1. CT ANGIOGRAPHY Dr Mohamed El Safwany, MD

2. Intended learning outcome The student should learn at the end of this lecture CT IMAGE OF THE BLOOD VESSEL OPACIFIED BY CONTRAST.

3. CT IMAGE OF THE BLOOD VESSELS OPACIFIED BY CONTRAST

4. REQUIREMENTS FOR CTA PATIENT PREPARATION ACQUSITION PARAMETERS CONTRAST MEDIUM ADMINISTRATION POSTPROCESSING TECHNIQUES

5. PATIENT PREP.

6. INFORMED CONSENT

7. PATIENT PREP. CREAT.- 0.6 –1.2 mg/dl IODINE ALLERGY- STEROID THERAPY HYPERVENTILATION BEFORE EXAM FOR BETTER BREATHOLD

10. UTILIZED

11. GAUGE SUITABLE FOR CTA 18 OR 20

12. CONTRAST ADMINISTERED WITH POWER INJECTOR

18. ACQUSITION PARAMETERS

19. PARAMETERS USUALLY ROUTINE CT PRECEDES A CTA EXAM. THE ROUTINE EXAM IS USED AS A REFERENCE SCAN HELPING TO DETERMING THE SCANNING RANGE IN CTA.

20. SLICE THICKNESS SPATIAL RESOLUTION

21. CEREBRAL CTA ABDOMINAL CTA THORACIC CTA 1MM (LOWER mA) 3MM SLICE THICKNESS

22. SPIRAL PITCH PITCHSPATIAL RESOLUTION

23. SPIRAL PITCH UP TO 2

24. kVp, mA, TIME SIMILAR TO NON- CTA EXAM OF THE SAME BODY PART

25. RECONSTRUCTION INTERVAL 50% OF OVERLAP

26. CONTRAST ADMINISTRATION

27. POWER INJECTOR

28. POWER INJECTOR PARAMETERS VOLUME OF CONTRAST-ml RATE ml/sec TIME OF INJECTION – sec SCAN DELAY TIME - sec

29. CONTRAST WARMER WHY???

30. RATE OF INJECTION 3-5 ml/sec

31. ORAL CONTRAST???? WATER NEGATIVE CONTRAST

32. AUTOMATED CONTRAST ADMINISTRATION SYSTEMS SMARTPREP CARE SURESTART

33. CONTRAST ADMINISTRATION AND SCANNING METHODS BOLUS TRACKING BOLUS TIMING MANUAL PRESET TIME

34. CARE BOLUS

35. SMART PREP

36. Bolus tracking- PE

37. PE?

38. Tracking slice

39. Bolus tracking- Carotids and Circle of Willis

41. Circle of Willis

42. Circle of Willis?! 40 SEC

43. Renal arteries 25-30 sec.

45. ABDOMINAL AND FEMORAL RUNOFF

46. MANUAL DELAYS CERBRAL CTA CAROTID CTA CHEST CTA (PE) 15 SEC 12 SEC 10-20 SEC

47. CARDIAC CT

48. TWO TECHNIQUES TO REDUCE MOTION ARTIFACTS IN CARDIAC CT PROSPECTIVE TRIGGERING RETROSPECTIVE GATING

49. Prospectively ECG-Triggered Sequential Scanning Cardiac CT applications require the synchronization of data acquisition to the cardiac cycle, i.e. to the movement of the heart. For sequential imaging, a prospective trigger is derived from the ECG-trace to initiate the CT-scan with a certain delay time after the R-wave. Usually, the delay is defined such that the scans are acquired during the diastolic phase of the heart

50. Retrospectively ECG-Gated Spiral Scanning For "retrospectively ECG-gated spiral scanning" a continuous spiral scan is acquired with the ECG- signal recorded simultaneously. The acquired scan data is selected for image reconstruction with respect to a pre-defined cardiac phase. Similar to ECG-triggered sequential scanning a certain R-wave delay time defines the start point of data that is used for image reconstruction. ECG-gated spiral scanning has several advantages over ECG- triggered sequential scanning. The continuous acquisition allows for reconstruction of overlapping slices. Due to the retrospective analysis of the ECG, the technique is less sensitive to arrhythmia.

51. BOTH METHODS REQUIRE ECG MONITORING DIASTOLIC PHASE

52. SCANNING DURING RR INTERVAL

53. Retrospective ECG-Gating

54. CARDIAC CT PROCEDURES CARDIAC ANGIOGRAM CALCIUM SCORING

55. CARDIAC ANGIOGRAM PERFORMED WITH CONTRAST INJECTION 4-5 cc/sec 150 cc total volume

56. CALCIUM SCORING NO IV CONTRAST USED

57. CARDIAC ANGIOGRAM

58. CALCIUM SCORING

59. 3-D VISUALIZATION TOOLS IN CTA MPR MIP SSD VR CINE

60. CARDIAC ANGIOGRAM

61. CTA - MPR PLANE?

62. MPR PLANE?

63. MIP - CTA

64. SSD -CTA

65. VR - CTA

66. CINE CTA

67. MPR SIMPLE FAST ANY PLANE VISUALIZATION LESS USEFUL IN COMPLEX VESSEL VISUALIZATION

68. SSD FAST LITTLE EDITING LITTLE AXIAL DATA USAGE CONTOUR, RELATIONSHIP OF VESSELS ARTIFACT GENERATION INACCURATE

69. MIP CALCIFICATION DETECTION THROMBUS DETECTION AILIASING ARTIFACT EDITING REQUIRED

70. VR ACCURATE ALL DATA USED GOOD STENOSIS DETECTION COMPLEX COMPUTER PROCESSING (PAST)

71. STEREOSCOPIC VIEWING

72. Text Book David Sutton’s Radiology Clark’s Radiographic positioning and techniques

73. Assignment Two students will be selected for assignment.

74. Question Define Care bolus technique?

75. Thank You