Coronary angiographic projections
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Common Projection Angles
1.RAO (Right Anterior Oblique) Caudal: The best view for the initial injection of the Left System. Also, the best overall view to assess the blush of the LCx, as it minimizes intra- and inter-arterial overlap. In this view, the system in question appears angiographically to the right of the spine with a slight inferior angulation (from below).
2.RAO Cranial: The best overall view to assess the blush of the LAD, as it minimizes intra- and inter-arterial overlap. In this view, the system in question appears angiographically to the right of the spine with a slight anterior angulation (from above).
3.RAO: In this view, the system in question appears angiographically to the right of the spine with little or no vertical angulation.
4.AP (Anterior-Posterior): In this view, the system in question angiographically overlaps or is in line with the spine.
5.LAO Caudal: Also called the spider view. In this view, the system in question appears angiographically to lie to the left of the spine with a slight inferior angulation (from below).
6.LAO Cranial: In this view, the system in question appears angiographically to lie to the left of the spine with a slight anterior angulation (from above).
7.LAO (Left Anterior Oblique): The best overall view to assess the blush of the RCA. In this view, the system in question appears angiographically to the right of the spine with little or no vertical angulation.
Standard Angiographic Views
For the beginner angiographer the anatomic landmarks formed by the spine, catheter and diaphragm provide information to discern which tomographic view from which the image is obtained. In the LAO view (figure 1) the catheter and spine are seen on the right side of the image, while in the RAO (figure 2) they are found on the right. PA imaging (figure 3) places these landmarks in the center of the image. Cranial angulation can usually be distinguished from caudal angulation by the presence of the diaphragm. For cranial imaging, the patient should be asked to inspire to remove the diaphragmatic shadow from the image.
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Left Coronary Artery
The left main coronary artery gives rise to the left anterior descending artery and the left circumflex coronary artery. Complete visualization of these arteries and their branches requires care and rigor to ensure complete anatomical documentation. Often bifurcations and vessel foreshortening and overlap cause errors in stenosis estimation. There are no steadfast rules in which tomographic views are most useful. Generally, for circumflex and proximal epicardial visualization the caudal views are most useful. For LAD and LAD/diagonal bifurcation visualization the cranial views are most useful. Overall, if there is not a significant limitation on contrast utilization, standard 'around the world' angiography using a selection of the following angiographic views will document left coronary anatomy.
RAO 20 - Caudal 20
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AP 0 - Caudal 30
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LAO 50 - Caudal 30
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LAO 50 - Cranial 30
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AP 0 - Cranial 40
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Right Coronary Artery
The Right coronary artery is engaged in the LAO position.
Initial angiographic imaging of the RCA in this view (LAO 30) gives the best view of significant ostial and proximal RCA disease.
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The mid RCA is best visualized in the straight RAO 30 position.
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The bifurcation of the distal RCA and rPDA is best seen in the AP 0 Cranial 30 view with a small breath in.
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