1: Custom-Made Rastermethod for Fistula and Graft

Abstract

Unfamiliarity with fistula and graft characteristics can lead to failed punctures, hematoma, and sometimes access occlusion. The custom-made Raster method provides detailed shunt visualization and angiographic images together by using photo-editing software. Access veins of an individual shunt and an adapted raster are projected on a digital picture of the arm. During angiography, the shunt arm is fixated, and a digital picture is taken from a fixed vertical angle and distance. Reference points are marked on the shunt arm, which serves as a fixation to draw a raster with coordination points. In this way, a picture is created like a roadmap with veins. There is complete integration of digitally and radiology images by using software programs (Adobe Photoshop + Illustrator en Agfa Web 1000) under Windows XP. All illustrations are made fit 1:1 by scaling up or down without distortion. Editing with Photoshop gives a precise projection of shunt veins on the real colored background of the digital photograph. In this projection, the grey angiography background is made completely transparent. The system can contain more detailed information in combination with original angiography pictures and echo (duplex) images of depth and diameter. This visualization method is a useful tool for multidisciplinary access meetings with intervention radiologists, access surgeons, and nephrologists. Access malfunction, aneurysms, stenosis, and even stents can be projected at the exact location. The system leads to clear and concrete puncture advise. Transfer of access information and communication to intervention specialists and other dialysis centers is facilitated. Unfamiliarity with fistula and graft characteristics can lead to failed punctures, hematoma, and sometimes access occlusion. The custom-made Raster method provides detailed shunt visualization and angiographic images together by using photo-editing software. Access veins of an individual shunt and an adapted raster are projected on a digital picture of the arm. During angiography, the shunt arm is fixated, and a digital picture is taken from a fixed vertical angle and distance. Reference points are marked on the shunt arm, which serves as a fixation to draw a raster with coordination points. In this way, a picture is created like a roadmap with veins. There is complete integration of digitally and radiology images by using software programs (Adobe Photoshop + Illustrator en Agfa Web 1000) under Windows XP. All illustrations are made fit 1:1 by scaling up or down without distortion. Editing with Photoshop gives a precise projection of shunt veins on the real colored background of the digital photograph. In this projection, the grey angiography background is made completely transparent. The system can contain more detailed information in combination with original angiography pictures and echo (duplex) images of depth and diameter. This visualization method is a useful tool for multidisciplinary access meetings with intervention radiologists, access surgeons, and nephrologists. Access malfunction, aneurysms, stenosis, and even stents can be projected at the exact location. The system leads to clear and concrete puncture advise. Transfer of access information and communication to intervention specialists and other dialysis centers is facilitated.