Coronary angiography film quality: Difference between revisions

	Coronary Angiography
Home
General Principles Overview ; Historical Perspective ; Contraindications ; Appropriate Use Criteria for Revascularization ; Complications ; Technique ; Film Quality
Anatomy & Projection Angles
Normal Anatomy Coronary arteries Dominance Right System Left System Left Main Left Anterior Descending Circumflex Median Ramus
Anatomic Variants Separate Ostia Anomalous Origins Case Example Fistula
Projection Angles Standard Views Left Coronary Artery Right Coronary Artery
Epicardial Flow & Myocardial Perfusion
Epicardial Flow TIMI Frame Count ; TIMI Flow Grade TIMI Grade 0 Flow TIMI Grade 1 Flow TIMI Grade 2 Flow TIMI Grade 3 Flow TIMI Grade 4 Flow Pulsatile Flow Deceleration
Myocardial Perfusion TIMI Myocardial Perfusion Grade TMP Grade 0 TMP Grade 0.5 TMP Grade 1 TMP Grade 2 TMP Grade 3
Lesion Complexity
ACC/AHA Lesion-Specific Classification of the Primary Target Stenosis
Preprocedural Lesion Morphology Eccentricity Irregularity Ulceration Intimal Flap Aneurysm Sawtooth Pattern Length Ostial location Angulation Proximal tortuosity Degenerated SVG Calcification Total occlusion Coronary Artery Thrombus TIMI Thrombus Grade TIMI Thrombus Grade 0 TIMI Thrombus Grade 1 TIMI Thrombus Grade 2 TIMI Thrombus Grade 3 TIMI Thrombus Grade 4 TIMI Thrombus Grade 5 TIMI Thrombus Grade 6
Lesion Morphology Quantitative Coronary Angiography Definitions of Preprocedural Lesion Morphology Irregular Lesion Disease Extent Arterial Foreshortening Infarct Related Artery Restenosis Degenerated SVG Collaterals Aneurysm Bifurcation Trifurcation Ulceration
Left ventriculography

VisualWikitext

Latest revision as of 14:30, 23 November 2015

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vanessa Cherniauskas, M.D. [2]

Cine Film Quality of Coronary Angiography

Uninterpretable

The primary endpoint cannot be analyzed secondary to exceedingly poor film exposure or quality (e.g., no images on the film, insufficient contrast injection).

Poor

The primary endpoint can be analyzed with some degree of uncertainty secondary to under- or over-exposure, poor panning, poor engagement, insufficient contrast injection, injection prior to cine-filming, inadequate cine-filming duration, excess collimation, partial obscuration by the diaphragm, and/or omission of images showing major coronary arteries (left or right coronary system).

Average

The primary endpoint can be analyzed. Some images show under- or over-exposure, poor panning, poor engagement, insufficient contrast injection, injection prior to cine-filming, inadequate cine-filming duration, excess collimation, and/or partial obscuration by the diaphragm.

Good

The primary endpoint can be analyzed. Most images show proper exposure, proper panning, proper engagement, sufficient contrast injection, injection after cine-filming, adequate cine-filming duration, minimal collimation, and minimal obscuration by the diaphragm.

Excellent

The primary endpoint can be analyzed. All images show proper exposure, proper panning, proper engagement, sufficient contrast injection, injection after cine-filming, adequate cine-filming duration, minimal collimation, and minimal obscuration by the diaphragm. The culprit lesion is centered in the film during some portion of the cine run to minimize pincushion distortion for quantitative analysis. The culprit lesion is well laid out with no overlap of branches and orthogonal views are obtained to show the culprit lesion in its tightest dimension.

