p.21
Angiographic Techniques for Vertebral and Carotid Arteries
What is the impact of poor tube alignment on imaging of the internal carotid arteries?
It can lead to distorted or unclear images.
p.21
Angiographic Techniques for Vertebral and Carotid Arteries
What anatomical landmarks are mentioned in relation to the internal carotid arteries?
Petrous ridge and superior orbital margin.
p.5
Pathway to Neck and Cerebral Vessels
What are the clinical implications of the pathway to neck and cerebral vessels?
It aids in diagnosing and treating conditions affecting cerebral circulation.
p.41
Digital Subtraction Angiography (DSA) as Gold Standard
What is the focus of the presentation mentioned?
Digital Subtraction Angiography of the Head and Neck.
p.16
Indications for Intracranial Angiography
What is one indication for performing intracranial angiography?
Diagnosis of primary neurovascular disease.
p.13
Angiographic Techniques for Vertebral and Carotid Arteries
What is the angle for the ipsilateral oblique view in neck angiography?
15° oblique towards the side of interest.
p.4
Digital Subtraction Angiography (DSA) as Gold Standard
What advantage does DSA have over CT and MR Angiography?
Superior temporal resolution.
p.4
Digital Subtraction Angiography (DSA) as Gold Standard
What is another advantage of DSA compared to other imaging modalities?
Superior spatial resolution.
p.9
Angiographic Techniques for Vertebral and Carotid Arteries
In the LAT projection for vertebral artery angiography, where should the center be positioned?
Vertebral body for R-L and skull base down/catheter tip up for S-I.
p.11
Indications for Intracranial Angiography
Why is angiography performed on the vertebral arteries?
To assess conditions such as stenosis, occlusion, or vascular anomalies.
p.15
Angiographic Techniques for Vertebral and Carotid Arteries
What imaging views are mentioned for the right common carotid artery?
PA (Posteroanterior) and Lateral views.
p.16
Indications for Intracranial Angiography
What is a third indication for intracranial angiography?
Follow-up imaging after treatment, such as after aneurysm coiling or clipping.
p.11
Digital Subtraction Angiography (DSA) as Gold Standard
What imaging technique is commonly used for vertebral arteries neck angiography?
Digital Subtraction Angiography (DSA).
p.19
Angiographic Techniques for Vertebral and Carotid Arteries
Why might a tube angle be required during the procedure?
Because the patient's head can be in multiple positions.
p.27
Angiographic Techniques for Vertebral and Carotid Arteries
What is the standard angle for a transorbital oblique of the right ICA?
30° external oblique to the non-affected side.
p.17
Indications for Intracranial Angiography
What are the 4 vessels involved in a '4 vessel' study?
The internal carotid arteries and the vertebral arteries.
p.2
Bi-Plane Angiography Advantages and Disadvantages
What is a benefit of bi-plane acquisition regarding contrast usage?
Only a single injection of contrast is required, leading to contrast savings.
p.36
Digital Subtraction Angiography (DSA) as Gold Standard
What is Brendan Erskine's position?
Head of DSA at Alfred Health.
p.26
Angiographic Techniques for Vertebral and Carotid Arteries
Where should the tube be positioned in relation to the petrous ridge?
On the inferior orbital margin.
p.32
Angiographic Techniques for Vertebral and Carotid Arteries
What is the focus of the imaging mentioned?
Selective Vertebral Arteries.
p.1
Procedural Preparations for Angiographic Procedures
What type of procedures does the guideline refer to?
Angiographic procedures with arterial puncture.
p.8
Angiographic Techniques for Vertebral and Carotid Arteries
What type of catheter is required for neck angiography of the vertebral and carotid arteries?
Selective (end hole) catheter.
p.5
Pathway to Neck and Cerebral Vessels
What is the primary focus of the pathway to neck and cerebral vessels?
To outline the anatomical routes and techniques for accessing these vessels.
p.28
Bi-Plane Angiography Advantages and Disadvantages
What are the two types of oblique views mentioned?
Transorbital and reverse transorbital obliques.
p.19
Angiographic Techniques for Vertebral and Carotid Arteries
How should the radiographer align the Petrous ridges during the standard PA projection?
