ct angiography presentation
Post on 19-Oct-2014
6.758 views
DESCRIPTION
our informations reference was the explanation of Mr. Kmal, the supervisor of CT department in KKUH, Riyadh, Saudi ArabiaTRANSCRIPT
![Page 1: CT Angiography presentation](https://reader036.vdocument.in/reader036/viewer/2022082310/5443f20bb1af9f700a8b46dd/html5/thumbnails/1.jpg)
![Page 2: CT Angiography presentation](https://reader036.vdocument.in/reader036/viewer/2022082310/5443f20bb1af9f700a8b46dd/html5/thumbnails/2.jpg)
•What is CTA?•Indications•Contraindication•Preparation•Protocol
•Cerebral to lower limb•Subclavian
•Pediatric patient•Patient after care
Outlines:
![Page 3: CT Angiography presentation](https://reader036.vdocument.in/reader036/viewer/2022082310/5443f20bb1af9f700a8b46dd/html5/thumbnails/3.jpg)
What is CTA?
Computerized tomographic angiography is used to visualize blood vessels that have been opacified by CM. C+This include:•Circle of Willis.•Carotid arteries•Subclavian arteries•Thoracic & abdominal aorta•Renal vasculature•Abdominal viscera vasculature•Lower limb arteries
![Page 4: CT Angiography presentation](https://reader036.vdocument.in/reader036/viewer/2022082310/5443f20bb1af9f700a8b46dd/html5/thumbnails/4.jpg)
Indication Contraindicati
on
•Aneurysm•Stenosis•Dissection of aorta•Atherosclerosis •A-V fistula•A-V malformation•Thrombosis•Pulmonary embolism•Guide to implanting or evaluating stents.•Thoracic Outlet Syndrom
•Pregnancy•unstable vital signs
•Allergic patient•Kidney problems•Severe diabetes
![Page 5: CT Angiography presentation](https://reader036.vdocument.in/reader036/viewer/2022082310/5443f20bb1af9f700a8b46dd/html5/thumbnails/5.jpg)
Saccular aneurysm of the abdominal aorta.
![Page 6: CT Angiography presentation](https://reader036.vdocument.in/reader036/viewer/2022082310/5443f20bb1af9f700a8b46dd/html5/thumbnails/6.jpg)
A 20-year old male pt . Known to have thoracic aortic aneurism post
endovascular aortic repair.
![Page 7: CT Angiography presentation](https://reader036.vdocument.in/reader036/viewer/2022082310/5443f20bb1af9f700a8b46dd/html5/thumbnails/7.jpg)
Left lower limb ischemia.
Complete occlusion of the left popliteal
artery
![Page 8: CT Angiography presentation](https://reader036.vdocument.in/reader036/viewer/2022082310/5443f20bb1af9f700a8b46dd/html5/thumbnails/8.jpg)
Preparation:•NPO 3-4 hrs before the exam.•Not severly allergic or asthmatic•Recent Renal function test(RFT) must be normal;
o1 week inpatient.o3 month diabetic patiento6 month non diabetic patient.
•Explain procedure•Signed consent form•Sedation if needed
![Page 9: CT Angiography presentation](https://reader036.vdocument.in/reader036/viewer/2022082310/5443f20bb1af9f700a8b46dd/html5/thumbnails/9.jpg)
We will present:
CT Angiography
[Cerebral to lower limb]
[Subclavian]
![Page 10: CT Angiography presentation](https://reader036.vdocument.in/reader036/viewer/2022082310/5443f20bb1af9f700a8b46dd/html5/thumbnails/10.jpg)
We will present:
CT Angiography
[Cerebral to lower limb]
[Subclavian]
![Page 11: CT Angiography presentation](https://reader036.vdocument.in/reader036/viewer/2022082310/5443f20bb1af9f700a8b46dd/html5/thumbnails/11.jpg)
Pt position:
•Supine, in the center of the table•Head first in the gantry.•The arms are raised above the head.
•Scanning from head to lower limb, as ordered.
V center (height center): mid of the body (mid of the axilla ).H center: mid of the head.
