VASCULAR & NONVASCULAR PROCEDURES
EQUIPMENT AND
ACCESSORIES USED
IN THE VASCULAR
LAB
MAJOR EQUIPMENT
X-RAY/FLUORO TUBE(S)
• IMAGE INTENSIFIER/TV
MONITOR
• X-RAY TABLE
• RAPID FILM CHANGERS
• PRESSURE INJECTORS
• DIGITAL SUBTRACTION
• VCR
• CATHETERS/GUIDEWIRES
•
ACCESSORIES
OXYGEN SUPPLY
• CONTRAST MEDIA/ WARMER
• IV SUPPLIES, NEEDLES,
SYRINGES
• PHARMACOLOGICAL SUPPLIES
• CRASH CART
• EKG MONITOR
•
1
CONTROL ROOM
CONTROL PANEL
(GENERATOR)
• PROGRAM SELECTOR
(1 PER FILM CHANGER)
• DIGITAL COMPUTER
•
X-RAY TUBE
MIN. 6 FILM/SEC x 5 SEC.
CAPACITY
• HIGH SPEED ROTOR (10K RPM)
• 3-PHASE GENERATOR
• 1,000 MA CAPACITY (MINIMUM)
• FRACTIONAL FOCAL SPOT (0.3 mm)
• ANODE ANGLE = 5° - 7° (Vs 10° - 15°)
•
SERIAL FILM CHANGER
USED FOR STUDIES
REQUIRING RAPID
FILMING SEQUENCES
USING 10X12 OR 14X14
INCH FILM.
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FILM CHANGERS
• ROLL
FILM
• CUT FILM
ROLL FILM CHANGER
USED A REEL OF 14” WIDE FILM.
AFTER AN IMAGING
SEQUENCE, THE TRAILING
EDGE OF THE FILM IS CUT AND
THE TAKE-UP ROLL IS
PROCESSED. IMAGES ARE
THEN CUT TO 14X14 “
RADIOGRAPHS.
ROLL FILM CHANGER
CAPABLE OF 4 TO 12 FILMS
PER SECOND DEPENDING
ON MANUFACTURER. THEY
WERE SIMPLE TO OPERATE,
BUT WASTED FILM. ROLL
FILM WAS CUMBERSOME
AND EASILY FOGGED.
3
CUT FILM CHANGERS
MAGAZINE-LOADED
FILM DEVICE
DESIGNED TO USE
10X12 OR 14X14 INCH
FILM. FILM RATE
RANGES FROM 4 TO 6
FILMS PER SECOND.
CUT FILM CHANGERS
• LESS
WASTE THAN ROLL
CHANGERS
• EASY FILM HANDLING
• SLOWER FILM RATES
• FREQUENT RELOADING
FILM CHANGERS &
BIPLANE FILMING
FILM CHANGERS CAN BE
POSITIONED
ORTHOGONALLY TO
PRODUCE RADIOGRAPHIC
IMAGES IN TWO POSITIONS
AT ONCE. TWO X-RAY TUBES
ARE NEEDED, ONE FOR EACH
FILM CHANGER.
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BIPLANE FILMING
XR
A
Y
F
I
L
M
PATIENT
X-RAY
FILM
PROGRAMMING
COORDINATION OF THE
FILMING SEQUENCE
WITH THE CONTRAST
INJECTOR, TABLE
MOVEMENT AND XRAY EXPOSURE.
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PROGRAM SELECTOR
A DEVICE WHICH IS LOCATED IN
THE CONTROL ROOM. MODERN
PROGRAMMERS USE
MICROPROCESSORS (COMPUTERBASED) WHICH EXECUTE THE
INSTRUCTIONS PROGRAMMED
INTO IT BY THE TECHNOLOGIST.
