ct cardiac angiography · ct cardiac angiography . what is ct coronary angiogram? • non invasive...
TRANSCRIPT
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A R A D I O G R A P H E R ’ S P E R S P E C T I V E P A U L A F E E H A N
CT CARDIAC ANGIOGRAPHY
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WHAT IS CT CORONARY ANGIOGRAM?
• Non invasive • Low risk • ECG Gated • IV contrast scan of the coronary arteries
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CT V ANGIOGRAM
• For patients with chest pain but not having a heart attack
• Radiation may be 50% less than traditional examinations (angiogram and Nuc Med combined) Lima 2012
• Sensitivity 91% • Specificity 92% Budoff 2016 • Highly accurate • Non invasive
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PREPARATION
• Cardiac angiography is only possible if the patient is well prepared
• Heart rate less than 60bpm • Green cannula in right cubital fossa • Comfortable clothing • Relaxed and not anxious • Contraindications • Pacemaker
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PRE-ASSESSMENT
• Examination explained • Medical history • Heart rate, blood pressure and renal function
checked • Medication prescribed if required • Anxieties addressed • Morning of test advice-no caffeine
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ON THE DAY
• Patient arrives • Top changed if necessary • HR checked – oral beta blockers/ivabradine if
required • Cannula fitted
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ECG LEADS
• 3-electrode system – Uses 3 electrodes (RA, LA and LL). – Monitor displays the bipolar leads (I, II and III) – To get best results – Place electrodes on the chest wall equidistant from the heart (rather than the specific limbs)
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VEINS OF THE FOREARM
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IN THE SCAN ROOM
• Patient positioned on the table • Connected to HR monitor • Breath exercise • Cannula flushed with the IV contrast pump • IV beta blockers if required • Slide into start position
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IN THE CONTROL ROOM
• Patient name and examination selected on scanner
• Protocol should always be double checked • Cardiac calcium score • GTN given- Nitroglycerin • Plan CT angiogram
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CT ANGIOGRAM
• Protocols… • Standard CT angiogram • Graft protocol: • TAVI protocol: gated root then whole aorta • CTA followed by angiogram of the aorta • CTA and portal abdomen and pelvis
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AFTERCARE
• Post scan BP and HR obs 15 mins after scan • Hot drink and a biscuit • Information leaflet • Sign off • Remove cannula
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HIGH CALCIUM SCORE
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RIGHT CORONARY ARTERY
RCA from right coronary Sinus
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LEFT ANTERIOR DESCENDING
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3D RECONSTRUCTION
Right coronary artery
Left main artery
Left circumflex
Left anterior descending
Ramus intermedius
Aorta
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3D VOLUME RENDERING :HEART
RCA
ACUTE MARGINAL BRANCH
DIAGIONAL BRANCH
LAD
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ANOMALOUS LEFT CIRCUMFLEX
LCx
RCA
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FISTULA
Saccular aneurysm
Pulmonary artery
Fistula
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GRAFT-LIMA TO LAD
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GRAFT
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LEFT CIRCUMFLEX ANEURYSM
Stent
Left circumflex aneurysm with a dissection flap
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3D AORTIC ROOT
Left ventricle
Aorta
Mitral valve