[Cerebral to lower
limb]
![Page 12: CT Angiography presentation](https://reader036.vdocument.in/reader036/viewer/2022082310/5443f20bb1af9f700a8b46dd/html5/thumbnails/12.jpg)
Protocol:
•Scout/ topogram Images: PA: plane 180º Lat: plane 90º
64 detector arraysKKUH
![Page 13: CT Angiography presentation](https://reader036.vdocument.in/reader036/viewer/2022082310/5443f20bb1af9f700a8b46dd/html5/thumbnails/13.jpg)
Contrast media:• Injection in the arm vein
CM Type: Omnipaque or Xenetix 300; injector machine.Volume: 120 ml.Flow rate: 4ml/sec. Cannula size: 18 gauge
Smart prep technique: With 64 detector arrays, the scan start when the CM is seen in the thoracic aorta.
With 16, CM in the thoracic pulmonary artery .
![Page 14: CT Angiography presentation](https://reader036.vdocument.in/reader036/viewer/2022082310/5443f20bb1af9f700a8b46dd/html5/thumbnails/14.jpg)
Start location: the head End location: down to the ordered lower limb limit.
FOV is adjusted to as small as possible; but still include all parts needed.
Axial slices
Circle of Willi’s
Lower limb
![Page 15: CT Angiography presentation](https://reader036.vdocument.in/reader036/viewer/2022082310/5443f20bb1af9f700a8b46dd/html5/thumbnails/15.jpg)
Scan parameters:
Type of scan
KV mA Scan delay Sec.Slice
thickensPitch FOV
Recon. Algorith
m
spiral 120Auto
min 150Max 500
15sec-thorasic a.
20sec-abdom. a.
.7sec
1.25xo.625mm (old)
.6x.6mm(new)
0.9(new)1.375(old)
30\40cm
StandardOr
Soft tissue
2nd reconstruction
2.5x2.5 mm
Note: scan delay time is used if we don’t have smart prep.
![Page 16: CT Angiography presentation](https://reader036.vdocument.in/reader036/viewer/2022082310/5443f20bb1af9f700a8b46dd/html5/thumbnails/16.jpg)
Filming:No print out; PAC system is used.
Windowing:
window WW WL
Soft tissue 500 35
Reformatting: 2D\3D must be done
Cont.
![Page 17: CT Angiography presentation](https://reader036.vdocument.in/reader036/viewer/2022082310/5443f20bb1af9f700a8b46dd/html5/thumbnails/17.jpg)
Reformatting: 2D\3D
2D sagital
2D coronal
3D
![Page 18: CT Angiography presentation](https://reader036.vdocument.in/reader036/viewer/2022082310/5443f20bb1af9f700a8b46dd/html5/thumbnails/18.jpg)
Pediatric patient:
•Very rare.•No injector machine. to avoid extravasations.
•Instead, hand injection is used with 22 Gag. canulla.
![Page 19: CT Angiography presentation](https://reader036.vdocument.in/reader036/viewer/2022082310/5443f20bb1af9f700a8b46dd/html5/thumbnails/19.jpg)
Patient after care:
• Bandage over the injection site
•Watch the patient for possible adverse
contrast reactions.
•Pt. can eat and drink as normal.
•He/she should drink plenty of fluids (CM
flush out).
![Page 20: CT Angiography presentation](https://reader036.vdocument.in/reader036/viewer/2022082310/5443f20bb1af9f700a8b46dd/html5/thumbnails/20.jpg)
We will present:
CT Angiography
[Cerebral to lower limb]
[Subclavian]
![Page 21: CT Angiography presentation](https://reader036.vdocument.in/reader036/viewer/2022082310/5443f20bb1af9f700a8b46dd/html5/thumbnails/21.jpg)
Indication Contraindicati
on
•Aneurysm•Stenosis•Dissection of aorta•Atherosclerosis •A-V fistula•Thrombosis•Pulmonary embolism•Guide to implanting or evaluating stents
•Pregnancy•unstable vital signs
•Allergic patient•Kidney problems•Severe diabetes
•Thoracic Outlet Syndrome
![Page 22: CT Angiography presentation](https://reader036.vdocument.in/reader036/viewer/2022082310/5443f20bb1af9f700a8b46dd/html5/thumbnails/22.jpg)
Thoracic Outlet Syndrome:
•The thoracic outlet is the area connecting the neck to the chest.
