1. RAD 254 Chapter 22 Interventional Radiography
Both diagnostic (imaging) and Therapeutic (interventional)

2. Brief History 1930’s angiography 1953 – Seldinger needle
1960’s transbrachial selective coronary angiography (common femoral artery is still the most commonly accessed artery for access to other structures)

3. Imaging procedures Angiography Aortography Ateriography
Cardiac Catherization
Myelography
Venography

4. Interventional Procedures
Stent placement
Embolization
Intravascular stent
Thrombolysis
Balloon angioplasty
Artherectomy
Electrophysiology

5. Materials needed
Needle (usually a Seldinger needle – blunt outer obturator; beveled inner stylet 18 g)
Guide (glide) wires
Catheters ( H1 – “headhunter”; C2 – “Cobra”; Pigtail)
Heparin saline for “flushing”
Contrast – most is now nonionic are preferred over ionic as they have less concentration of ions and lower adverse effects

6. Patient Prep and Monitoring
Informed consent – radiologist visits patient PRIOR to the procedure and explains it in detail
Prep – NPO 8 hours prior and usually hydrating IV’s
During procedure – cardiac monitoring, blood pressure and pulse oximetry
Post – manual pressure on the puncture site followed by a sand bag for pressure and monitoring for hours after – prevent bleeding!

7. Equipment considerations
Tube
Focal spot size 1.0 mm/ 0.1 mm
Disc size 15 cm diameter (heat load)
Power rating – 80kW (rapid sequence, serial radiography)
Expanded anode heat capacity (massive amounts of heat are produced)
Couch – non-tilting, slim design with “stepping” capability

8. Filming considerations
Cine camera for cardiac catherization (camera and fluoro are synchronized so the fluoro only emits x-ray when the film frame is accessible)
Photofluorographic camera
Charge-Coupled Device (CCD) photosensitive silicon chips (replacing the TV camera) convert light to digital video images