PROGRAMMING
VARIABLES
•
FILM CYCLE TIME
•STATIONARY TIME (%)
•TIME IN MOTION (%)
•
X-RAY GENERATOR
•ZERO-TIME
ƒ PHASING-IN TIME
•
MAXIMUM PERMISSIBLE
EXPOSURE TIME
FILM CYCLE TIME
THIS IS THE TIME THAT THE FILM
IS EITHER MOVING THROUGH
THE FILM CHANGER OR
REMAINING STATIONARY. EACH
IS INDICATED IN PERCENTAGE
TERMS. EXPOSURES ARE MADE
WHEN THE FILM IS STATIONARY.
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FILM CYCLE TIME
NOT ALL OF THE STATIONARY
TIME IS AVAILABLE FOR X-RAY
EXPOSURE. THIS IS DUE TO
DELAYS THAT OCCUR IN THE XRAY GENERATOR.
ZERO TIME
THE DELAY INHERENT IN
OLDER SYSTEMS WHICH RELY
ON MECHANICAL SWITCHES
TO SIGNAL FOR AN
EXPOSURE. MODERN SOLIDSTATE GENERATORS HAVE
MADE ZERO TIME ALMOST
NON-EXISTENT.
PHASING-IN TIME
WHEN THE ACTUAL
EXPOSURE IS TRIGGERED, A
DELAY CAN OCCUR
DEPENDING ON THE
POSITION OF THE SINE
WAVE AT THAT MOMENT.
ON 3-PHASE SYSTEMS, THE
AVERAGE DELAY IS 2.78 ms.
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MAXIMUM PERMISSIBLE
EXPOSURE TIME
IN ORDER TO PROPERLY PREVENT
AN X-RAY EXPOSURE FROM
OCCURRING WHILE THE FILM IS
IN MOTION THROUGH THE FILM
CHANGER, THE MAXIMUM
EXPOSURE TIME MUST BE
DETERMINED.
MAXIMUM PERMISSIBLE
EXPOSURE TIME -- STEP 1
EXPOSURE TIME
1000
_______________________________
= PER FILM
# FILMS EXPOSED PER SECOND
IN MSECONDS
MAXIMUM PERMISSIBLE
EXPOSURE TIME -- STEP 2
EXPOSURE TIME PER X
FILM IN MSEC
% THAT FILM IS
=
STATIONARY
EXPOSURE TIME AVAILABLE PER FILM
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MAXIMUM PERMISSIBLE
EXPOSURE TIME -- STEP 3
EXPOSURE TIME
- PHASING-IN TIME =
AVAILABLE PER FILM
IN MSECONDS
MAXIMUM PERMISSIBLE EXPOSURE TIME
PROBLEM:
WHAT IS THE MAXIMUM
PERMISSIBLE EXPOSURE
TIME ON A 6 EXPOSURE/SEC
FILMING SEQUENCE USING
A 3-PHASE UNIT WITH A
FILM STATIONARY TIME OF
40%?
SOLUTION:
• 1000/6
= 166.7 MSEC PER
FILM
• 166.7 X .40 = 66.7 MSEC
AVAILABLE PER FILM
• 66.7 - 2.78 = 63.9 MSEC
MAXIMUM PERMISSIBLE PER
FILM
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PRESSURE INJECTORS
ALSO CALLED
ELECTROMECHANICAL
INJECTORS ARE DEVICES
WHICH CAN DELIVER
IODINATED CONTRAST
AT A PRECISE RATE AND
PRESSURE FOR A
SPECIFIED TIME.
PRESSURE INJECTOR
TYPES
• CONSTANT
FLOW RATE
• CONSTANT PRESSURE
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CONSTANT FLOW RATE
INJECTORS
PERMIT THE TECHNOLOGIST TO SET
THE FLOW RATE (IN ML/SEC) AND
THE INJECTION TIME (IN
SECONDS). INJECTION PRESSURE
WILL DEPEND ON VISCOSITY OF
THE CONTRAST, DIAMETER,
LENGTH AND TYPE OF THE
CATHETER USED.