References

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 __NOTOC__
+{| class="infobox" style="float:right;"
+|-
+| [[File:Siren.gif|30px|link=Cardiac catheterization pre-procedure evaluation resident survival guide]]|| <br> || <br>
+| [[Cardiac catheterization pre-procedure evaluation resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']]
+|}
 {{Coronary angiography2}}
 {{CMG}}; {{AE}} {{VC}}
-==Coronary Angiography Film Quality==
+== Cine Film Quality of Coronary Angiography ==
-====Uninterpretable====
+=== Uninterpretable ===
+The primary endpoint cannot be analyzed secondary to exceedingly poor film exposure or quality (e.g., no images on the film, insufficient contrast injection).
-The primary endpoint cannot be analyzed secondary to exceedingly poor film exposure or quality (i.e. no images on the film, inadequate injection of contrast material, etc.).
+=== Poor ===
-====Poor====
+The primary endpoint can be analyzed with some degree of uncertainty secondary to under- or over-exposure, poor panning, poor engagement, insufficient contrast injection, injection prior to cine-filming, inadequate cine-filming duration, excess collimation, partial obscuration by the diaphragm, and/or omission of images showing major coronary arteries (left or right coronary system).
-The primary endpoint can be analyzed but with some degree of uncertainty secondary to under or overexposure, poor panning, poor engagement, poor contrast injection, excess collimation, partial obscuration by diaphragm, and/or omission of images showing major coronary arteries (left or right system).
+=== Average ===
-<!--The distinction between [[TIMI flow grade 1|TIMI grade one]] and [[TIMI flow grade 2|two]] flow is unobtainable because the cinefilming is of inadequate duration to make the distinction.-->
-====Average====
+The primary endpoint can be analyzed. Some images show under- or over-exposure, poor panning, poor engagement, insufficient contrast injection, injection prior to cine-filming, inadequate cine-filming duration, excess collimation, and/or partial obscuration by the diaphragm.
-Adequate film quality. The primary endpoint can be analyzed. Some images show under or overexposure, poor panning, poor engagement, poor contrast injection, excess collimation, and/or partial obscuration by diaphragm.
+=== Good ===
-====Good====
+The primary endpoint can be analyzed. Most images show proper exposure, proper panning, proper engagement, sufficient contrast injection, injection after cine-filming, adequate cine-filming duration, minimal collimation, and minimal obscuration by the diaphragm.
-The primary endpoint can be analyzed. The majority of images show proper exposure, proper panning, proper engagement, proper contrast injection, minimal collimation, and/or minimal obscuration by diaphragm.
+=== Excellent ===
-====Excellent====
+The primary endpoint can be analyzed. All images show proper exposure, proper panning, proper engagement, sufficient contrast injection, injection after cine-filming, adequate cine-filming duration, minimal collimation, and minimal obscuration by the diaphragm. The culprit lesion is centered in the film during some portion of the cine run to minimize pincushion distortion for quantitative analysis. The culprit lesion is well laid out with no overlap of branches and orthogonal views are obtained to show the culprit lesion in its tightest dimension.
-The primary endpoint can be analyzed. All images show proper exposure, proper panning, proper engagement, proper contrast injection, minimal collimation, and/or minimal obscuration by diaphragm.
 ==References==
 {{Reflist|2}}