•TOS symptoms: pain in the arms, shoulder and neck, can turn blue.
•Caused by nerve or BV compression.
3D reconstructed image of RT subclavian artery compressed at costo-
clavicular level.
![Page 23: CT Angiography presentation](https://reader036.vdocument.in/reader036/viewer/2022082310/5443f20bb1af9f700a8b46dd/html5/thumbnails/23.jpg)
Differ than the previous technique in
the following…
![Page 24: CT Angiography presentation](https://reader036.vdocument.in/reader036/viewer/2022082310/5443f20bb1af9f700a8b46dd/html5/thumbnails/24.jpg)
[Subclavian]
• Exam is done twice, in two arm
positions;
1. Stress(elevated) &
2. Rest (beside the Patient)
• Each has its own scout(pa/lat)
image.
Pt position:
![Page 25: CT Angiography presentation](https://reader036.vdocument.in/reader036/viewer/2022082310/5443f20bb1af9f700a8b46dd/html5/thumbnails/25.jpg)
Contrast media:• Injection in foot vein. Why?
To avoid the artifact caused by the thick CM in the subclavian artery of the injected arm.
• Volume: 160 ml
80 ml for rest80 ml for
stress
![Page 26: CT Angiography presentation](https://reader036.vdocument.in/reader036/viewer/2022082310/5443f20bb1af9f700a8b46dd/html5/thumbnails/26.jpg)
Axial slices
Start location: half of carotid a. or neck.
End location: down to mid chest (bifurcation).
FOV is adjusted to as small as possible; but include shoulder. Carotid arteries
![Page 27: CT Angiography presentation](https://reader036.vdocument.in/reader036/viewer/2022082310/5443f20bb1af9f700a8b46dd/html5/thumbnails/27.jpg)
Axial slices
Start location: half of carotid a. or neck.
End location: down to mid chest (bifurcation).
FOV is adjusted to as small as possible; but include shoulder. Carotid arteries
![Page 28: CT Angiography presentation](https://reader036.vdocument.in/reader036/viewer/2022082310/5443f20bb1af9f700a8b46dd/html5/thumbnails/28.jpg)
•In CT angiography, 3D reconstruction is a must.
•Thin slices are needed or overlapped slices are needed.
•Auto Bone subtraction, or any other unwanted soft tissue structure is subtracted.
• Ct angio is not likely repeated.
To conclude..
![Page 29: CT Angiography presentation](https://reader036.vdocument.in/reader036/viewer/2022082310/5443f20bb1af9f700a8b46dd/html5/thumbnails/29.jpg)
Subtraction or
Cleaning
![Page 30: CT Angiography presentation](https://reader036.vdocument.in/reader036/viewer/2022082310/5443f20bb1af9f700a8b46dd/html5/thumbnails/30.jpg)
20 yr old male with hypertension, CT Renal Angiography showed Renal Artery Stenosis.
50 yr old asymptomatic male. CT Thoracic Angio shows a twisted dilated descending aorta with celiac artery aneurysm.
Cases
![Page 31: CT Angiography presentation](https://reader036.vdocument.in/reader036/viewer/2022082310/5443f20bb1af9f700a8b46dd/html5/thumbnails/31.jpg)
Thank U
No thing is impossible, the word itself says “I’m possible”
![Page 32: CT Angiography presentation](https://reader036.vdocument.in/reader036/viewer/2022082310/5443f20bb1af9f700a8b46dd/html5/thumbnails/32.jpg)
References:
King Khalid Universal Hospital, CT Department
Protocol.
Explained by Mr. Kamal, the supervisor of CT
department.
Some of the CT angiographic images
were taken from websites.
![Page 33: CT Angiography presentation](https://reader036.vdocument.in/reader036/viewer/2022082310/5443f20bb1af9f700a8b46dd/html5/thumbnails/33.jpg)