Angiography in the general practice of radiology.

Abstract

The need and demand for extracardiac angiography are increasing in our community hospitals. Since angiography is a special radiographic procedure, more satisfactory examinations will be possible if our radiologists prepare themselves to accept full responsibility as angiographers (1). A few relatively inexpensive additions to existing equipment will enable any radiology department to undertake peripheral vascular angiography. It has been shown that, once the equipment and a radiologist-angiographer become available, case material grows continuously. In St. Paul, the demand for these examinations has shown a considerable increase during the author's two-year experience. From Jan. 1, 1961, to Nov. 12, 1962, 587 angiographic procedures were personally performed in similarly equipped hospitals having an average daily census of 60, 200, 230, 250, and 300 patients (Table I). The angiographic facilities and technics developed for use in these community hospitals form the basis of this report. Automatic Equipment Owing to the prohibitive cost, none of the community hospitals covered by this report is equipped with an automatic rapid film changer. These machines are a convenience in angiography, but they are not a prerequisite to accurate extracardiac diagnosis. With suitable catheters and contrast media, most extracardiac examinations can be performed with a hand injection, though efficiency is enhanced when the speed of injection and the timing of exposures are automatically controlled. The Amplatz (2) injector2 provides these features and is particularly useful for studies above the diaphragm and in some patients with hypertension. One such injector was available and was transported from hospital to hospital. Manual Equipment The additions to existing manual equipment can be obtained at a cost of $400.00 or less. Most of the materials can be constructed in a hospital maintenance shop. These removable additions should be designed for use with a fluoroscopy table so that the position of the catheter tip can be checked under direct vision by a small test dose of contrast medium. The rear of the table Bucky slot should be opened. The usual Bucky tray is removed and a 17 × 52-inch metal or plywood tray is inserted in the fashion of the Paessler-Wentzlik table.3 This tray will hold three 14 × 17-inch or four 10 × 12-inch film cassettes. The tray is successively advanced to film-centering markers which are placed along its edge. Film fogging is eliminated by horizontal 5-inch strips along both sides of the table top. In addition, an 18-inch vertical wood or rod support is clamped to both sides of the table, and lead aprons are draped to overlap the horizontal lead strips (Fig. 1). Brachiocephalic and Abdominal Studies: Brachiocephalic and abdominal studies can be performed with the arrangement described above, and films can be obtained without motion at one-second intervals with exposures of two-tenths of a second or less. This filming rate has proved adequate for mapping collateral channels and rate of blood flow where there is occlusion of carotid, innominate, subclavian, celiac, hepatic, or renal arteries.