CONSTANT PRESSURE
INJECTORS
REQUIRE SETTING THE
PRESSURE (IN PSI). RESULTING
FLOW RATE WILL DEPEND ON
CATHETER LENGTH,
CATHETER INSIDE DIAMETER,
AND VISCOSITY OF CONTRAST
PRESSURE INJECTORS -OPTIONAL EQUIPMENT
• EKG
MONITOR
• DUAL SYRINGE SYSTEM
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SAFETY
CONSIDERATIONS
• PRESSURE
LIMIT CONTROL
• RATE RISE CONTROL
• MECHANICAL STOP
• ELECTRICALLY INSULATED
PLASTIC JACKET
PROBLEM:
25 ML OF IODINATED
CONTRAST IS
INJECTED OVER THE
COURSE OF 6
SECONDS. WHAT IS
THE FLOW RATE?
SOLUTION:
•
DOSE = FLOW RATE X TIME
•
25 ML = FLOW RATE X 6 SEC
•
25 ML/6 SEC = FLOW RATE
•
4.17 ML/SEC = FLOW RATE
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ANGIOGRAPHIC
CATHETERS
SLENDER FLEXIBLE TUBES
OF VARYING LENGTHS,
SHAPES AND DIAMETERS
WHICH ARE INSERTED
INTO BLOOD VESSELS IN
ORDER TO DELIVER
IODINATED CONTRAST.
ANGIOGRAPHIC
CATHETERS
MADE FROM TEFLON,
POLYETHYLENE OR
POLYURETHANE.
THEY COME WITH
SINGLE OR MULTIPLE
HOLES.
ANGIOGRAPHIC
CATHETERS
TO GIVE ADDED STRENGTH
AND THE ABILITY TO
RESPOND TO TORQUE,
SOME CATHETERS ARE
BRAIDED. THAT IS, THE
PLASTIC IS IMBEDDED
WITH A WIRE MESH.
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BRAIDED CATHETER
ANGIOGRAPHIC
CATHETERS
THE SHAPE OF THE
DISTAL END IS
DESIGNED TO PERMIT
INSERTION INTO THE
APPROPRIATE VESSEL,
ESPECIALLY DURING
SELECTIVE STUDIES.
ANGIOGRAPHIC
CATHETERS
THE NUMBER OF HOLES
AT THE END OF THE
CATHETER DEPENDS
ON THE SIZE OF THE
VESSEL TO BE
CATHETERIZED.
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ANGIOGRAPHIC
CATHETERS
SIZES ARE INDICATED USING
THE FRENCH (F) SCALE.
EACH FRENCH SIZE IS
EQUAL TO 0.33 mm. THE
OUTSIDE DIAMETER OF THE
CATHETER DETERMINES
THE FRENCH SIZE.
ANGIOGRAPHIC
CATHETERS
THE AVERAGE ADULT
REQUIRES THE USE OF
A 4 OR 5 F CATHETER
(WHICH IS 1.3 mm or 1.7
mm IN DIAMETER).
GUIDEWIRES
STAINLESS STEEL WIRE
IS USED TO GUIDE THE
ANGIOGRAPHIC
CATHETER TO THE
DESIRED LOCATION IN
A BLOOD VESSEL.
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GUIDEWIRES
MAY BE OF SOLID STEEL
CONSTRUCTION (A
SINGLE WIRE) OR CONSIST
OF A THIN STAINLESS
STEEL CORE AROUND
WHICH MORE STEEL IS
WRAPPED.
GUIDEWIRES
GUIDEWIRES
MAY HAVE A RIGID OR
FLEXIBLE “J” TIP.
FLEXIBLE TIPS HAVE
MOVABLE CORES.
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VESSEL DILATORS
DILATORS ARE USED TO DILATE
THE TISSUE TRACT AND
LUMEN OF THE BLOOD
VESSEL. IT IS SLIPPED OVER
THE GUIDEWIRE. NEVER
DILATE A VESSEL LARGER
THAN THE CATHETER TO BE
USED.
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