On the Superior Orbital margin.
p.24
Angiographic Techniques for Vertebral and Carotid Arteries
What adjustments may be required during the Lateral projection?
Slight craniocaudal and left-right angulation.
p.2
Bi-Plane Angiography Advantages and Disadvantages
Does bi-plane angiography provide radiation dose savings?
No, it only provides time and contrast media dose savings.
p.30
Angiographic Techniques for Vertebral and Carotid Arteries
How does the standard PA projection for Selective Vertebral Arteries differ from that for ICA?
It has a steeper cranial angle to visualize more of the foramen magnum.
p.13
Angiographic Techniques for Vertebral and Carotid Arteries
What is the purpose of additional views in neck angiography?
To increase separation of internal and external carotid arteries.
p.4
Digital Subtraction Angiography (DSA) as Gold Standard
What are the greater risks associated with DSA compared to CT and MR Angiography?
Greater complication rates and contrast media load.
p.27
Angiographic Techniques for Vertebral and Carotid Arteries
Where should the center be positioned during a transorbital oblique?
On the contralateral orbit.
p.27
Angiographic Techniques for Vertebral and Carotid Arteries
What type of images are referenced in the content?
Standard transorbital oblique and reverse transorbital oblique of the right ICA.
p.26
Angiographic Techniques for Vertebral and Carotid Arteries
What does the transorbital oblique projection help to separate?
Middle and anterior cerebral arteries.
p.12
Acquisition Parameters for Angiographic Imaging
What is the magnification setting used in the angiography?
Mag 2 (tight collimation).
p.10
Clinical Protocols for Aneurysms and Arteriovenous Malformations
What clinical protocol are the parameters based on?
The clinical protocol used at Alfred Health.
p.11
Angiographic Techniques for Vertebral and Carotid Arteries
What is a key advantage of using Lateral PA views in angiography?
It provides a clear view of the vertebral arteries' anatomy.
p.23
Angiographic Techniques for Vertebral and Carotid Arteries
What does the term 'Selective Internal Carotid Arteries' refer to?
It refers to a specific imaging technique focusing on the internal carotid arteries.
p.16
Indications for Intracranial Angiography
What are some specific conditions diagnosed using intracranial angiography?
Intracranial aneurysms, arteriovenous malformations, atherosclerotic stenosis, cerebral vasospasm, and acute ischemic stroke.
p.13
Angiographic Techniques for Vertebral and Carotid Arteries
Who are the authors referenced for the projection techniques in neck angiography?
Harrigan & Deveikis (2018).
p.25
Angiographic Techniques for Vertebral and Carotid Arteries
What does the term 'Selective Internal Carotid Arteries' refer to?
It refers to imaging techniques focused on the internal carotid arteries.
p.29
Angiographic Techniques for Vertebral and Carotid Arteries
Which arteries are included in the posterior cerebral circulation?
Distal vertebral and basilar arteries, cerebellar arteries, and posterior cerebral arteries.
p.34
Angiographic Techniques for Vertebral and Carotid Arteries
What aspects of imaging could be improved in the selective vertebral arteries procedure?
Centring and collimation.
p.39
Clinical Protocols for Aneurysms and Arteriovenous Malformations
What is the purpose of using magnified high frame rate runs in AVM imaging?
To identify feeding vessels.
p.33
Angiographic Techniques for Vertebral and Carotid Arteries
What adjustments may be required during the lateral projection?
Slight craniocaudal and left-right angulation.
p.33
Acquisition Parameters for Angiographic Imaging
What is the only change to acquisition parameters from PA to lateral projection?
Reduce tube voltage to 70 kV.
p.38
Clinical Protocols for Aneurysms and Arteriovenous Malformations
What additional views are recommended for AVM imaging?
3D DSA and magnified collimated view.
p.3
Importance of Patient Positioning in Angiography
What is the role of the radiographer in patient positioning?
To position the patient correctly for angiographic procedures.
p.8
Indications for Intracranial Angiography
What are the clinical indications for stand-alone neck angiography?
Atherosclerosis, Dissection, Vascular Malformations, Epistaxis.
p.16
Indications for Intracranial Angiography
What is a second indication for intracranial angiography?