v t e Coronary Angiography
Coronary Anatomy	Normal coronary anatomy • Anomalous origins of coronary arteries (Left coronary artery • Right coronary artery) • Congenital abnormalities of coronary arteries • Coronary artery segments • Cinefilm frame speed • Coronary artery dominance (Left dominance • Right dominance • Co-dominance)
TIMI Flow Grade	TIMI flow grade 0 • TIMI flow grade 1 • TIMI flow grade 2 • TIMI flow grade 3
TIMI Frame Count	TFC for SVG • TIMI Myocardial Frame Count • Washout TIMI Frame Count
TIMI Myocardial Perfusion Grade	TIMI MPG 0 • TIMI MPG 1 • TIMI MPG 2 • TIMI MPG 3
Thrombus Grading	Thrombus Grade 0 • Thrombus Grade 1 • Thrombus Grade 2 • Thrombus Grade 3 • Thrombus Grade 4 • Thrombus Grade 5 • Thrombus Grade 6
Lesion Complexity	Type A • Type B₁ • Type B₂ • Type C
Dissection Classification	Type A • Type B • Type C • Type D • Type E • Type F
Coronary Collaterals	Grade 0 • Grade 1 • Grade 2 • Grade 3 • Rentrop and Cohen’s Collateral Classification
Lesion Morphology	Myocardial bridge •Definitions of Preprocedural Lesion Morphology • Luminal irregularities • Disease extent • Arterial foreshortening • Infarct related artery (Culprit lesion) • Reocclusion • Restenosis • Degenerated saphenous vein graft • Coronary artery fistula
Angiographic complications	Distal embolization • Coronary spasm • Abrupt closure • Side branch loss • Slow flow • No-reflow • Pulsatile flow • Flow deceleration • Ectasia • Intimal flap • Staining •
Performing Coronary Angiography	Patient preparation • Catheter selection • Standard angiographic views • High risk groups • Patients with special need • Access site closure (Manual compression • Assisted compression • Closure devices) •
Quantitative Coronary Angiography (QCA)	Minimal lumen diameter • Percent stenosis • Reference diameter • Lesion length • Residual stenosis • Average reference segment diameter • Plaque area • Plaque volume •
Contrast Media	High-osmolar contrast media • Iso-osmolar contrast media • Low-osmolar contrast media
Left Ventriculography & Aortography	Ejection fraction • Aortography • Quantitative Left Ventricular Analysis (LAO projection • RAO projection • LVA) • Left Ventricular Wall Motion Analysis (Normokinesia • Hypokinesia • Akinesia • Dyskinesia • Aneurysm) • Evaluation of mitral regurgitation • Evaluation of aortic regurgitation
Right Heart Catheterization	Pressure waveforms (Right atrial pressure • Rirght ventricular pressure • Pulmonary artery pressure • Pulmonary artery wedge-pressure) • Endomyocardial biopsy
Complications	Access site complications • Dumping • Contrast hypersensitivity • Contrast induced nephropathy • Hypotension • Hypertension • Dissection • Vessel perforation • Acute myocardial infarction • Ventricular fibrillation • Cardiac arrest • Stroke • ASD • VSD • Pulmonary emboli • Myocardial rupture • Peripheral arterial emboli • Radiation injury


Coronary Angiography
Home

General Principles Overview Historical Perspective Contraindications Appropriate Use Criteria for Revascularization Complications Technique Film Quality

Anatomy & Projection Angles

Normal Anatomy Coronary arteries Dominance Right System Left System Left Main Left Anterior Descending Circumflex Median Ramus

Anatomic Variants Separate Ostia Anomalous Origins Case Example Fistula

Projection Angles Standard Views Left Coronary Artery Right Coronary Artery

Epicardial Flow & Myocardial Perfusion

Epicardial Flow TIMI Frame Count TIMI Flow Grade TIMI Grade 0 Flow TIMI Grade 1 Flow TIMI Grade 2 Flow TIMI Grade 3 Flow TIMI Grade 4 Flow Pulsatile Flow Deceleration

Myocardial Perfusion TIMI Myocardial Perfusion Grade TMP Grade 0 TMP Grade 0.5 TMP Grade 1 TMP Grade 2 TMP Grade 3

Lesion Complexity

ACC/AHA Lesion-Specific Classification of the Primary Target Stenosis

Preprocedural Lesion Morphology Eccentricity Irregularity Ulceration Intimal Flap Aneurysm Sawtooth Pattern Length Ostial location Angulation Proximal tortuosity Degenerated SVG Calcification Total occlusion Coronary Artery Thrombus TIMI Thrombus Grade TIMI Thrombus Grade 0 TIMI Thrombus Grade 1 TIMI Thrombus Grade 2 TIMI Thrombus Grade 3 TIMI Thrombus Grade 4 TIMI Thrombus Grade 5 TIMI Thrombus Grade 6

Lesion Morphology Quantitative Coronary Angiography Definitions of Preprocedural Lesion Morphology Irregular Lesion Disease Extent Arterial Foreshortening Infarct Related Artery Restenosis Degenerated SVG Collaterals Aneurysm Bifurcation Trifurcation Ulceration

Left ventriculography

Technique Quantification of LV Function Quantification of Mitral Regurgitation