. LAD
3. Circumflex
4. Diagonals
5. Septals
6. Obtuse Marginals
 Angle is LAO

Circumflex

LAD

Spine is on the Right

LCA LAO View

1. Left Main
2. LAD
3. Circumflex
4. Diagonals
5. Septals
6. Obtuse Marginals
LEFT CORONARY ARTERY
(LAO Lateral)
LCA Lateral View

1. Left Main
2. LAD
3. Circumflex
4. Diagonals
5. Septals
6. Obtuse Marginals
LCA AP View

1. Left Main
2. LAD
3. Circumflex
4. Diagonals
5. Septals
6. Obtuse Marginals
 LCA AP

SPINE
 Helpful Hints
Left Coronary Artery
• RAO View – LAD will be on “top”
• LCX lies closest to the spine.
• Lateral View – LAD and LCx appear to outline the heart.
• The LAD will be away from the spine
• The LAD “should be” the longest artery
• In LAO the LAD will be to the LEFT
• In RAO the LAD will be to the RIGHT
AP Caudal View of LCA
AP Cranial View of LCA

Diagonal
AP Cranial LCA Angiogram
LAO Cranial View of LCA
 Review General Rules

• In LAO, the spine in on the right

• In RAO, the spine is on the left
• The CX, lies closest to the spine
• In LAO, the Apex points to the left
• In RAO, the Apex points to the right
• In LAO, the LAD lies on the left
• Only the LAD reaches the Apex
• In LAO, the RCA resembles a “C”
• In RAO, the RCA resembles a “L”
• If the spine bisects the screen it is AP
Some Best Views for
Coronary Arteries
 Some Best Views for
Coronary Arteries contd….
THANK YOU