Planning for neuro-interventional procedures.
p.2
Bi-Plane Angiography Advantages and Disadvantages
What is a key advantage of bi-plane angiography?
The ability to view 2 projections simultaneously (generally PA + Lateral) for better depth perception.
p.2
Bi-Plane Angiography Advantages and Disadvantages
Why is bi-plane angiography essential for neuro-interventional cases?
It provides better depth perception through simultaneous viewing of projections.
p.9
Importance of Patient Positioning in Angiography
What should be done to the patient's shoulders during vertebral artery angiography?
Lower the patient's shoulders if possible.
p.26
Angiographic Techniques for Vertebral and Carotid Arteries
What is the purpose of the transorbital oblique projection in relation to the middle cerebral artery?
It separates branches of the middle cerebral artery.
p.12
Angiographic Techniques for Vertebral and Carotid Arteries
What should be noted in the PA and Lateral images of the right common carotid artery?
The location of the carotid bifurcation.
p.30
Angiographic Techniques for Vertebral and Carotid Arteries
What are the two standard projections for Selective Vertebral Arteries in an intracranial angiogram?
PA (Posteroanterior) and Lateral.
p.37
Clinical Protocols for Aneurysms and Arteriovenous Malformations
What is the baseline imaging protocol for intracranial aneurysms?
Include all 4 vessels, as patients with 1 aneurysm are at an increased risk of having others.
p.32
Angiographic Techniques for Vertebral and Carotid Arteries
What should be noted in the imaging?
The different phases included.
p.38
Clinical Protocols for Aneurysms and Arteriovenous Malformations
What is a key characteristic of arteriovenous malformations (AVMs) in terms of flow?
AVMs have a high flow state, requiring a higher frame rate (e.g., 6 fps).
p.3
Importance of Patient Positioning in Angiography
What equipment is used to assist in patient positioning during angiography?
An angiography head holder.
p.18
Indications for Intracranial Angiography
What does a selective internal carotid angiogram demonstrate?
Anterior cerebral circulation.
p.8
Pathway to Neck and Cerebral Vessels
Where do the common carotid arteries arise from?
The aorta (or the brachiocephalic trunk on the right side).
p.9
Angiographic Techniques for Vertebral and Carotid Arteries
What is the recommended field of view (FOV) for neck angiography of the vertebral arteries?
Mag 1 / 2 with tight collimation.
p.9
Angiographic Techniques for Vertebral and Carotid Arteries
In the PA projection for vertebral artery angiography, where should the center be positioned?
Ipsilateral transverse foramen for R-L and skull base down/catheter tip up for S-I.
p.11
Angiographic Techniques for Vertebral and Carotid Arteries
What is the primary focus of vertebral arteries neck angiography?
To visualize the vertebral arteries for diagnostic purposes.
p.25
Angiographic Techniques for Vertebral and Carotid Arteries
What should be noted in the imaging of the right internal carotid artery?
The different phases included in the imaging.
p.24
Acquisition Parameters for Angiographic Imaging
What is the only change to acquisition parameters for this procedure?
Reduce tube voltage to 70 kV.
p.37
Clinical Protocols for Aneurysms and Arteriovenous Malformations
What is the first step in interventional imaging for aneurysms?
Begin with the vessel of interest.
p.1
Neurovascular Observations Pre-Examination
What is the purpose of pre-examination neurovascular observations in angiographic procedures?
To establish a baseline for any changes that may occur during or after the procedure.
p.15
Pathway to Neck and Cerebral Vessels
What are the common carotid arteries?
Major blood vessels in the neck that supply blood to the head and neck.
p.20
Angiographic Techniques for Vertebral and Carotid Arteries
Which arteries are selectively imaged in the mentioned angiogram?
Internal Carotid Arteries.
p.20
Acquisition Parameters for Angiographic Imaging
What is the standard projection used for the Internal Carotid Arteries?
Standard PA (Posteroanterior).
p.24
Angiographic Techniques for Vertebral and Carotid Arteries
What are the two standard projections for Selective Internal Carotid Arteries in an intracranial angiogram?
PA (Posteroanterior) and Lateral.
p.29
Angiographic Techniques for Vertebral and Carotid Arteries
What does a selective vertebral artery angiogram demonstrate?
