Coronary angiography film quality

Resident Survival Guide

Coronary Angiography
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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

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

Coronary Angiography Film Quality

Uninterpretable

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

Poor

The primary endpoint can be analyzed with some degree of uncertainty secondary to under- or overexposure, poor panning, poor engagement, insufficient contrast injection, injection prior to cinefilming, inadequate cinefilming 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 overexposure, poor panning, poor engagement, insufficient contrast injection, injection prior to cinefilming, inadequate cinefilming 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 cinefilming, adequate cinefilming 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 cinefilming, adequate cinefilming duration, minimal collimation, and minimal obscuration by the diaphragm. The culprit lesion is centered in the film during some portion of the cinerun to minimize pincushion distortion for quantitative analysis. The culprit lesion is well layed out with no overlap of branches and orthogonal views are obtained to show the culprit lesion in its tightest dimension.