Posterior cerebral circulation.
p.2
Bi-Plane Angiography Advantages and Disadvantages
What space requirement is a disadvantage of bi-plane angiography?
It requires a larger procedure room.
p.22
Acquisition Parameters for Angiographic Imaging
What is the frame rate for the imaging during the angiogram?
2 fps x 5 sec; 1 fps x 5 sec; 0.5 fps x 10 sec.
p.34
Angiographic Techniques for Vertebral and Carotid Arteries
What should be noted during the selective vertebral arteries imaging?
The different phases included.
p.23
Angiographic Techniques for Vertebral and Carotid Arteries
Which artery is specifically mentioned in the context of the PA run?
Right Internal Carotid Artery.
p.35
Angiographic Techniques for Vertebral and Carotid Arteries
How are PA and Lateral projections achieved simultaneously?
By adjusting the tube setup to capture both views at once.
p.37
Clinical Protocols for Aneurysms and Arteriovenous Malformations
What is performed if the standard PA + Lateral is positive for aneurysm in vertebral arteries?
3D DSA for measurements and working projections.
p.15
Pathway to Neck and Cerebral Vessels
How can you differentiate between the internal and external carotid arteries?
Typically, the internal carotid artery is located deeper and supplies the brain, while the external carotid artery supplies the face and neck.
p.13
Angiographic Techniques for Vertebral and Carotid Arteries
What does the 15° LAO PA projection help with in neck angiography?
It aids in visualizing the carotid arteries more clearly.
p.4
Digital Subtraction Angiography (DSA) as Gold Standard
What unique capability does DSA offer that CT and MR Angiography do not?
Ability to perform intervention.
p.12
Angiographic Techniques for Vertebral and Carotid Arteries
What projections are used in the neck angiography?
PA (Posteroanterior) and Lateral.
p.24
Angiographic Techniques for Vertebral and Carotid Arteries
What should the radiographer ensure during the Lateral projection?
The floor of the left and right anterior fossa aligns.
p.25
Angiographic Techniques for Vertebral and Carotid Arteries
Which artery is specifically mentioned in the context of lateral run?
Right Internal Carotid Artery.
p.2
Bi-Plane Angiography Advantages and Disadvantages
What is a challenge associated with setting up bi-plane angiography projections?
It is slightly more difficult to set up projections.
p.22
Acquisition Parameters for Angiographic Imaging
What anatomical landmarks should be included in the field of view (FOV)?
Top of cranium and mastoid tips.
p.40
Clinical Protocols for Aneurysms and Arteriovenous Malformations
How is the vessel of interest identified before angiographic procedures?
It will have been previously identified on a CT Angiogram.
p.18
Pathway to Neck and Cerebral Vessels
Which arteries are involved in the intracranial internal carotid artery?
Anterior and middle cerebral arteries.
p.5
Pathway to Neck and Cerebral Vessels
Why is understanding the pathway to neck and cerebral vessels important?
It is crucial for performing angiographic procedures safely and effectively.
p.5
Pathway to Neck and Cerebral Vessels
What anatomical structures are involved in the pathway to neck and cerebral vessels?
Includes the carotid arteries, vertebral arteries, and associated vascular structures.
p.5
Pathway to Neck and Cerebral Vessels
What imaging techniques are commonly used to visualize the pathway to neck and cerebral vessels?
Angiography and other vascular imaging techniques.
p.19
Angiographic Techniques for Vertebral and Carotid Arteries
What are the two standard projections for Selective Internal Carotid Arteries in an intracranial angiogram?
PA (Posteroanterior) and Lateral.
p.7
Pathway to Neck and Cerebral Vessels
What is the power injection volume and rate for Thoracic Arch Aortography?
30 - 40 ml @ 20 ml/s; 1000 psi.
p.34
Angiographic Techniques for Vertebral and Carotid Arteries
What is the focus of the selective vertebral arteries procedure?
Left Vertebral Artery lateral run.
p.39
Clinical Protocols for Aneurysms and Arteriovenous Malformations
What imaging technique is used to identify feeding vessels in AVMs?
Magnified high frame rate run.
p.37
Clinical Protocols for Aneurysms and Arteriovenous Malformations
What is performed if the standard PA + Lateral is positive for aneurysm in internal carotids?
3D DSA for measurements and working projections.
p.22
Acquisition Parameters for Angiographic Imaging
What imaging phases are included in the acquisition parameters?
Arterial, Capillary & Venous phases.
p.39
Clinical Protocols for Aneurysms and Arteriovenous Malformations
What clinical indication protocols are used for arteriovenous malformations (AVMs)?
Protocols include specific imaging techniques to identify feeding vessels.
p.26
Angiographic Techniques for Vertebral and Carotid Arteries
What angulation is used for the tube positioning in this procedure?
Straight tube or caudal angulation.
p.33
Angiographic Techniques for Vertebral and Carotid Arteries
What are the two standard projections for Selective Vertebral Arteries in an intracranial angiogram?
PA (Posteroanterior) and Lateral.
p.40
Clinical Protocols for Aneurysms and Arteriovenous Malformations
What projections are typically used for the vessel of interest in acute ischemic stroke?
Standard PA and lateral projections.
p.19
Importance of Patient Positioning in Angiography
What should be considered regarding patient positioning during the procedure?
Let the patient position their head comfortably before applying the tube angle.
p.26
Angiographic Techniques for Vertebral and Carotid Arteries
What is the external oblique angle for the tube positioning?
30° to the affected side.
p.30
Importance of Patient Positioning in Angiography
What is recommended regarding patient positioning during the procedure?
Let the patient position their head comfortably before applying the tube angle.
p.35
Angiographic Techniques for Vertebral and Carotid Arteries
What does Lateral projection refer to in radiography?
A side view of the body or structure being imaged.
p.6
Pathway to Neck and Cerebral Vessels
What do the great vessels arising from the aorta include?
The great vessels include arteries that supply blood to the neck and cerebral regions.
p.33
Angiographic Techniques for Vertebral and Carotid Arteries
What alignment must the radiographer ensure during the lateral projection?
The floor of the left and right anterior fossa aligns.
p.33
Angiographic Techniques for Vertebral and Carotid Arteries
What should be included in the field of view (FOV) for the lateral projection?
C1 inferiorly and sella turcica anteriorly.
p.30
Angiographic Techniques for Vertebral and Carotid Arteries
What does the PA projection for Selective Vertebral Arteries resemble?
It looks more like a 'Townes' projection.
p.31
Acquisition Parameters for Angiographic Imaging
What imaging phases are included in the selective vertebral arteries acquisition?
Arterial, Capillary & Venous phases.
p.38
Clinical Protocols for Aneurysms and Arteriovenous Malformations
What standard projections are used for internal carotids in AVM imaging?
Standard PA + Lateral + Transorbital oblique (full FOV).
p.31
Acquisition Parameters for Angiographic Imaging
What is the frame rate for the selective vertebral arteries acquisition?
2 fps x 5 sec; 1 fps x 5 sec; 0.5 fps x 10 sec.
p.38
Clinical Protocols for Aneurysms and Arteriovenous Malformations
What is necessary to include in the field of view (FOV) when imaging AVMs?
All of the skull must be included in the FOV.
p.38
Clinical Protocols for Aneurysms and Arteriovenous Malformations
What projections are used for vertebral arteries in AVM imaging?
Standard PA + Lateral (large FOV).
p.40
Clinical Protocols for Aneurysms and Arteriovenous Malformations
What is the key point regarding time in acute ischemic stroke?
Time is brain tissue; speed is a priority even at the reduction of image quality.
p.38
Clinical Protocols for Aneurysms and Arteriovenous Malformations
What is the purpose of including external carotids in AVM imaging?
To ensure comprehensive assessment if they are involved.
p.23
Acquisition Parameters for Angiographic Imaging
What should be noted during the imaging of the Right Internal Carotid Artery?
The different phases included in the imaging.
p.6
Pathway to Neck and Cerebral Vessels
What is the significance of the AP/PA image in relation to the aorta?
It provides a realistic view of the thoracic aorta.
p.33
Angiographic Techniques for Vertebral and Carotid Arteries
What area should be included in the lateral projection?
Only the posterior skull vault.
